The European Society for Medical Oncology (ESMO) Congress is a premier global event for cancer research, bringing together clinicians, researchers, and patient advocates. This annual conference serves as a critical platform for unveiling the latest advancements in oncology. A significant focus was placed on prevention, early detection, and treatment when the disease is least advanced.
Overarching Themes and Innovations
A theme at the ESMO Congress 2022 was the advancement of personalized medicine, driven by new evidence from trials focusing on biomarker-defined patient subgroups. This included significant progress in the development and application of antibody-drug conjugates (ADCs). These therapies function like targeted missiles, combining a monoclonal antibody that seeks out specific proteins on cancer cells with a potent chemotherapy payload, allowing for direct delivery of the drug to the tumor while minimizing exposure to healthy tissues.
Another area of innovation was the expanded use of immunotherapy, particularly checkpoint inhibitors, in earlier stages of cancer treatment. Researchers presented data on the use of these therapies in the neoadjuvant setting, meaning before a patient’s primary treatment like surgery. The strategy of using immunotherapy before surgery aims to treat the cancer when the disease burden is at its lowest, potentially improving long-term outcomes. This approach was a recurring topic across various cancer types discussed at the congress.
The congress also highlighted the theme of treatment de-escalation. Several studies explored whether shorter durations of immunotherapy could achieve similar or better outcomes compared to the current standard of treating until disease progression. This line of inquiry is important for reducing patient toxicity and the overall burden of treatment.
Practice-Changing Updates in Lung Cancer
The ESMO 2022 congress featured significant updates in the treatment of non-small cell lung cancer (NSCLC), particularly for patients with early-stage disease. One of the presentations involved the final results of the CheckMate 816 trial. This study evaluated the use of the immunotherapy drug nivolumab in combination with chemotherapy before surgery for patients with resectable NSCLC. The data demonstrated a significant improvement in event-free survival, reinforcing the benefit of this neoadjuvant approach.
Furthering the discussion on early-stage lung cancer, the congress also saw the presentation of the KEYNOTE-091 trial, also known as the PEARLS study. This trial investigated the use of pembrolizumab, another checkpoint inhibitor, as an adjuvant therapy, meaning it was administered after surgery. The results showed a notable improvement in disease-free survival for patients who received pembrolizumab compared to a placebo.
These findings from both the CheckMate 816 and KEYNOTE-091 trials are poised to change clinical practice by solidifying the role of immunotherapy in the perioperative setting for early-stage NSCLC. The data provides a strong rationale for using checkpoint inhibitors both before and after surgery to improve outcomes for this patient population.
Transformative Findings in Breast Cancer
The most talked-about presentation at ESMO 2022 was the results from the DESTINY-Breast04 trial. This trial focused on an antibody-drug conjugate called trastuzumab deruxtecan (Enhertu) in patients with a newly defined category of breast cancer: HER2-low. Previously, breast cancers were categorized as either HER2-positive or HER2-negative.
The DESTINY-Breast04 study enrolled patients whose tumors had low levels of the HER2 protein, a group that was historically considered HER2-negative and thus did not benefit from traditional HER2-targeted therapies. The trial demonstrated that trastuzumab deruxtecan led to a significant improvement in both progression-free survival and overall survival for these patients compared to standard chemotherapy.
The implications of the DESTINY-Breast04 trial are substantial, as a large percentage of patients previously classified as HER2-negative now fall into the HER2-low category and have a new, effective treatment option. The results were widely hailed as practice-changing, establishing a new standard of care for this large patient population. The success of this trial further underscored the broader theme of the congress: the power of innovative drug designs like ADCs to address unmet needs in oncology.
Key Developments in Gastrointestinal Cancers
Beyond lung and breast cancer, the ESMO 2022 congress also delivered important updates in the treatment of gastrointestinal (GI) cancers. A presentation in this area was the NICHE-2 trial, which investigated the use of neoadjuvant immunotherapy in patients with a specific type of colon cancer known as mismatch repair deficient (dMMR). This genetic characteristic makes the cancer cells more susceptible to checkpoint inhibitors.
The results of the NICHE-2 study were notable, showing that a short course of immunotherapy before surgery led to a major pathological response in a very high percentage of patients. In many cases, there was no residual cancer found at the time of surgery. These findings suggest that this neoadjuvant immunotherapy approach could potentially become a new standard of care for dMMR colon cancer, possibly even allowing some patients to avoid surgery altogether.
The congress also featured several other studies in GI cancers, including trials in hepatocellular carcinoma. While not all of these studies met their primary endpoints, they contributed to a deeper understanding of the disease and the patient populations most likely to benefit from certain therapies.