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ESMO 2025 Lung Cancer

CME

Key Studies in Lung Cancer: Independent Conference Coverage of ESMO 2025

European Learners: 1.50 EBAC® CE Credit

Physicians: Maximum of 1.50 AMA PRA Category 1 Credits™

Released: December 16, 2025

Expiration: June 15, 2026

Luis Paz-Ares
Luis Paz-Ares, MD, PhD
David Planchard
David Planchard, MD, PhD
CME/CE Information

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MDT-BRIDGE: Phase II Trial of Neoadjuvant Durvalumab + CT and Subsequent Surgery With Adjuvant Durvalumab or CRT + Consolidation Durvalumab for Resectable Stage IIB-IIIB NSCLC

Luis Paz-Ares, MD, PhD:
The main question of the nonrandomized, exploratory MDT-BRIDGE phase II study was whether it is feasible to begin neoadjuvant treatment with chemoimmunotherapy—specifically chemotherapy plus durvalumab—before deciding definitively between surgery and local treatment such as chemoradiation for patients with resectable or borderline-resectable tumors.1

This question reflects what often happens in real-world multidisciplinary practice. When a patient sits on the borderline between a surgical approach and a chemoradiation approach, we are frequently unsure about committing to a full treatment pathway up front. Instead of making the entire decision at the beginning, we typically start with chemoimmunotherapy, reassess how the tumor responds and how the patient is doing, and then decide whether surgery or chemoradiation is the better path. This study sought to formalize and evaluate this decision-making approach. Rather than deciding everything at baseline, the idea was to make the final treatment decision after the initial cycles of chemoimmunotherapy.

In terms of design, the trial enrolled patients with resectable or borderline-resectable tumors who were medically fit for surgery, including adequate cardiac and pulmonary function. All patients received 2 cycles of chemotherapy plus durvalumab followed by reevaluation. At that point, a decision was made; patients would either proceed to radical surgery or to definitive chemoradiotherapy. Patients selected for surgery were given a third cycle of chemoimmunotherapy before the operation. After completing either surgery or chemoradiation, patients were considered for additional durvalumab treatment. This structure allowed investigators to test whether a response-guided approach—delaying the definitive choice until after neoadjuvant therapy—could help refine treatment selection in a complex, borderline-resectable population.

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MDT-BRIDGE: Change in Resectability and Local Treatment

Luis Paz-Ares, MD, PhD:
I think an important finding was that through neoadjuvant therapy and reassessment, more than 95% of patients were candidates for local treatment, whether surgery or chemoradiotherapy.

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MDT-BRIDGE: Resection Rates and Outcomes (Primary Endpoint)

Luis Paz-Ares, MD, PhD:
Of equal importance is what happened in the borderline resectable group of patients. After neoadjuvant therapy, 71.4% of these patients were considered resectable, and 86% of all patients in the study underwent surgery. In most cases, the surgery achieved an R0 resection, which is precisely the oncologically adequate outcome we aim for.

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MDT-BRIDGE: Presurgery/CRT ORR and pCR

Luis Paz-Ares, MD, PhD:
Of importance, roughly 28% of patients considered resectable after neoadjuvant therapy achieved a pCR at the time of resection, meaning no residual viable tumor was found. This is very important clinically, because patients with a pCR have an excellent prognosis—historically, more than 90% of them do not experience relapse.

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MDT-BRIDGE: Safety

Luis Paz-Ares, MD, PhD:
In terms of safety, the trial showed that both the neoadjuvant chemoimmunotherapy and the adjuvant durvalumab performed as expected, with no new safety signals identified. The treatments were consistent with their known safety profiles.

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MDT-BRIDGE: Clinical Implications

David Planchard, MD, PhD:
The MDT-BRIDGE study really brings forward a compelling new concept for managing patients with borderline resectable or initially unresectable NSCLC. In routine practice today, we tend to separate patients into 2 clear pathways: those with clearly resectable disease who receive neoadjuvant chemoimmunotherapy followed by surgery, and those with unresectable disease who receive chemoradiotherapy followed by consolidation immunotherapy. What MDT-BRIDGE attempts to explore is the ‘in-between’ and whether induction chemoimmunotherapy can convert them into surgical candidates.

Luis Paz-Ares, MD, PhD:
MDT-BRIDGE showed that this strategy is indeed feasible, and that making the surgical vs chemoradiation decision after 2 cycles of neoadjuvant chemoimmunotherapy rather than at baseline is possible and oncologically reasonable. The early data support the idea that our treatment algorithms may eventually be more dynamic.

David Planchard, MD, PhD:
Exactly. And the clinical signal is striking. After just 2 cycles of chemotherapy plus durvalumab, a majority of these borderline patients became resectable and approximately 82% went to surgery. This suggests that neoadjuvant chemoimmunotherapy might meaningfully shift the treatment paradigm by converting patients who would otherwise receive definitive chemoradiation into surgical candidates, which could have long-term outcome implications.

Luis Paz-Ares, MD, PhD:
Of course, we need to remember that MDT-BRIDGE is not a randomized trial comparing chemoradiation against chemoimmunotherapy followed by surgery. In addition, definitions of resectability evolve; patients considered unresectable years ago might now be seen as resectable or borderline resectable. I fully agree that the feasibility is exciting, but we must be cautious. For patients who are clearly unresectable, this approach may be quite sensible. But for those who are borderline, I would still argue that the multidisciplinary team’s individualized judgment remains essential.

David Planchard, MD, PhD:
Yes, I agree completely. Also, from a safety standpoint the strategy appears manageable with no unexpected toxicities. But again, this is an early, nonrandomized study result. To truly change practice, we will need prospective randomized evidence.

Luis Paz-Ares, MD, PhD:
There are some early randomized efforts. For instance, within this year’s ESMO presentations, another study in initially unresectable disease used induction chemotherapy plus immunotherapy, serplulimab in that case, and then reassessed patients.2 Those who converted to resectable disease were randomized to surgery or radiotherapy. Although the trial was small, the early event-free survival data favored surgery. This was the LungMate-013 trial, and although preliminary, the results of these 2 studies are consistent.

David Planchard, MD, PhD:
So we are seeing a convergence of early signals—biologically plausible, clinically encouraging, but still hypothesis-generating.

Luis Paz-Ares, MD, PhD:
Absolutely. MDT-BRIDGE doesn’t change practice today, but it opens the door. It shows the concept is viable and gives us a strong rationale to test, in randomized trials, whether neoadjuvant chemoimmunotherapy can reliably convert borderline or unresectable NSCLC into operable disease and whether that ultimately improves outcomes.

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