The good news
The World Conference on Lung Cancer was held in Seoul, Korea in September. Researchers from all over the world attended the conference, where the most recent developments in the treatment of lung cancer were presented. The top research abstracts are chosen to be presented at the Presidential Symposia. These presentations typically spotlight major findings that should be heard by the entire group of attendees. I have highlighted the results from several of these clinical trials.
MAVERICK (SWOG 1827)
Why it’s important
MAVERICK is a study that evaluated prophylactic cranial radiation (PCI) in patients treated for limited or extensive stage small cell lung cancer (SCLC). The purpose of PCI is to deliver radiation to the brain to prevent the development of brain metastases. Brain metastases are a very frequent occurrence in SCLC. Because of their frequency, PCI has been part of the treatment protocol, particularly in patients with limited stage disease. However, the use of PCI has been controversial because of its potential for causing cognitive (neurologic) side effects. On the trial patients received either surveillance for the development of brain metastases by utilizing frequent MRIs or PCI with surveillance. The study found that there was improved survival free of cognitive deficits for the patients who just received MRI surveillance.
What it means for patients
MAVERICK is the first trial to evaluate MRI surveillance for brain metastases as an option for patients with SCLC. There have been many new advances in the treatment of SCLC and patients are living longer, making it increasingly important to support and address quality of life throughout their care. The results support MRI surveillance as the standard of care for patients with SCLC, helping patients avoid the side effects associated with PCI.
What to look for
The final overall survival (how long patients lived) and a longer follow-up on the outcomes associated with the development of brain metastases is expected in the near future. It is anticipated that these results will change practices for the treatment of SCLC.
TAISHAN-302 and ARTEMIS-008
Why it’s important
Tambotatug pelitecan (Tam-Peli) and risvutatug rezetecan (Ris-Rez) are antibody drug conjugates (ADC, a type of treatment designed to attach to a target and deliver chemotherapy directly to the cancer cell). Both drugs target B7-H3 on the cancer cell which is a protein that is expressed on SCLC and plays a role in the immune system and can support cancer growth. In both trials, patients with previously treated SCLC received either the ADC or topotecan, which is standard chemotherapy. In the TAISHAN-302 trial utilizing Tam-Peli, the survival was 13.3 months compared to 9.4 months for toptecan. On the ARTEMIS-008 trial that evaluated Ris-Rez the survival was 18.5 months compared to 10.3 months for topotecan. Both ADCs were able to produce better tumor responses that lasted longer than the standard of care chemotherapy.
What it means for patients
The particular importance of these trials is that we are seeing progress in the treatment of SCLC, which remains a great area of need. These results show encouraging progress for treating patients with SCLC whose cancer has returned or progressed after their first treatment. Both ADCs helped patients to live longer, and the side effects associated with these novel agents were more manageable and less frequent when compared to the standard of care chemotherapy, topotecan.
What to look for
These ADCs are not yet approved for treatment in the US. Both trials were performed entirely in China. Thus, we await results from large global studies with a more diverse population to see if they will continue to benefit and advance the treatment of patients with SCLC.
ADAURA
Why it’s important
The ADAURA trial established the use of osimertinib as adjuvant therapy (treatment after surgery) for patients with early-stage lung cancer that has an EGFR exon 19 or 21 mutation. The results of this trial changed how these patients are treated. At the meeting, researchers presented updated results showing how patients were doing eight years later. The survival benefit for osimertinib continued over time, with 79% of patients who received osimertinib after surgery still alive after 8 years, compared to 64% of the patients who did not receive osimertinib as adjuvant treatment.
What it means for patients
The results of this trial are a validation of the benefit of adjuvant (after surgery) osimertinib in patients diagnosed with early-stage EGFR-positive lung cancer that has translated into lasting survival. This study also serves as a model for conducting trials using other targeted therapy as adjuvant treatment after surgery for other types of early-stage lung cancer.
What to look for
There are still many questions that we need to answer, including the role of chemotherapy and the length of adjuvant treatment that is required to reach the greatest benefit. There is a growing interest in the use of such techniques as liquid biopsy to establish biomarkers that could help answer some of these questions.
Although the results of these trials represent significant advancements, there is more work to be done. More research is needed to further improve outcomes for all these patients.