2024年世界肺癌大会（WCLC）年会刚刚在美国圣地亚哥落幕。作为全球规模最大的肿瘤领域学术会议之一，WCLC大会发布的最新前沿进展令人目不暇接，内容更是覆盖肺癌领域的方方面面。《肿瘤瞭望》有幸现场采访了IASLC首席执行官Karen Kelly教授和2024 WCLC大会共同主席Sandip Patel教授，邀请两位专家分享2024 WCLC大会热点。
01
国际肺癌研究协会（IASLC）在2024 WCLC庆祝胸部肿瘤学领域50周年国际合作与教育事业的发展。在过去50年里，IASLC如何改善全球肺癌的预防和治疗？
Dr. Kelly: 2024 WCLC是一次非常特别的WCLC，因为正值IASLC成立50周年。在1974年，当时肺癌在全球正处于爆发阶段（尤其是在男性中，但女性中也同样如此），死亡率确实在飙升，几乎没有治疗方法，如果及早发现，可以通过手术将其切除。当时肺癌没有治愈手段，甚至没有人为了治愈肺癌而展开竞争，因为真的没有人知道该怎么做。但我认为当时有一群非常有远见的研究人员，这些外科医生和肿瘤内科医生大胆地迎接挑战，去改变不可接受的现实。他们知道抗击肺癌应采取多学科方法，需要进行全球合作，因为全球肺癌死亡在上升。他们走到了一起，并于1974年正式成立了IASLC。
自那时以来，他们取得了许多进展，只有真正的合作才能找到答案，这就是IASLC的作用所在。如果能为研究人员提供了一个交流的平台，他们永远不会缺少想法。IASLC将他们聚集在一起，因为他们对做某事充满热情，并扮演着重要研究的倡导者的角色，而且他们已经开展了如此多的研究。
回想过去，再看看当下的研究进展，你会意识到这是一段前所未有的旅程。当我在1990年代开始工作时，我无法想象肺癌研究能发展到哪一步，我只是对所有的工作感到敬畏。IASLC不仅提供了研究平台，也为世界各地的医生和研究人员提供了教育平台，助力年轻研究人员开始职业生涯。
Dr. Kelly: So yes, this is a really special WCLC because we are celebrating 50 years. When you go back to 1974 (and just to be clear, I was not involved in the very beginning of this), it was time in the world when lung cancer was really taking off, particularly in men, but also in women, where the mortality rate was really skyrocketing. At that time, there was really no treatment. If you happened to catch it early, you might have it surgically removed. I always have a phrase that I say that there wasn’t a cure, there wasn’t even a race for a cure, because really no one knew what to do. But there was a group of researchers who I believed so visionary, surgeons and medical oncologists, at that time who boldly decided to take this on - to say that this is not acceptable. But they also knew two things - that it was going to take a multidisciplinary approach, and that it was going to take a global approach, because we were seeing the worldwide mortality rate go up. With that, they got together, and in 1974 they officially formed the International Association for the Study of Lung Cancer. Since that time, they have been so many advances, that the answers can only happen if there is truly collaboration. That is where the IASLC comes in. If you provide researchers a platform to get together, they are never short on ideas. The IASLC brings them together because they are so passionate about doing something and plays the role of advocate for great research. And there has just been tremendously so much research. When you think back then and see what is happening now, it has been an unprecedented journey. When I began in the 1990s, I never would have thought that we would be where we are today. We never had any idea of where we would be. I am just in awe of all the work, and that the IASLC provides a platform for research, but also for education. It brings a platform for educating physicians and researchers around the world, but also young investigators and trying to help jumpstart their career.
Dr. Patel：我是加州大学圣地亚哥分校肿瘤内科学教授Sandip Patel医学博士，担任WCLC 2024的共同主席之一。IASLC是一个国际肺癌研究组织。癌症是我们面临的最大难题，就死亡率而言，肺癌是抗癌过程中的最大难题。IASLC从过去到现在不断演化，从收集患者治疗和各种治疗方法的国际数据，到展示所有治疗方式（外科、介入、放射学、病理学、肿瘤内科等）的最新数据，我们成为一个跨专业的国际社区，共同致力于改善患者的治疗效果。在2024 WCLC庆祝IASLC的50周年，提醒我们IASLC的历史就是改善肺癌生存的历史，而致力于改善肺癌生存的历史就是IASLC的历史。
Dr Patel: I’m Sandip Patel MD, Professor of Medical Oncology at the University of California San Diego. I am one of the co-Chairs of WCLC 2024 here in San Diego. It is a pleasure to be joining you to discuss the data.
IASLC is an international organization. Cancer is the biggest problem that we fight. Lung cancer is the biggest problem within cancer that we fight in terms of mortality. The IASLC has been involved all the way from the initial staging to modern versions, collecting international data that helps us identify patients for treatment, and different therapeutic approaches. This has morphed into the ability to present the latest data across all therapeutic modalities - surgical, interventional, radiology, pathology, medical oncology - and it is ideal that we work together as an international community across specialties to improve outcomes for patients. To celebrate our 50th year at WCLC 2024, it has really been a reminder that the history of the IASLC is the history of improving survival in lung cancer, and the history of survival for lung cancer is the history of the IASLC.
