ASCO: a promising new therapy for lung cancer

Lung cancer is the leading cause of cancer death in France and worldwide. In France, it is responsible for 40,000 new cases each year. It is the leading cause of cancer death in men and the second in women. In this cancer, there are two categories: non-small cell lung cancer and small cell cancer. The first represents approximately 80% of lung cancer cases. It is more easily detected and treated than small cell cancer. About 30% of patients with this condition are candidates for surgery at diagnosis, but the five-year recurrence rate after surgery and standard adjuvant chemotherapy remains high.

According to Dr. Herbst, head of the medical oncology service at the Yale Cancer Center at Smilow cancer Hospital (New haven, Connecticut, United States), it would be 45% for grade I tumors, 62% for those grade II and 76 for grade III tumours. But for cases of locally advanced or metastatic non-small cell lung cancer, Dr. Herbst and his colleagues would have tested a molecule with “extraordinary results”, osimertinib. They presented the results of a global phase III trial conducted in the United States, China, Korea, Australia and Europe at ASCO. The event was held virtually from May 29 to 31.

In their trial called Adora, the researchers followed about 700 patients. All had non-small cell lung cancer and presented an EGFR mutation on their tumor. They had also fully recovered from the surgery which consisted of removing the tumor and some had received a first postoperative chemotherapy.

Over 83% chance of survival

EGFR determines epidermal growth factor receptors. According to the Roche laboratory website, these last “are found on the surface of tumor cells and their role is to send a growth signal to the cell nucleus. Some lung cancer tumors may contain an EGFR mutation in their DNA. The tumor is then said to be positive for EGFR mutations.”

The patients were divided into two groups. The first was administered a so-called adjuvant molecule, osimertinib (Tegresso, Astra Zeneca laboratories), on which good results had already been communicated at the European Cancer Congress, Esmo, in September 2019. The second received a placebo. Result: patients who had been treated with osimertinib experienced an 83% increase in survival, without disease progression.

Osimertinib is a third-generation tyrosine kinase (TKI) inhibitor. It targets epidermal growth factor receptors (EGFR) with activating mutations (mainly L858R mutations) associated or not with a first-generation TKI resistance mutation (T790M mutation).

“Proof of benefit of osimertinib at an early stage of the disease”

According to Dr. Herbst, who presented the study, this targeted therapy is the first to show a statistically and clinically significant improvement in progression-free survival against this type of cancer.

“These results demonstrate the benefit of osimertinib at an early stage of the disease as adjuvant treatment for selected patients. This should certainly change the way we care for these patients after surgery”, adds Dr. Tina Cascone (MD Anderson Cancer Center, Houston, USA), invited to comment on the study at ASCO. However, this remains to be demonstrated for overall survival.

Each year, lung cancer kills 30,991 people in France. It is mainly due to smoking, but also to passive smoking and exposure to carcinogenic particles present in the air. In particular those coming from asbestos, arsenic, radon or air pollutants such as carbon monoxide or ozone.

Below, the interview of Pr Nicolas Girard by Dr Jean-François Lemoine on the advances in the management of lung cancer presented at the American congress of oncology ASCO 2020: