ESMO24 Congress Highlights

Thank you for your patience, my ESMO congress highlights are finally here. I have been busy since returning from the congress in Barcelona, hence the slight delay.

Introduction

The 2024 European Society for Medical Oncology (ESMO) conference in Barcelona was a landmark event for the oncology field. Over 33,000 attendees from around the world gathered to discuss breakthrough research and advances in cancer treatments across nearly 300 sessions. This year’s conference showcased over 5,000 abstracts, including numerous late-breaking presentations. Central themes included advances in immunotherapy, precision oncology, antibody-drug conjugates (ADCs), artificial intelligence, and emerging biomarkers. Let’s dive into the highlights of the most significant findings by tumor type.

Breast Cancer

Breast cancer was a major focus at ESMO 2024, with updates on multiple clinical trials showcasing promising therapies.

1. KEYNOTE-522: This phase 3 trial (LBA4) evaluated pembrolizumab in high-risk triple-negative breast cancer (TNBC) in a neoadjuvant setting, followed by adjuvant pembrolizumab. The results were practice-changing, revealing improvements in overall survival (OS) and progression-free survival (PFS)

2. NATALEE Trial: This trial examined ribociclib combined with endocrine therapy (ET) in hormone receptor-positive (HR+)/HER2-negative breast cancer, confirming efficacy in early disease, reducing the risk of disease progression

3. ICARUS-BREAST01: This ADC-focused trial evaluated the safety and efficacy of novel antibody-drug conjugates in patients with advanced breast cancer, showing meaningful reductions in tumor size.

Non-Small Cell Lung Cancer (NSCLC)

Lung cancer continues to be a critical area of research, with substantial breakthroughs reported in both early and late-stage NSCLC.

1. c-Met Directed Therapy: A key breakthrough at ESMO 2024 was the preliminary efficacy of the c-Met-directed antibody-drug conjugate (ADC), telisotuzumab vedotin (ABBV-400), in patients with EGFR wild-type, non-squamous NSCLC. The trial showed a clinical benefit with an overall response rate (ORR) of 47.9% and a clinical benefit rate of 85.4%, demonstrating its potential as a novel treatment approach.

2. Alectinib and TROP2-Directed Therapy: AstraZeneca’s research presented TROP2 biomarkers as strong predictive tools for better outcomes with datopotamab deruxtecan, especially in TROP2-QCS-positive patients.

Melanoma

Melanoma updates focused heavily on immunotherapy, with significant findings in early-stage and advanced disease.

1. Adjuvant Immunotherapy: Immunotherapy for melanoma has delivered robust long-term outcomes, particularly in patients receiving checkpoint inhibitors such as pembrolizumab and nivolumab. Data from the KEYNOTE-716 trial revealed a 38% reduction in recurrence risk when pembrolizumab was use.

2. LEAP-012 Trial: This trial explored a combination of lenvatinib and pembrolizumab in advanced melanoma, offering significant survival improvements in patients who previously had limited options.

Bladder Cancer

Bladder cancer treatments saw significant advancements at ESMO 2024, particularly in the integration of immunotherapies.

1. NIAGARA Trial: This practice-changing phase 3 trial evaluated the combination of neoadjuvant gemcitabine and cisplatin with or without durvalumab in muscle-invasive bladder cancer, with a 32% reduction in the risk of recurrence or death (hazard ratio of 0.68). The trial also demonstrated overall survival benefits.

2. AMBASSADOR Trial: This phase 3 trial on pembrolizumab in high-risk muscle-invasive bladder cancer doubled disease-free survival (DFS), suggesting that pembrolizumab could follow nivolumab's success as an adjuvant theraps.

Prostate Cancer

Prostate cancer therapies highlighted precision oncology and hormone-sensitive strategies.

1. ARANOTE Trial: This phase 3 trial demonstrated that NUBEQA? (darolutamide) significantly reduces the risk of radiological progression or death in metastatic hormone-sensitive prostate cancer, opening new avenues for managing advanced-stage patients.

2. SPLASH Trial: Lantheus presented results from this phase 3 trial in PSMA-positive metastatic castration-resistant prostate cancer, with promising survival data in patients treated with a PSMA-targeting radiopharmaceutical.

Immunotherapy and Antibody-Drug Conjugates (ADCs)

Immunotherapy and ADCs were dominant at ESMO 2024, continuing to reshape oncology practices.

1. ADCs in Ovarian and Lung Cancer: AbbVie’s ADCs targeting ovarian cancer and c-Met-overexpressing tumors showed robust responses. Teliso-V and ABBV-400 were particularly promising in non-small cell lung cancer.

2. TAR-200 and Masofaniten: The TAR-200 study, focused on non-muscle-invasive bladder cancer, achieved an 84% complete response rate, while Masofaniten (EPI-7386) presented early clinical data showing its potential in hormone-sensitive prostate cancer.

Artificial Intelligence (AI) in Oncology

AI has started to make significant inroads into cancer care, particularly in diagnostics and personalized treatment planning.

1. AI in Radiology and Pathology: At ESMO 2024, deep learning AI models were highlighted for their ability to detect intricate details in radiological and pathological images, with applications that could replace complex molecular analyses in certain cases

2. AI in Drug Discovery: AI continues to evolve, with various presentations showcasing its use in discovering new therapies and generating tailored treatment options based on patient data

Company Contributions

Pharmaceutical companies played a pivotal role at the conference. AstraZeneca, Merck, BMS, and Daiichi Sankyo dominated the presentation of new therapies (see LARVOL charts), especially in ADCs and immunotherapy, and had the most impactful trials.

- AstraZeneca led the way with high-impact presentations, particularly focusing on the NIAGARA and TROP2-directed therapies.

- Merck (MSD) followed closely, with updates on KEYNOTE trials in multiple cancers, including breast and lung cancer.

Conclusion

ESMO 2024 confirmed that oncology is rapidly advancing, driven by immunotherapies, ADCs, precision medicine, and AI. Trials like NIAGARA, ARANOTE, and KEYNOTE-522 offer new treatment possibilities across various cancer types, from early-stage to metastatic disease. These advancements are not only improving survival outcomes but also providing hope for patients with previously limited options. As immunotherapy and targeted therapies continue to evolve, the next few years will likely see a shift in how cancers are treated, with more precise and patient-centric approaches.

? Dr. Robert F. Siegmund, Life Code GmbH, Bottmingen, Switzerland, 20.6.2024

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