Another brainstorming #ILCS26 in Lausanne hosted by @Alfdoc2 and @peters_solange with @HHorinouchi giving a state-of- the art current #EGFR and #ALK landscape in #NSCLC, including the plethora of options and issues on access, cost and QoL 👏
[Slide 2]
EGFR-POSITIVE NSCLC AS A TEXTBOOK OF TARGETED THERAPY
[Matrix of colored boxes; column headers: Chemo | VEGFi | 3rd G | 2nd G | 1st G | EGFR Select | Partially Select | Non Select | 2020s | 2010s | 2000s]
[Bar chart, median PFS by trial:]
IDEAL-1 | 2.7 m
BR.21 | 2.2 m
ISEL | 3 m
INTEREST | 2.2 m
V-15-32 | 2 m
ICOGEN | 4.6 m
IPASS | 5.7 m
First-SIGNAL | 5.8 m
WJTOG3405 | 9.2 m
NEJ002 | 10.8 m
OPTIMAL | 13.1 m
EURTAC | 9.7 m
CONVINCE | 11.2 m
LUX-Lung 3 | 11.1 m
LUX-Lung 6 | 11 m
LUX-Lung 7 | 11 m
ARCHER 1050 | 14.7 m
JO25567 | 16 m
NEJ026 | 16.9 m
CTONG1509 | 17.9 m
BEVERLY | 15.4 m
RELAY | 19.4 m
FLAURA | 18.9 m
AENEAS | 19.3 m
FURLONG | 20.8 m
LASER301 | 20.6 m
NEJ009 | 20.9 m
FLAURA2 | 25.5 m
[Inset Kaplan–Meier curves labeled ISEL, IPASS, NEJ002; inset text illegible]
[citation list, small print: Fukuoka M et al., JCO, 2003; Shepherd FA et al., NEJM, 2005; Thatcher N et al., Lancet, 2005; Kim ES et al., Lancet, 2008; Maruyama R et al., JCO, 2008; Shi Y et al., Lancet Oncol, 2013; Mok TS et al., NEJM, 2009; Han JY et al., JCO, 2012; Mitsudomi T et al., Lancet Oncol, 2010; Maemondo M et al., NEJM, 2010; Zhou C et al., Lancet Oncol, 2011; Rosell R et al., Lancet Oncol, 2012; Shi YK et al., Ann Oncol, 2017; Sequist LV et al., JCO, 2013; Wu YL et al., Lancet Oncol, 2014; Park K et al., Lancet Oncol, 2016; Wu YL et al., Lancet Oncol, 2017; Seto T et al., Lancet Oncol, 2014; Saito H et al., Lancet Oncol, 2019; Zhou Q et al., Cancer Cell, 2021; Piccirillo MC et al., JTO, 2022; Nakagawa K et al., Lancet Oncol, 2019; Soria JC et al., NEJM, 2018; Lu S et al., JCO, 2022; Shi Y et al., Lancet Respir Med, 2022; Cho BC et al., JCO, 2023; Hosomi Y et al., JCO, 2020; Planchard D et al., NEJM, 2023; Cho BC et al., NEJM, 2024; Wu YL et al., ESMO, 2025 — partly illegible]
Hidehito Horinouchi, MD, PhD. @Hhorinouchi horinou@ncc.go.jp
ILCS 2026
[photo of speaker inset at right]
---
[Slide 3]
ALK-POSITIVE NSCLC AS ANOTHER TEXTBOOK OF TARGETED THERAPY
[Matrix of colored boxes; column headers: 3rd G | 2nd G | 1st G | ALK Select | 2020s | 2010s]
[Bar chart, median PFS by trial:]
PROFILE 1001 | 9.7 m
PROFILE 1007 | 7.7 m
PROFILE 1014 | 10.9 m
PROFILE 1029 | 11.1 m
ASCEND-4 | 16.6 m
ALTA-1L | 24 m
eXalt3 | 25.8 m
Envonalkib | 24.87 m
INSPIRE | 27.7 m
AF-001JP | 40 m
J-ALEX | 34.1 m
ALEX | 34.8 m
ALESIA | 41.6 m
CROWN | >84 m
[Inset Kaplan–Meier curve labeled CROWN; inset text (median follow-up for PFS in lorlatinib and crizotinib arms, numbers-at-risk table) too small to read: illegible]
EGFR-POSITIVE NSCLC
• EGFR-TKIs: Born WITHOUT rational biomarkers
• Relatively HETEROGENEOUS tumor from beginning
• Transition to COMBINATION strategies even in 1st line.
