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Dr. Luis Corrales discusses with Dr. Henry Gómez the most important studies in lung cancer presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in 2024.
Dr. Henry Gómez Moreno: Dear colleagues, I am Dr. Henry Gómez from Lima, Peru, medical oncologist for Medscape in Spanish in our coverage of the American Society of Clinical Oncology (ASCO) 2024 Annual Congress and we have as our guest the renowned oncologist, Dr. Luis Corrales from Costa Rica, a thought leader in the field of lung cancer. Welcome Dr. Luis!
Dr. Luis Corrales: Hello, Dr. Henry, thank you very much for the invitation, it’s a pleasure to be here.
Dr. Henry Gomez: Dr. Luis, you have selected 3 studies that are relevant in our region for lung cancer. Let’s start with LAURA, Dr. Luis, what can you tell us about this?
Dr. Luis Corrales: This congress was really very important for those of us who see patients with lung cancer, and among the studies that were presented, the LAURA study stood out.
Let us remember that this is a phase 3 study for patients who have stage 3 non-small cell lung cancer that is not resectable and that in the end it is decided to give treatment with chemotherapy and radiotherapy. And those patients who were included in this study, since they are patients who have the common mutation of EGFR (Ex19del/L858R). And in these patients, in a maximum of 6 weeks, osimertinib is started constantly, until progression or toxicity. This study also compared against placebo, which is important; This is part of what we often see in our consultation, patients who may not be the most frequent who come with stage 3, but certainly the frequency of mutation. EGFR It is very high in our population, so obviously this study becomes very relevant.
Perhaps it is important to emphasize here that more than 90% of patients received concomitant therapy, which is what you want to give patients when they have these stages. And the benefit was very broad. And this is important because at the end of the day, it gives us an opportunity for these patients who have the mutation. EGFR who are treated with chemotherapy and radiotherapy. A positive study in terms of progression-free survival.
It is also important to emphasize that of the patients who progressed in the placebo group, 80% received it immediately. These are data from a crossover very high.
In terms of the things that concern me about this study, the most important thing is the treatment time that osimertinib will be given, because there is really no established time. Let us remember that the study talked about toxicity until we have to suspend treatment or until progression, so this also gives us something to think about for those of us who see these patients and also when it comes to informing the patients. Because many of these patients in stage 3 manage to recover from the disease, until how long are we going to give osimertinib to these patients?
Dr. Henry Gomez: There are no real tools to be able to manage when to stop a complete response. The studies are designed to initiate follow-up, but not for treatment.
Dr. Luis Corrales: Exact.
Dr. Henry Gomez: It’s a topic, the other study you selected is very interesting. It’s CROWN in patients with positive lung cancer. ALK. What can you share with us?
Dr. Luis Corrales: The CROWN study, well, we already had the results and at this congress the data from a 5-year follow-up were presented.
Recall that this study included patients with advanced non-small cell lung cancer with a translocation of ALKImportantly, patients were not required to have received treatment. That is, this was a first-line study and compared lorlatinib (100 mg/day) versus crizotinib (250 mg/12 h).
What was important about this study and why did it resonate so much at this congress? Basically, the 5-year results are that over 60% of patients in the lorlatinib group have not progressed over 5 years and this is really striking in the context of patients with advanced lung cancer. When we look at the progression-free survival curves we have not reached the median for the lorlatinib group and when we look at the frequency, the patients who have not progressed in the crizotinib group are only 8% without progression, and this is comparatively to over 60% in the lorlatinib group. This was highly significant with a hazard ratio of 0.19 (95% confidence interval: 0.13 to 0.27) that this is something we rarely see in oncology.
Something also important about this study is that it included patients with central nervous system disease and it is important to consider that there was also a benefit in these patients. That is, the patient with or without central nervous system disease, the patient presented benefit from the use of lorlatinib. Also, in those patients who did not have disease, the time of progression at the intracranial level was really extended and has been extended, which, when one looks at the curves, is almost a horizontal curve, which is also very striking since patients with positivity to ALKwho have a more than 90% chance of having central nervous system disease in their lifetime.
Dr. Henry Gómez: Do you consider that it is the new standard in patients with positive lung cancer? ALK?
Dr. Luis Corrales: When considering the progression-free survival we have, I believe it is the study that has had the best results. We don’t have a studio head-to-head, such as, for example, compared to alectinib or brigatinib, treatment options considered valid and appropriate. But when considering the curves and the median progression-free survival, for me it does become a very important study to consider as a first line of treatment, and here, again in our patients and in the context of Latin America, see the access part which is definitely something that we have to consider, starting as soon as possible with these patients. And in the end, this can also turn the needle from one side to the other.
Dr. Henry Gómez: Finally, regarding the management of patients with small cell lung cancer and immunotherapy, what can you tell us about ADRIATIC?
Dr. Luis Corrales: Well, ADRIATIC is also a very important study for me. Let us remember that small cell lung cancer is a very aggressive disease. If we manage to make the diagnosis at an early stage, either from I to III, and these cannot be operated on, which is quite unusual. But in the sense that if we managed to find these patients, this was the group included. These are patients who are treated with chemotherapy and radiotherapy, and those patients who did not progress were started on treatment with durvalumab versus placebo.
More than 500 patients were included in this study. The primary endpoint was overall survival, which showed statistical significance in favor of using durvalumab after chemotherapy and radiotherapy, with a median of 55.9 months with durmaluvab versus 33.4 months against placebo.
And the other primary endpoint, which was also positive, was the median progression-free survival, which was also in favor of durvalumab at 16.6 months versus 9.2 months, so this also provides an additional opportunity for these patients, since they can be treated with chemotherapy and radiotherapy with localized small cell lung cancer and extend their survival.
Dr. Henry Gómez: One question, what can you tell us about the additive effects of radiotherapy and immunotherapy?
Dr. Luis Corrales: Yes, of course, this is something that we already have from previous studies that we have had in non-small cells, we know that there is a greater increase in inflammatory effects, especially at the pulmonary level; namely, pneumonitis. So, this does increase. Now, whether it was significant from the clinical point of view was not so important. We have also managed to manage pneumonitis with immunotherapy. We have also managed to manage pneumonitis by adding immunotherapy and radiotherapy. And this is also something that is part of what I tell patients: as soon as there are any type of symptoms, they have to let us know, because the faster we manage to identify and treat, the evolution will really be much better.
Dr. Henry Gomez: Perfect, thank you very much! Dr. Luis Corrales from Costa Rica joined us for Medscape in Spanishcovering lung cancer at the Annual Congress of the American Society of Clinical Oncology (ASCO) of 2024.
Dr. Henry Gómez is a medical oncologist, graduated from the Universidad San Agustín de Arequipa, he completed his specialization in Oncologic Medicine at the Universidad Peruana Cayetano Heredia at the National Institute of Neoplastic Diseases (INEN); he continued his training in Clinical Research at the Hospital 12 de Octubre in Madrid, Spain, he has a master’s and doctorate in Medicine from the Universidad Peruana Cayetano Heredia, a master’s degree in Molecular Oncology from the National Center for Oncological Research (CNIO) of Spain, a master’s degree in Management of Health Service Centers from the Virtual University of Barcelona. He is currently an Academician of the National Academy of Medicine of Peru and an affiliated physician at AUNA.