“There still are a lot of unmet needs in the field of thoracic oncology”

<p class="article-intro">In an interview during this year’s European Lung Cancer Conference (ELCC), the co-chair of the meeting, Assoc. Prof. Dr. Pilar Garrido from Madrid, shared her opinion on the reasons for the success of this meeting as well as on the unmet needs in thoracic oncology and talked about her personal highlights of the congress.</p> <hr /> <p class="article-content"><p><em><strong><img src="/custom/img/files/files_datafiles_data_Zeitungen_2019_Jatros_Onko_1903_Weblinks_jatros_onko_1903_s60_tab1_garrido+schwender.jpg" alt="" width="350" height="324" /></strong></em></p> <p><em><strong>Dr. Garrido, since its first edition in 2008, the ELCC has become quite a success. What do you think is the secret of this success? </strong></em></p> <p><em><strong>P. Garrido:</strong></em> First, the ELCC is a meeting organized by two big societies, by the European Society for Medical Oncology (ESMO), and the International Association for the Study of Lung Cancer (IASLC), along with their partner societies, the European Society for Radiotherapy and Oncology (ESTRO), the European Society for Thoracic Surgeons (ESTS) and the European Thoracic Oncology Platform (ETOP). Thus, I think the congress is a model of great collaboration in this field. Secondly, this meeting is very multidisciplinary. This means that we have sessions dedicated to a lot of different specialists, e.g. medical oncologists and radiation oncologists, but also to pulmonologists and surgeons. But several sessions are also dedicated to and organized primarily by nurses, by the European Oncology Nursing Society (EONS). And finally, there are two sessions organized by the patient representative group Lung Cancer Europe (LuCE). So, I think one of the great ideas of this meeting is the multidisciplinary approach that also includes nurses and patients&rsquo; representatives.</p> <p><em><strong>As immunotherapy has become such a mainstay in the field of lung cancer in the last years, is there still room for more traditional therapeutic options like chemotherapy or targeted agents? </strong></em></p> <p><em><strong>P. Garrido:</strong></em> Yes, I think so. In fact, at the beginning, the first clinical trials in non-small cell lung cancer (SCLC) in Caucasian patients were investigating the role of immunotherapy alone in heavily pre-treated patients. But then immunotherapy was moved to other scenarios like the first-line setting or as consolidation strategy in a subset of patients with curable disease. Now we have a lot of studies demonstrating the value of adding immunotherapy to chemotherapy or radiotherapy. So, when speaking about immunotherapy, we have to differentiate between different drugs and different scenarios. In patients with specific mutations, in the advanced situation, we have the possibility to give oral drugs specifically targeting the relevant mutation. In these patients the value of immunotherapy is not clear yet. But for the other patients, we do have immunotherapy in combination with other strategies as part of our standard of care.</p> <p><em><strong>What strategies are there for patients progressing during or after immunotherapy, what are the challenges here? </strong></em></p> <p><em><strong>P. Garrido:</strong></em> We don&rsquo;t have a good answer here yet. We are running a lot of clinical trials in this setting. Actually, we have two different scenarios here. Firstly, the patients primarily resistant to immunotherapy, meaning the ones who progress during immunotherapy. Secondly, we also have a subset of patients in whom we can obtain a durable response but finally they will progress, too. We are trying to elaborate clinical trials to answer the question on how to treat these two groups, but we are far from having an answer.</p> <p><em><strong>Moving to the field of SCLC, what have been the main advances here lately? </strong></em></p> <p><em><strong>P. Garrido:</strong></em> We have tried many different strategies here, but unfortunately most of them failed. So, our standard of care last year was still the same as it was thirty years ago: the use of chemotherapy, meaning a platinum-based chemotherapy alone or, in patients with limited disease, in combination with radiotherapy. Last year one clinical trial focused on adding immunotherapy to chemotherapy in patients with extensive stage SCLC. This study demonstrated a benefit of adding the checkpoint inhibitor atezolizumab, so probably we are going to have a new standard of care. On the other hand, further trials testing immunotherapy in SCLC patients didn&rsquo;t show very consistent results. So, I&rsquo;m not sure what is going to be the final role of immunotherapy in these patients. But there are many trials still to come.</p> <p><em><strong>What would you say are the main unmet needs in the field of thoracic oncology? </strong></em></p> <p><em><strong>P. Garrido:</strong></em> Lung cancer is a disease closely related to tobacco. So, the first unmet need is the fight against tobacco, to help people successfully quitting smoking. The second is probably the implementation of a screening strategy. We need to move from the palliative treatment of the disease to the development of disease prevention. We have two positive trials in this field, but in many countries the implementation of screening strategies is very difficult. But I think we have to move forward here. And then, of course, there still is unmet need in offering patients better treatment strategies providing long term survival with good quality of life. So, we still do have a lot of unmet needs (table 1) although I am really optimistic due to the rapid pace of advances.</p> <p><em><strong>What was your personal highlight of this congress so far? </strong></em></p> <p><em><strong>P. Garrido:</strong></em> In general, during such a meeting we would discuss a lot of positive studies, but it is also important to learn from negative results in order to build the best clinical trials in the future. So, at this meeting there was the first presentation of the results of a trial on maintenance immunotherapy in patients with SCLC. This study proved to be negative. The discussion after the presentation mainly focused on the question of predictive biomarkers, biomarkers that could help us identifying a subset of patients who might benefit from this strategy. There have been hints in this study that there might be such patients. And last but not least, in the field of radiation oncology some interesting new approaches, new technologies have been presented, which probably will be of key importance in the future.</p> <p><em><strong>Thank you for the interview!</strong></em></p></p>