Cecilia Brown

Lung Cancers Today

With thousands of abstracts and posters presented at the American Society of Clinical Oncology (ASCO) Annual Meeting, it&rsquo;s critical to help clinicians find the information that&rsquo;s most relevant to their practice and research.To help meeting attendees navigate the clinical data coming out of ASCO 2025, Sanjay Juneja, MD, partnered with Formedics to host the Oncology Forum. The event, which featured expert perspectives on lung, gastrointestinal, genitourinary, and breast cancers, was held while the annual meeting was in full swing on Sunday, June 1, 2025.The event kicked off with the lung cancer panel, which featured Stephen Liu, MD, of Georgetown University, Millie Das, MD, of Stanford University and the Palo Alto VA, and Eric Singhi, MD, of the University of Texas MD Anderson Cancer Center.&ldquo;The first thing that we wanted to talk about was some of the updates in non&ndash;small cell lung cancer, and the one I get excited about is this whole concept of neoadjuvant therapy, not just in lung [cancer], but in general,&rdquo; Dr. Juneja said as he introduced the lung cancer panel.<h2>Experts Share Insights on NeoADAURA at ASCO 2025</h2>The panel began with a discussion of <a href="https://www.lungcancerstoday.com/post/neoadaura-insights-evaluating-neoadjuvant-osimertinib-with-or-without-chemotherapy-for-resectable-egfr-mutated-nsclc">NeoADAURA,</a> which evaluated the use of osimertinib given in a neoadjuvant therapy setting for patients with stage II-IIIB non&ndash;small cell lung cancer (NSCLC) who harbor an EGFR mutation.Patients in the NeoADAURA trial were assigned to three cycles of chemotherapy plus osimertinib, osimertinib monotherapy, or chemotherapy alone before surgery. The combination of osimertinib plus chemotherapy showed a major pathologic response (MPR) rate of 26%, with osimertinib monotherapy showing an MPR rate of 25%. Both the combination therapy and the monotherapy showed a significant improvement compared with placebo plus chemotherapy, which had an MPR rate of 2%.&ldquo;I was hoping that chemotherapy was going to make that more of a robust response, but we didn&rsquo;t see it&hellip; I&rsquo;m still leaning towards more of an ADAURA approach,&rdquo; Dr. Singhi said. &ldquo;It&rsquo;s important to note that these patients had to have surgically resectable disease&mdash;deemed resectable before they enrolled on the study&mdash;this wasn&rsquo;t to try and convert patients to have surgically resectable disease. It&rsquo;s a lot to think about, but for me, personally, it&rsquo;s not practice-changing.&rdquo;Dr. Liu also shared his perspective on the NeoADAURA findings, emphasizing that &ldquo;a lot of things have to go right for that approach to work,&rdquo; but pointed out a bigger-picture consideration surrounding NeoADAURA and similar trials.&ldquo;This moves us a little bit closer to refining our therapy in a logical, rational way. And right now, you&rsquo;re right, the pCR [pathologic complete response] and the MPR rates are low&hellip;. But the real value here is, when we give osimertinib, we don&rsquo;t kill all the cancer cells; we kill some. Now, let&rsquo;s try to understand why we don&rsquo;t kill all the cancer cells, and then develop tools to kill all the cancer cells, and maybe put to rest the myth that we can&rsquo;t cure cancer with targeted therapy. We can&rsquo;t cure [cancer] with today&rsquo;s targeted therapy, but that&rsquo;s our goal, and we will get there. These window-of-opportunity studies are how we learn about how cells persist and how they survive, despite our best efforts.&rdquo;Dr. Das agreed, explaining that NeoADAURA is a &ldquo;proof-of-concept&rdquo; trial that may offer lessons beyond the EGFR-positive space.&ldquo;EGFR is the driver mutation that we&rsquo;ve been most interested in, [affecting] a higher percentage of patients, but we&rsquo;re now finding lots of other driver mutations in our patients that are present at much lower frequencies&hellip; But what do we do in our ROS1 patients or our RET patients? Is there a rule for any targeted therapy in the earlier-stage setting for those patients?