Highlights in Lung Cancer From ESMO 2021 - Pasi Jänne, MD, PhD, Discusses Promising Studies from the Meeting

Significant advances in the field of lung cancer continue with some very promising data recently presented at the virtual European Society for Medical Oncology (ESMO) meeting.

In this exclusive MedPage Today video, ESMO Scientific Co-Chair Pasi A. Jänne, MD, PhD, director of the Chen-Huang Center for EGFR-Mutant Lung Cancer at Dana-Farber Cancer Institute in Boston, highlights some of the important lung cancer abstracts from the conference.

Following is a transcript of his remarks: 

A couple of them [important lung cancer studies from ESMO 2021] include the DESTINY-Lung trial, which was the trial of trastuzumab deruxtecan [Enhertu], a HER2 antibody drug conjugate in patients with HER2 mutant lung cancer. So this is a subset of lung cancer characterized by genetic alterations where we do not have an approved targeted therapy.

There have been many attempts to develop targeted therapies in this space, and most of them have not had a large degree of activity. I think the trastuzumab deruxtecan trial stands a little bit in contrast to that as really the highest level of activity in terms of both response rate and progression-free survival that has been seen to date. And it does have toxicity -- lung disease, interstitial lung disease is one of its limiting toxicities -- but certainly on the balance, the efficacy for this population with no approved targeted therapies is favorable in my mind.

Another important study presented was the IMpower010, the adjuvant atezolizumab [Tecentriq] study in patients with surgically resected non-small cell lung cancer.

This study was initially presented at ASCO [American Society of Clinical Oncology] and additional degree of data shown at the ESMO meeting this past week. It really highlights for the first time that there is a disease-free survival benefit in patients who receive adjuvant immune checkpoint inhibition for surgically rejected lung cancer. We've seen this in other diseases; we had yet to see it in lung cancer, this is really the first demonstration of that.

And the data at the meeting was interesting, and it showed some more gradations in the PD-L1 stainings. The patients that had greater than 50% PD-L1 staining had the highest degree of benefit, with no benefit in patients that had a low degree of PD-L1 staining, and sort of an intermediate in patients with 1% to 49% PD-L1 staining. So I think more to come from this study. But I think it clearly emphasizes the point that one can have a benefit in disease-free survival from adjuvant atezolizumab, and of course we eagerly await to see what the impact is on overall survival. 

Another study that focused on another antibody drug conjugate targeting TROP2. Called DS-1062a, this is an agent that's in clinical development. And the presentation at ESMO focused really on patients who have targeted genomic alterations, who were treated with this agent and most of the patients there had EGFR mutations and there was definitely some activity in that patient population. So this is a population of patients that are, of course, initially treated with EGFR inhibitors. But having options for individuals once EGFR inhibitors are exhausted is an important piece of information. At the current time, we're using typically chemotherapy in this patient population, but having activity of the antibody drug conjugate I think was encouraging as well.

There is an ongoing trial studying this agent specifically in patients with targetable genomic alterations who have exhausted phenotype-directed therapy to understand is it sort of across the board an effective strategy. Similarly, patients who do not have genomic alterations, there's a randomized trial versus chemotherapy of this particular agent.

So I'm excited to see how this agent, and antibody drug conjugates in general, evolve over the next several years, because I think we're starting to see that this is really a new class of therapies for our patients and I think trying to understand the exact therapeutic arenas for this agent will be important.