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Jun 15 / Springer Healthcare

2020 Annual Meeting In-Depth Report: Lung Cancer


This in-depth report of the American Society of Clinical Oncology Annual Meeting 2020 outlines and discusses recent research in lung cancer.

American Society of Clinical Oncology 2020 ASCO Annual Meeting

May 29–31st, 2020

In-Depth Report: Lung Cancer


The Annual Meeting of the American Society of Clinical Oncology (ASCO), now in its 56th year, took place under a new virtual format on 29–31 May 2020. Opening the meeting, ASCO President Howard A. “Skip” Burris III highlighted that although COVID-19 had changed the format of this year’s ASCO 2020, the collective determination to make progress against cancer was as strong as ever.

ASCO President Howard A. “Skip” Burris III

Dr Burris explained that the COVID-19 pandemic has changed the way patients with cancer receive care and has encouraged healthcare professionals in the oncology community and their patients to weigh the risks and benefits of delaying treatment.

Dr Burris highlighted that data on how COVID-19 was impacting patients was being collected through the new ASCO Registry and CancerLinQ database, which this year crossed a milestone of 2.5 million patients.

As ever, this year’s ASCO meeting aimed to enable clinicians to understand how and when to integrate novel research into patient care. Dr Burris noted that the galvanising theme of the ASCO20 Virtual Scientific Program – “Unite and Conquer: Accelerating Progress Together” – would take on even more resonance given the extraordinary times as ASCO’s global audience learnt about new developments in cancer care.

“The world is grappling with a pandemic and we are all readjusting to a new reality, but it cannot stop us. We, the ASCO Community, are absolutely unwilling to let anything stop us in the fight against cancer.”

Howard A. “Skip” Burris III, ASCO President

Lung Cancer

Lung Cancer, NSCLC, Small Cell, Other

Interim DFS data from the Phase III ADAURA study presented by Roy S. Herbst, Yale School of Medicine and Yale Cancer Center, New Haven, USA, unequivocally support the use of osimertinib, a third-generation, CNS-active, EGFR-tyrosine kinase inhibitor, as a standard component of care in patients with early-stage EGFR-mutated non-small-cell lung cancer (NSCLC) following complete tumour resection (Abstract LBA5; NCT02511106). ADAURA included patients with:

Patient populations in the ADAURA study

This unplanned interim analysis revealed a significant 83% reduction in the risk of disease recurrence or death with the use of adjuvant osimertinib in comparison with placebo among patients with stage II or IIIA non-squamous NSCLC, which met and exceeded expectations for this global study. At the time of ADAURA being unblinded, the disease-free survival (DFS) data for the overall population were only 29% mature; however, the 2 year DFS rate was 89% with osimertinib versus 53% with placebo. Notably, the strong DFS advantage observed with osimertinib persisted across all patient subgroups, including those patients who received adjuvant chemotherapy and those who did not. Overall survival (OS) data are not yet mature.

“Adjuvant osimertinib provides an effective new treatment strategy for patients with stage IB/II/IIIA EGFR-mutated NSCLC following complete tumour resection and adjuvant chemotherapy.”

Roy S. Herbst, Yale School of Medicine and Yale Cancer Center, New Haven, USA

David R. Spigel, Sarah Cannon Research Institute, Nashville, USA, emphasised the strengths of the ADAURA study but questioned whether osimertinib was eliminating disease or simply controlling and deferring disease that could not be eradicated. However, despite the questions that remain regarding survival and limited study follow-up, Dr Spigel felt that he would still choose to use osimertinib.

“I believe all patients with NSCLC - at any stage - should now be tested for the presence of a sensitising EGFR mutation.”

David R. Spigel, Sarah Cannon Research Institute, Nashville, USA

Data from the Phase II PrE0505 study suggest patients with treatment-naïve and unresectable malignant pleural mesothelioma may respond to treatment with durvalumab when used in combination with pemetrexed and cisplatin according to Patrick M. Forde, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA (Abstract 9003; NCT02899195). Patients received a maximum of six cycles of durvalumab plus chemotherapy, followed by one year of maintenance durvalumab alone. The 6-, 12- and 24-month OS rates were 87.2%, 70.4% and 44.2%, respectively, while corresponding progression-free survival (PFS) rates were 69.1%, 16.4% and 10.9%. Median PFS was 6.7 months. These findings will be explored further in the forthcoming Phase III DREAM3R (PrE0506) study.

PrE0505 study: median OS

Median PFS in the PrE0505 study

“OS and PFS did not correlate with various tumour characteristics, including TMB and PD-L1 expression.”

Patrick M. Forde, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA


Lung Cancer

Metastatic NSCLC

12-month OS in the CheckMate 9LA study

Data on first-line immunotherapy strategies for metastatic NSCLC included those from the Phase III CheckMate 227 (Abstract 9500; NCT02477826) and CheckMate 9LA (Abstract 9501; NCT03215706) studies. Three-year follow-up data from CheckMate 227 demonstrated that the combination of nivolumab and ipilimumab as first-line therapy continued to provide durable and long-term OS benefits compared with platinum-doublet chemotherapy in patients with advanced NSCLC and programmed cell death ligand 1 (PD-L1) ≥1% according to Suresh S. Ramalingam, Winship Cancer Institute, Atlanta, USA.

Martin Reck, German Center for Lung Research, Großhansdorf, Germany, presented data from the CheckMate 9LA study supporting the use of nivolumab plus ipilimumab alongside first-line, histology-driven chemotherapy in patients with advanced NSCLC without sensitising EGFR or ALK mutations. Nivolumab in combination with NSCLC-optimised ipilimumab and a limited course of chemotherapy resulted in a statistically significant improvement in OS compared with four cycles of chemotherapy as first-line treatment. One-year OS rates were 63% versus 47%, respectively, and this clinical benefit was consistent across all efficacy measures in key subgroups including by PD-L1 and histology. Median OS was
15.6 months with nivolumab plus ipilimumab and chemotherapy versus 10.9 months for chemotherapy alone. Of note, the combination regimen appeared to be efficacious in patients with CNS metastases.

“Nivolumab and ipilimumab, together with a limited course of chemotherapy, should be considered as a new first-line treatment opportunity for patients with NSCLC.”

Martin Reck, German Center for Lung Research, Großhansdorf, Germany

Trastuzumab deruxtecan (T-Dxd) is a novel antibody-drug conjugate composed of an anti-HER2 antibody, cleavable tetrapeptide-based linker, and topoisomerase I inhibitor payload. Interim data from the ongoing Phase II DESTINY-Lung01 study demonstrated a high overall response rate and durable responses with the use of T-Dxd in patients with HER2-mutated NSCLC, said Egbert F. Smit, Netherlands Cancer Institute, Amsterdam, Netherlands (Abstract 9504; NCT03505710). The safety profile of T-Dxd was reported to be consistent with that in previously reported studies, with drug-related interstitial lung disease noted in some patients.

“These data demonstrate the potential of trastuzumab deruxtecan as a new treatment option for patients with HER2-mutated NSCLC.”

Egbert F. Smit, Netherlands Cancer Institute, Amsterdam, Netherlands

Closing Remarks

In response to the COVID-19 pandemic, ASCO completely reimagined and reinvented its 2020 Annual Meeting by delivering a successful virtual meeting. This virtual platform still had the aim of achieving an engaging and educational meeting experience for participants from around the world. Delegates were able to view data, clinical experiences, patient perspectives and best practices that will hopefully stimulate new ways of thinking and ultimately translate into optimal patient care within the oncology field.


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