In early September 2022, the oncology community was able to resume one of its most anticipated annual in-person events. Paris hosted the ESMO 2022 Congress, which brought together 29,000 delegates, of whom approximately 5,000 joined the online meeting.
We commend the program committee for a careful selection of subjects covering a broad spectrum. In addition to clinical trial results, translational studies and health policy initiatives have also received well-deserved attention. The variety of topics covered at the three presidential symposia organized this year reflects the diversity of the ESMO 2022 programme.
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Optimizing the treatment of patients with locally advanced and resectable cancers was one of the major themes discussed during the presidential symposia. In the Phase II NICHE-2 trial, patients with nonmetastatic colon cancer that was deficient in mismatch repair received ipilimumab plus nivolumab before undergoing surgery. With an incidence of grade 3-4 adverse events (AEs) of 3%, neoadjuvant therapy was deemed safe. The rates of pathological response, major pathological response, and pathological complete response were 99%, 95%, and 67%, respectively. At a median follow-up of 13 months, none of the patients experienced disease recurrence. One of the most memorable images from ESMO 2022 is the waterfall chart depicting this data.
In the Phase II SWOG S1801 trial, patients with stage IIIB-IV melanoma receiving pembrolizumab before and after surgery had improved event-free survival (EFS) compared to those receiving the same number of pembrolizumab cycles only in the adjuvant setting (HR 0.59, 95% CI 0.40–0.86). Neoadjuvant therapy was also associated with a benefit in overall survival (OS) (HR 0.63, 95% CI 0.32-1.24).
The Phase III IPSOS trial is another study whose results could change practice and which was presented at a presidential symposium. In this trial, patients with non-small cell lung cancer (NSCLC) without actionable driver alterations deemed ineligible for platinum-based chemotherapy receiving atezolizumab had longer SG durations. longer than those receiving physician’s choice of vinorelbine or gemcitabine (10.3 months versus 9.2 months; HR 0.78, 95% CI 0.63–0.97). Importantly, AEs were less common with atezolizumab, both grade 3-4 (16.3% vs. 33.3%) and grade 5 (1% vs. 2.7%).
Other data presented at the Presidential Symposia include data from a phase III trial of adoptive cell therapy with tumour-infiltrating lymphocytes (TILs), an approach for which previously available evidence came from phase I/II trials. In this study, patients with unresectable stage IIIC-IV melanoma had longer progression-free survival (PFS) times with TIL-based therapy than with ipilimumab (7.2 months versus 3 .1 month; HR 0.5, 95% CI 0.35-0.72).
Another phase III trial with promising results is DeFi, in which patients with progressive desmoid tumors receiving the γ-secretase inhibitor nirogacestat had longer durations of PFS than those receiving placebo (not achieved versus 15.1 months; HR 0.29, 95% CI, 0.15-0.55) . Nirogacestat was also associated with improvements in patient-reported outcomes, including pain intensity.
Not all trials presented at presidential symposia have had positive results. In the phase II randomized, placebo-controlled trial KEYNOTE-412, the addition of pembrolizumab to chemoradiotherapy (concurrent and as maintenance treatment) was not associated with significant differences in EFS in patients with locally advanced squamous cell carcinoma of the head and neck. Phase III CodeBreak 200 trial met primary endpoint showing PFS benefit for sotorasib over docetaxel in patients with advanced disease krasG12C-NSCLC mutated, but no significant difference in OS was observed.
One translational study worth mentioning looked at how air pollution drives the formation of EGFR-Mutated NSCLCs. Although the role of environmental factors in cancer risk has been known for decades, this study provides mechanistic insight into the etiology of lung cancer, including the identification of IL-1β as a potentially actionable signaling axis. .
“One of the most memorable images of ESMO 2022 is the cascading plot [from NICHE-2]”
In summary, the first truly in-person ESMO Congress since the COVID-19 pandemic hiatus did not disappoint. We look forward to attending the ESMO Congress in October 2023 in Madrid.