The chronification of lung cancer is ceasing to be a utopia to become a reality that is gaining ground thanks to the results of the study Conflict. The last big step in this direction has been carried out by AstraZeneca’s Tagrisso (Osimertinib), a drug that is already available in spain for patients with non-small cell lung cancer early stage with mutation EGFR. “Data are awaited overall survivalbut with this high impact on the disease free survival there will be soon positive information”, he explains to Medical Writing Dolores Island, Head of the Medical Oncology Service at the Hospital Clínico Universitario lozano blesa de Zaragoza, who has participated in the investigation.
After verifying the benefits of this new treatment with Adaura, specialists want to go a step further to expand the indicationso they have started two more clinical trials, Law II y Neo Adaura: “The first study focuses on patients with even earlier stages and that they may suffer some risk factor by different clinical, physiological or pathological characteristics. On the contrary, Neo Adaura will use the drug before and after surgery to compare its effects with the results achieved so far”. Oncology is gaining ground on lung cancer, a disease that was already a protagonist in the last congress of the European Society of Medical Oncology (ALMOST), which is why, in the words of Isla, a “paradigm shift” is beginning to take place.
Osimertinib is now available for the adjuvant treatment of patients with early-stage EGFR-mutant non-small cell lung cancer. How will it change the lives of these patients and the professionals who treat them?
The lives of patients will change because there will be a high percentage that will be able to benefit from this drug, generating an impact on the possibility of the disease recurring. This is a selected population, patients who underwent surgery who have received or not complementary chemotherapy and who have the EGFR mutation. This mutation is suffered by between 10 and 15 percent of the European population. Now, they will be able to receive the drug and it has been seen that the recurrence of the disease is delayed in a high percentage, so it has a great impact on the prognosis. Patients will be able to benefit from a new treatment strategy, precision medicine. On the other hand, professionals will have the possibility of offering useful drugs in a situation such as early stages. There is the option that the result is the right path towards curing the disease, as well as delaying it.
What does it mean for the patient to transfer the benefit achieved by the drug in advanced disease to the context of early disease?
In this early disease we did not have the possibility of improving the results in this subgroup of patients. The study had not been done to find out what impact it had on them. In the Adaura trial, this drug, which improved survival results in advanced disease, is also improving it in early stages. There is an impact that is relevant, since they are patients who can even be cured of their disease. We are facing a very important forecast benefit.
Is there an estimate of how many patients will be able to benefit from this treatment in Spain?
I do not know the exact numbers at the Spanish level. These patients represent 15 percent of the total 30 percent of non-small cell lung cancer. It is a subgroup that is not the majority, it is a selected percentage, but the benefit is very important because the results of Adaura are spectacular. The benefit is so important that these lung cancer patients are worth identifying and carry out a diagnosis to find out if they have the mutation or not. If they do, they may be candidates for the drug.
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“EGFR patients account for 15 percent of the total 30 percent of non-small cell lung cancer” |
Is work being done to expand the indication so that more patients can benefit from the therapy?
Currently, two more clinical trials have already begun to expand the indications with Osimertinib: Adaura II and Neo Adaura. In the first one, patients are being treated with a much smaller tumor, in earlier stages, and who have some risk factor. It will be assessed whether the drug is effective in them, particularly in those at high risk due to different clinical, physiological or pathological characteristics. Regarding Neo Adaura, the drug will be used before and after surgery to compare its effects with the results of Adaura. This research seeks to assess the impact generated by treatment before surgery.
The approval of the drug has come thanks to the positive results of the Adaura Phase III trial. What are the main benefits that have been demonstrated?
The main objective, which was to improve disease-free survival in certain patients with early stages completely resected, who have or have not received complementary chemotherapy, has been met. This is an important step in this selected population. It is the first time that a targeted treatment in lung cancer achieves results in early stages in completely resected patients. Another milestone is that, for the first time, a positive precision medicine study has been achieved in these early stages, generating a paradigm shift in the diagnostic and therapeutic approach to these patients. We have the obligation to determine if the EGFR mutation exists and, if it is positive, to administer the drug that has a very significant impact on disease-free survival.
How likely is it that the disease will affect the patient’s nervous system with this treatment?
This disease very often affects the central nervous system at the brain level. It is one of the most serious problems for patients, it greatly conditions survival and quality of life. The drug is very effective in its use in advanced disease. It is effective in patients who already had brain metastases, and generates prevention so that it does not appear in early stages. It has been seen how disease progression in the central nervous system is very low and reduced in patients who have received the drug compared to those who have not received it.
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“The drug is effective in patients who already have brain metastases, and generates prevention so that it does not appear in early stages” |
30 percent of NSCLC patients can be diagnosed early enough to undergo curative surgery, yet recurrence remains common. Is it necessary to promote new strategies?
It is necessary to carry out progress as soon as possible in this direction. Surgery and adjunctive chemotherapy treatment when indicated are not enough. In order to improve these results and reduce the percentage of patients in whom the disease reappears, new approach strategies must be considered and thus improve the prognosis. This is what we are incorporating in this group of patients incorporated into EGFR. Data related to overall survival are awaiting, but with this high impact there will soon be positive data.
Are the Adaura results a further step towards making lung cancer chronic?
Totally, it is an important advance that has changed the paradigm of care for these patients. It is the path that must be followed with research so that we can build better results in our patients and change the prognosis, improve and provide clinical benefit to our patients.
Europe contemplates cancer screening in 90 percent of the population by 2025. Since lung cancer is the third most diagnosed tumor in Spain, do you think that this number of screenings can be reached among the Spanish population by 2025?
for now screening for lung cancer is not contemplated in our country at the national level. It is a pending subject. Yes, there are initiatives such as pilot feasibility studies, such as the Cassandra study, but there is still a long way to go.
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