As always, this year’s ASCO 2014 was a mammoth event with representation from every corner of the world.
In addition to discussion of upcoming topics, new and refreshing perspectives on older concepts were presented as well. Without focusing on a particular path, following the breadth and scope of the conference is a monumental task. Thankfully, I have found my niche.
Similar to other oncological areas, immunotherapy dominated many of the posters and talks in thoracic oncology. It is an exciting time for this new genre of therapy, which has not only grabbed the attention of researchers but has also infused a feverish enthusiasm among the media and patients.
The following are a few of the posters and presentations that I found interesting while browsing the conference.
Combination Therapy for NSCLC
One of the posters that caught my attention was titled “Phase II study of cetuximab , pemetrexate , cisplatin and concurrent radiotherapy in patients with locally advanced, unresectable, stage III , non-squamous (non-small cell lung cancer [NSCLC]).” The findings were presented by Jean Tredaniel, MD, PhD, from Groupe Hospitalier Paris Saint Joseph in France.
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The standard of treatment has not changed in a while, and this study represents a promising effort to push the envelope. The patients were treated with four cycles of cisplatin and pemetrexate every 21 days, with radiation, and were also given cetuximab weekly for 12 weeks. The primary endpoint was disease control rate at 16 weeks, 1 month after completion of the treatment.
This combination was associated with higher disease control rate and tolerable toxicity profile. This is a promising addition to the treatment regimen, but clearly further studies are needed before prompting a change in current practice.
Another poster that is worth mentioning was presented by Nathan A. Pennell, MD, PhD, from Cleveland Clinic. The title was “A multicenter phase II trial of adjuvant erlotinib in resected early stage EGFR mutation positive NSCLC.”
This was a prospective clinical trial in which patients with stage IA to stage IIIA NSCLC harboring a tyrosine kinase inhibitor (TKI)-sensitizing epidermal growth factor receptor (EGFR) mutation were examined.
A total of 100 patients were selected. They were treated with erlotinib 150 mg daily for 2 years. Endpoints included disease-free survival (DFS) and overall survival (OS). Forty-five percent of patients were stage I, 27 % were stage II, and 28% were stage III.
The DFS was noted to be 90% total (stage I, 97%; stage II, 73%; and stage III, 92%). Twenty-four patients experienced disease recurrence, two of whom were on erlotinib and 22 of whom had completed the 2-year course. The median time of recurrence was about 12 months after erlotinib was stopped.
The DFS of patients with EGFR mutations was improved compared to historical genotype-matched controls. Recurrence was rare on erlotinib but occurred around a median of 12 months when not on the treatment, suggesting a role of prolonged adjuvant treatment for patients with EGFR mutations.