The good news
The initial results of the NeoADAURA trial were presented at the American Society of Clinical Oncology (ASCO) annual meeting in June. This is the first report of a large clinical trial using targeted therapy before surgery in early stage lung cancer.
Why it’s important
Until recently, the standard of care for the treatment of earlier stage resectable non-small cell lung cancer (NSCLC) (without certain targetable genomic abnormalities) has been surgery followed by adjuvant (after surgery) chemotherapy, with immunotherapy if the cancer is PD-L1 positive, to eliminate small undetectable metastases. There has been great interest in moving the treatment up before surgery as neoadjuvant (before surgery) or perioperative (before and after surgery). Due to the results of several clinical trials these approaches are being adopted by many oncologists for the treatment of resectable NSCLC. Patients whose tumor has a targetable epidermal growth factor (EGFR) mutation in an earlier stage receive surgery followed by osimertinib with or without chemotherapy.
The NeoADAURA trial was a large, global study in which patients with resectable EGFR-mutated NSCLC received osimertinib with chemotherapy, osimertinib alone, or chemotherapy alone prior to surgery. For patients who received osimertinib alone or with chemotherapy, results showed a better major pathologic response – live cancer was present in less than 10% of surgically removed tumors. The study also showed better event-free survival (i.e. less recurrence of cancer). This approach to treatment was safe, and patients receiving neoadjuvant treatment did not experience an increase in surgical complications.
What it means for patients
The results of the NeoADAURA trial are still early, and at this point it is difficult to say whether there will be a change in the standard of care – which currently is to give osimertinib with or without chemotherapy after surgery. It is important to note that even patients with early-stage NSCLC – which is amenable to surgery – should receive molecular (genomic) testing of their lung cancer so they can receive the appropriate treatment. Another recommendation is to arrange a multidisciplinary conference around these patients’ cases. This enables physicians of various specialties – medical oncologists, thoracic surgeons, radiation oncologists, radiologists, pulmonologists, and pathologists as well as other health care personnel – to individualize patient health care plans.
What to look for
We expect to see updates of the results of the NeoADAURA trial. This should help determine moving forward what the best treatment approach is for these patients. Further studies will attempt to answer many questions – among them, determining the role of chemotherapy and the optimal length of treatment. Also look for clinical trials assessing the neoadjuvant/perioperative treatment approach for early-stage patients with other oncogene driven lung cancers such as ALK, RET, ROS1, etc.