Adjuvant Systemic Therapy Trends in 2021

As our understanding of systemic therapies expands with a greater breadth of research, established agents in the metastatic setting have begun to assert themselves as options in earlier stages of cancer care.

A big breakthrough in this regard came at the end of 2020 when osimertinib (Tagrisso) was approved as an adjuvant therapy for patients with non–small cell lung cancer (NSCLC) whose tumors harbored mutations in EGFR exon 19 deletions or exon 21 L858R. Results of the phase 3 ADAURA trial (NCT02511106) supported the FDA’s decision to grant this standard-of-care agent in the metastatic setting an addition indication for use in patients with stage IB to IIIA disease.

Since then, there have been multiple approvals of established agents for use in patients with early disease across multiple solid tumors malignancies. Both abemaciclib (Verzenio) and pembrolizumab (Keytruda) earned full approval for indications in early breast cancer. The CDK4/6 inhibitor may now be used in combination with endocrine therapy in the adjuvant setting for hormone receptor–positive, HER2-negative, node-positive early breast cancer at high risk of recurrence with a Ki-67 score of 20% or greater. Pembrolizumab is to be used as both a neoadjuvant treatment in combination with chemotherapy, then as a single agent in the adjuvant setting following surgery.

The PD-1 inhibitor nivolumab (Opdivo) earned an indication from the FDA as adjuvant treatment for patients with resected esophageal or gastroesophageal junction cancer who have residual pathologic disease and who previously received chemotherapy. In NSCLC, atezolizumab (Tecentriq) may now be used to treat patients with stage II to IIIA NSCLC with PD-L1 expression of 1% or higher following complete resection and platinum-based chemotherapy. And recently, pembrolizumab won another FDA approval for the adjuvant treatment of patients with renal cell carcinoma who are determined to have intermediate- or high-risk disease following nephrectomy or following nephrectomy and resection of metastatic lesions.

Turning the page on a new year, news trends in oncology for 2022 are yet to be determined but are certainly anticipated to be as or even more exciting than what has already occurred in this space. As always, keep up with the latest issue of ONCOLOGY^® to stay up-to-date on the latest practical and timely clinical information necessary to deliver the highest level of patient care.