A couple of them [important lung cancer studies from ESMO 2021] include the DESTINY-Lung trial, which was the trial of trastuzumab deruxtecan [Enhertu], a HER2 antibody drug conjugate in patients with HER2 mutant lung cancer. So this is a subset of lung cancer characterized by genetic alterations where we do not have an approved targeted therapy.
There have been many attempts to develop targeted therapies in this space, and most of them have not had a large degree of activity. I think the trastuzumab deruxtecan trial stands a little bit in contrast to that as really the highest level of activity in terms of both response rate and progression-free survival that has been seen to date. And it does have toxicity — lung disease, interstitial lung disease is one of its limiting toxicities — but certainly on the balance, the efficacy for this population with no approved targeted therapies is favorable in my mind.
This study was initially presented at ASCO [American Society of Clinical Oncology] and additional degree of data shown at the ESMO meeting this past week. It really highlights for the first time that there is a disease-free survival benefit in patients who receive adjuvant immune checkpoint inhibition for surgically rejected lung cancer. We’ve seen this in other diseases; we had yet to see it in lung cancer, this is really the first demonstration of that.
And the data at the meeting was interesting, and it showed some more gradations in the PD-L1 stainings. The patients that had greater than 50% PD-L1 staining had the highest degree of benefit, with no benefit in patients that had a low degree of PD-L1 staining, and sort of an intermediate in patients with 1% to 49% PD-L1 staining. So I think more to come from this study. But I think it clearly emphasizes the point that one can have a benefit in disease-free survival from adjuvant atezolizumab, and of course we eagerly await to see what the impact is on overall survival.