Presidential symposium 1

Dr Kristof Cuppens, pulmonologist & thoracic oncologist at the Jessa Hospital in Hasselt summarises the key findings from the first presidential symposium at WCLC.  

The SWOG S1827 / MAVERICK trial compared regular brain MRI surveillance alone with prophylactic cranial irradiation (PCI) followed by MRI surveillance in patients with limited- or extensive-stage SCLC who had completed initial treatment without developing brain metastases. MRI surveillance alone significantly improved cognitive failure-free survival, defined as time to cognitive decline or death. Preliminary OS results showed no apparent difference between the groups, although the final survival analysis is pending. These findings support MRI surveillance as an option that can spare patients the cognitive and other toxicities of PCI, provided that regular imaging is feasible.

Two studies evaluated B7-H3-directed ADCs against topotecan after relapse following platinum-based chemotherapy. In TAISHAN-302, tam-peli improved median OS from 9.4 to 13.3 months (HR 0.46). In ARTEMIS-008, risvutatug rezetecan improved median OS from 10.3 to 18.5 months (HR 0.46). Both agents caused fewer severe treatment-related adverse events than topotecan, but interstitial lung disease or pneumonitis remains a safety concern. As both trials were conducted in China, their applicability to other populations and to patients previously treated with tarlatamab requires further study. The results nevertheless provide strong evidence for the potential of B7-H3-directed ADCs in relapsed SCLC.

Finally, EVOKE-03/KEYNOTE-D46 tested sacituzumab govitecan plus pembrolizumab against pembrolizumab alone as first-line treatment for metastatic NSCLC with PD-L1 expression of at least 50%. Although median PFS was numerically longer with the combination (11.8 versus 7.7 months), it did not meet the prespecified threshold for statistical significance. Overall survival was not improved at the interim analysis, while severe treatment-related adverse events were substantially more frequent. The findings do not support adding sacituzumab govitecan to pembrolizumab for an unselected PD-L1-high population; identifying patients who might benefit from ADC-based combinations remains an important research question.