The Best Science Presented at the 2025 European Society for Medical Oncology
The STS 2025 Best of Lung Cancer Science special edition podcast series offers members direct access to the most relevant and practice-changing science in lung cancer, curated and interpreted by thoracic surgeons for thoracic surgeons.
This executive summary breaks down the key takeaways on pivotal research and emerging themes from top studies presented at the 2025 European Society for Medical Oncology (ESMO).
Gain insight into the evolving science transforming surgical management and multidisciplinary care of lung cancer, featuring perspectives from Erin Gillaspie, MD, thoracic surgeon and surgical oncologist, Chief of Thoracic Surgery at CHI Health; Jessica Donington, MD, thoracic surgeon and surgical oncologist, Chief of Thoracic Surgery at UChicago Medicine; and Christine Bestvina, MD, medical oncologist and Associate Professor of Medicine at UChicago.
1. The Targeted Era: Cementing ALK Inhibitors in Early-Stage Care
• Drs. Donington and Bestvina reviewed updated data from ALINA and ELEVATE, underscoring how ALK inhibitors are redefining adjuvant therapy for resected ALK-positive NSCLC.
• ALINA Update: With four years of follow-up, adjuvant alectinib markedly improved disease-free survival over platinum-based chemotherapy, reinforcing its role as a standard adjuvant therapy.
• CNS Protection: Alectinib continued to show robust intracranial efficacy, with 90% of patients remaining free from CNS recurrence at four years. Dr. Bestvina emphasized that “the brain is the most important real estate,” highlighting the quality-of-life implications of CNS control.
• ELEVATE Trial: Evaluating adjuvant ensartinib, ELEVATE followed a schema more akin to ADAURA, permitting chemotherapy prior to randomization. The inclusion of a substantial Stage IB population reinforced the class-wide benefit of second-generation ALK TKIs, particularly in younger, never-smoking patients.
2. Surgical Quality as the Foundation for Precision Therapy
• Dr. Donington emphasized that the success of adjuvant targeted therapies is contingent upon high-quality surgical staging. Inadequate lymph node assessment risks understaging and may exclude patients from life-prolonging systemic therapy.
• The panel discussed a recalibration of what constitutes “early-stage” disease. Tumors larger than 2 cm were framed as biologically closer to locally advanced disease, necessitating lobectomy and comprehensive nodal dissection.
• Dr. Gillaspie reinforced that both ALINA and ELEVATE required R0 resections and lobectomies, cautioning against extrapolating these data to sublobar resections in larger tumors.
3. Immunotherapy Moves Earlier: Perioperative Checkpoint Inhibition
• The conversation transitioned to immunotherapy with a review of KEYNOTE-671, which reported five-year follow-up data on perioperative pembrolizumab in early-stage NSCLC.
• The panel highlighted the durability of benefit with the perioperative approach, reinforcing the concept that integrating immunotherapy before and after surgery can meaningfully improve long-term outcomes.
• These findings further support a multidisciplinary model in which systemic therapy is no longer an adjunct to surgery, but a core component of curative-intent care.
4. Expanding the Neoadjuvant Space: MDT-BRIDGE and Borderline Resectable Disease
• MDT-BRIDGE interim data evaluating neoadjuvant durvalumab plus chemotherapy in resectable and borderline resectable Stage IIB–IIIB NSCLC were discussed as a paradigm-expanding study.
• Dr. Bestvina highlighted that delivering chemoimmunotherapy upfront—rather than concurrently—resulted in high radiographic response rates (~60%), enabling tumor shrinkage that may reduce radiation fields and improve long-term outcomes.
• The panel emphasized the importance of multidisciplinary coordination when treating borderline resectable disease, where neoadjuvant immunotherapy may improve resectability and pathologic response.
• These data highlight the expanding role of thoracic surgeons as collaborative leaders in treatment planning and sequencing across the continuum of care.
Main Points:
• Adjuvant alectinib demonstrates sustained DFS benefit and exceptional CNS protection through four years of follow-up in ALK-positive early-stage NSCLC.
• Ensartinib, as evaluated in the ELEVATE trial, reinforces the efficacy of ALK TKIs across different adjuvant treatment schemas, including post-chemotherapy use.
• Perioperative immunotherapy (KEYNOTE-671) provides durable long-term benefit, supporting its integration into curative-intent treatment strategies for early-stage NSCLC.
• Neoadjuvant durvalumab plus chemotherapy (MDT-BRIDGE) highlights the growing importance of multidisciplinary planning in managing borderline resectable disease.
Bottom Line:
The data from recent landmark trials discussed at the 2025 ESMO Congress underscore a fundamental shift in early-stage lung cancer care: surgery, targeted therapy, and immunotherapy are now inseparable. For thoracic surgeons, excellence extends beyond the operating room to include meticulous staging, early biomarker testing, and close collaboration with medical oncologists to ensure patients can access the full potential of modern perioperative therapies.