The ESMO Congress 2023, held from October 20th to 24th in Madrid, Spain, has concluded, marking a significant milestone in the field of oncology. With a central theme of “Disseminating innovative research for optimal cancer care,” this year’s event featured a unique blend of in-person and virtual components, uniting cancer researchers, clinicians, and experts from across the globe. The congress delivered cutting-edge research and unprecedented achievements across various areas of oncology. The notable achievements are particularly eye-catching in five main domains of oncology research, including Lung Cancer, Gynaecological Cancers, Genito-Urinary Cancers, Gastrointestinal Cancers, and Breast Cancer.
Significant Research Achievements in Lung Cancer
LBA1 – CheckMate 77T: A Phase III study brought to light an exciting revelation. It compared neoadjuvant nivolumab (NIVO) plus chemotherapy (chemo) versus neoadjuvant placebo plus chemo, followed by surgery and adjuvant NIVO or placebo for patients with previously untreated, resectable stage II–IIIb NSCLC. The study found that neoadjuvant NIVO plus chemo significantly improved event-free survival (EFS), pathologic complete response (pCR), and major pathologic response (MPR) rates compared to the placebo group. The results are highly promising and offer new hope to lung cancer patients.
LBA2 – ALINA: Efficacy and safety of adjuvant alectinib presented another major leap in the treatment of early-stage ALK+ non-small cell lung cancer (NSCLC). For patients with resected, stage IB–IIIA, ALK+ NSCLC, adjuvant alectinib outperformed chemotherapy, leading to significantly longer disease-free survival (DFS) and an improved chance of long-term remission. These findings demonstrate the potential of alectinib as a preferred first-line treatment.
LBA4 – Randomized phase III study of first-line selpercatinib explored the groundbreaking treatment of RET fusion-positive NSCLC. Selpercatinib, a highly selective and potent RET inhibitor, significantly improved progression-free survival (PFS) compared to chemotherapy and pembrolizumab. This marks a critical advancement in the treatment of patients with RET fusion-positive NSCLC.
LBA5 – Amivantamab plus chemotherapy heralds a new era for patients with EGFR Exon 20 insertion-mutated advanced non-small cell lung cancer (NSCLC). In the PAPILLON study, amivantamab in combination with chemotherapy provided a substantial improvement in PFS, offering a new standard of care for this specific subset of patients.
Significant Research Milestones in Gynaecological Cancers
LBA8-INTERLACE: Trial A groundbreaking approach to the management of locally advanced cervical cancer (LACC) was unveiled through the INTERLACE trial. The trial investigated the effectiveness of short course weekly induction chemotherapy (IC) followed by chemoradiation (CRT) versus CRT alone, aiming to improve both progression-free survival (PFS) and overall survival (OS).Those receiving IC followed by CRT exhibited a significant improvement in 5-year PFS (73%) and 5-year OS (80%), as compared to those who received CRT alone (64% and 72%).The INTERLACE trial sets a new standard in LACC treatment, emphasizing the potential benefits of induction chemotherapy followed by chemoradiation for these patients.
LBA9-InnovaTV 301: In the fight against recurrent or metastatic cervical cancer (r/mCC), the innovaTV 301 study focused on Tisotumab vedotin (TV), an investigational antibody-drug conjugate. Patients who had experienced progression following first-line therapy were randomized to receive TV monotherapy or investigator’s choice of chemotherapy.Patients treated with TV demonstrated a 30% reduction in the risk of death and achieved a longer median OS (11.5 months) compared to chemotherapy (9.5 months).TV showed superiority in progression-free survival (PFS) and confirmed objective response rate (ORR).The innovaTV 301 study’s results indicate a significant breakthrough in the treatment of r/mCC, offering hope to patients facing this challenging condition.
Significant Research Achievements in Genito-Urinary Cancers
LBA6 – EV-302/KEYNOTE-A39: Researchers have introduced a groundbreaking approach for the management of locally advanced metastatic urothelial carcinoma (la/mUC). A global phase 3 study called EV-302 demonstrated remarkable results when evaluating enfortumab vedotin in combination with pembrolizumab (EV+P) for previously untreated la/mUC patients eligible for cisplatin- or carboplatin-containing chemotherapy.EV+P represents a promising new standard of care for first-line treatment of la/mUC.
LBA7-CheckMate 901: The CheckMate 901 study provides hope for patients with unresectable or metastatic urothelial carcinoma (mUC). The study evaluated nivolumab (NIVO) in combination with gemcitabine-cisplatin (GC) versus GC alone for mUC patients. With a median follow-up of 33.6 months, NIVO+GC demonstrated substantial advancements: A significant improvement in overall survival (OS) with a 22% reduction in the risk of death compared to GC; Progression-free survival (PFS) was significantly improved with a 28% reduction in the risk of progression or death;A higher overall response rate (ORR) was observed (57.6% with NIVO+GC vs. 43.1% with GC). The CheckMate 901 results introduce NIVO+GC as the first frontline concurrent checkpoint inhibitor and chemotherapy combination to improve OS in this setting, representing a new standard of care for mUC patients.
Pioneering Research in Gastrointestinal Cancers
LBA10-CodeBreaK 300 Phase III Study Reveals Promising Results for KRAS G12C-Mutated metastatic colorectal cancer (mCRC).The study, which included 160 patients with chemorefractory KRAS G12C-mutated mCRC, demonstrated significant advances: Both sotorasib (soto)+panitumumab (pani) arms showed superior progression-free survival (PFS) compared to standard-of-care (SOC); The combination therapy exhibited tolerable side effects, with lower rates of Grade ≥3 treatment-related adverse events compared to SOC.This marks the first phase 3 study exploring the potential of a KRASG12C-inhibitor combined with an anti-EGFR antibody for chemorefractory mCRC. These results offer new hope and a promising avenue for the management of this challenging form of colorectal cancer.
Major Advancements in Breast Cancer Treatment
LBA11 – Groundbreaking Phase III TROPION-Breast01 Trial Reveals Promising Results for Dato-DXd in Previously-Treated HR+/HER2- Breast Cancer.732 patients, who had previously experienced progression on endocrine therapy and received 1-2 prior lines of systemic chemotherapy, were randomized to receive either Dato-DXd or investigator’s choice of chemotherapy (ICC).Key findings: Dato-DXd demonstrated a significant improvement in progression-free survival (PFS) compared to ICC, with a hazard ratio (HR) of 0.63 and P<0.0001; Median PFS for Dato-DXd was 6.9 months (BICR assessed), while ICC achieved 4.9 months;The overall survival (OS) data were not yet mature, but a favorable trend favoring Dato-DXd was observed; Patients receiving Dato-DXd experienced lower rates of grade ≥3 treatment-related adverse events (TRAEs) and dose reductions compared to those on ICC. In summary, the TROPION-Breast01 trial met its primary endpoint of PFS, offering hope for patients with inoperable or metastatic HR+/HER2- breast cancer who have previously received 1-2 lines of chemotherapy. The results support Dato-DXd as a novel and effective treatment option, emphasizing both statistically significant and clinically meaningful improvements in PFS.
Brief Summary
The ESMO Congress 2023 has illuminated the path forward in oncology, showcasing remarkable advancements and setting new standards of care in the battle against cancer. These achievements stand as a testament to the tireless dedication of researchers, clinicians, and patients in the field of oncology, offering renewed hope and the promise of better outcomes for cancer patients worldwide.