02
您能否谈谈IASLC未来与中国学术机构的合作和学术交流？
Dr. Kelly: 据我们了解，IASLC中国成员非常渴望交流，在好奇心驱动下努力学习，这值得赞赏和重视。参加WCLC是一种参与IASLC的方式，同时可参与IASLC为年轻研究人员设立的学院和国际会员计划，并申请IASLC奖项和研究项目。IASLC确实是唯一设置国际奖项的组织。IASLC为全球各地的成员提供更多机会，因为我们知道拥有这些机会可助力他们的职业生涯，这包括中国成员。下个月我将在香港参加亚洲肺癌会议，这将是见面的好机会；然后前往上海了解那里的工作方式。事实上，我不久前刚在北京度过了一段美好的时光，更重要的是获取了新的知识，以便更好地帮助所有人。
IASLC致力于为会员提供更多帮助和价值。我总是扪心自问，IASLC还能做些什么？我重申我个人想做的事情还有很多，但和你们继续建立和维持关系非常重要。
Dr. Kelly: I think one of the things we know about our Chinese members, all of whom are appreciated and valued, is that they really do crave this communication and this yearning for learning with their inquisitive minds. So coming to a meeting like this is one way to be involved, but also participating in our Academy that we have for young investigators and our international membership program, and applying for some of our awards and research projects. We truly are the only group that has international awards. We give people across the globe more opportunities because we know that having these types of opportunities help accelerate their careers, and also coming to you in China. That is really important as well. I will be in Hong Kong next month for the Asia Conference on Lung Cancer, and it is going to be a great opportunity to meet with all of you. I will be going from there to Shanghai to discover myself how you work. I was actually just in Beijing not too long ago, and I had a wonderful time. But I am gaining knowledge so that I can better help all of you. We are committed to being more helpful and more valuable. I am always going around to say, what more can we do Again, I am only one person and there is a lot that I want to do, but it is very important that we continue to build relationships and sustain relationships. It has been really fantastic.
03
能否请您评价2024 WCLC的会议主题以及会议日程安排？
Dr. Kelly: 2024 WCLC的主题是庆祝IASLC和IASLC会员50周年。我特意确保IASLC会员们都能领略部分庆祝活动，因为这次真的是为你们庆祝，是你们取得了这些惊人进步，对医生、患者和年轻研究人员进行教育，是你们付出了所有的努力，现在才出现了这些惊人的新疗法（包括手术、放疗、药物、筛查和诊断）。我真的强烈地感觉到，这次IASLC庆典必须以IASLC会员为主题，对所有IASLC会员表达欣赏和重视，这是50周年庆典活动的目标，我认为我们做到了，我们在这里度过了美妙的四天。
2024 WCLC的科学日程非常精彩，这才是推动WCLC的真正动力。伟大的科学进步激励人心，每个人都会欣然拥抱这些进步。2024 WCLC参会者充满热情，最重要的是一起庆祝IASLC成立50周年，你可以想象这里的气氛多么狂热。
Dr. Kelly: The theme this year has been about celebrating 50 years and celebrating our members. I made a point to make sure that members felt a part of the celebration, because we are really celebrating you. It is you who is making all of these wonderful discoveries and advances, and educating our physicians and patients and young researchers. It is you who is doing all the work to bring all of this to where we are today with amazing new therapies across surgery, radiation and drugs, but also screening and diagnosis. It is all of you. I really felt strongly that this conference had to be about you, and appreciating and valuing all of you as our members. That is really my goal, and I think we pulled it off. It has been an amazing four days here.
The science though has been incredible. That really drives the conference - when you have great science happening, it is motivating and passionate and everybody embraces it. There is enthusiasm, and then on top of that, to put a celebration of 50 years, my goodness gracious, you can just imagine how wild and crazy this place was.
Dr. Patel：2024 WCLC会议主题是庆祝IASLC在过去50年取得的进步，同时也思考为帮助患者IASLC还有哪些大量工作要做。至少在美国，癌症的总体死亡率在过去几年中有所改善，这主要得益于肺癌患者护理的改善，包括倡导戒烟、更好的筛查和治疗手段，合理使用新疗法，例如在局部晚期患者中应用靶向和免疫治疗，改善转移患者的治疗结局（免疫治疗可以治愈一些晚期患者），使用生存数据愈来愈持久的靶向治疗，以及为患者提供适当的姑息治疗和支持治疗。2024 WCLC的主题是确保我们全面满足癌症患者和癌症社区的需求，并在过去50年的基础上在肺癌领域更加有所作为，期待未来五十年IASLC的发展。
Dr. Patel: The theme is really celebrating the progress we’ve made in this organization over the past 50 years, but also thinking about the immense work we still have left to be done to help patients. The overall mortality from cancer, at least in the United States, has improved over the past several years driven predominantly by improvements in the care of patients with lung cancer. This includes everything from smoking cessation, to better screening and intervention, appropriate use of next-generation therapies such as targeted therapy and immunotherapy in the localized space, and improvements in the metastatic space where immunotherapy can cure some patients with advanced disease, and the use of targeted therapies which increasingly have durable efficacy, and the ability to also provide appropriate palliative and supportive care to patients and patient advocates. Making sure we are comprehensive in addressing the needs of cancer patients and the cancer community, and improving and increasing our activities in this area over the past 50 years is the theme of this year’s meeting. I am excited to see what the next 50 years will hold for this organization.
