ESMO Congress 2023
Aiming for a change in clinical practice in NSCLC
The need for practice-changing data to improve patient outcomes is the main focus of research among oncologists treating patients with various tumor types. NSCLC is a big area of unmet need, with few treatments affording the desired balance of long-term efficacy with safety as the disease progresses. A number of studies aimed to overcome this unmet need in several subpopulations of patients with NSCLC, with varying levels of initial success.
Population: ALK+
In the Presidential Symposium 1, findings from an interim analysis of the ALINA trial were presented. The results showed that in patients with completely resected ALK+ NSCLC with stage IB–IIIA disease, treatment with the ALK inhibitor alectinib was associated with a significant DFS benefit versus platinum-based chemotherapy (p<0.0001 for the ITT population). Grade 3–4 AEs were seen in a similar proportion of patients in each treatment arm.1 Comments on the data were largely positive, with many expecting this to lead to a change in clinical practice; however, some were more reserved as the OS data are immature and long-term data are needed to fully assess the clinical impact.
Population: Without actionable genomic mutations
There are limited second-line treatment options available for patients with NSCLC who have progressed on ICI, so there were high hopes among the oncology community for TROPION-Lung01. The study assessed the TROP2-directed ADC datopotamab deruxtecan in previously treated patients with advanced NSCLC. For the co-primary endpoints, PFS was significantly longer than with docetaxel, but OS data are still immature. Although these new data were welcomed by some, many expressed concerns over the safety data, indicating that this may not lead to the shift in clinical practice they had hoped.2
Population: EGFR+
Combination therapy with the EGFR-MET bispecific antibody amivantamab in the first or second line in patients with EGFR-mutated NSCLC led to clinically meaningful PFS improvements over standard of care, as shown in MARIPOSA and MARIPOSA-2, respectively.3,4 Despite positive efficacy data, discussions emphasized the need to manage the side effect profile. The balance of efficacy, safety, and quality of life data must be carefully considered before drawing conclusions about how these regimens may alter the treatment landscape.
ADC, antibody–drug conjugate; AE, adverse event; ALK, anaplastic lymphoma kinase; DFS, disease-free survival; ICI, immune checkpoint inhibitor; NSCLC, non-small cell lung cancer; OS, overall survival; PFS, median progression-free survival; TROP2, trophoblast cell surface antigen 2.
1. Solomon BJ et al. ESMO Congress 2023. Abstract LBA2; 2. Ahn M-J et al. ESMO Congress 2023. Abstract LBA12; 3. Cho BC et al. ESMO Congress 2023. Abstract LBA14; 4. Passaro A et al. ESMO Congress 2023. Abstract LBA15.