The targeted therapy with tyrosine kinase inhibitors (TKIs) against the epidermal growth factor receptor mutation (EGFRm) in advanced non-small cell lung cancer (NSCLC) changed the treatment paradigm. REFLECT study (NCT04031898) explored EGFR/T790M testing and treatment patterns in EGFRm NSCLC patients receiving first- or second-generation (1G/2G) EGFR TKIs as front-line (1L) in eight countries. Pooled data from Central Eastern Europe (CEE) countries from this study (Bulgaria, Poland, Romania, Slovenia) are presented here. This physician-led chart review study was conducted in patients with confirmed-EGFRm NSCLC initiating 1L 1G/2G EGFR TKIs between 2015–2018. The CEE cohort included 389 patients receiving 1L erlotinib (37%), afatinib (34%), and gefitinib (29%). Overall, 320 (82%) patients discontinued 1L, and 298 (77%) progression events were registered. Median progression free survival on 1L TKIs was 14.0 (95% CI: 12.6–15.6) months. Median overall survival from 1L start was 26.6 (95% CI: 24.1–29.0) months. Attrition rate between 1L and next line was 30%. Among patients with 1L progression, 200 (67%) were tested for T790M and 58% were positive. This first CEE analysis of treatments and outcomes in EGFRm NSCLC patients highlights the importance of using the most efficacious therapies currently available in 1L to reduce attrition and improve patient outcomes.

Many analyses of the efficacy of neoadjuvant treatment (NAT) for early breast cancer including a meta-analysis derived from 10 randomized trials came to the conclusion that patients who would achieve pathologic complete response (pCR) following NAT would experience significant improvement in disease-free and overall survival (OS). Thus, pCR was proposed as a surrogate endpoint for OS, with pCR representing a robust prognostic marker for survival at an individual level. In the current analysis, we argue that OS following NAT-induced pCR might have reflected the initial prognosis of patients mainly defined – among other factors – by the initial pathological lymph node status while being largely independent on the type of administrated treatment, thus pleading against the pCR surrogacy hypothesis. We therefore propose to redefine pCR as a surrogate endpoint of NAT trials by the involvement of additional biologic parameters.

7322 Background: Previous experience with concurrent chemo-radiation regimens at our institution showed a high rate of associated toxicities, which precludes the delivery of the whole protocol in a large fraction of patients (pts.). Methods: This prospective study was aimed to evaluate the efficacy and dose intensity (DI) of a split course radiation-therapy (RT) strategy, delivered concurrently with NVB and CDDP chemotherapy (CT). To be eligible, pts. had to have histologically or cytologically documented, locally advanced NSCLC, ECOG performance status(PS) 0–2. NVB 25 mg/m² + CDDP 40 mg/ m² on day 1+8 were administered in 4 cycles (days 1,8,22,29,57,64,78,85). Concurrent with the second CT cycle, RT (2 courses of 30 Gy separated by a 2 weeks break) was started, and was planned to achieve a total dose of 60 Gy (2 Gy/day/5 days /week). Results: From October 2000 to July 2004, 28 pts. were evaluated. Patients’ characteristics: males/females= 25/3, median age =61 years old, stage III B/III A = 25/3, ECOG PS 0–1=19 (68%) and PS 2= 9(32%), histology: adenocarcinoma/ squamous cell/ large cell/ unclassified 11/8 /1/8. Grade 3–4 toxicities : leucopenia 3 (11%), thrombocytopenia 1(4%), anemia 1(4%), esophagitis 3 (11%). The response rates were : 2 CR (7%), 12 PR (43%), 9 SD (32%) and 5 PD (18%), with an overall response rate of 50%. The estimated progression free and median survival was 9 and 12 months respectively. After a median follow-up of 11 months 19 pts (68%) relapsed, with 9 (32%) local and 10 (36%) distant failures. The sites of distant failures were : PUL 5(19%), OSS 2 (7%), BRA 2(7%), LYM 1(4%). Conclusions: Our concurrent schedule allows for good CT and RT dose intensities, with low associated toxicities. The pattern of relapses is equally divided between local and distant failures. Given the high proportion of pts. with stage IIIB and PS 2 status the survival data are promising. No significant financial relationships to disclose.

Summary This article is not intended to be a comprehensive review of all highlights presented at the recent ESMO Annual Meeting, but rather a summary from a personal point of view in three very different fields of oncology. Breast cancer and lung cancer are traditionally in the focus of interest, and again, relevant new data were presented. The third part of this overview is focused on novel treatment strategies in malignant lymphoma, a field that is also quickly evolving and traditionally underrepresented at meetings dealing with solid cancers.