04
您对2024 WCLC哪些研究报告或主题报告印象最深刻？
Dr. Patel：我认为2024 WCLC科学日程内容非凡，强大的IASLC成员队伍使WCLC收到大量优质摘要。我在这里将快速强调几项研究。
围绕HER2外显子20插入这个新靶点和EGFR PACC突变，WCLC进行了几次会议，表明肺癌精准医疗可以特别精确，仅仅确认患者有HER2或EGFR变异是不够的，还要进一步细分，因为针对HER2外显子20插入（SOHO-01研究）和EGFR PACC（FURTHER研究）有了靶向疗法。TROPION-Lung01研究采用定量连续评分（QCS）分析TROP2表达，以此来预测患者对靶向TROP2的抗体-药物偶联物（ADC）dato-DXd的疗效，这是肿瘤学领域首次基于人工智能（AI）的数字病理学解决方案为患者选择治疗方式。就像我们十年或二十年前谈论分子测序一样，我们将在未来几年讨论基于AI的数字病理学，这是首次展示该领域的数据。对比新辅助和围手术免疫治疗的CheckMate 77T和CheckMate 816患者水平数据分析非常有趣，此前没有研究回答围手术期免疫方案中术后治疗的贡献，所以这项研究数据非常好。HARMONi-2研究显示与PD-1单抗帕博利珠单抗相比，同时抑制PD-1/VEGF的依沃西单抗改善了驱动基因突变阴性晚期NSCLC多个高风险亚组的无进展生存（PFS）,我们也热切地等待该研究中的总生存（OS）数据。
2024 WCLC展示了很多全球性研究，开展地域从欧洲到美国和加拿大，进行跨国专业合作，我认为这正是解决肺癌这种最复杂的科学难题所需要的。
Dr. Patel: I think it has been a phenomenal scientific program, and I want to congratulate the members of the society for having such strong faculty to attract such strong abstracts. I want to highlight a couple quickly. We had a couple of sessions around HER2 exon20 insertion, which is a novel target, and PACC mutations for EGFR, really showing that we can be particularly precise in precision medicine approaches. It is just not enough to say someone has a HER2 aberration or an EGFR aberration, but what is the specific molecular aberration now that we have targeted therapies. I think that is one aspect. We also had the use of artificial intelligence-based molecular pathology and digital pathology for the prediction of antibody-drug conjugate efficacy for TROP2 with datapotamab by using a QCS Score. This is the first time ever in oncology where we have an AI-based digital pathology solution for patient selection. Just like we were talking a decade or two ago about sequencing, we are going to be talking about AI-based digital pathology approaches for the years to come, and this is the first meeting to show data in that space. There were other really interesting abstracts on the neoadjuvant perioperative setting and comparing across studies, because there is no study that addresses the contribution of the backend component after surgery. So that is really nice data there. There was also some data around PD-1/VEGF combinatorial blockage with ivonescimab, which compared to pembrolizumab, had profound impacts on progression-free survival across multiple high-risk subgroups. We are eagerly awaiting overall survival data in that study as well. But a lot of global studies. These studies range from Europe to the United States and Canada and internationally employing expertise across countries. I think that is what it is going to take for us to tackle what is one the most complex scientific problems that is lung cancer.
Dr. Kelly: 2024 WCLC有很多令人印象深刻的研究，比如周彩存教授介绍的HARMONi-2研究（比较依沃西单抗与帕博利珠单抗）确实非常令人印象深刻，表明我们可能已经突破了免疫疗法的瓶颈，这太棒了。我认为，对于HER2突变肿瘤患者，口服HER2靶向药的研究进展令人印象深刻（SOHO-01研究和Beamion LUNG-1研究）。针对其他分子靶点的研究也有令人印象深刻的数据，我可以继续说下去，重要内容太多了。
Dr. Kelly: I think there were many impressive studies. Of course, the HARMONi-2 study with ivonescimab versus pembrolizumab was really very impressive, presented by Dr Zhou, showing that maybe we have broken through the plateau of where we have been with immunotherapy. That is fantastic. I think to have oral medications for HER2 for patients whose tumors have HER2 mutations is impressive. Some of the other molecular targets were also impressive. I could go on and on and on. There were just lots of impressive things.