ALK-POSITIVE NSCLC
• ALK-TKIs: Born WITH rational biomarker
• Relatively UNIFORM tumor especially in 1st line
• TKI MONOTHERAPY remaining standard in 1st line
[citations, small print, partly illegible: Kwak EL et al., NEJM, 2010; Shaw AT et al., NEJM, 2013; Solomon BJ et al., NEJM, 2014; Wu YL et al., JTO, 2018; Soria JC et al., Lancet, 2017; Camidge DR et al., NEJM, 2018; Horn L et al., JAMA Oncol, 2021; Yang Y et al., STTT, 2023; Seto T et al., Lancet Oncol, 2013; Hida T et al., Lancet, 2017; Peters S et al., NEJM, 2017; Zhou C et al., Lancet Respir Med, 2019; Shaw AT et al., NEJM, 2020]
Hidehito Horinouchi, MD, PhD. @Hhorinouchi horinou@ncc.go.jp
ILCS 2026
[photo of speaker inset at right]
---
[Slide 4]
STRUGGLES TO OVERCOME RESISTANCES
[Matrix of colored boxes; column headers: EGFR/HER3 ADC | METi | EGFRi | TROP2 ADC | HER3 ADC | VEGFi | ICI | Chemo | 3rd G | 1st G | MET Select | EGFR Select | 2020s | 2010s]
[Bar chart, median PFS by trial:]
IMPRESS | 5.4 m
KEYNOTE-789 | 5.6 m
CheckMate 722 | 5.6 m
ORIENT-31 | 7.2 m
ATTLAS | 8.48 m
NEJ043 | 7.4 m
IMpower 151 | 8.5 m
HARMONi-A | 7.1 m
HARMONi | 6.8 m
HERTHENA-Lung01 | 5.5 m
HERTHENA-Lung02 | 5.8 m
TROPION-Lung05 | 5.8 m
OptiTROP-Lung04 | 8.3 m
MARIPOSA-2 | 6.3 m
SACHI | 8.2 m
SAFFRON | 7.6 m
PANKU-Lung01 | 11.1 m
[Inset Kaplan–Meier curves labeled KEYNOTE 789, HARMONi, OptiTROP-Lung04; inset text illegible]
ISSUES IN CLINICAL DEVELOPMENT
• EMERGING but UNSATISFACTORY new strategies with mPFS around 5-10 months
• COMBINATION strategies necessary, especially in TKI resistant EGFR+ NSCLC
• Limited new BIOMARKERS other than classical actionable gene alterations ("MET High" first in 25 years)
[citations, small print: Soria JC et al., Lancet Oncol, 2015; Yang JC et al., JCO, 2024; Mok T et al., JCO, 2024; Lu S et al., Lancet Oncol, 2022; Park S et al., JCO, 2024; Watanabe S et al., EJC, 2024; Zhou C et al., Nat Med, 2025; Fang W et al., JAMA, 2024; Le X et al., Lancet Oncol, 2026; Yu HA et al., JCO, 2023; Mok T et al., ASCO, 2025; Sands J et al., JCO, 2025; Fang W et al., NEJM, 2025; Passaro A et al., Ann Oncol, 2024; Lu S et al., Lancet, 2025; Lu S et al., NEJM, 2026; Zhang L et al., Lancet, 2026]
Hidehito Horinouchi, MD, PhD. @Hhorinouchi horinou@ncc.go.jp
ILCS 2026
[photo of speaker inset at right]