The Oncology Forum: Expert Panel Discusses Key Updates in NSCLC

Sanjay Juneja, MD, partnered with Formedics to host the Oncology Forum during the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, kicking off the robust discussion with the lung cancer panel.

The expert panel featured Stephen Liu, MD, of Georgetown University, Millie Das, MD, of Stanford University, and Eric Singhi, MD, of the University of Texas MD Anderson Cancer Center. Dr. Juneja initiated the forum with an intensive conversation about key updates in the field of non–small cell lung cancer (NSCLC).

“The [topic] I get excited about is this whole concept of neoadjuvant therapy,” Dr. Juneja said.

Dr. Singhi also emphasized his excitement about bringing more targeted, personalized therapies into the early-stage setting for patients with lung cancer, highlighting recent NeoADAURA updates, which compared neoadjuvant osimertinib plus or minus chemotherapy with chemotherapy alone for resectable EGFR-mutated NSCLC.

“What we saw in the NeoADAURA study, which is a phase 3 study, was bringing that oral osimertinib upfront, plus or minus chemotherapy,” Dr. Singhi explained. “The major pathologic response was right around 25% to 26%, and that’s even with the addition of chemotherapy. I actually found that a little disappointing. To be honest, I was really hoping that chemotherapy was going to make that more of a robust response, but we didn’t see it. [Pathological complete response] was around 4% to 9%, so for me, I’m still leaning towards more of an ADAURA approach.”

Later during the panel, Dr. Juneja directed the discussion toward the final analysis of alectinib as a neoadjuvant treatment for patients with potentially resectable stage 3, ALK-positive NSCLC.

“I think here we’re seeing more encouraging data where the path CR [pathological complete response] rate was a little bit higher,” Dr. Das explained. “I believe it was 12% or 13%, so better than the single digits that we saw in NeoADAURA. I’m excited about the idea of using other modalities, such as ctDNA [circulating tumor DNA] or looking at other ways of predicting whether patients are responding to these drugs and how much of the drug they need. I think that’s one of the big pushes forward—to really be able to individualize treatment beyond [not] just the driver mutation, but duration of treatment.”

Dr. Liu also expressed excitement about the final analysis of alectinib, but noted an important question that oncology healthcare professionals should consider: “What is in the best interest of the patient?”

“We look at path CR rates. We want them to be high, but we also have to know that pathological complete response—its value right now in our current standards in the setting of immunotherapy where it really predicts long-term survival, maybe cure. I don’t know that the same thing applies to targeted therapy,” Dr. Liu explained. “We have to prove that path CR is a good surrogate for survival and these are early data, so we have to wait and see. That said, I’m also very excited about this. I think these [data] are exciting because of that word potentially, and one thing these TKIs [tyrosine kinase inhibitors] do isthey can shrink cancers. We can get responses right there. So, if someone has a borderline resectable or, frankly, unresectable tumor, but I say we can shrink that by 40% within a couple weeks, would that facilitate resection, lobectomy? There are bigger questions.”