The AEGEAN trial

The AEGEAN trial is a perioperative study evaluating the efficacy of combining immunotherapy with chemotherapy in patients with resectable non-small cell lung cancer (NSCLC). Specifically, the trial compared neoadjuvant chemotherapy alone to neoadjuvant chemoimmunotherapy with durvalumab, followed by adjuvant immunotherapy. The study demonstrated a significant improvement in pathological response rates and event-free survival (EFS) for the immunotherapy arm. Additionally, a favorable trend in overall survival (OS) was observed, contributing to the approval of this combined approach in Europe.

At ESMO 2025, an exploratory analysis was presented to identify predictive factors for treatment response. Biomarker analyses in this trial focused on two key biomarkers: circulating tumor DNA (ctDNA) dynamics and radiomic signatures derived from computed tomography (CT) imaging. Prior findings from the trial indicated that ctDNA clearance during induction therapy correlated strongly with improved EFS and OS outcomes, suggesting a potential role for ctDNA as a predictive biomarker.

In a new analysis, presented at ESMO 2025, researchers extended the investigation to include radiomics, quantifying changes in imaging patterns between baseline and preoperative CT scans. In this video, Prof Martin Reck, pulmonologist at the German Center for Lung Research in Grosshansdorf and lead investigator of the MDT-BRIDGE trial explains the key findings from this analysis to Dr Dieter Stevens, pulmonologist and thoracic oncologist at the Ghent University Hospital. 

In the presented analysis, the investigated radiomic features were assessed individually and in combination with ctDNA dynamics to determine their predictive value. While the radiomic signature alone showed some predictive capability, the combination of ctDNA data and radiomic features provided the highest predictive accuracy, reflected by the strongest area under the curve (AUC) for forecasting EFS and OS.

Overall, the exploratory findings underscore the growing value of integrating molecular and imaging biomarkers in personalizing perioperative treatment strategies for NSCLC. The results affirm the clinical benefit of chemoimmunotherapy in this setting and highlight the potential of combining ctDNA and radiomic analyses to refine patient selection and optimize outcomes. Further validation in larger cohorts is warranted to establish these tools for routine clinical use.