The American Society of Clinical Oncology (ASCO) updated adjuvant therapy guidelines in early lung cancer in five years, strongly recommending AstraZeneca’s EGFR tyrosine kinase inhibitor (TKI) Tagrisso (ingredient: osimertinib).
On Tuesday, ASCO renewed the 2017 guideline on systemic adjuvant and radiation therapy in resected stage 1-3A non-small cell lung cancer (NSCLC).
ASCO released the new guideline in the online issue of the Journal of Clinical Oncology (JCO) so that clinicians can use it immediately.
The update was based on Tagrisso’s proven efficacy in a randomized control ADAURA study in 2020 and resulted from the IMpower010 study on Roche’s Tecentriq (atezolizumab) in 2021.
ADAURA compared the efficacy and safety of three-year administration of Tagrisso and placebo as postoperative adjuvant therapy in patients with EGFR mutation-positive stage 1B-3A NSCLC. Before patients were randomly assigned, adjuvant chemotherapy was not mandatory. However, 26 percent of stage 1B patients and 75 percent of stage 2-3A patients received it.
The results showed that disease-free survival (DFS) was achieved in 90 percent of stage 2-3A patients receiving Tagrisso, versus 44 percent in the placebo group, at 24 months. In addition, Tagrisso lowered the risk of disease relapse and death by 83 percent.
In the total patients, including stage 1B patients, the DFS was 89 percent in Tagrisso-treated patients vs. 52 percent with placebo.
The benefit of Tagrisso was not affected by postoperative chemotherapy, ASCO said.
Based on the study results, ASCO made a “strong” recommendation with high evidence to use adjuvant Tagrisso for stage 1B patients with sensitizing EGFR (Ex19del or L858R) mutations.
Also, ASCO did not recommend adjuvant cisplatin-based chemotherapy and/or Tecentriq for routine use in this patient group.
For stage 2A-3A patients with sensitizing EGFR mutations, ASCO recommended adjuvant Tagrisso after cisplatin-based chemotherapy, regardless of the PD-L1 status. The evidence quality was “high,” and the strength of recommendation was “strong.”
ASCO’s recommendation for Tecentriq was based on IMpower010 results.
The results showed that at 32 months median follow-up, Tecentriq lowered the risk of disease relapse and death by 34 percent compared to best supportive care (BSC) in PD-L1 positive patients. In contrast, it lowered the risk by 21 percent in all patients.
Tecentriq’s DFS benefit was greater for PD-L1 positive patients than for all.
Based on the outcome, ASCO recommended adjuvant Tecentriq for stage 2-3A patients with PD-L1 expression is 1 percent or more after cisplatine-based chemotherapy except for those with sensitizing EGFR mutations. The evidence quality was “high,” and the strength of recommendation was “strong.”
With the adjuvant targeted therapy and immunotherapy recommendation in early NSCLC, it will become more important to analyze the genes of lung cancer patients before setting a treatment strategy, observers said.
According to a recent survey by the Korean Cancer Society on Korean lung cancer patients, only 61 percent of 286 patients diagnosed with lung cancer had a genetic mutation test.
This indicates that the local treatment environment should be improved to apply the ASCO’s new guidelines.