This report will highlight 10 important studies presented during ESMO 2014, and 4 small but promising future directions in the treatment of NSCLC. The presidential symposium featured two negative studies in a large cohort of non-small cell lung cancer (NSCLC) patients: the MAGRIT and IMPRESS. The other topics include immunotherapy, targeted treatment and biomarkers, development of new drugs in ALK-EML rearranged NSCLC, and prevention of cachexia in NSCLC. Lastly, an important study in malignant pleural mesothelioma (MPM) was presented.
B. Hiddinga MD, P. Van Schil MD, PhD, J. Van Meerbeeck MD, PhD
Malignant pleural mesothelioma remains a lethal disease and its incidence is expected to increase until the 2020’s. Disease extent and performance status at diagnosis are the clinical prognostic factors, besides epithelioid subtype which confers a better outcome than the less common sarcomatoid one. Currently, only administration of palliative chemotherapy has a proven impact on outcome. Treatment of early stage malignant pleural mesothelioma should be offered in a multimodality setting, including at least a systemic and a locoregional treatment. The role of radical surgery remains controversial. Optimal treatment schedules are not defined yet. The standard first line palliative treatment consists of platinum in combination with an antifolate, either pemetrexed or raltitrexed. As the outcome in first line remains modest, it is ethical to include these patients in clinical trials comprising a chemotherapy backbone. For maintenance therapy there’s still no standard in malignant pleural mesothelioma. In second line treatment, referral of patients for inclusion in trials is highly recommended.