Editor's Note: The 2023 European Lung Cancer Congress (ELCC) recently concluded in Copenhagen. In an interview with "Tumor Insights," 2023 ELCC Scientific Co-Chairs Professor Martin Reck reviewed the most significant oral presentations of the conference and shared insights on the selection of first-line immunotherapy regimens.
Martin Reck
2023 ELCC Scientific Co-Chair German Center for Lung Research
Grosshansdorf Lung Clinic, Germany
Could you please discuss the highlights of the 2023 ELCC conference and summarize the key research presented during the event?
Martin Reck: The ELCC conference takes place annually and is jointly organized by the International Association for the Study of Lung Cancer (IASLC) and the European Society for Medical Oncology (ESMO). The 2023 ELCC Annual Meeting invited experts from around the world to review the latest advancements in the diagnosis and treatment of thoracic tumors, including non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), and thymic tumors.
The important oral presentations at the 2023 ELCC can be divided into two main categories:
1. Targeted Therapy: This includes the APPLE trial in EGFR-mutated NSCLC patients, where liquid biopsies were conducted during first-line treatment with first-generation EGFR-TKIs to detect disease progression early. Following the detection of EGFR resistance mutations in ctDNA, patients were switched to subsequent therapies, leading to significant benefits for patients. Another notable study in this category was the patient-reported outcomes (PRO) update of the KRAS G12C inhibitor sotorasib (CodeBreaK 200 trial) in treated KRAS G12C-mutated NSCLC patients, demonstrating substantial quality of life (QoL) improvements compared to docetaxel.
2. Immunotherapy: Exciting data came from the 3-year results update of the CheckMate 816 trial, further confirming the superiority of neoadjuvant chemotherapy/immunotherapy over chemotherapy alone in resectable NSCLC patients. In addition to 3-year event-free survival data, updates on overall survival and biomarker research were presented. Data from the EMPOWER Lung 3 trial showed that the novel anti-PD-1 antibody cemiplimab, in combination with chemotherapy, exhibited consistent efficacy across all histological types of NSCLC (squamous and non-squamous). We delved into these research findings extensively.
With an increasing number of first-line immunotherapy options for advanced NSCLC, how can we determine which regimen benefits patients the most, and which patients are suitable for single-agent immunotherapy?
Martin Reck: For advanced NSCLC patients without oncogenic driver gene mutations, the options for first-line treatment are expanding, including single-agent immunotherapy or combination immunotherapy regimens. We are conducting various trials to observe overall survival and progression-free survival with different regimens. To determine which regimen offers the most benefit, we need to perform personalized assessments of patients, taking into account factors such as patient characteristics, oncogenic genes, PD-L1 expression, and tumor burden. For example, the combination of pembrolizumab with pemetrexed-platinum is a highly effective first-line combination regimen for patients with high PD-L1 expression levels. For PD-L1-negative NSCLC patients, double immunotherapy combinations have shown promising signals in studies like CheckMate-227 and CheckMate-9LA. There is also evidence from several trials that single-agent immunotherapy is superior to platinum-based chemotherapy, making it the standard treatment for patients with high PD-L1 expression in advanced NSCLC. We now need to understand which patients with high PD-L1 expression still require combination therapy, and therefore, research into clinical factors beyond PD-L1 is ongoing.
Even as we gather more evidence from first-line immunotherapy studies, we must focus on individual patients' needs.