ASCO 2024: Lung cancer roundup

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Published: 4 Jun 2024
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Dr Luis Raez - Memorial Cancer Institute, Miami, USA

Dr Luis Raez gives his thoughts on key studies in lung cancer from ASCO 2024.

He covers the following studies:

CROWN: 5 year progression-free survival and safety from study into lorlatinib versus crizotinib in treatment-naïve patients with advanced ALK positive non-small cell lung cancer.
ADRIATIC: Durvalumab as consolidation treatment for patients with limited-stage small-cell lung cancer.
LAURA: Osimertinib after definitive chemoradiotherapy in patients with unresectable stage III epidermal growth factor receptor-mutated non-small cell lung cancer.

 

ASCO 2024: Lung cancer roundup

Dr Luis Raez - Memorial Cancer Institute, Miami, USA

Hi everybody, this has been a very exciting ASCO 2024, especially for the lung cancer community. As many have heard in the news, we have at least three major presentations that have a tremendous impact in our patients.

The first one was the study called CROWN with a drug lorlatinib. We were familiar with this drug because it was already FDA approved a couple of years ago when they showed they can increase progression free survival compared with the standard of care that was before that crizotinib. However, in this meeting we are presenting the five-year data of progression free survival and it’s amazing that after five years we still have more than half of the patients responding to the drug. That is something unheard for ALK positive patients. The standard of care that is alectinib or brigatinib usually have a progression free survival of three years, that was also a major advance at that time when we made these drugs the standard of care. But now having an agent that can have five years or more as a progression free survival is amazing. As you can understand, we haven’t reached the progression free survival, we have not even reached the survival. That’s why we are very, very happy, very excited for our patients that maybe now they have the opportunity to have a treatment that can really cause a major impact in their survival.

The only thing is we need to get familiar with the side effects. We know lorlatinib is the strongest of all the TKIs for ALK but also has particular toxicities like high cholesterol and toxicities that we are not very familiar with as cancer doctors. But this is a drug that is going to benefit the patients tremendously. The fact that the toxicities like, again, the high cholesterol, the increase of the liver function tests, the changes in mood, paresthesia, should not preclude us to give the best treatment for the patients.

The other important presentation I want to mention is a study called ADRIATIC, like the ocean. This is a very important study because our standard of care for small cell lung cancer limited stage, contained small cell lung cancer, is chemoradiation. It’s the same standard of care for close to ten years with no progress. To have something finally progressing in that field is amazing for us.

In this case, the patients were randomised to have the standard of care or after the chemoradiation they received immunotherapy with durvalumab. The results are astonishing – they were presented and basically the results are showing that the survival if we add immunotherapy can go from the standard survival after chemoradiation of 33 months to 55 months. So we can increase the overall survival 22 months. 22 months is close to two years. In other words, if you give the patient with small cell lung cancer after chemoradiation immunotherapy now the patients may be able to be alive for two more years. So that’s why it is amazing, exciting for us in the lung cancer community, and the toxicity profile is not a big deal. We are very familiar with checkpoint inhibitors, we use these drugs all the time now in lung cancer. So that’s very happy also for our patients.

Finally, the third presentation that I think is very important is the study called LAURA. In this study the standard of care for non-small cell lung cancer stage 3 unresectable is to have again chemoradiation. These patients have the genetic alteration, the EGFR mutation. So instead of giving them immunotherapy that we discovered that is no good for them and they don’t benefit, now the patients are getting osimertinib. Thanks to that, the progression free survival has increased tremendously from 6 months with chemoradiation, 6.9 months, to 39 months. So the benefit is 84%, the hazard ratio is 0.16, that is a very, very low number. That’s why it’s very exciting for us because the patients are benefitting tremendously from this intervention, adding osimertinib after chemoradiation for unresectable stage 3 if you have the mutation in EGFR.

We knew a little bit about this, we can infer these results, but it’s nice that finally we have corroboration that these results are true and all of these three things I mentioned today are becoming now the new standards of care for lung cancer thanks to the presentations in this meeting.

Thank you very much for your attention.