At #ELCC25, Prof. Benjamin Besse from Gustave Roussy delivered an amazing and inspiring presentation on the potential of treatment de-escalation in thoracic oncology.
While drug de-escalation strategies continue to gain traction, challenges—including limited research funding—still hinder their broader implementation. The primary goal of de-escalation is to spare patients unnecessary toxicity and reduce the burden of frequent hospital visits, with the potential added benefit of reducing treatment costs within our health systems.
Immunotherapy, particularly PD-1 and PD-L1 inhibitors, has been a major focus for de-escalation due to their pharmacokinetics, which allow flexibility in dosing. Three main approaches have been explored:
✅ Reducing treatment duration: Although PD-1/PD-L1 inhibitors are often prescribed for at least two years, retrospective studies suggest no clear benefit to continuing beyond this period. The DIAL trial (NCT05255302) is currently investigating whether stopping treatment after six months, with the option to reintroduce it upon progression, might yield similar outcomes.
✅ Extending dosing intervals: Trials such as the French PULSE study and the UK’s REFINE-Lung trial (NCT05085028) are evaluating whether immunotherapy can be given less frequently while maintaining efficacy.
✅ Lowering the dose: Some early studies suggest that much lower doses of certain immunotherapies may still provide clinical benefit, particularly in resource-constrained settings. However, cost savings depend on drug pricing models, which do not always align with dose reductions.
While these strategies hold promise, de-escalation must be grounded in strong biological rationale and tailored to each drug class.
So, what’s needed to move the field forward?
🔬 Biomarker research to identify which patients can safely undergo de-escalation.
💰 Greater investment in de-escalation trials, as long-term cost savings could offset trial expenses.
📄 Regulatory adaptation to ensure evidence-based dosing changes are incorporated into guidelines.
Collaboration among researchers, clinicians, industry, and regulators will be key to making drug de-escalation a safe and effective reality.
#Oncology #Immunotherapy #DrugDe-escalation #CancerResearch #LungCancer #ESMOAmbassadors ESMO - European Society for Medical Oncology
