TOGA's Post-ASCO Re-Cap

Post ASCO did an excellent job of showcasing what must’ve been a plethora of lung cancer studies presented at ASCO 2024. Presented as a virtual symposium, TOGA’s Post-ASCO was chaired by A/Prof Melissa Moore. Here are a summary of the presentations: 

A/Prof Thomas John – Early Stage NSCLC

• Common themes were the continuing advancement in TKI therapy for oncogene-addicted NSCLC, best exemplified by the 5 year CROWN data, presented by Prof Ben Solomon, and continuing to show an outstanding PFS benefit for lorlatinib compared to crizotinib (HR, 0.19; 95% CI, 0.131-0.274)in ALK+ metastatic NSCLC. 
• This benefit was seen in both patients with and without brain metastases. TKI therapy in early-stage NSCLC continued to show worth beyond metastatic NSCLC, with both positive primary endpoint analysis of the LAURA study comparing osimertinib or placebo after definitive chemoradiotherapy, and the molecular residual disease analysis (MRD) from the ADAURA trial of adjuvant osimertinib in patients with resected EGFR-mutated stage IB–IIIA non‑small cell lung cancer. 
• In conclusion, the LAURA study was indeed practice-changing, as while chemo radiation is considered curative in Stage III NSCLC, this has mainly been demonstrated in patients with EGFR wild type disease. 
• In ADAURA, MRD events were detected more frequently with placebo vs. osimertinib, but the real question is whether we can use this to predict those likely to relapse early upfront? This is the basis of the TOGA OCEANIC clinical trial that adds chemotherapy in addition to osimertinib post-resection for patients who are MRD and the tumour is co-mutation positive. 

A/Prof Jaclyn Yoong – Advanced Stage Lung Cancer and Palliative Care

• The EGFR+ metastatic arena continued to benefit from further analyses on the MARIPOSA clinical trial, showing that the combination of amivantamab and lazertinib also had superior PFS to that obtained with Osimertinib in several high-risk groups (e.g patient with brain metastases).
• Subcutaneous amivantamab was not inferior to iv amivantamab in the PALOMA-3 trial, representing a more resource-efficient method of delivery.
• The KRYSTAL-12 study showed the entry of adagrasib into the KRAS G12C mutant advanced NSCLC field (2L), although not in a head-to-head with sotorasib, a KRAS G12C TKI already to have shown benefit in 2L.
• Variations in early palliative care delivery in low-resource settings, such as stepped care after specific patient experiences, or in a telehealth model, were non-inferior to the original Temel 2010 study showing an OS benefit for early referral to palliative care in NSCLC.

A/Prof Steven Kao – Mesothelioma/ Small Cell Lung Cancer

• There hasn’t been an advance in the treatment of LS-SCLC for several decades so the ADRIATIC trial, showing an OS benefit of durvalumab was practice-changing, in the opinion of A/Prof Steven Kao. Listen more for detailed toxicity and subgroup analyses.
• The much-anticipated BEAT-meso study investigating the benefit of immunotherapy (Atezoluzimab) to chemotherapy and bevacizumab was negative but reinforces that non-epithelioid mesothelioma derives a greater benefit from immunotherapy than epithelioid mesothelioma.
• Antibody-drug conjugates (ADCs) continue to feature in clinical trials, with ABBV-706, (SEZ-6 ADC) appearing to be very active in heavily pretreated SCLC. You heard it here first- listen in for more!

A recap on the Microsatellite Symposium: Does the latest 5-year data for lorlatinib change the paradigm for lung cancer treatments going forward? to come soon. 

If you would like to stream the full Post ASCO symposium, registrations are open until 24 June.