ESMO Expert Consensus Statements: A new resource to offering doctors practical guidance in unmet areas of oncology

ESMO, the leading professional organization for medical oncology, announces a new series of resources designed to guide physicians in areas of oncological practice not covered by guidelines, where current evidence is insufficient to evenly inform clinical decision-making. The ESMO Expert Consensus Statements on the Management of EGFR Mutant Non-Small Cell Lung Cancer published this month in Annals of Oncology constitute an example of the ongoing effort by ESMO to bring together leading specialists in the field to shed light on issues in cancer care that are either controversial or represent burning questions for the practicing oncologists. 

"The pace of progress in oncology, driven simultaneously by advances in our molecular understanding of cancer and by the unprecedented number of new medicines entering the clinic, inevitably creates gaps in evidence that leave us, as physicians, in doubt about how best to manage certain cases in our practice," said ESMO Director of Education Prof. Florian Lordick, University of Leipzig, Germany. "The ESMO Expert Consensus Statements will meet clinicians in these gaps to offer orientation until more robust data becomes available, in line with ESMO's commitment to providing doctors with continuous education and ensuring access to high-quality care for all cancer patients."  

Following a modified methodology developed by ESMO in order to guide cancer patient management during the COVID-19 pandemic, the newly published paper presents the results of a consensus-building process on EGFR mutant non-small cell lung cancer (NSCLC) held by ESMO in 2021. The virtual meeting brought together a multidisciplinary panel of 34 international experts on lung cancer to discuss open questions in the management of this tumor subtype, including patient needs and perspectives represented by EGFR-positive patient advocate Jill Feldman. 

The introduction of EGFR-targeted therapy in the last 15 years has drastically changed the treatment landscape of a disease representing about 15% of non-small cell lung cancers, and there are areas where the optimal approach is still unclear. For example, when it comes to choosing a treatment for patients with concurrent targetable mutations besides EGFR. "We explored this and other issues where the evidence is either limited or conflicting with the aim of producing actionable insights to support oncologists' decision-making in situations that currently cannot be adequately addressed in the evidence-based ESMO Clinical Practice Guidelines," said ESMO Chief Medical Officer and paper co-author Prof. George Pentheroudakis explaining the importance of this work. 

A total of 29 consensus statements were developed covering the role of tissue and biomarker analyses, treatment and follow-up approaches for both early-stage and metastatic disease, as well as the need to initiate specific molecular-driven and molecular-agnostic clinical trials in the future. "Each statement is supported by findings from the panel discussions and accompanied by consensus recommendations with a summary of the evidence supporting them, thus offering a detailed picture for doctors to consider how to translate it to individual patients in their practice," Pentheroudakis added.  

Noting that efforts are already underway to apply this methodology to further areas of oncological care where uncertainty exists—among them, cancer survivorship care and research, the optimisation of the management of cancer patients treated with radiotherapy concurrently with immunotherapy or targeted agents, and the management of pregnancy-associated breast cancer—Pentheroudakis concluded that "this document stands as a point of reference for future therapeutic steps in the field of EGFR mutant non-small cell lung cancer, at a time when new perspectives are continuing to emerge for pathologies with EGFR mutations thanks to the approval of new drugs for specific alterations and the active search for strategies to optimize first-line treatment and better manage resistance. Going forward, ESMO will work consistently to provide the best answers available to other pressing questions that oncology professionals—and patients—need us to address."