IO has changed ttx and outcome in adv 🫁.It’s time that Academic trials (PULSE @BenjaminBesseMD )and international grants test IO de-escalation to ensure ➕ pts receive these drugs, ⬆️outcomes to more pts worldwide, while ⬇️financial tox.Thk all authors!👏🏻

🎺TelisoV+Osi potential ttx in MET overex meta EGFRm NSCLC with osi resist disease 👏🏻. Hw: ✏️Other ADCs with activity ✏️Not easy tissue Bx at PD for testing MET ✏️New 1stL options may ⬇️ MET expression at PD? ✏️🧠 activity @stephanieplsaw @HHorinouchi

RT @stephanieplsaw: Inspired by my good friend and slide master @JordiRemon - sharing these updated summary slides for 1L and post-progress…

2024: Fortunately is difficult to merge all ttx for NSCLC 🫁 in 1 slide. Hwv, still pending: ✏️avoid “me too” approvals if prices not ⬇️ ✏️ consol TKI for all and for lifetime? ✏️⬆️genotyping access & drug access ✏️➕ academic trials of de-escalating ✏️periop vs neoadj@OncoAlert

@NormandBlais KEYNOTE 671 4y follow-up. EFS benefit regardless PDL1 (lower HR in neg). Similar magnitude of OS benefit in PDL1 positive. Not OS benefit in PDL1 <1% and >65 years (more cardiovascular deaths related to cisplatin in “older”?immunesenescense?). 🤷🏻‍♂️ #ESMOImmuno24

In HER2 mutant and HER2 overexpression aNSCLC the combination of TRASTUZUMAB DERUX ➕ Pembro is promising and synergistic but safety 🆘could raise some concerns specially in HER2m. A strategy to follow as could replace CT strategies in 1st line in this population #ESMOImmuno24

It is difficult to break the bar reached wit CT+IO in adv NSCLC all PDL1 SKYSCRAPER adding antiTIGIT to CT+IO not ⬆️PFS/OS vs CT+IO, and more toxic. Even longer mOS with CT+IO alone New ⛔️ trial with anti-TIGIT Should we continue with anti-TIGIT in ling? Biomarkers? #ESMOImmuno24

Final results DUART trial. Sequential Durva after RT in pts with sIII NSCLC not eligible to chemo. Median PFS & OS: 9.1 and 20.1 mo. ⬆️ benefit in PDL1 +. Good approach in this poor prognosis frail patients and PFL1 counts. New options for PDL1 negative awaited #ESMOImmuno24

4y update of KEYNOTE 671 in periop setting Median OS not reached at 4years, with 4Y OS:68% and 52% of patients w/o PD or death in pembro arm ( 3 times higher than CT arm) However 4y OS 71% in CM 816 trial only with induction. So do we need escalate to all patients #ESMOImmuno24

ALESIA Trial: Alectinib vs crizotinib in 1st line in Asian patients with ALK+ NSCLC. OS: NE alectinib vs 81 mo. crozotinib!! Yes with crizotinib 🙄. Difference not significant. What would be the CROWN trial (Lorlatinib vs Crizo) if comparator was alectinib? 🤷🏻‍♂️#ESMOASIA2024

Future of ADCs in NSCLC looks more promising for EGFRm NSCLC Pooled analysis TROPION Lung01&05evaluating datopotamab deruxtecan in EGFRm. Activity promising, but ~ to platinum/Pemetrexed. Future? Osi -> Chemo -> Dato? Osi + Ct -> Dato? Lazer + Ami ->CT->Dato? #ESMOASIA24

PACIFIC5 Trial support consolidarion treatment with durvalumab after sequential or concurrent CTRT #ESMOASIA24

BEAMING-Lung01 updated: Zongertinib 120 mg a potential treatment approach in HER2-mutant NSCLC Challenges 🙉 in HER2-m: -Brain activity with TKI, -1st L: ADCs vs TKI, ADC vs CT, Chemo + TKI vs TKI/ADC? 😵‍💫🤯 -Zongertinib vs BAY292708 (ORR 72% PFS 7,5mo.) -ImmunoTx #ESMOASIA24

Thymic Carcinoma in #ESMOASIA24 *MARBLE trial: Atezo+CT in 1st L. Promising ORR/PFS.Will it be new SoC? By indirect comparisons not better than current SoC, & 67% G3 irAEs 📛 *Lucitanib a new antiangiogenic🩸in pretreated Thymic Ca but modest outcome vs others AA available🐄🦓

Several ADCs & Bispecific antibodies developped in 🫁 cancer. For SCLC, ADCs antiB7H3 Promising but 7-14% treatment-deaths 📛. Now moving to ph3 trial in 2nd L: IDeate-Lung2. For Tarlatamab, a BiTE, dose of 3 mg would have also been optimal with lower adverse events a& ⬇️💶tox?

In early-stage NSCLC 🫁 IO is a reality with several approvals by FDA/EMA 👏🏻. ADJ trials with IO « more controversial » , Hwv, neoadj and periop CT+O trials more consistent results. Are we sure periop IO is better than only induction CT+IO in OS? Overtreating 🫁 w/pCR? #ILCS24

PDL1 negative NSCLC

In CM77T trial perioperative nivolumab clearance ctDNA correlates with pCR. However, half of patients with pCR do not have clearance. Poorer subgroup of patients? ctDNA clearance is not yet an « universal » biomarker for all #ESMO24

MARIPOSA Ami+Lazer 1L EGFRm NSCLC: Acq resist mec in liquid Bx. Ami as expected reduced acquired MET amp and EGFR mut as bispecific EGFR/MET. Lower TP53/RB1 with ami/laz vs osimertinib means lower risk of histologic transformation with this combo upfront?#ESMO24 @BenjaminBesseMD