During this SIOG conference I presented the updates in medical oncology focussing mainly on GU and lung cancers and on new treatment modalities. What was really striking in 2024 is actually the tsunami of ADCs, antibody-drug conjugates, where we see a lot of efficacy in various cancer types and where it’s now approved in first line in combination with immune checkpoint inhibitors in urothelial cancers. The main issue, and I would say it’s an issue for most clinical trials, as the geriatric oncology community knows, we don’t have a lot of data around these new drugs, and especially ADCs in monotherapy or in combination, in older patients. So we don’t really know how to treat and how to approach these new therapeutic modalities.
The other treatment that was presented, especially in prostate cancer and in lung cancer showing big advances, is T-cell engagers. The idea is really to stimulate again the immune system, targeting both the tumour cells through a tumour antigen that is presented and also the lymphocyte, the CD3 or the CD28. So in the studies presented this year during medical conferences such as ASCO but also ESMO and in many publications in high-factor journals showing that those therapeutic modalities in small-cell lung cancer and in prostate cancer are promising. Tarlatamab is now approved in the US in the treatment of small-cell lung cancer and the results presented from a CD3 PSMA showed promising results and might be also a new treatment modality in prostate cancer.
Once again, we don’t have a lot of data in that population. We wish that some scores, and especially, of course, the G8 but also the G-CODE or the PGA developed by ASCO are included in those clinical trials so that we can actually extrapolate the data of the randomised phase III to the reality of the real-life populations of patients that we treat.
The other point in an overall reflection around clinical trials is also to think about the design and the endpoints dedicated to the older population. We are currently working with ESMO, as with the SIOG community and ESMO, to define what are the good, the right, endpoints and the right design for older patients in clinical trials and it should be published this year.
Is there anything else you would like to discuss?
Another study was presented at ESMO this year, in 2024, looking at patients undergoing radiation therapy for localised breast cancer. The study was called HypoG-01 and was presented by Sofia Rivera. What was interesting in that randomised clinical trial is that patients were randomised whatever their age between hypofractionated radiation therapy and normal fractionated radiation therapy. What was seen in this clinical trial is that actually whatever the regimen, either hypofractionated or normal fractionated, patients had the same local recurrence free survival and also the same distant free survival, showing no impact of the hypofractionated regimen. I think this is very interesting, especially in the context of older patients where we don’t want them to go daily to the hospital and to have the same results with this specific hypofractionated regimen is very interesting and probably a new standard of care that we can integrate in the care of older women treated for early breast cancer.
What is also very important and that we want to work on as a geriatric oncology community is work about involving patients and patient advocacy groups at the beginning of the reflection around the clinical trial design. We are working on that right now in France, creating a patient committee that is helping our research group to design the clinical trials and to think about more focussed endpoints and what is definitely a priority for the patients. We also want, in this area of patient-centred endpoints, to insist on what we call patient-related outcome and the importance of electronic patient reported outcomes. In a study that was presented during the SIOG conference, it was shown that older patients use a lot some electronic portals and telemonitoring, remote patient monitoring, to implement their patient-related outcomes or quality of life assessment. So these modalities can definitely also be integrated in the design of clinical trials in older patients.
