The good news
The results of three lung cancer trials – LAURA, ADRIATIC, and REACH PC – were among the top five presentations at the plenary session of the annual ASCO meeting. This is very unusual and speaks for the advances that are being made in the treatment of lung cancer.
Why it’s important
LAURA trial: The standard of care (SOC) for treating stage 3 non-small cell lung cancer (NSCLC) that cannot be surgically removed and containing an epidermal growth factor receptor mutation (EGFRmut+) is chemotherapy and radiation, preferably given together. Despite aggressive treatment, most patients in this category are not cured. In the LAURA trial, over 200 patients with stage 3 EGFRmut+ NSCLC received either osimertinib or placebo after completing SOC chemoradiation. Patients who received osimertinib had control of their disease for a median of 39 months and 74% were alive and free of disease progression at 12 months, compared with 5.6 months and 22% for the placebo group. (Shun Lu et al, New England Journal of Medicine, DOI:10.1056/NEJMoa2402614)
ADRIATIC trial: Small cell lung cancer (SCLC) is a fast-growing type of lung cancer that represents 10-15% of lung cancers. The SOC for limited stage SCLC (limited to the chest) has been chemoradiation and there have been very few advances in treatment since the 1980s. In the ADRIATIC trial, patients with limited stage SCLC were treated with durvalumab (anti-PD-L1 immunotherapy) or placebo after SOC chemoradiation. Patients receiving durvalumab saw a significant improvement in median survival of 55.9 months, compared with 33.4 months for patients on placebo. At 2 years, 12% more patients who received immunotherapy were alive than those in the control group that just received SOC treatment.
REACH PC trial: Palliative care represents a number of services including but not limited to pain and symptom control, psychological and social support, and, when appropriate, end of life care. Palliative care is very important in the management of patients with lung cancer and is known to help them live longer and better. Telemedicine has become a frequently used tool in patient care, particularly as a result of the COVID pandemic. The REACH PC trial took place in multiple centers, led by the palliative care team from the Massachusetts General Hospital. Over 1,200 patients received palliative care through telemedicine or in-person visits. The primary outcome was patient-reported quality of life. Researchers found that the benefits of providing palliative care for patients diagnosed with advanced lung cancer were not diminished when delivered via telemedicine as opposed to in-person visits.
What it means for patients
LAURA trial: Osimertinib is already being used in metastatic EGFRmut+ NSCLC and has also been approved for use as treatment after surgical removal of early-stage disease. It now has shown benefit for EGFRmut+ patients who have stage 3 NSCLC that is limited to the chest and is not able to be surgically removed. This represents a major advancement in treatment. Side effects of treatment were as expected and there were no new concerns. Mature survival results are awaited but it is likely that the survival advantage for osimertinib treatment will be maintained.
ADRIATIC trial: Chemotherapy and immunotherapy (atezolizumab or durvalumab) are the standard of care for the treatment of patients with extensive stage SCLC. The results of the ADRIATIC trial establish the use of durvalumab in the treatment of patients with limited stage SCLC. This is of particular importance considering there have not been any treatment advances for these patients in many years. The side effects associated with immunotherapy are well known and there were no new problems seen when it was used with chemoradiotherapy. Of note, there was no increase in the occurrence of severe pneumonitis (lung inflammation) with the addition of immunotherapy.
REACH PC trial: Palliative care already has an important role in the care management for patients with advanced lung cancer. The findings from the REACH PC trial add critical evidence to support ongoing access to telehealth services and show that early palliative care can be delivered successfully via telemedicine. Telemedicine could be very important in providing access to palliative care for patients who otherwise may not be able to get it.
What to look for
All of these clinical trials will change oncology practice. Expect to see future updates for the LAURA and ADRIATIC trials. Although the results of these trials represent significant advancements, there is more work to be done. More research with new agents will be conducted to try and further improve outcomes for these patients. The REACH PC trial will allow oncologists to provide palliative care to many more patients. The convenience of telemedicine will also allow patients to reap the benefits of these services without the hassle of traveling to appointments. Receiving palliative care remotely will be the norm for patients with advanced cancers of any type.