Lung cancer, anticipating target therapy increases survival
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From the Asco (American Society of Clinical Oncology) congress, underway in Chicago, comes an important novelty for the treatment of early-stage small cell lung cancer that has alterations of the EGFR gene (epidermal growth factor receptor), particularly frequent in non-smokers. The results of the Adaura study, just presented, in fact show that administering the targeted drug osimertinib as an adjuvant treatment, i.e. after surgery with radical resection, reduces the risk of death by 51% compared to placebo: i.e. a statistically significant and clinically significant improvement relevant to overall survival. The data is published simultaneously on the New England Journal of Medicine.
SPECIAL ASCO 2023
The results
Specifically, in the stage II-IIIA population, 85% of patients treated with osimertinib are alive at five years compared with 73% of patients treated with placebo. In the overall population (stage IB-IIIA), 88% of patients treated with osimertinib are alive at five years, compared with 78% of those treated with placebo. Median overall survival has not yet been reached in both the experimental and control arms. Placebo-treated patients who developed metastatic disease had the opportunity to receive osimertinib as subsequent treatment.
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The importance of anticipating the target therapy
“In the early stages of the disease the intent of treatment is curative – he explains Philip de Marinis, Director of the Thoracic Oncology Division of the European Institute of Oncology (IEO) in Milan and Principal Investigator of the Adaura study for Italy, where a total of 8 centers were involved -. Traditional chemotherapy fails to have a significant impact on decreasing the risk of local or distant disease recurrence, with rates exceeding 5%. The relevance of these data is unprecedented: osimertinib is the first EGFR tyrosine kinase inhibitor to demonstrate an overall survival benefit in the adjuvant setting in patients with EGFR mutant non-small cell lung cancer undergoing radical surgery. These results are even more important if we consider that, in operable disease, 5-year survival decreases from 73% in stage IB to 41% in IIIA. The benefit of osimertinib extends across all patient subgroups. In fact, in stages II-IIIA, 5-year survival reached 85%”. The safety and tolerability of osimertinib at the extended follow-up was consistent with the established profile and previous analyses, with no new safety reports. The most serious adverse events occurred in 23% of patients in the osimertinib arm compared with 14% in the placebo arm.
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The recurrences
In 2022, almost 44 thousand new cases of lung cancer were estimated in Italy. About 30% of patients with the non-small cell form are diagnosed early enough to undergo surgery with radical intent. Nonetheless, recurrence is still frequent in early stage cancer. Recurrences depend, in fact, on the possible presence of micrometastases that are not removed with surgery. Hence the fact that about half of patients with stage I-II cancer and three quarters of stage III patients recur five years after surgery.
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The importance of NGS genomic tests even in the initial stages
“For this reason we welcome the results of the Adaura study, further confirming the great progress that oncology research is making – he comments Saverio Cinieri, President of the Italian Association of Medical Oncology (Aiom) -. Targeted and effective therapies such as osimertinib actually lead to an improvement in the patient’s therapeutic pathway and increase the chances of long-term survival. At this point, therefore, the possibility of offering patients NGS genomic tests to identify the presence of mutations from the early stages of the tumor, and not only when the disease progresses, is fundamental”, concludes Cinieri.
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