&rdquo; she said.<h2>The ALNEO Study: Panel Unpacks New ASCO 2025 Data</h2>The panel then shifted the conversation to another targeted therapy trial, the <a href="https://www.lungcancerstoday.com/post/alneo-trial-supports-neoadjuvant-alectinib-in-resectable-stage-iii-alk-positive-nsclc">ALNEO study</a>. The study evaluated neoadjuvant and adjuvant alectinib in patients who had resectable, locally advanced stage III ALK-positive NSCLC. The phase 2 study met its primary end point, with the study investigators suggesting that the treatment is a &ldquo;feasible peri-operative option&rdquo; for this population of patients.Dr. Das explained that the ALNEO study showed &ldquo;more encouraging data&rdquo; than the NeoADAURA study, with a higher pCR rate.&ldquo;We need to get more data, and then we need to really figure out, is this something that we should be applying for all of our patients? I am excited about the idea of using other modalities such as ctDNA [circulating tumor DNA] or looking at other ways of predicting whether patients are responding to these drugs and how much of the drug they need,&rdquo; Dr. Das said. &ldquo;That&rsquo;s one of the big pushes forward: to individualize treatment, beyond just the driver mutation, to the duration of treatment.&rdquo;She also emphasized that &ldquo;patient preference plays a huge role&rdquo; in determining the treatment approach.Dr. Liu also weighed in on the data, explaining that pCR predicts long-term survival in the context of immunotherapy but that &ldquo;we have to prove that pathological CR is a good surrogate for survival&rdquo; in the targeted therapy setting. He also spoke about what the ALNEO data could mean for patients who have borderline resectable tumors.&ldquo;We&rsquo;re very confident we can get a response,&rdquo; Dr. Liu said. &ldquo;If someone has a borderline resectable, or frankly, unresectable tumor, but if we can shrink that by 40% within a couple weeks, would that facilitate resection, lobectomy? There are bigger questions. Is that actually in the best interest of the patient? Is that better than radiation? I think that a lot of times we assume that it is. I&rsquo;m a believer in surgery, not just to get us to cure, but also to delay resistance, to remove those clones that don&rsquo;t persist.&rdquo;Dr. Singhi agreed, noting that the ALNEO study has a number of differences in its design and patient population compared with the NeoADAURA trial, including the perioperative approach of ALNEO. He also highlighted that the ALNEO study included patients with &ldquo;potentially resectable disease&rdquo; in contrast to NeoADAURA, which only included patients whose disease was deemed resectable. In addition, the ALNEO trial only included patients with stage III disease, whereas NeoADAURA included patients with earlier stages of disease.&ldquo;Those are big differences to consider. I&rsquo;m also very excited about this potential for conversion, for nodal downstaging, for making an impact for the surgeons, to make it easier for them to take it out and hopefully improve outcomes for our patients,&rdquo; Dr. Singhi said.<h2>TROPION-Lung02: Lung Cancer Panel Weighs In on Data From ASCO 2025</h2>The panel then shifted to discussing <a href="https://www.lungcancerstoday.com/post/dato-dxd-plus-pembrolizumab-with-or-without-chemotherapy-demonstrates-encouraging-first-line-activity-in-advanced-nsclc">TROPION-Lung02,</a> which is evaluating a combination therapy approach that includes an antibody-drug conjugate (ADC).&ldquo;We&rsquo;re talking about advanced, unresectable stage IV disease, and if this antibody-drug conjugate plus pembrolizumab with or without chemotherapy is an option, because classically, for stage IV disease, we think of chemotherapy plus or minus IO [immuno-oncology], if tolerable and no contraindication,&rdquo; Dr. Juneja said.Dr. Das explained that with &ldquo;a lot of interest in antibody-drug conjugates across tumor types, including lung cancer,&rdquo; this new data &ldquo;is exciting.