T. Feys MBA, MSc

Highlights in melanoma

SUMMARY

At ASCO 2023, updated distant metastasis-free survival data from KEYNOTE-716 trial provided additional support for the use of adjuvant pembrolizumab in Stage IIB/IIC melanoma. While a biomarker analysis of the CheckMate 76K study provides some insights into biomarkers that correlate with a greater benefit from adjuvant nivolumab, these factors unfortunately do not allow a selection of the most suitable patients for this therapy in daily practice. In addition to this, promising data were generated with a new immune-oncology strategy combining a personalised therapeutic RNA vaccine and pembrolizumab in patients with stage III melanoma. Finally, a two-year update of the RELATIVITY-047 trial confirmed the benefit of nivolumab plus relatlimab over nivolumab alone in patients with previously untreated, unresectable, or metastatic melanoma.

(Belg J Med Oncol 2023;17(5):89–92)

Highlights in breast cancer

The 2023 ASCO meeting again featured several ground-breaking presentations in the field of breast cancer (BC). Early-stage highlights include the long-awaited data of the NATALEE trial assessing adjuvant ribociclib in combination with endocrine therapy (ET) and the PHERGain trial exploring chemotherapy de-escalation using 18F-FDF PET/CT metabolic response assessment. Other studies discussed new molecular biomarkers for recurrence and response, and the impact of ET timing intake on outcomes. Finally, flibanserin was shown to be effective in countering sexual dysfunction in BC patients receiving adjuvant ET. In the metastatic setting, the SONIA trial questioned the universal use of CDK4/6 inhibitors in the first line treatment of patients with hormone-receptor (HR) positive metastatic BC. Furthermore, a pooled analysis of the DESTINY-Breast01, -02, and -03 trials reaffirmed trastuzumab deruxtecan as an effective treatment option for patients across all age subgroups in HER2-positive BC. Finally, a less toxic capecitabine regimen emerged as an alternative to standard treatment in metastatic BC. These results, along with other important findings, are summarised in this report. We would like to acknowledge Prof. Hans Wildiers and Prof. Patrick Neven (University Hospitals Leuven) for their help in selecting the abstracts and adding a clinical interpretation to this overview.

(BELG J MED ONCOL 2021;15(5):193–201)

Immunotherapy: a game changer for patients with extensive stage small cell lung cancer

Over the past years, immune checkpoint inhibition has caused a dramatic therapeutic shift in the first-line treatment of patients with extensive-stage small cell lung cancer (ES-SCLC). After more than three decades without meaningful improvements in the treatment paradigm for these patients, combinations of platinum-etoposide with either durvalumab, or atezolizumab finally resulted in improved survival outcomes. Notwithstanding the convincing results with these innovative regimens in their respective clinical trials, real-world data on the safety and efficacy of chemo-immunotherapy in patients with ES-SCLC are still relatively scarce. Reassuringly, however, all the available data continue to point towards a clinical benefit of PD-L1 inhibitors in combination with platinum-etoposide vs. chemotherapy alone in this setting. Importantly, this benefit was also observed in patients who would not have been eligible for the pivotal clinical trials evaluating these regimens, including patients with a poor performance status.

Targeted therapy and immunotherapy in early-stage non-small cell lung cancer

For many years, the treatment options for patients with early-stage non-small cell lung cancer (NSCLC) were limited to surgery, with or without chemotherapy. When chemotherapy was used, a platinum-based doublet regimen has been the long-standing standard adjuvant treatment for resected patients with stage II-III disease. Adjuvant chemotherapy results in a benefit of disease-free survival (DFS) and overall survival (OS) in early-stage NSCLC with an absolute survival benefit of 4-5% compared to observation or best supportive care. In recent years, however, early-stage NSCLC has been entering the era of precision medicine. Recent trials have been testing the efficacy both of driver mutation-specific tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) (Figure 1). For oncogene-addicted disease, clinical trials mostly focused on Epidermal Growth Factor Receptor mutations (EGFRm) and Anaplastic Lymphoma Kinase (ALK) rearrangements. In the immunotherapy trials, many pharmacological agents have been tested in the adjuvant as well as neoadjuvant setting.¹ In this review, we aim to report on the already available literature data with targeted agents and immunotherapy in early-stage NSCLC, focusing on the most practice-changing results and new perspectives.

Antibody-drug conjugates in lung cancer: a paradigm shift on the horizon?

Antibody-drug conjugates (ADCs) are a unique class of drugs that combine the power of cytotoxic chemotherapy with that of targeted therapy to deliver highly potent cytotoxic agents to cancer cells that express a pre-defined cell surface target. In 2020, trastuzumab deruxtecan became the first FDA-approved ADC for the treatment of non-small cell lung cancer (NSCLC). Since then, two other ADCs have been granted an FDA Breakthrough Therapy Designation in this setting: patritumab deruxtecan and telisotuzumab vedotin. So far none of these ADCs received EMA-approval for the treatment of lung cancer yet. Nonetheless, several early-phase trials are assessing various novel ADCs in patients with advanced lung cancer and have demonstrated promising efficacy. This review provides an overview of the structure and relevant clinical data of ADCs currently under investigation for the treatment of advanced lung cancer.

Journal Scan

In this section of the BJMO, we aim to provide a snapshot of pivotal studies published in recent issues of the most important international journals focusing on oncology. Importantly, the selection of the studies discussed here is the sole responsibility of the publisher and was not influenced by third parties. Do you miss an important study, or did you read a hidden jewel that deserves to be shared with your colleagues? Please, let us know (editor@bjmo.be) and we will make sure to include it in the journal scan section of the next BJMO issue.

(BELG J MED ONCOL 2023;17(4):135–8)

New oncology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

(BELG J MED ONCOL 2023;17(4):150)