The treatment landscape for early-stage lung cancers is evolving, with perioperative immunotherapy and targeted therapies showing promising results. Experts, including Mark G. Kris from Memorial Sloan Kettering Cancer Center, highlighted these advancements, emphasizing the impact of recent clinical trials on treatment strategies.
Neoadjuvant Immunotherapy in NSCLC
The phase 3 CheckMate 816 trial has led to the FDA approval of nivolumab in combination with chemotherapy as a neoadjuvant treatment for early-stage non-small cell lung cancer (NSCLC). The trial demonstrated a significant improvement in event-free survival (EFS) with the combination therapy, reporting a median EFS of 31.6 months (95% CI, 30.2-not reached) compared to 20.8 months (95% CI, 14.0-26.7) for chemotherapy alone. Furthermore, the pathological complete response (pCR) rate was significantly higher in the nivolumab plus chemotherapy arm, with 24.0% (95% CI, 18.0% -31.0%) versus 2.2% (95% CI, 0.6%-5.6%) in the chemotherapy arm (OR, 13.94; 99% CI, 3.49%-55.8%; P < .001).
Kris noted, "The findings using checkpoint inhibitors given before surgery were unexpected and amazing. I urge physicians who treat patients with early-stage lung cancer to consider neoadjuvant immunotherapy with chemotherapy."
Osimertinib After Chemoradiotherapy in EGFR-Mutated NSCLC
The LAURA trial investigated the use of osimertinib after definitive chemoradiotherapy in patients with locally advanced, unresectable, stage III NSCLC harboring EGFR mutations. The results showed a significant improvement in progression-free survival (PFS) with osimertinib. Patients treated with osimertinib (n=143) experienced a median PFS of 39.1 months (95% CI, 31.5- not calculable) vs 5.6 months (95% CI, 3.7-7.4) for patients who received placebo (n=73). The agent reduced the risk of progression or death by 84% compared with placebo (HR, 0.16; 95% CI, 0.10-0.24; P < .001).
According to Kris, "For patients with tumors that harbor EGFR mutations, giving osimertinib after definitive chemoradiotherapy improves disease-free survival and overall survival. This approach will replace durvalumab in these patients."
Durvalumab in Limited-Stage SCLC
The ADRIATIC study explored durvalumab as consolidation therapy for patients with limited-stage small cell lung cancer (SCLC). The study demonstrated that durvalumab significantly improved overall survival (OS) and progression-free survival (PFS) over standard chemoradiotherapy, suggesting a promising new treatment option for this patient population.
The Importance of NGS Testing
Kris emphasized the importance of next-generation sequencing (NGS) in lung cancer management. "Even if the disease involves squamous cells, even if the clinician isn’t sure what cell type the cancer is, it’s important to order NGS testing, because it can open up other avenues of treatment for the clinician given the number of targetable drivers that can be identified," he stated.
