ESMO 2022: Advances in oncology

Earlier this month, 29,300 people took part in ESMO 2022. Although online attendance remained an option, thousands flocked to Paris, France to experience the action-packed program in-person for the first time since 2019. There was a plethora of world-class science and practice-changing data shared over the five-day congress and below are some of the key themes that emerged.

Combination immunotherapy

One of the standout datasets at ESMO was a presidential symposium presentation by Dr Myriam Chalabi on the response to neoadjuvant combination immunotherapy (nivolumab + ipilimumab) in patients with locally advanced mismatch repair-deficient colon cancer in the NICHE-2 trial. The waterfall plot presented was likened to a “tidal wave” as it demonstrated a major pathologic response in a phenomenal 95% of patients; 67% of whom had a pathologic complete response (no residual tumor).

However, not all combination immunotherapy studies presented at the congress demonstrated such positive results. The CheckMate 914 trial failed to demonstrate disease-free survival benefit for adjuvant nivolumab + ipilimumab versus placebo in patients with localized renal cell carcinoma.

New therapeutic interventions – ADCs and bispecific antibodies

Trastuzumab deruxtecan (T-Dxd), an HER-2-directed antibody–drug conjugate (ADC), is already revolutionizing the treatment of breast cancer. An update was provided on the benefit of this regimen in gastric cancer and emerging data in lung cancer were presented, which look promising despite some associated safety risks. Preliminary data and planned trials with patritumab deruxtecan (HER3-Dxd) and datopotamab deruxtecan (Dato-Dxd) were also presented, giving a glimpse into the long-term potential of deruxtecan ADCs in different tumor types.

Another growing area, especially in lung cancer, is the role of bispecific antibodies. Data at ESMO included Phase 2 study data on KN046, a novel bispecific antibody that blocks both PD-L1 and CTLA-4 interactions, which was shown to be well tolerated with promising efficacy in patients with advanced lung cancer who had failed prior therapy.

Biomarkers – predicting risk and response

A clear theme of the discussions at ESMO was our evolving understanding of the gene signatures and other biomarkers that are important in predicting disease risk and response to different therapies.

Professor Charles Swanton gave a very interesting presentation on the emerging link between exposure to the pollution marker PM2.5 and the risk of lung cancer, detailing how PM2.5 can drive interleukin 1 (IL-1) beta release and the potential to use anti-IL-1 beta agents, such as canakinumab, as treatment.

Artificial intelligence (AI)

AI has had mixed success in oncology so far, with IBM Watson promising to revolutionize clinical decision-making but falling short and leaving some oncologists skeptical of the value of AI to the field. However, at ESMO, the exciting expanding role of AI was discussed, including important applications in colonoscopy, radiology, and pathology, where we can harness the power of machine learning to increase efficiency in both the diagnosis and treatment of patients.

Real-world evidence

Combining real-world data with clinical trial data to ensure patients receive the most appropriate treatment remains of great importance in oncology, both in terms of identifying patients who may benefit from a specific treatment and identifying areas of unmet need.

At the congress we heard about WAYFIND-R, a new global and collaborative registry designed to generate evidence in precision oncology by compiling next-generation sequencing (NGS), treatment, and outcomes data. Enhanced accessibility via an online summary dashboard will enable clinical centers to use the registry and a research dataset will also be accessible for all.

Conclusion

ESMO 2022 provided us with a vast amount of cutting-edge data in cancer diagnosis, treatment, and care, which ultimately support the ongoing goal of achieving better outcomes in patients with cancer. Thanks go to all of those who contributed, and we look forward to ESMO 2023 in Madrid, Spain to see what exciting progress is made over the next year.