ASCO 2024. National consultant: The results of these studies in lung cancer are the biggest breakthrough

Katarzyna Pinkosz, Wprost: A few days ago, the largest oncology congress in the world: the American Society of Clinical Oncology (ASCO) ended. What reports from the congress raise the greatest hopes for lung cancer patients? What could be the biggest breakthrough?

Prof. Maciej Krzakowski: The most important are the research results that indicate new and effective options for radical treatment (which may lead to cure – editor’s note). In previous years, the value of complementary postoperative immunotherapy or adjuvant use of anti-EGFR and anti-ALK drugs in patients with non-small cell lung cancer (NSCLC) was proven.

During this year’s meeting of the American Society of Clinical Oncology, the results of two studies were presented, which cover the use of modern drugs used in combination with radiochemotherapy during radical treatment.

The first study is the LAURA study (phase III study). The aim was to compare the value of maintenance anti-EGFR treatment with osimertinib after effective radiochemotherapy in patients with locally advanced NSCLC (non-small cell lung cancer) with an activating mutation in the EGFR gene. If response or stabilization of the disease was achieved after radiochemotherapy (in most patients it was administered simultaneously), patients received osimertinib or placebo.

A very significant benefit was achieved in patients taking osimertinib in terms of prolonging progression-free survival. This was an extension of almost 3 years (median progression-free survival was 39.1 months in the osimertinib-treated group versus 5.6 months in the placebo group).

The second study is the ADRIATIC study, also phase III. It concerned patients with small cell lung cancer (SCLC) and involved comparing the value of maintenance immunotherapy with durvalumab versus placebo in patients with stages I-III undergoing combined radiochemotherapy.

The reduction in the risk of death in patients receiving durvalumab was 27%, and the median overall survival was 55.9 months (in the durvalumab group) versus 33.4 months (in the placebo group). The difference was almost 2 years.

In the case of patients with small cell lung cancer, the treatment of which has seen no progress for many years, are the results of the ADRIATIC trial a breakthrough?

In the group of patients with small cell cancer at the so-called stage limited disease (stages I-III), the current standard of care is radiochemotherapy.

The almost two-year increase in the chance of overall survival is very important because no significant progress has been achieved in this stage of SCLC for over 20 years.

The LAURA study concerned patients with locally advanced non-squamous cell lung cancer, after radiochemotherapy, with a mutation in the EGFR gene. What can the results of this study contribute to clinical practice?

The results of the LAURA study are of great importance because maintenance anti-EGFR treatment after radiochemotherapy in patients with locally advanced NSCLC resulted in a three-year overall survival rate of 84%.

It should be remembered that the currently available maintenance immunotherapy after radiochemotherapy is not effective in patients with activating mutations in the EGFR gene.

To obtain the greatest benefits of maintenance treatment with osimertinib, an increase in the number of patients with locally advanced NSCLC undergoing simultaneous radiochemotherapy and testing of the EGFR gene status is required.

What is the current direction in lung cancer treatment? Can new research results give hope that lung cancer will become a chronic disease for an increasing number of patients and that more and more patients will be able to be cured?

The introduction of modern targeted drugs and immunotherapy in the treatment of advanced lung cancer is undoubtedly a very beneficial method. The skillful use of the above-mentioned drugs creates a real chance of transforming cancer into a chronic disease.

Combining radical treatment methods with modern drugs is even more important, because it can lead to cure in a significant number of patients.

It is also worth adding that the congress also presented the results of the phase III CROWN study regarding 5-year follow-up of patients with advanced non-squamous NSCLC with ALK gene rearrangement. During first-line treatment, patients randomly received lorlatinib or crizotinib. The reduction in the risk of progression or death was as much as 81% in favor of lorlatinib. The above-mentioned result justifies the use of lorlatinib in the first-line treatment of patients with non-squamous cell lung cancer with ALK gene rearrangement – provided, of course, that genetic tests are performed.

People diagnosed in the early stages have a chance of curing lung cancer, so I will ask for which people the use of low-dose computer CT is currently recommended for screening? Who should have this test done as soon as possible?

Low-dose chest computed tomography according to current indications is justified as part of a program for the early detection of lung cancer in people aged 55 to 74 years with a smoking history of at least 20 pack-years (smoking an average of a pack of cigarettes a day for 20 years – note). ed.). Performing the test is justified earlier (from the age of 50) in people who additionally have another risk factor (occupational exposure, e.g. to asbestos or exhaust fumes, lung cancer in first-degree relatives, chronic obstructive pulmonary disease, history of other tobacco-related cancers). ).