2022 World Conference on Lung Cancer

WCLC roundup

Luis Raez – Memorial Cancer Institute, Florida, USA

Today I want to give thanks to ecancer for this interview. We want to talk to you about what are probably the best presentations for the World Lung Cancer Congress that just happened in Vienna in August 2022. This was very exciting and there are so many good news, that’s why we had to focus, probably, on the four most important ones.

In that regard, during the plenary session the study called IMpower010 was presented at World Lung. That study is very popular, everybody knows about that because, as you know, last year in 2021 IMpower010 made history because it’s the first positive study in lung cancer as adjuvant therapy, meaning after surgery. IMpower010 showed last year that it prolongs significantly the disease free survival when the adjuvant immunotherapy with atezolizumab is given after surgery for one year. The controversy at the time was there was no overall survival data but because for lung cancer there was nothing better – for 18 years we have been giving adjuvant chemo only that only improved survival in 5% of the patients. The FDA, based on the disease free survival, approved the indication. So that’s our standard of care now.

So this year in the World Lung Cancer Congress it was very exciting that investigators, led by Dr Enriqueta Felip from Spain, presented the survival data, the first analysis of the survival data. We can say in conclusion that if the patients have a PD-L1 more than 50% in their tumours after surgery they get a benefit in overall survival and the hazard ratio was 0.43, meaning that there is a more than 50% benefit in survival when we give atezolizumab for one year after surgery for stage 2 and 3. If you are a little bit negative you can say, ‘Hey, but you’re only saying 50%.’ Yes, that’s true – if the tumours don’t have the 50% of PD-L1 staining, meaning they have less than that, there is no survival benefit seen in this data. So that was the first important study. We are eagerly waiting for more updates in the near future so we can know if maybe the patients that have a PD-L1 of less than 50% will benefit. In the meantime, as I said at the beginning, this indication is approved for everybody with PD-L1 positive stage 2 and 3 non-small lung cancer after surgery as per the American FDA.

The second presentation it’s worth to mention that is very important is a study called NADIM II. As we know, this year in 2022 in March the American FDA approved the indication of neoadjuvant chemoimmuno, meaning chemoimmunotherapy before surgery. This is another historic approval for lung cancer because we have never had this approval, not even for chemo. We didn’t use a lot of chemo as neoadjuvant but this was based, remember, on the study CheckMate 816 that basically is the administration of three cycles of chemo with nivolumab before surgery. Thanks to that, and the disease free survival information from the study for stages 1b, 2 and 3, the FDA approved that and that’s the standard of care. But we didn’t have survival data and this was only one study that is showing progression free survival so a lot of people always said, ‘We want more studies; we want more data.’ That’s why NADIM II presented, first at ASCO this year and now in World Lung in Vienna, is very important because it shows that patients with stage 3a and 3b that are technically resectable, if you give these patients three cycles of chemotherapy with nivolumab and then you follow them with six more months of immunotherapy they have a significant improvement of progression free survival and we knew about that. Now they have a significant improvement in overall survival. An overall survival improvement – the hazard ratio was 0.4, meaning that that it’s close to a 60% benefit in survival giving immunotherapy with three cycles of chemo before surgery, followed by six months after surgery. So this was another historic study.

Then another important point was that if the patients achieve a complete pathological response they have practically a 100% survival at three years. So these are the patients that will do better. If the patient has a complete pathological response, there is a large number of patients that we discovered are in the surgery, and these are the patients that are going to have probably a very good survival. So that’s very exciting with this news.

The other study that is important is GEMSTONE-301. GEMSTONE-301 is a study from China and, if you remember, we have been doing as a standard of care for the last five years for patients that are unresectable with lung cancer the PACIFIC study, the PACIFIC approach we call it. The PACIFIC study is basically patients will have chemoradiation for a couple of months and then we give them one year of immunotherapy. Now, this study, GEMSTONE-301, is the same approach but this is with a new anti-PD-L1 called sugemalimab. This is another PD-L1, it’s nothing different but at least it’s the second agent that is showing that the PACIFIC results are true because these were 381 patients treated with chemoradiation followed by the antibody versus placebo. There is a 10 month progression free survival with the antibody compared with six months if the patients get placebo. The overall survival from the antibody has not been reached yet but it’s exciting to know that at least 56% of the patients are still without progression and alive after three years. That’s more or less what we expect from our standard of care PACIFIC.

So you can say, ‘But this is another antibody, it’s very similar to durvalumab that is the one that was in PACIFIC, but at least now give us a second option. A second option for stage 3 non-small cell lung cancer because we didn’t have any other option than durvalumab due to the lack of studies.’

Finally, because these presentation videos are short I cannot extend too much, maybe we can comment about a surgical study. We have a CALGB study presented at World Lung. If you remember, in lung cancer standard of care when we do surgery is the lobectomy. We do the lobectomy because that prevents local recurrences and we had the idea if we do something less than the lobectomy there can be more local recurrences, that’s why the standard of care is the lobectomy. However, the CALGB presented a very interesting study – if the tumours are less than 2cm, a sublobar resection or segmentectomy, so a much smaller resection, is equivalent to lobectomy. This is a very important thing because now we know that our surgeons don’t have to do lobectomy. To give you an idea, the left lung only has two lobes. When we do lobectomy we practically are taking half of the left lung in every patient. So this study is showing that if a tumour is less than 2cm maybe we don’t have to take half of the left lung, we can take only a segment, what we can call a sublobar resection and the results of survival will be the same. So we are very happy this is going to benefit tremendously our patients. I know that stage 1 patients are not very common but, remember, we are doing now lung cancer screening worldwide so the number of patients at stage 1 is going to increase tremendously thanks to the lung cancer screening and we are going to have more people benefit from this.

Thank you very much for your attention today.