COMMENTARY

ASCO Data Present 'Clear Roadmap' to Treat Locally Advanced NSCLC

Mark G. Kris, MD

Disclosures

July 09, 2021

This transcript has been edited for clarity.

This is Mark Kris from Memorial Sloan Kettering Cancer Center in New York City. Today I'm presenting the first of three discussions on lung cancer, reporting on sessions at the American Society of Clinical Oncology (ASCO) 2021. I've divided the content into three areas: locally advanced cancers, immune therapeutics, and targeted therapies.

The greatest advances presented this year were in the area of locally advanced cancers, particularly the study reported by Heather Wakelee and colleagues. This was a phase 3 trial of atezolizumab after resection and adjuvant chemotherapy of non–small cell lung cancer (NSCLC) vs best supportive care. All patients had expression of PD-L1 of 1% or greater. Approximately 1 year of atezolizumab was beneficial compared with best supportive care.

That's potentially a practice-changing result, and I believe this study will march through to publication, further presentations, FDA approval, and incorporation into guidelines. This is a real advance.

The second paper is by Spicer and colleagues, who reported surgical outcomes following neoadjuvant therapy. Patients with NSCLC received neoadjuvant chemotherapy + nivolumab or chemo alone before tumor resection. The investigators found an impressive array of pathologic complete response (pCR). We know from the literature that pCR in lung cancer generally means better overall survival. This study showed the clear benefit of the combination of chemotherapy and a checkpoint inhibitor in the neoadjuvant setting.

Finally, Spigel and colleagues reported the 5-year data from the PACIFIC trial of durvalumab following concurrent chemoradiotherapy in patients with unresectable NSCLC. They found a 33% progression-free survival and a 43% overall survival at 5 years for patients getting durvalumab after concurrent chemoradiotherapy.

Together, these studies point to the need for multimodality therapy for the patients with locally advanced NSCLC. Each of these abstracts gave a definitive local control measure, either radiation or surgery; they all gave an immunotherapeutic, and they all gave chemotherapy. Putting those three strategies in place for patients with local-regional disease is critical. All three phase 3 randomized trials point to that.

This is great news. We have a way to improve the care of people with locally advanced disease. We have a way to cure more of these patients. Obviously, there's more work to do and a lot of questions to be asked. But these studies support clear roles for an adjuvant checkpoint inhibitor, the neoadjuvant combination of chemotherapy and a checkpoint inhibitor, and durvalumab following concurrent chemotherapy and radiation.

It is very good news for our patients and for the oncology community. We have a clear roadmap of how to proceed with these patients thanks to the data presented at ASCO 2021.

Mark G. Kris, MD, is chief of the thoracic oncology service and the William and Joy Ruane Chair in Thoracic Oncology at Memorial Sloan Kettering Cancer Center in New York City. His research interests include targeted therapies for lung cancer, multimodality therapy, the development of new anticancer drugs, and symptom management with a focus on preventing emesis.

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