&rdquo;&ldquo;This is the largest dataset that we have, close to 100 patients getting this ADC in combination with a checkpoint inhibitor in this study with pembrolizumab plus or minus chemotherapy,&rdquo; Dr. Das said. &ldquo;What we saw was that this combination is safe. We&rsquo;re not seeing any unexpected toxicity here. In my mind, an ADC is like a targeted chemotherapy. Can we actually replace the platinum-doublet chemotherapy that&rsquo;s been in our treatment paradigm for decades now?&rdquo;She explained that the response rates in the study are &ldquo;encouraging&rdquo; and suggest that &ldquo;perhaps ADCs can potentially substitute or replace platinum-based chemotherapy.&rdquo;&ldquo;We need larger studies to confirm that, but that&rsquo;s really the goal, to be able to provide targeted chemotherapy and perhaps shift the treatment paradigm,&rdquo; Dr. Das said. &ldquo;This is not the study that&rsquo;s going to prove that. This is, again, proof of concept, and hopefully we can move this forward.&rdquo;Dr. Singhi agreed, noting that ADCs in lung cancer &ldquo;have historically over-promised and under-delivered,&rdquo; but &ldquo;there was a lot of excitement this time when we actually saw some of the data.&rdquo; He also highlighted potential ways to optimize patient selection for the treatment, including through an artificial intelligence (AI)&ndash;driven biomarker for TROP2.Dr. Liu agreed, emphasizing that the AI-driven biomarker for TROP2 is a &ldquo;rational biomarker&rdquo; that is aligned with the mechanism of the ADC and noted that &ldquo;outcomes were much better than those that were biomarker positive.&rdquo; He also shared the big-picture reason behind his excitement about this study.&ldquo;The reason I&rsquo;m excited is that when we look at what ADCs can do&hellip; they could be better partners than chemotherapy and getting us to that immune response. Not just holding off disease to let immunotherapy work, but letting immunotherapy work, more likely, by targeting suppressive tumor cells by their T cells, by disrupting the microenvironment and that architecture, using the bystander effect to allow our T cells [to] get access,&rdquo; Dr. Liu said. &ldquo;I think that it could manifest, not in [a] higher response rate, not in the better PFS [progression-free survival], but in better long-term survival, elevating the tail. That&rsquo;s really what we want. Other forms of chemo are not going to get us there. ADCs could get us there. That&rsquo;s why I think these phase III randomized trials will be so important.&rdquo;Dr. Juneja concluded the conversation on TROPION-Lung02 by reflecting on the overall landscape and the implications.&ldquo;In the long-run, does this multi-shot, multi-mechanistic approach, does it permit your body to really have these deep responses? That&rsquo;s just so exciting,&rdquo; Dr. Juneja said. &ldquo;With TROP2, it&rsquo;s something that&rsquo;s available on multiple malignancies. Now you&rsquo;re opening the box on where you could kind of see this benefit.&rdquo;

The Oncology Forum: Lung Cancer Experts Unpack Key NSCLC Data From ASCO 2025

Non-Small Cell Lung Cancer

Raffaele Califano, MD

MARIPOSA-2: How Baseline Mechanisms of Osimertinib Resistance Influence Outcomes in NSCLC

EGFR+ NSCLC

Laura Litwin

How Is Oligoprogressive Disease Managed in Patients With EGFR-Positive NSCLC?

Cheryl Czerlanis, MD

Lung Cancer Risk: The Role of Family History and Germline Genetic Alterations

ASCO 2025

Molly Li, MBBS

AI-Based Lung Cancer Screening: Molly Li, MBBS, Shares Insights From the LC-SHIELD Study

FDA Grants Approval of Taletrectinib for ROS1-Positive NSCLC

Latest News

At ASCO 2025, the Oncology Forum was held by Dr. Sanjay Juneja, who spoke with lung cancer experts Dr. Stephen Liu, Dr. Millie Das, and Dr. Eric Singhi about ASCO updates in NSCLC.