Mini oral 2: NSCLC non-metastatic

Prof Dr Lore Decoster, a thoracic oncologist at UZ Brussels, provided an analysis of several abstracts presented during the second mini-oral session on NSCLC.

An updated analysis of the LAURA study, a RCT evaluating the efficacy of osimertinib compared to placebo in patients with unresectable stage III NSCLC who had undergone concurrent chemoradiotherapy was presented. Importantly, osimertinib is administered continuously until disease progression or the onset of unacceptable toxicity. New data were presented regarding distant metastasis and CNS metastasis. Consistent with expectations, osimertinib significantly delayed the onset of distant and CNS metastasis, with a substantially lower cumulative risk of metastasis observed in patients receiving osimertinib compared to those on placebo.

In the ALINA study, patients with resected ALK+ NSCLC were randomized between four cycles of adjuvant chemotherapy or two years of adjuvant alectinib. An exploratory biomarker analysis demonstrated that regardless of the variant of ALK, the benefit with adjuvant alectinib treatment is the same. Patients that had TP53 co-mutations had worse DFS and also less benefit with alectinib than patients with wild-type TP53. 

Patients with early stage, phase I, high risk NSCLC were treated with neoadjuvant nivolumab for three cycles every two weeks in the POTENTIAL study. High risk was defined as a pure solid tumor with no ground-glass opacity component or a solid component measuring 2-4 cm on preoperative high-resolution CT. The primary endpoint of pCR was met with 23%. In addition, 46% of patients had a major pathological response. When you compare this to the neoadjuvant chemo immunotherapy studies in higher stage NSCLC, where the pCR is around 20%, this is a very good outcome, but of course, this needs to be confirmed, and maybe also patient selection needs to be done, because some of these patients may be cured without any treatment and just surgery. The adverse events were around 90%, so there is a risk of toxicity in patients that may be potentially cured without surgery. 

A phase II open-label RCT  investigated the effect of inhaling corticosteroids concurrently with radiotherapy in patients with locally advanced NSCLC. Patients were treated with either concurrent or sequential chemoradiotherapy, and the use of inhalation corticosteroids significantly reduced the incidence of radiation-induced pneumonitis from 53% to 35%. Although these findings are promising, further validation through a phase III trial is warranted.