Author: GO2 for Lung Cancer Specialist, Science & Research, Brittney Nichols MPH, BSN-RN

Each year, scientists and doctors from across the globe gather at IASLC’s World Conference on Lung Cancer (WCLC) to discuss the latest and greatest in lung cancer treatment and research.

New treatment options on the horizon

While most current research focuses on expanding current treatment options, some major breakthroughs for new potential treatments were discussed.

  • Learning the ADCs
    Over the last 3 years, antibody-drug conjugates have begun to break into lung cancer research. These medications use an antibody to identify and latch onto specific tumor cells, and then deliver high doses of cancer-killing medicine right into the tumor. Several exciting new ADC studies were discussed this year, including the HER-targeting Destiny-Lung and Herthena-Lung-02 trials, as well as LUMINOSITY and Tropion-LUNG-02.
  • Surgical Breakthroughs
    The goals of surgery include smaller incisions, shorter recovery, and above all, high success rates. Studies from G. Wright in Australia and T. Ochi in Japan highlighted work using IV (intravenous) solutions to enhance surgical accuracy, while H. Liang from China shared updates on developing uses of AI in thoracic surgery.

Updates in immunotherapy

Immunotherapy (medicines that help the body’s immune system fight off cancer) were a key focus at this year’s WCLC meeting.

  • New immunotherapies
    The phase 3 ASTRUM-004 Study conducted in China suggests that the new PD-L1 inhibitor serplulimab, when given with chemotherapy, may be a good first-line option for people with squamous cell NSCLC. Cell therapies, such as CAR-T cell and TILs (tumor-infiltrating lymphocytes) are still being developed and studied, with promising results such as the trial of LN-145 pointing to future progress. In addition, new targets for immunotherapy such as LAG3 and TIM3 are beginning to enter the clinical trial space for studies in NSCLC.
  • Updates in best practices
    Investigators shared their work in fine-tuning current IO (immuno-oncology) prescribing practices for advanced NSCLC. The Checkmate-227 trial confirmed the advantages of a regimen of first-line Opdivo (nivolumab) + Yervoy (ipilimumab) given with chemotherapy, while the phase 3 Impower-151 study highlighted the use of Avastin (bevacizumab) + Tecentriq (atezolizumab) and chemotherapy, also in the first-line.

Latest in targeted therapy

When to use targeted therapies, what to combine them with, and how to overcome resistance were the highlight of targeted therapy talks this year.

  • Understanding risk
    Dr. Marisa Bitoni of Ohio State University shared early data from the Epidemiology of Young Lung Cancer Study from GO2, ALCMI, Ohio State University, and University of Southern California showing there may be different risk factors for lung cancer diagnosed at young ages (<50) and there are potential differences in ALK+ and EGFR+ young lung cancer. This is study is still recruiting and you can participate from home – learn more here.
  • New agent
    Drug development is underway for mutations that have previously been known as tricky to target. Dr. Arbour with Memorial Sloan Kettering shared news of multiple drugs in development to target KRAS mutations outside of G12C, several with promising pre-clinical data. EGFR Exon 20 mutations are a more difficult sub-set of EGFR mutations, however, two new potential frontline therapies designed specifically for cancers with EGFR Exon 20 mutations were addressed at WCLC this year: Sunvonertinib and Furmonertinib (with the FAVOUR study showing very strong initial response rates). A new, fourth-generation ALK-targeted therapy is being trialed in the ALKOVE study, for people with ALK-positive NSCLC who are both new to and resistant to previous ALK-targeted medications.
  • Resistance to targeted therapy
    Resistance to targeted therapy drugs is well documented and can occur through many different mechanisms. Now, scientists are developing new ways to tackle this problem. Dr. H. Guo shared news of an upcoming phase I clinical trial in China, looking at a 3-drug combination of medications believed to be effective in EGFR-positive NSCLC that has grown resistant to Osimertinib (Tagrisso): BC3448+WBP3425+Tucidnostat. Now that targeted therapies for KRAS G12C have achieved FDA approval, we’re starting to see resistance to these as well. A presentation by Dr. Ricciuti at Dana Farber highlighted studies working to understand and fight this, including the GO2+ALCMI SPARK study.

SCLC highlights

Small cell lung cancer (SCLC) has been moved from the side lines to center stage and was the focus for multiple sessions.

  • Limited stage SCLC (LS-SCLC)
    Inspired by the recent CALBG 140503 trial in NSCLC, investigators at Mass General Hospital undertook an analysis to identify if sublobar resection + chemotherapy could be as effective as lobectomy + chemotherapy in LS-SCLC. Their findings were positive, showing similar rates of 5-year overall survival.
  • Extensive stage SCLC (ES-SCLC)
    There are several trials looking at novel agents for the treatment of ES-SCLC. The ETER701 study from China and the CeLEBrATE trial from Italy both found that combining VEGF inhibitors (medications such as Avastin (bevacizumab)) with PD-1 inhibitors and chemotherapy in the first line is more effective than chemoimmunotherapy alone in ES-SCLC. Another study, Rationale-312, looks at the novel monoclonal antibody Tislelizumab (BGB-A317), and found that by combining this drug with platinum-based chemotherapy and etoposide we may be able to produce a longer and stronger first line response for people with advanced SCLC.