By Jennifer C. King, PhD, Chief Scientific Officer, GO2 for Lung Cancer 

While the past decade has seen the development of many new therapies for lung cancer, these drugs are typically first approved for metastatic cancer (cancer that has spread) and not used for earlier stages. We are now seeing an increasing number of studies with newer classes of drugs, some of which were showcased at the 2023 American Society of Clinical Oncology (ASCO) meeting.  

Survival benefit of early targeted therapy

One of the hottest topics at the 2023 ASCO meeting was the ADAURA clinical trial results. This trial addressed this question: if you give a targeted therapy after surgery for stage 1B – 3A lung cancer, will that help prolong a person’s life? The ADAURA study was for EGFR-positive non-small cell lung cancer and the targeted therapy given was Tagrisso (osimertinib). Tagrisso was approved in late 2020 by the U.S. FDA for this “adjuvant” – additional, after surgery – use based on data that showed that it delayed cancer recurrence. At ASCO, the community finally saw the survival results. Taking Tagrisso after surgery resulted in more people with lung cancer surviving long-term (88% of people alive at five years who took Tagrisso vs 78% who did not).  

Helpful definitions

– Neoadjuvant: additional therapy before surgery
– Adjuvant: additional therapy after surgery
– Perioperative: additional therapy around surgery (before and after)

There are still many open questions, including whether adjuvant chemotherapy should be given with Tagrisso. (In the study, doctors and patients could choose whether chemotherapy was given or not – Tagrisso showed a benefit either way.) However, this study was an important step forward in understanding that early-stage targeted therapy can improve survival. Many other targeted therapies are being studied in earlier stages. 

Immunotherapy as an earlier option 

ASCO also showcased several studies on how to best use immunotherapy to treat early-stage cancers. One study showed that either a single immunotherapy or a combination could safely be given before surgery without causing surgical complications. The Neotorch study examined “perioperative” immunotherapy – treatment both before and after surgery – combined with chemotherapy for people with stage 3 NSCLC. That study, which used a new checkpoint inhibitor called Loqtorzi (torpalimab), is consistent with others that show potential benefit to adding immunotherapy to early-stage treatment.  

A lot of important patient-centric questions remain when thinking about early-stage lung cancer. Most importantly, when and how should we be giving targeted therapy and immunotherapy with other known treatment options such as surgery, radiation, and chemotherapy? “Multidisciplinary care” which means treatment consultation by many different areas of expertise (medical oncology, radiation oncology, surgery, pathology, and more) will be increasingly important in treatment planning.   

Despite the questions, it is great to see some of these newer treatments showing benefit in stage 1 to 3 lung cancer. GO2 is excited about the hope and potential of continuing to increase survivorship for those in our community.  

 

Questions about lung cancer treatment or clinical trials? We’re here to help.

Call 1-800-298-2436, email support@go2foundation.org or use the “Lung Cancer Questions?” tab on the right to get started.