Coming Up at ESMO 2022: Trial Results That Improve Outcomes

After 2 years of being held online because of the pandemic, this year the annual meeting of the European Society for Medical Oncology (ESMO) is once again welcoming oncologists attending in person, this time in Paris, France.

Among the key themes is a focus on preventing, detecting, and treating cancer when the disease burden is at its lowest, as well as educating oncologists to better understand cancer processes and face the challenges of the future, say the organizers.

Charles Swanton, PhD

“The whole purpose of the meeting is to emphasize the importance of a cross-disciplinary approach to oncology care, from discovery science all the way through to clinical impact,” says Charles Swanton, PhD, scientific co-chair of the ESMO Congress 2022 and group leader at the Francis Crick Institute, London, United Kingdom.

The meeting, which will be held both in person and virtually online from 9 to 13 September, aims to “bring together various different fields of expertise across the scientific, clinical and medical domains to create progress and improve outcomes,” Swanton told Medscape Medical News.

The key to this, he explained, is to emphasize the need for prevention and early, targeted intervention.

“Curing advanced disease is very challenging,” he said. “The major gains are going to come from the prevention, early detection, and adjuvant therapy spaces.”

This is when “you are either preventing the disease from occurring or treating it when the disease burden is at its lowest, and the number of pathways resulting in drug resistance and drug escape are at their lowest.”

Fabrice André, MD, PhD

Scientific co-chair Fabrice André, MD, PhD, director of research at the Gustave Roussy Cancer Center, Villejuif, France, says that none of this can be achieved without education.

He would like delegates to leave the ESMO Congress with a “deeper understanding” of the cancer disease processes, because “we have so many waves of clinical trials,” it is the “only way for oncologists to…digest and interpret” the results.

“Otherwise, it’s going to be very difficult to remain up to date,” André added.

“We are entering an era where diseases are defined by their molecular characteristics and their mechanism of progression or malignant transformation,” he elaborated.

Most of the current trials are investigating “drugs that address these mechanisms,” so if an oncologist does not understand how these mechanism work, it becomes “impossible” to understand the trial and therefore make the right clinical decisions, he suggested.

Another facet of the conference program, André told Medscape Medical News, is to address the “many challenges oncology will face over the next 5-10 years” around prevention, cancer detection, and workforce shortages.

Above all, he wants ESMO Congress 2022 to give a “very strong message…that the oncology community needs to move to cancer prevention,” as well as to more personalized medicine via targeted therapies.

This, says André, could have “massive implications” for the “human and technology resources needed to cure a cancer,” because these could be “far lower than what we currently believe,” owing to patients receiving shorter courses of therapy.

Key Data Presented at Presidential Sessions

As in previous years, the most important clinical data will be presented at the three afternoon presidential sessions.

Swanton will open the first of these, on September 10, with a study exploring the links between air pollution and lung cancer — specifically, “how air pollution causes lung cancer in ways that are quite unexpected; not through direct mutational mechanisms, but through an inflammatory pathway,” he explained.

This will be followed by a late-breaking abstract on the DeFi phase 3 trial of nirogacestat vs placebo for progressing desmoid tumors. This is a “first-in-class drug targeting a pathway that’s not been targeted before,” Swanton said, adding that it is going to be “extremely exciting” and will show “the importance of understanding the disease to offer patients better medicines.”

The third presentation in that day’s symposium will be on the “new field of advanced T-cell therapies targeting cancer neoantigens,” he continued, with results from the TIL study, a multicenter, randomized phase 3 trial of tumor-infiltrating lymphocytes vs ipilimumab for advanced melanoma.

This, Swanton said, is expected to show the ability of “cell immunotherapies to target melanoma, and hopefully change the face of this disease and further improve outcomes, even in patients who’ve failed on previous immune checkpoint inhibitor therapy.”

André added that, with TIL and similar trials, ESMO 2022 is really the “kick-off meeting for cell therapy in solid cancers.”

The second Presidential Symposium, on September 11, will focus on results with adjuvant and neoadjuvant therapy combinations.

Results from CheckMate 914 will show how the use of adjuvant treatment with nivolumab (Opdivo) plus ipilimumab (Yervoy) compares with placebo in patients with localized renal cell carcinoma who are at high risk for relapse after nephrectomy.

This will be followed by primary results from KEYNOTE-412, examining pembrolizumab (Keytruda) vs placebo in patients receiving chemoradiation therapy for locally advanced head and neck squamous cell carcinoma.

This afternoon will also see results with neoadjuvant pembrolizumab vs adjuvant treatment with the same drug in patients with resected stage III-IV melanoma in SWOG S1801, whereas the NICHE-2 study results will report on neoadjuvant immune checkpoint inhibition in locally advanced mismatch repair–deficient colon cancer.

In the third Presidential Symposium, which takes place on Monday, September 12, “we’ll be looking at advanced disease and new breakthroughs in advanced disease,” said Swanton.

Specifically, this symposium will include results from the COSMIC-313 study of cabozantinib plus nivolumab and ipilimumab in patients with previously untreated advanced renal cell carcinoma of intermediate or poor risk, as well as the RADICALS-HD study looking at the duration of androgen deprivation therapy (ADT) with postoperative radiation therapy in patients with prostate cancer.

Also presented in this session with be the CodeBreak 200 trial of sotorasib vs docetaxel for previously treated non–small cell lung cancer (NSCLC) with KRAS G12C mutation, alongside the IPSOS study of first-line atezolizumab vs single-agent chemotherapy in patients with NSCLC who are not eligible for a platinum-containing regimen.

Keynote Lectures

Swanton also highlighted three keynote lectures that will take place during the ESMO Congress 2022.

The first one, which will delivered by Deborah Schrag, MD, MPH, from the Dana-Farber Cancer Institute, Boston, Massachusetts, on Saturday, September 10, will ask: What is the future of digital medicine for cancer patients?

A talk on Sunday, September 11, from John B. Haanen, MD, PhD, Professor Translational Immunotherapy of Cancer at Leiden University, Leiden, the Netherlands, will discuss the promise of antibody and cell-based therapies in cancer. And the third, on Monday, September 12, will looked at BRCA mutation research and will be given by Judy Garber, MD, MPH, also from the Dana-Farber Cancer Institute.

Overall, Swanton believes that the ESMO Congress 2022 is going to be “probably the best ESMO for years in terms of its clinical impact, and in really advertising the importance of basic science in delivering the medicines of the future.”

No funding or relevant financial relationships have been declared.

ESMO Congress 2022

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