If we want to ⬇️ num futur smokers and ⬇️🫁 the lung cancer pandemic we must ban tobacco, vaping ❌ and ⬆️ the age to buy these devices.Our teenagers will be our future society so a
we must protect them.Nice programe in Ireland.Exemple for all EU #AILCC24  IASLC #IrishLungCancerAlliance

In this #ASCO Educational Book📕 we summarize in EGFR mut🫁:
✏️New EGFR TKI options in early stage
✏️New options in metastatic setting
✏️Mechanisms of acquired resistance and new drugs 🧬
online at ascopubs.org/journal/edbk
Thanks to Stephanie Saw Xiuning Le MD PhD Lizza Hendriks

PACIFIC2 ⛔️: Durva+CTRT➡️Durva did not improve PFS/OS vs CTRT alone in sIII NSCLC
Patients were randomized upfront
Should we continue to explore this approach(CM73L)? OR test induction CT+IO➡️IO+CTRT with or w/o IO consolidation would be an optimal future approach?(KN799) #ELCC24

Academia has the power💪🏻.We need to test how to use the drugs.There’s a room to assess de-escalation immuno for patients (to ⬇️tox) and society (to ⬇️ econom tox) such PULSE trial (lead Benjamin Besse) testing ⬆️ interval btw pembro infusions (Q6W) keeping 200mg not 400 #ELCC24

#ELCC24 : immunotherapy is a game winner in aNSCLC. Hwv, questions unresolved, benefit new drugs like anti-TIGIT (ph3 ⛔️in 1st L in PDL1⬆️ atezo plus tiragolumab no significant OS benefit…) anti LAG3, anti TIM3, dual ICB
Download very good presentation by Dr Reck@MartinReck2

The ⬆️ of irAEs 🩻is within 10 weeks after initiation, 👀relevant for NEOADJ Ttx. In 🫁 G 3-4 AEs CT+IO = CT, with higher Ttx discontinuation
Hwr,in CT+IO arm, only 5% of overall population do not undergo to surgery due to AEs (the same in CT arm)
➡️NEOADJ CT+IO🫁 is safe & SoC

APPLE Trial 🍎🍏 doi.org/10.1200/JCO.23…
Thanks a lot Rafal Dziadziuszko, Benjamin Besse for giving me the opportunity and for trusting me, and EORTC , all authors for helping in this “adventure” started almost 10 years ago. THANKS

Maximalist ⭐️treatment strategies in advanced 🫁 cancer like:
-The most potent TKI upfront (APPLE Trial doi.org/10.1200/JCO.23…)
-TKI 🧬at MTD (sotorasib)
-Immunotherapy for 2 y or until disease PD (DIAL Trial)
Not ⛔️always correlates with ⬆️ outcomes.We need➕academic trials

We’ll start 2024 with this ttx algorithm for NSCLC🫁including non-metastatic NSCLC
Pending Qx💡:
✏️Will ADC overcome docetaxel? 📛
✏️ADC 2n L for oncogenic-driven? 🎉
✏️Perioperative vs Induction?🥊
✏️Adjuvant RET TKI?🧬
✏️Academic trials for ↗️ / ↘️ ttx
And more!! @oncoalert

Several by MET TKI reported activity in METex14 mut 🧬 NSCLC🫁.Activity of MET TKI is clinically better upfront than in 2nd line but the EMA approval is in 2nd L🤦🏻.Hwv, ⬆️% of Gr3 TRAEs, are we sure that ⬇️doses 💊 would not reach the same efficacy with lower toxicity? #ESMOAsia23

EXCLAIM2 trial: mobicertinib vs CT in 1st line EGFRex20ins 🫁NSCLC is ⛔️. Amivantamab + CT potential🦋new SoC in this population. However our hopes in new EGFRex20ins TKI with promising efficacy and better toxicity profile, and perhaps better icRR 🧠➡️relevant point!! #ESMOAsia23

In KRAS G12Cmut NSCLC 🫁 we have reached a plateau in outcome w/KRAS G12C inh (~ safety). Intracranial RR🧠 and activity regardless of co-mutations may make difference btw them. Hwvr, in the future🔮, will we use KRAS inhibitors for each KRASmut subtype or panRAS inh? #ESMOAsia23

In NSCLC🫁 we use maximalist strategies with immunotherapy 🦠despite no correlation btw dose and response and btw treatment duration and outcome. Liquid biopsy🩸may help to de-escalate treatment with immunotherapy, but not SoC Benjamin Besse d.planchard
authors.elsevier.com/a/1i0HP3QE--VK…

PAPILLON🦋: Amivantamab + CT new SoC in 1st L EGFRex20ins NSCLC. However several challenges remain: crossover 45%, 🧠 activity, AEs, QoL.
Despite mobocertinib did not achieve primary endpoint vs CT, several 💎NEW EGFRex20TKI interesting so, EGFR ex20ins TKIs are NOT yet #ESMO23

in 1st L EGFRm NSCLC addition of Chemo ⬆️PFS (29.4 mo) over osi alone, with real impact in patients w 🧠 mets!! Addition of 🩸ramucirumab ⬆️PFS in RAMOSE trial but NOT🚫 in OSIRAM trial. Addition of apatinib NOT ⬆️PFS . Role of TP53 and smoking pattern for deciding🩸? #ESMO23

Rare thoracic tumors🫁 have also place at #ESMO2023 . RELEVENT study in metastatic thymic carcinoma in 35 out of 52 tested ramucirumab plus paclitaxel carboplatine report promising RR 80% by INV but 58% by central, good PFS and OS with 49% grade 3 TEAEs. New option in 1st line😊

Can we spare CT in neadjuvant NSCLC? Exploratory analysis from CheckMate 816:
-Similar % of surgery cancelled ~20%
-Higher pCR MPR
-Longer EFS, but curves crossover at de biguining due to toxicity? Delayed effect of ICB
Good strategy for PDL1 negative tumors?🔮
#ESMO2023

Is there a role for ADC in EGFR+ metastatic NSCLC? HERTHENA-Lung01 patritumab deruxtecan data are promising, although many questions remain. Read our view Jordi Remon in the accompanying editorial, finally out Journal of Clinical Oncology ascopubs.org/doi/abs/10.120… #LCSM

ADJ Osi is SoC in resected EGFRmut 🧬NSCLC, but:
-What is the role of Minimal Residual disease?
-Do we need ADJ chemo🧪?
-Can we ⬇️dose of Osi?
-Treatment duration?
Some answers: doi.org/10.1016/j.jtho…
Thanks: Stephanie Saw Francesco Cortiula Jessica Menis Giannis Mountzios Lizza Hendriks

🎉FLAURA2 in EGFR-mut aNSCLC is➕
Escalating 🏔️ ttx in blinded way provides toxicity, not all need intensive ttx. CT-DNA status before EGFR TKI (data from FLAURA) is poor prog marker.These are the patients who may benefit of intense ttx.Only more to some pts,not for all #WCLC23