ELCC 2024 Daily highlight 3

Dr Anouk Goudsmit, medical oncologist at the Institut Jules Bordet in Brussels, discusses the highlights of the third mini oral session at ELCC 2024.

During this session, two main topics were addressed: potential benefits of lung cancer screening and advances in the management of small-cell lung cancer (SCLC).

Previously, several large-scale studies convincingly demonstrated that lung cancer screening using low-dose CT (LDCT) scans significantly improves the lung cancer specific survival. From the presented Polish study, it became clear that this form of lung cancer screening also significantly reduces the all-cause mortality of participants. In fact, after 10 years of follow-up, the overall survival (OS) rate among participants in the screening program (N=7,281) was 5.6% higher than in a matched control group (N=36,405).

4-IN-THE-LUNG-RUN is an ongoing European lung cancer screening trial that is currently running in 6 countries. In addition to screening for lung cancer, this program also allows to screen for cardiovascular risk factors. By calculating the Agatson score of the different participants to the screening program, this trial revealed that about a third of participants had a high or very high cardiovascular risk, warranting preventive treatment. As such, these findings illustrate the challenge of incidental findings during a lung cancer screening program.

Tarlatamab is a bispecific T cell engager (BiTE®) that redirects cytotoxic T-cells to cancer cells expressing delta-like ligand 3 (DLL3). Long-term result from the DeLLphi-300 phase I study showed a high rate of durable responses, a median OS of 17.5 months and promising intracranial activity of tarlatamab in a cohort of 152 patients with previously treated, extensive stage (ES) SCLC. Furthermore, follow-up data from this study did not reveal any new safety signals and indicated a low rate of treatment discontinuation due to treatment-related adverse events (<6%). As such, these encouraging findings support the evaluation of tarlatamab in earlier treatment lines.

ETER 701 is a randomized phase III trial comparing the multikinase inhibitor anlotinib in combination with etoposide/carboplatin (EC) with or without the PD-L1 inhibitor benmelstobart to EC + placebo in the first-line treatment of patients with ES-SCLC. Previously, the triplet combination was shown to significantly improve the progression-free (PFS) and OS compared to placebo + EC. During ELCC 2024, also the anlotinib-EC combination proved to be associated with a significant PFS benefit (HR[95%CI]: 0.44[0.36-0.55]) compared to the control arm, although this delayed disease progression did not (yet) translate into a significant benefit in OS (HR[95%CI]: 0.86[0.67-1.10]). Importantly, the anlotinib-EC combination came with a high incidence of grade ≥3 adverse events (94.3% vs. 87% in the control arm). However, this did not lead to a high rate of treatment discontinuation (9.8% vs. 5.3%).