© Springer-Verlag 2021 www.memoinoncology.com www.memoinoncology.com 01/21 memo – inOncology SPECIAL ISSUE Congress Report WCLC 2020 A GLOBAL CONGRESS DIGEST ON LUNG CANCER Report from the International Association for the Study of Lung Cancer (IASLC) 2020 World Conference on Lung Cancer, 28th–31st January 2021, virtual congress IMPRESSUM/PUBLISHER Media owner and publisher: Springer-Verlag GmbH, AT, Prinz-Eugen-Straße 8–10, 1040 Vienna, Austria, Tel.: +43/(0)1/330 24 15-0, Fax: +43/(0)1/330 24 26, Internet: www.springer.at, www.SpringerMedizin.at. Owner and Copyright: © 2021 Springer-Verlag GmbH Austria, part of Springer Nature. Managing Directors: Joachim Krieger, Juliane Ritt, Dr. Alois Sillaber. Medical Writer: Dr. Judith Moser. Corporate Publishing: Elise Haidenthaller. Editorial Support: Anna Fenzl, PhD. Layout: Katharina Bruckner. Published in Vienna. Produced in Linz. Printer: Global-Print, Wien, Austria. 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WCLC 2020 special issue Table of Contents 3 Preface 3 Pushing the bounds in early-stage lung cancer 8 KRAS, HER2 & ALK: targeted options and sequencing issues 11 Specific treatment approaches in the EGFR-mutated setting 15 Interview: Antibody-drug conjugates: the age of almost unlimited possibilities has just begun 16 What is new in SCLC? 18 Immunotherapy: combination regimens and new data on the significance of mutations 21 Interview: Lung cancer screening: hurdles in daily routine and in the research laboratory 22 Nivolumab as a new option in patients with relapsed malignant mesothelioma 23 J-AXEL: nab-paclitaxel at least equal to docetaxel in pretreated NSCLC © metamorworks / Getty Images iStock Editorial Board: Alex A. Adjei, MD, PhD, Mayo Clinic, Department of Oncology, Rochester, Minnesota, USA Maria Rosario Garcia Campelo, MD, Lung Cancer and Thoracic Tumors, University Hospital Quirón A Coruña, La Coruña, Spain Federico Cappuzzo, MD, Medical Oncology Department, Ospedale Civile di Livorno, Livorno, Italy Wolfgang Hilbe, MD, Departement of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria Vera Hirsh, MD, McGill University, Health Centre, Montreal, Quebec, Canada Maximilian Hochmair, MD, Department of Respiratory and Critical Care Medicine, KH Nord, Vienna, Austria Herbert H F Loong, MD, The Chinese University of Hong Kong, Department of Clinical Oncology, Hong Kong Massimo Di Maio, MD, National Institute of Tumor Research and Therapy, Foundation G. Pascale, Napoli, Italy Filippo de Marinis, MD, PhD, Director of the Thoracic Oncology Division at the European Institute of Oncology (IEO), Milan, Italy Barbara Melosky, MD, FRCPC, University of British Columbia and British Columbia Cancer Agency, Vancouver, Canada Nir Peled, MD, PhD, Pulmonologist & Medical Oncologist, Thoracic Cancer Unit, Petach Tiqwa, Israel Robert Pirker, MD, Medical University of Vienna, Vienna, Austria Martin Reck, MD, Lungen Clinic Grosshansdorf, Grosshansdorf, Germany Matthias Scheffler, MD, Lung Cancer Group Cologne, Universitätsklinikum Köln, Cologne, Germany Riyaz Shah, PhD, FRCP, Kent Oncology Centre, Maidstone Hospital, Maidstone, UK Yu Shyr, PhD, Department of Biostatistics, Biomedical Informatics, Cancer Biology, and Health Policy, Nashville, TN, USA Masahiro Tsuboi, MD, Hospital East, National Cancer Center, Chiba, Japan Gustavo Werutsky, MD, Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil Yi-Long Wu, MD, FACS, Guangdong Lung Cancer Institute, Guangzhou, PR China Lecture Board for this issue: Maximilian Hochmair, MD; Luis M. Montuenga, PhD; Ross Soo, MB BS, PhD; Alexander Spira, MD, PhD Supported by Boehringer Ingelheim in the form of an unrestricted grant 2 1/2021 © Springer-Verlag memo special issue WCLC 2020 the same time, customization of adju- Preface vant chemotherapy based on genomic profiling did not contribute to survival Dear Colleagues, prolongation. In advanced lung cancer, targeted therapy is gaining ground as The 2020 World Conference of Lung various molecular aberrations are be- Cancer (WCLC) originally scheduled coming amenable to treatment, includ- for August 2020 in Singapore had to be ing the KRAS p.G12C mutation which is postponed to January 2021 due to the found in approximately 13 % of lung COVID-19 pandemic and was finally adenocarcinomas. Convincing findings own © author’s held as a worldwide virtual conference have been