Key Takeaways from the 2025 European Lung Cancer Congress

Overall, the team was struck by both the significant advancements we continue to achieve for patients but also the mounting challenges in navigating an increasingly complicated treatment landscape.

2025 marks 10 years since the approval of two transformational treatments in NSCLC, pembrolizumab and osimertinib. Whilst both TKIs and IOs remain cornerstones of therapy, significant unmet needs remain. Data from ELCC leaves us optimistic that the latest wave of innovations will continue to advance outcomes, albeit not without some ‘growing pains’.  

In short, we’ve come far but we still have a way to go.

Key Takeaways

More support is needed to help physicians navigate an increasingly fragmented and complex series of treatment decisions.

• Activation and engagement of pathologists is key: Our knowledge of therapeutic targets continues to deepen paving the way for a dizzying array of targeted treatment options. As the number of treatments and targets increases so too does the important role played by pathologists. Those seeking to establish oncogene-targeted treatments in 1L, and especially 2L post-progression, must facilitate close connection between treating physicians and pathologists.
• Rebiopsy – risk and reward: Outcomes from the biomarker-selective SAVANNAH trial which assessed osimertinib + savolitinib in patients with EGFRm advanced NSCLC with MET overexpression +/- amplification post osi-progression point to the potential rewards available to those that re-biopsy. However, rebiospy-induced delays to treatment in these rapidly progressing patients have the potential to be catastrophic. This may lead physicians down the path of existing biomarker-agnostic regimens such as MARIPOSA-2 (amivantamab+chemotherapy).
• New tools and technology should be embraced to inform decision making: A number of prognostic markers are now established including ctDNA, co-mutations and additional sites of metastases. These prognostic markers, whilst adding an increasing level of complexity, can play a critical role in patient stratification. Here novel technologies including artificial intelligence (there’s really no escaping it!) can advance the field. Those that can best integrate these tools without succumbing to the hype are best placed to win.
• Where do I go next? Sequencing challenges:  Targeted therapies continue to move earlier and earlier within the treatment paradigm with an increasing number of options across each stage. Determining the optimal treatment sequence is often confounded by trial designs and a desire to preserve later line options. Whilst pharma seeks to provide answers, the practice of treating with your best option first stands true.

Within an increasingly crowded and complex treatment landscape the winners will be those that can keep it simple for oncologists. Pharma must go beyond answering Why me? and also address Which patients? and What next?

As first line combination therapies continue to advance outcomes in metastatic NSCLC the role of supportive care strategies becomes increasingly important.

• The next era of EGFR-mutated advanced NSCLC is here: One highly anticipated readout was the final overall survival analysis from the MARIPOSA trial assessing amivantamab in combination with lazertinib vs. osimertinib. The results demonstrated a significant overall survival benefit for the amivantamab + lazertinib combination with median overall survival projected to reach over 4 years. Whilst we eagerly await the OS results from the FLAURA-2 trail (osimertinib + platinum chemotherapy), it is clear that significantly greater efficacy is available for EGFR-mutated patients with combination therapy.
• With more combinations coming, it’s important we get the balance right:  Updated data from the KRYSTAL-7 and KROCUS trials underlined the promising efficacy achieved by multi-targeted combination therapies in the first-line treatment of patients with advanced/metastatic KRAS_G12C-mutated NSCLC. As anticipated these combinations also come with higher levels of toxicity. Given the additional toxicity associated with combination treatment – the question becomes how can we best manage key AEs and for whom are these regimens best / not suited?
• Evidence-based supportive care strategies are required: It’s important that physicians are equipped to ensure a positive treatment experience for their patients. The COCOON trial is an example of the important role pharma can play in informing supportive care strategies. The trial demonstrated significantly reduced incidence and severity of derm AEs with a prophylactic enhanced dermatologic regimen compared with standard dermatologic management following the initiation of amivantamab + lazertinib for 1L treatment of EGFR-mutated advanced NSCLC. Beyond generating additional data, it’s important that we continue to challenge and evolve the make-up of the multidisciplinary team to ensure that the right experts are consulted when building treatment plans for lung cancer patients. Ultimately this means more burden on the clinic, but with potentially additional years of patient survival at stake, it’s worth it.

In the near term, combining existing treatments will help unlock additional months and years of survival for patients. Those pharma companies that can remain solutions-focused in light of the additional treatment burden to both clinic and patients will lead this next advancement in outcomes.

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