The management of lung cancer has been revolutionised with targeted therapy and immunotherapy at various stages of treatment. Here, we will briefly discuss some of the latest updates presented at ASCO 2023.

Adaura's overall survival update

1. It is a global study conducted in 26 different countries across Europe, Asia-Pacific, North America, and South America. 682 patients with completely resected, EGFR-mutated lung cancer were randomly assigned 1:1 to receive osimertinib (n = 339) at 80 mg once daily or placebo (n = 343).
2. Disease-free survival in people with stage II to stage IIIA disease was the major goal, whereas overall survival, safety, and disease-free survival in individuals with stage IB to stage IIIA disease were important secondary outcomes.
3. Osimertinib-treated patients with IB to IIIA NSCLC had a 5-year survival rate of 88% compared to 78% for patients who received a placebo in this final overall survival analysis of the ADAURA trial.
4. Overall, there was a 51% lower risk of death for those who received osimertinib compared to those who received a placebo (P < .0001).

Keynote-671

1. This double-blind, placebo-controlled phase III trial randomly assigned 797 patients with resectable stage II, IIIA, or IIIB NSCLC to receive pembrolizumab at 200 mg intravenously every 3 weeks or placebo for four cycles of cisplatin-based chemotherapy.
2. Following that, there was surgery and an additional 13 rounds of pembrolizumab or placebo. Event-free survival was statistically significant favouring the pembrolizumab arm with a hazard ratio of 0.58.
3. Although a benefit was seen across all PD-L1 levels of expression, the amount of benefit was greater in individuals with higher PD-L1 levels.
4. Patients in the pembrolizumab group were more likely than those in the placebo group to attain major pathologic response: 30.2% vs 11%, respectively (P < .00001) and pathologic complete response: 18.1% vs 4%, respectively (P < .00001).

Keynote-789

1. This randomised phase 3 study required patients to have had prior EGFR TKI treatment and disease progression as per RECIST v1.1 criteria.
2. Other critical inclusion criteria were EGFR exon 19 deletions or L858R mutations and an ECOG performance status of 0 or 1. Patients were randomly assigned in a 1:1 fashion to pembrolizumab or placebo in combination with pemetrexed and carboplatin or cisplatin for 4 cycles, followed by maintenance pembrolizumab or placebo plus pemetrexed.
3. The duration of the pembrolizumab treatment was two years. However, those who were randomly assigned to the placebo arm were allowed to cross over to receive pembrolizumab monotherapy upon disease progression.
4. In the second interim analysis, patients treated in the pembrolizumab arm (n = 245) experienced a median PFS of 5.6 months (95% CI, 5.5-5.8) vs 5.5 months (95% CI, 5.4-5.6) for those in the placebo plus chemotherapy arm (n = 247; HR, 0.80; 95% CI, 0.65-0.97; P = .0122).
5. In the final analysis, participants treated with pembrolizumab plus chemotherapy had a median OS of 15.9 months (95% CI: 13.7-18.8), compared to 14.7 months (95% CI: 12.7-17.1) for patients treated with placebo plus chemotherapy (HR: 0.84; 95% CI: 0.69-1.02; P =.0362).

Lunar study

1. 276 adults with metastatic non-small cell lung cancer (NSCLC) progressing on or after platinum therapy (prior immunotherapy permitted) and ECOG PS ≤2 were randomised 1:1 to Tumor Treating Fields (TTFields + standard of care (SOC) or SOC. The 150 kHz TTFields therapy was continued administered until progression or severe toxicity.
2. Overall survival (OS) was significantly extended with TTFields + SOC vs SOC. After a minimum follow-up of 12 months (mo), mOS (95% CI) was 13.2 (10.3–15.5) mo with TTFields + SOC vs 10.0 (8.2–12.2) mo with SOC (HR 0.74; 95% CI 0.56–0.98; P=0.037).
3. 95% confidence intervals for 1-year survival rates were 53% (44-61) and 42% (34-50), respectively (P=0.040). mOS (95% CI) 18.5 (10.6-30.3) vs 10.6 (8.2-17.6) mo (HR 0.63; 95% CI 0.41-0.96; P=0.032) are the differences in OS between TTFields and ICI alone.
4. The incidence of TTFields-related adverse effects (AEs) was 71%, the majority of which were grade 1 and 2 local skin irritation. 8 patients (6%) reported a grade 3 AE.

Wu-Kong6 study

1. Sunvozertinib is a rationally designed selective, irreversible EGFR exon20 insertion (exon20ins) inhibitor.
2. This is a phase II, multi-center pivotal study in NSCLC patients with EGFR exon20ins, whose diseases had progressed on or after platinum-based chemotherapy.
3. The primary and critical secondary endpoints were objective response rate (ORR) and duration of response (DoR), respectively. The efficacy analysis set included 97 patients compromising a total of 30 different exon20ins subtypes. ORR (cORR) was 60.8% (59/97).
4. In patients with baseline brain metastasis, the cORR was 48.5%.

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About the author of this article: Dr Khemeswar Agasti is an MD in General Medicine from Cuttack.