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Lung cancer remains one of the most fatal cancers worldwide, with several thousand new cases diagnosed each year. However, new research presented at the 2024 American Society of Clinical Oncology annual meeting could change the treatment landscape for the disease. Two pivotal clinical trials, the LAURA and ADRIATIC, unveiled promising new therapies for patients with stage 3 unresectable non-small cell and limited-stage small cell lung cancers, offering hope for significantly improved survival rates and better outcomes.

Osimertinib Extends Survival in Patients with Stage 3 Unresectable EGFR-Mutated NSCLC

In a major advance for patients with unresectable stage 3 non-small cell lung cancer harboring epidermal growth factor receptor (EGFR) mutations, the phase 3 LAURA trial found that osimertinib substantially improved progression-free survival. The study recruited 216 patients who had not progressed after receiving definitive platinum-based chemoradiotherapy. These patients were then randomly assigned to osimertinib or a placebo.

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Alberto Chiappori, MD

Median progression-free survival in patients treated with osimertinib was 39 months versus six months for those on the placebo. Additionally, 74% of patients in the osimertinib arm did not experience cancer progression at 12 months, and 65% had not progressed at 24 months, compared with 22% and 13%, respectively, in the placebo group. Osimertinib also reduced the incidence of new brain metastases to 8%, compared to 29% in the placebo group.

"The LAURA trial is the first to define the role of EGFR-directed therapy in unresectable stage 3 disease. These data will change the standard of care for this group of patients," said Alberto Chiappori, MD, a medical oncologist in the Thoracic Oncology Department at Moffitt Cancer Center.

Durvalumab Enhances Survival in Limited-Stage Small-Cell Lung Cancer

The phase 3 ADRIATIC trial revealed that durvalumab, when given as consolidation treatment after chemoradiotherapy, significantly improves survival in patients with limited-stage small cell lung cancer. This study enrolled 730 patients who had finished chemoradiotherapy within the past 42 days. The patients were then randomized to receive durvalumab or a placebo.

The interim analysis showed a median overall survival of about 56 months for patients receiving durvalumab compared to 33 months in the placebo arm. Median progression-free survival was also longer at 17 months in the durvalumab arm compared to nine months in the placebo arm. The 36-month overall survival rate was 57% in the durvalumab arm versus 48% in the placebo arm, and the 24-month progression-free survival rate was 46% versus 34%, respectively.

“Small cell lung cancer is an aggressive disease, and the standard of care has remained unchanged for almost 40 years. This shows that adding immunotherapy after conventional chemotherapy and radiation can extend survival and decrease recurrence," Chiappori said.

Continued research is needed to evaluate potential improvements in the long-term benefits of durvalumab when combined with other agents and/or therapies.