2021 World Conference on Lung Cancer: Highlights and Thoughts

Adalynn Harris, PhD, MPH, MHA

The 2021 World Conference on Lung Cancer (WCLC) took place virtually from September 8th through 14th. As it is true that the global pandemic has changed the way we participate in scientific meetings, the great benefit of a virtual platform is the opportunity for global participants to present scientific/medical ideas and convincing data while still having meaningful engagement. I was looking forward to hearing from experts from around the world on lung cancer, its treatments, and the diagnostics for the intended use to provide the best outcomes for patients – I was not disappointed. The International Association for the Study of Lung Cancer’s (IASLC’s) promotion of the WCLC as a thoracic comprehensive congress was true to form- it included compelling presentations across lung cancer management, novel therapies, treatments and, of course, diagnostics intensive data.

WCLC Presentations of Interest

The plenary sessions in non-small cell lung cancer (NSCLC) were very engaging.  It began with a discussion of healthcare, clinical trial access and addressing health disparities in underserved populations globally.  Dr. Raymond Osarogiabon outlined the importance of minority clinical trial participation in the US by identifying the percentage of black patients included by tumor type and support category as the barriers to their inclusion1.  Following, Dr. Alex Adjei from the Mayo Clinic, relayed global disparities, accentuating the differences in drug access in Sub Saharan Africa in comparison to the US2.  I was pleased to watch the presentations during the opening address of the conference.  The emphasis on access within lung cancer was a fantastic start to the congress.

Next, the results were presented from AstraZeneca’s POSEIDON first line trial in treatment naïve stage IV NSCLC (metastatic) patients who didn’t have EGFR or ALK alterations.  The strategy was to combine anti-PD-L1 and anti-CTLA randomized durvalumab with or without tremelimumab and chemotherapy.  The phase 3 POSEIDON trial provided data that pointed to improvements in progression free survival (PFS) and overall survival (OS) for the triplet over chemotherapy alone in this patient population.  Moreover, the implication is that it could be a new first line treatment option for metastatic NSCLC patients3.  Following the data presentation, McMaster University’s Rosalyn Juergens, served as discussant and provided further insights of the study and a scientific/medical assessment across other similar trials that compared information for both future long term data and detailed subgroup analyses.  The significance could provide exact population characteristics for people that would benefit the most from this intervention4.  As an employee of Inivata, a company whose mission is to transform the lives of cancer patients and their families through the power of liquid biopsy, the finding of the POSEIDON trial which benefits OS in NSCLC is especially exciting.

Other interesting presentations included updates within immune checkpoint inhibition and how the present options have evolved and expanded.  Dr. Taofeek Owonikoko discussed bispecific antibody trials in NSCLC such as amivantamab, an FDA approved therapy that targets EGFR ex20 mutations and zenocutuzumab which targets HER2 and HER35.  Others also included discussions around optimal endpoints and early phase trial considerations as well as the integration, or use of biomarkers within immuno-oncology development for go/no go decisions.  Moreover, the optimal workflow for personalized oncology ideology suggested the use of diagnosis and predictive biomarkers6.

Many presenters mentioned liquid biopsy technology as a potential strategy to refine endpoints, and the usefulness of ctDNA was addressed during the panel sessions.  Other sessions were presented with applications of liquid biopsy technology for targeted therapy, immuno-oncology and early-stage NSCLC.  The Impower150 trial was used as an example and the sub-study design was presented to support the concept of ctDNA as a surrogate endpoint to inform risk-based treatment7.  Yue Pu’s application of PEAC technology to monitor ctDNA in early stage lung cancer after surgery concluded with 60 patients positive test results (EGFR, KRAS, ALK, NRAS, BRAF and PIK3CA mutations)8.

MRD

Data was shared on monitoring minimal residual disease (MRD) and early detection recurrence in early-stage lung cancer.  Aaron Tan presented a prospective study that applies the knowledge around ctDNA detection.  Specifically, plasma samples were collected before and after surgery and again after adjuvant chemotherapy and another three collection times with planned radiologic scans.  The objectives were to assess ctDNA detection and stratify patients by risk of recurrence (high versus low)9.   Emanuela Fina’s poster presentation shared a pilot study showing the probability of circulating tumor cell usage in prognosis in NSCLC.  Blood samples in healthy volunteers, high risk and NSCLC patients’ were retrieved prior to surgery and used to show that the subpopulations are prognostic in disease recurrence10.  Finally, Max Diehn raised the discussion around consolidation of immunotherapy enhancing outcomes in ctDNA MRD patients.

Drawing parallels to the presentations shared at WCLC, Inivata’s personalized, multi-tumor liquid biopsy assay for Residual Disease and Recurrence (RaDaR) is a sensitive and specific technology which detects traces of cancer ctDNA in the body.  The opportunity to assist health care professionals with early disease detection and monitoring makes me enthusiastic to be a part of the Inivata team of scientists.

To find out more about how highly sensitive and specific ctDNA detection and accurate monitoring may enhance your studies and clinical trials, please contact us for more information.

References:

  1. Raymond Osarogiagbon, “Disparities in Lung Cancer Care Across the Population”, presented at: 2021 World Conference on Lung Cancer, September 8-14, 2021, virtual. Plenary session.
  2. Alex Adjei, “Disparities in Lung Cancer Care: The Global Burden”, presented at: 2021 World Conference on Lung Cancer, September 8-14, 2021, virtual.  Plenary session.
  3. Melissa L. Johnson, Byoung Chul Cho, Alexander Luft, Jorge Alatorre-Alexander, Sarayut Lucien Geater, Konstantin Laktionov, Aleksandr Vasilev, Dmytro Trukhin, Sang-We Kim, Grygorii Ursol, Maen Hussein, Farrah Louise Lim, Cheng-Ta Yang, Luiz Henrique Araujo, Haruhiro Salto, Niels Reinmuth, Xiaojin Shi, Lynne Poole, Solange Peters, Edward Garon, and Tony Mok, “Durvalumab plus or minus Tremelimumab plus Chemotherapy as First Line Treatment for mNSCLC: Results from the Phase 3 POSEIDON Study”, presented at: 2021 World Conference on Lung Cancer, September 8-14, 2021, virtual. Plenary session.
  4. Rosalyn Juergens, “Task Force in Methodology: Developing New Trials with Immunotherapeutic Agents”, presented at: 2021 World Conference on Lung Cancer, September 8-14, 2021, virtual. Abstract ES06.01.
  5. Taofeek Owonikoko, “Bi-Specific Agents”, presented at: 2021 World Conference on Lung Cancer, September 8-14, 2021, virtual. Abstract ES06.02.
  6. Fernando Lopez-Rios, “The Role of Biomarkers for Targeted Therapy in the Adjuvant and Neoadjuvant Setting”, virtual. Abstract ES03.04
  7. M. Reck, “Evaluating Circulating Tumor DNA to Predict Overall Survival Risk in Non-Squamous Non-Small Cell Lung Cancer in Impower150”, virtual. Abstract MA07.02.
  8. Yue Pu, “Dynamic Monitoring of Blood Samples by PEAC Technology for Early-Stage Lung Cancer Patients After Surgery”, virtual.  P22.05.
  9. Aaron Tan, “Circulating tumor DNA for monitoring minimal residual disease and early detection of recurrence in early-stage lung cancer”, virtual. Abstract MA07.06.
  10. Emanuela Fina, “Role of Circulating Tumor Cell Subpopulations in Operable NSCLC Diagnosis and Prognosis”, virtual. P22.03.
  11. Max Diehn, “ctDNA for Minimal Residual Disease Detection”, virtual. ES14.04.

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