Dr Herbst on the Implications of the AEGEAN Trial in NSCLC

Roy S. Herbst, MD, PhD, Ensign Professor of Medicine, Medical Oncology, professor of pharmacology, director, the Center for Thoracic Cancers, deputy director, Yale Cancer Center, assistant dean for Translational Research, Yale School of Medicine, chief of Medical Oncology, Smilow Cancer Hospital, assistant dean, Translational Research, Yale Cancer Center, Smilow Cancer Hospital, discusses the implications of the phase 3 AEGEAN trial (NCT03800134) in patients with resectable non–small cell lung cancer (NSCLC).

At the 2023 AACR Annual Meeting, preliminary findings from the phase 3 trial were read out from the first interim analysis. The AEGEAN trial evaluated patients that received perioperative durvalumab (Imfinzi) plus neoadjuvant platinum-based chemotherapy compared with placebo with chemotherapy, Herbst begins, noting that the trial was positive. Investigators reported a hazard ratio of 0.68 and a 32% improvement in event-free survival (EFS). Moreover, the pathologic complete response rate was 17.2% compared with 4.3% in the control arm. However, the median follow-up was only 11.7 months, so the data are still early, Herbst expands.

These data raise the question of how to use neoadjuvant and adjuvant therapy, as clinicians already use neoadjuvant therapy based on the regimen evaluated in the phase 3 CheckMate 816 trial (NCT02998528), Herbst notes. The use of durvalumab in this setting represents another potential option in this setting, Herbst emphasizes. More research must be conducted before a definitive standard of care is selected.

Pre-competitive collaboration and pragmatic trial approaches are vital in further research, Herbst continues. There are many other trials in this setting that will read out soon. As such, groups should work together to better understand treatment sequencing, Herbst explains. Notably, in the AEGEAN trial, investigators noted the output of EFS by pathological complete response, which could help to determine which patients should receive more or less therapy.