TROPION-Lung12: A phase 3 study of adjuvant datopotamab deruxtecan and rilvegostomig in ctDNA-positive or high-risk pathology stage I non-small cell lung cancer.

backgroundFive-year disease recurrence rates for patients with stage I non-small cell lung cancer (NSCLC) postsurgery are variable (15%-40%). There is an urgent need for novel biomarker strategies to identify high-risk patients who may benefit from adjuvant treatment. High-risk pathologic features, including high-grade histology and lymphovascular or visceral pleural invasion, serve as independent risk factors for worse outcomes. Preoperative circulating tumor DNA (ctDNA) detection is also correlated with poorer outcomes in stage I NSCLC. Datopotamab deruxtecan (Dato-DXd), an antibody-drug conjugate composed of a humanized anti-TROP2 antibody conjugated to a potent topoisomerase I inhibitor via a plasma-stable linker, and rilvegostomig, an Fc-reduced monovalent bispecific humanized IgG1 antibody targeting both PD-1 and TIGIT receptors, have shown promise in NSCLC studies. Combining Dato-DXd with rilvegostomig may improve treatment outcomes in selected patients with stage I NSCLC.

methodsTROPION-Lung12 (NCT06564844) is a phase 3 randomized study enrolling approximately 660 patients with stage I adenocarcinoma without actionable genomic alterations who have undergone complete surgical resection. Eligible patients must have preoperative ctDNA-positive status or 1 or more high-risk pathologic features. Patients will be randomized 2:1:2 to receive Dato-DXd (6 mg/kg intravenously [IV] every 3 weeks) plus rilvegostomig (750 mg IV every 3 weeks) for 4 cycles, followed by rilvegostomig (up to 12 months/18 cycles total), rilvegostomig alone (up to 12 months/18 cycles total), or standard of care (SoC) for up to 12 months. The primary endpoint is disease-free survival, assessed using blinded independent central review according to RECIST v1.1, with key secondary endpoints including overall survival, for the Dato-DXd plus rilvegostomig arm versus the SoC arm.