Proferred paper session 2

In this video, Prof Dr Mariana Brandão, medical oncologist at the Institut Jules Bordet In Brussels, shares her key take-aways from the second proffered paper session of the 2025 European Lung Cancer Conference (ELCC).

Arguably the most anticipated presentation of this session provided updated overall survival (OS) data of the randomized, phase III LAURA trial.¹ Previously, this study demonstrated an impressive benefit in progression-free survival (PFS) for patients with unresectable, stage III, EGFR-mutant non-small cell lung cancer (NSCLC) who received osimertinib vs. placebo after chemoradiotherapy (CRT) (HR[95%CI]: 0.16[0.10-0.24]; p< 0.001). ELCC 2025 featured the second interim analysis of OS (31% maturity), suggesting that this delayed disease progression may in time also translate into a significant benefit in OS (HR[95%CI]: 0.67[0.40;1.14]; p= 0.140). As such, these data suggest that immediate osimertinib after CRT may lead to a longer OS than deferred osimertinib once patients suffer a disease progression. In fact, the vast majority of patients in the placebo arm did receive osimertinib at the time of progression.¹

A second interesting study evaluated potential predictors for complex surgery after neoadjuvant immunotherapy (IO) in patients with resectable NSCLC (mainly stage II/III).² In fact, thoracic surgeons have indicated that the use of neoadjuvant IO can lead to more laborious surgical interventions. In this academic, prospective study, surgeons were asked to score the complexity of the surgery after neoadjuvant IO. Overall, 44% of surgeries were scored as being complicated. A closer look into the characteristics of the surgery in complicated and non-complicated surgery learned that complicated surgeries took longer (on average 15 minutes longer), were associated with more blood loss (+/- 100 ml more) and came with a higher conversion rate. Interestingly, a high PD-L1 expression, cN2 disease and the absence of a nodal response were significantly associated with a more complicated surgery. These factors were subsequently used to develop a score that is able to predict complicated surgery with a very high positive predictive value.² If validated, this score would be a very usefull tool in clinical practice, that would allow surgical departments to allocate the expected complicated cases to more experienced surgeons.

A third and final abstract that was selected by Prof Brandão consists of a presentation of patient-reported outcomes (PROs) in the phase III AEGEAN study.³ In this trial, perioperative durvalumab was shown to significantly improve the PFS of patients with resectable, stage II to IIIB NSCLC. Importantly, the use of durvalumab did not lead to a detriment in quality of life (QoL). While these data are reassuring, Prof Brandão underscores that the follow-up is still limited. As such, longer follow-up will be necessary to see the potential impact of persistent (low-grade) adverse events, such as mouth or eye dryness, articular pain or endocrinopathies. More insight into the long term impact of these adverse events on QoL will probably come from the EORTC-led, academic SONAR study which will follow-up the QoL of patients treated with neoadjuvant IO for up to 5 years.