In This Issue

ASCO Journal of Oncology Practice Cancer.Net Journal of Clinical Oncology The ASCO Cancer Foundation ASCO Press Center

Scientific Highlights from Other Meetings

Lung Cancer Advances and Clinical Trials Highlighted at Recent Meetings

10th International Lung Cancer Congress



Kohala Coast, Hawaii
June 17-20, 2009


By David Gandara, MD
Co-chair, 10th International Lung Cancer Congress
University of California, Davis Cancer Center

Roy S. Herbst, MD, PhD
Co-chair, 10th International Lung Cancer Congress
The University of Texas M. D. Anderson Cancer Center

David J. Lee, PhD
Physicians’ Education Resource

The 10th Annual International Lung Cancer Congress, organized by David Gandara, MD, of the University of California, Davis, and Roy Herbst, MD, PhD, of M. D. Anderson Cancer Center, highlighted recent advances in the diagnosis and treatment of thoracic malignancies, including data presented at the 2009 ASCO Annual Meeting. Approximately 200 attendees gathered for the event, with significant representation of physicians from European and Asian lung cancer cooperative groups. Morning sessions featured state-of-the-art didactic lectures followed by the presentation of recent research results, expert debates, and case-based discussions. At afternoon workshops, renowned oncology experts discussed novel therapeutic agents in the pipeline and conducted a multidisciplinary tumor board. During a special session, representatives from North American, European, and Japanese lung cancer cooperative groups presented updates from ongoing clinical trials and discussed potential intercontinental scientific collaborations.

Early-stage Non-small Cell Lung Cancer

Heather Wakelee, MD, of Stanford University, discussed the (Neo)Adjuvant Taxol/Carboplatin Hope (NATCH) trial evaluating preoperative or postoperative carboplatin/paclitaxel or observation in patients with resected non-small cell lung cancer (NSCLC).1 The results demonstrated no significant difference in the primary endpoint of five-year disease-free survival between the patients who were randomized to surgery alone, adjuvant, or neoadjuvant chemotherapy. Of note is the fact that approximately 75% of the patients on this trial had clinical stage I disease, a patient subgroup that has been shown to receive the least benefit from perioperative chemotherapy.

Maintenance Therapy
Karen Kelly, MD, of the University of Kansas, presented the results of phase III studies on maintenance therapy, also referred to as early second-line therapy, in patients with advanced NSCLC. These studies investigated pemetrexed, single-agent erlotinib (Sequential Tarceva® in Unresectable NSCLC [SATURN] trial), and the addition of erlotinib to maintenance bevacizumab (AVF3671g [ATLAS]) in patients who achieved a response or stable disease after a frontline regimen.2-4 All three trials met the primary endpoint of improved progression-free survival compared to the placebo arm. Pemetrexed also demonstrated improved overall survival compared to placebo; with regards to efficacy, the benefit was restricted to patients with nonsquamous histology. In the SATURN trial, an overall survival benefit for erlotinib versus placebo was announced in a press release, with details to be presented at the 13th World Conference on Lung Cancer. Survival information from the ATLAS trial is still pending.

Epidermal Growth Factor Receptor Inhibitors
Paul A. Bunn, Jr., MD, of the University of Colorado, summarized the use of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in patient populations selected for response to this class of agents. This trial, known as the Iressa™ Pan-Asia Study (IPASS) study, was conducted in Asia and compared gefitinib to carboplatin/paclitaxel in never smokers or light ex-smokers with adenocarcinoma.5 In this trial, gefitinib demonstrated superior progression-free survival compared to chemotherapy; however, biomarker analysis revealed that even in these patients clinically selected to favor EGFR TKI therapy, only those with EGFR mutations derived a significant progression-free survival benefit from gefitinib compared to chemotherapy.

Román Pérez-Soler, MD, from the Albert Einstein College of Medicine, reviewed recent data on the use of EGFR antibodies in patients with lung cancer. Biomarker analyses were performed to examine correlations between efficacy and KRAS mutations or EGFR status (mutations, gene copy number, protein expression). Unlike what was observed in colorectal cancer, retrospective analyses of the First-line in Lung Cancer with Erbitux® (FLEX) and BMS-099 trials did not show KRAS mutations as a negative predictive marker for cetuximab in NSCLC.6,7 Additionally, EGFR gene copy number by fluorescence in situ hybridization (FISH) did not correlate with treatment outcomes with cetuximab in either trial. However, these biomarker analyses were limited in statistical power by the small sample size.

Multidisciplinary Tumor Board
A new activity that had its debut at the event was a multidisciplinary tumor board held during one of the afternoon workshops. The distinguished panel included surgeon Harvey I. Pass, MD, of the New York University School of Medicine, radiation oncologist Walter Curran, Jr., MD, of Emory University School of Medicine, and medical oncologist Martin Edelman, MD, of the University of Maryland. Cases included resectable stage III disease, earlystage disease with poor pulmonary function, and prophylactic cranial irradiation in stage III disease. This session fostered interaction between community physicians and the multidisciplinary panel of lung cancer experts.

Cooperative Group Session
One of the unique features of the International Lung Cancer Congress is the special session for cooperative groups from the United States, Europe, and Asia to present current and planned clinical studies. Senior representatives from each cooperative group presented an overview of their group’s activities in various disease settings, thereby stimulating interaction between the different groups. The proceedings of this session will be summarized in a special peer-reviewed manuscript to be published in an upcoming issue of Clinical Lung Cancer.

References
  1. Felip E, Massuti B, Alonso G, et al. J Clin Oncol. 2009; 27(suppl): 382s (Abstract 7500).
  2. Belani CP, Brodowicz T, Ciuleanu T, et al. J Clin Oncol. 2009; 27(suppl):806s (Abstract CRA8000).
  3. Cappuzzo F, Ciuleanu T, Stelmakh L, et al. J Clin Oncol. 2009; 27(suppl):407s (Abstract 8001).
  4. Miller VA, O’Connor P, Soh C, et al. J Clin Oncol. 2009; 27(suppl):799s (Abstract LBA8002).
  5. Fukuoka M, Wu Y, Thongprasert S, et al. J Clin Oncol. 2009; 27(suppl):408s (Abstract 8006).
  6. O’Byrne KJ, Bondarenko I, Barrios C, et al. J Clin Oncol. 2009; 27(suppl):408s (Abstract 8007).
  7. Khambata-Ford S, Harbison C, Woytowitz D, et al. J Clin Oncol. 2009; 27(suppl):412s (Abstract 8021).
 
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