obtained for a first-in-class from 28th to 31st January. WCLC, which KRASG12C inhibitor. Furthermore, re- free treatment. Combinations with tar- is the leading gathering of interna- fined treatment of HER aberrations of- geted agents allow for tackling the tional scientists, researchers and fers new possibilities, and in EGFR-mu- disease from different directions and patient advocates in the field of lung tant lung cancer, innovative agents and might enhance the efficacy of immuno- cancer and thoracic malignancies, regimens have demonstrated antitumor therapy. Nevertheless, early detection continues to provide a forum to con- efficacy in difficult-to-treat settings in- of lung cancer undoubtedly provides nect, share knowledge and learn about cluding resistant disease. Among others, unique advantages, even though the the latest developments in the research antibody-drug conjugates represent a implementation of low-dose com- and treatment of these diseases. versatile new technology that certainly puted tomography screening still faces This publication summarizes con- meets the expectations regarding a 21st- obstacles in many countries. Biomark- tent reported at the conference in vari- century individualized approach. ers might help to improve the selection ous areas of clinical interest ranging Immunotherapy has become a main- of high-risk individuals who can be from early-stage disease to the meta- stay of lung cancer treatment in various expected to benefit from screening static setting. Targeted therapies have settings. Important analyses presented programs. succeeded in improving disease-free at WCLC 2020 related to findings ob- survival in patients diagnosed with tained with a range of combination regi- Ross A. Soo, MB BS, PhD, FRACP early-stage lung cancer who tended to mens not all of which proved successful, Department of Haematology-Oncology experience recurrence regardless of although checkpoint inhibition gener- National University Cancer Institute, postoperative chemotherapy use. At ally opens up the road to chemotherapy- Singapore Pushing the bounds in early-stage lung cancer ADAURA: role of adjuvant icant and clinically meaningful im- therapy use and outcomes observed in chemotherapy provement in disease-free survival ADAURA [10]. (DFS) with the adjuvant administration As expected, higher-stage disease Approximately 30 % of patients with of the third-generation EGFR tyrosine and younger age (< 70 years) were gen- non-small-cell lung cancer (NSCLC) kinase inhibitor (TKI) osimertinib (HR, erally associated with increased adju- present with resectable disease at diag- 0.20; p < 0.0001) in patients with com- vant chemotherapy use as compared to nosis [1-3]. Surgery with curative intent pletely resected stage IB-IIIA, EGFR- lower disease stage and older age, while is the recommended treatment here, mutated NSCLC [8, 9]. Osimertinib WHO performance status (0 or 1) did followed by adjuvant cisplatin-based (n = 339) was compared to placebo not affect the treatment decision. Over- chemotherapy in stage II/IIIA and select (n = 343) with and without concomitant all, chemotherapy use was in keeping cases of stage IB disease [4-6]. However, use of adjuvant chemotherapy. In both with observations from previous studies recurrence rates remain high across dis- treatment arms, 60 % of patients re- and clinical practice [11, 12]. DFS bene- ease stages, regardless of postoperative ceived chemotherapy for a median of 4 fits obtained with osimertinib vs. pla- chemotherapy use [7]. The randomized, cycles prior to randomization. At WCLC cebo did not depend on whether double-blind, phase III ADAURA study 2020, Wu et al. reported an exploratory chemotherapy had been administered has revealed a highly statistically signif- analysis relating to adjuvant chemo- or not. Patients after adjuvant chemo- memo © Springer-Verlag 1/2021 3 WCLC 2020 special issue TABLE 1 Disease-free survival in ADAURA according to disease stage and use of adjuvant chemotherapy Stage Study treatment Median DFS, months HR Median DFS, months HR With adjuvant chemotherapy Without adjuvant chemotherapy Overall Osimertinib Not reached 0.16 Not reached 0.23 Placebo 22.1 33.1 IB Osimertinib Not reached Not calculable Not reached 0.38 Placebo 48.2 Not reached II Osimertinib Not reached 0.15 Not reached 0.20 Placebo 29.4 22.1 IIIA Osimertinib 38.8 0.13