The perioperative data from ASCO and the tolerability data for stage IV disease allows us to do that without significant concern for increased toxicity, so there is little reason to delay integration of this approach for these patients. When identified preoperatively, stage IIIA patients are treated with induction therapy, which is simply a modification to that regimen. Adding nivolumab to chemotherapy does not represent a dramatic change in treatment. The current cure rates for stage III NSCLC are dismal, and the EFS benefit for stage IIIA patients with the addition of nivolumab in CheckMate 816 was impressive (HR 0.54). 13 For these reasons, EFS and DFS are frequent surrogates for OS in recent adjuvant and neoadjuvant trials. The median time from trial initiation to publication for adjuvant platinum chemotherapy trials in NSCLC was longer than 10 years. Following curable patients until death to determine efficacy is time-consuming, requires a large sample, is expensive, and results in slow adoption of novel agents. Sensitivity to the intervention is declining due to increasing effectiveness of subsequent therapies after recurrence, but the greatest challenge to OS end points for adjuvant NSCLC relates to cost and ease of measurement. 12 Overall survival carries obvious clinical relevance but falls short on other criteria. Ideal trial end points are clinically relevant, easily measured, low in cost, reproducible, and sensitive and specific to the intervention. Overall survival is the treatment goal in curable populations, but OS is being used less frequently as a clinical trial end point in curable NSCLC cohorts due to time, costs, and its accuracy as an efficacy measure. The exploration of these studies showcased the potential for improving patient outcomes and the ongoing evolution in lung cancer therapy.Some clinicians have hesitancy about integrating this therapy as standard of care in resectable NSCLC until an OS benefit is reported. In summary, the discussion reflected on significant advancements in lung cancer treatment, emphasizing the need for additional data to refine treatment choices and further expand the available options for different patient subsets. Reuss highlighted the potential of other compounds, such as patritumab deruxtecan, in the treatment landscape, especially in patients with EGFR mutations, offering more options in this challenging space. The dialogue addressed the need for further investigation and data analysis in these areas. The conversation also touched upon the potential role of dat DxD in patients with actionable mutations who have progressed on upfront TKIs. The results revealed a modest progression-free survival advantage, primarily visible in non-adenocarcinoma subgroups. In metastatic non-small cell lung cancer, the discussion covered the TROPION Lung 01 study, exploring the antibody-drug conjugate dat DxD compared to standard treatment. TROPION Lung 01 study, exploring the antibody-drug conjugate The conversation explored the balance between chemotherapy and alectinib in treatment strategies for these patients. The ALINA trial investigated the role of alectinib in resectable non-small cell lung cancer with ALK-positive mutation, displaying a notable benefit in disease-free survival, particularly in the CNS, which could be groundbreaking for this patient population. ALINA trial investigated the role of alectinib This discussion highlighted the complexities of treatment decisions in this evolving landscape. Regarding the selection between CHECKMATE 816 and KEYNOTE 671 for patients, they emphasized the need for additional data, especially focusing on factors like pathologic response, disease stage, and biomarker analysis. The FDA also approved this regimen for certain patient criteria, marking a significant step in enhancing patient outcomes. ![]() This benefit was observed across different disease parameters, indicating practice-changing implications. The results showed an overall survival benefit, demonstrating a hazard ratio of 72 in favor of the IO chemo combination. KEYNOTE 671, a phase 3 study, examined the peroperative IO chemo combination and its impact on overall survival. Joshua Reuss from Georgetown Lombardi Kansas Center. They segmented the lung cancer highlights into two key studies: KEYNOTE 671 focusing on resectable non-small cell lung cancer and the Alina trial for ALK-positive patients. Rahul Gosain, MD and Rohit Gosain, MD, referred to as the oncology brothers, reflected on the impressive content presented at ESMO 2023. Top 4 ESMO Trials: KEYNOTE 671, CHECKMATE 816, ALINA, TROPIONÄrs.
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