The European Society for Medical Oncology (ESMO) Congress in Madrid in October 2026 brought several important results for people with lung cancer. Two of them could change how treatment is chosen in the coming years.
The SAFFRON trial looked at what to do when EGFR-positive lung cancer stops responding to the tablet osimertinib, and showed that two tablets can do better than chemotherapy for some people. The OptiTROP-Lung06 trial looked at the very first treatment for advanced lung cancer, and tested a targeted “smart chemotherapy” in place of standard chemotherapy.
Dr Dionysis Papadatos-Pastos, a consultant medical oncologist in London specialising in lung cancer, mesothelioma and thymic tumours, explains what each trial found and what it may mean for patients. Our article on divarasib and the KRAScendo 1 trial covers another key study from the same congress.
Topics Covered
Topics Covered
Topics Covered
Topics CoveredSAFFRON: When EGFR Lung Cancer Stops Responding to Osimertinib
Osimertinib is a targeted tablet used for lung cancer with an EGFR gene change, and for many people it controls the cancer well, often for years. Our article on EGFR mutations in lung cancer explains this treatment in more detail.
Over time, however, the cancer can find a way around osimertinib and start growing again. One of the most common ways it does this is by switching on a second growth signal called MET. In these cancers, MET acts like a back-up engine: osimertinib still blocks EGFR, but the cancer keeps growing through MET.
What the SAFFRON Trial Tested
SAFFRON included 338 people with EGFR-positive advanced lung cancer that had grown again on osimertinib, and whose tests showed that the cancer now relied on MET.
Half continued osimertinib and added a second tablet, savolitinib, which blocks MET. The other half switched to standard chemotherapy (platinum and pemetrexed), which is the usual next step in this situation.
What SAFFRON Found
The two-tablet combination did better than chemotherapy on the main measures:
- Shrinking tumours: tumours shrank in about half of people on the combination, about twice as often as with chemotherapy.
- Keeping the cancer under control: the cancer was held in check for longer, about 7.6 months on average compared with 5.4 months.
- Living longer: people lived about five months longer on average (17.8 months compared with 12.9 months). These survival results are still early and will become clearer with longer follow-up.
Swelling of the ankles and legs was common with the combination, and some people needed to stop treatment because of side effects. Severe side effects caused by the treatment itself were less common than with chemotherapy, but the overall number of serious health problems during treatment was higher in the combination group. This is why treatment needs careful monitoring by an experienced team.
The results were presented at ESMO 2026 and published at the same time in the New England Journal of Medicine.
Why Re-Testing Matters When Cancer Grows
The most important message from SAFFRON for patients is that re-testing the cancer matters. When EGFR lung cancer grows on osimertinib, the reason is not the same for everyone. Only about a third of people tested for SAFFRON had the MET change needed for this approach.
Finding the reason usually means a new biopsy or a blood test (liquid biopsy) at the time of progression. Our article on molecular profiling and biomarker testing explains how these tests work.
Savolitinib is not licensed in the UK. The combination has been submitted for approval in the United States, and it may be available in some clinical trials. If your cancer has grown on osimertinib, it is reasonable to ask your team about re-biopsy or blood testing, and whether MET is part of the testing.
OptiTROP-Lung06: A New Option for First Treatment
The second trial looked at people with newly diagnosed advanced non-small cell lung cancer (non-squamous type) with no targetable gene change, whose tumours did not show a marker called PD-L1. Immunotherapy alone works less well in these cancers, so the usual first treatment is immunotherapy (pembrolizumab) combined with standard chemotherapy. Our article on immunotherapy for lung cancer explains how PD-L1 is used to plan treatment.
OptiTROP-Lung06 kept pembrolizumab but replaced the standard chemotherapy with sacituzumab tirumotecan (sac-TMT), an antibody-drug conjugate. This is a targeted drug that carries chemotherapy straight to cancer cells, like a guided missile. It recognises a protein called TROP2 on the surface of cancer cells and releases its chemotherapy inside them, with less effect on healthy cells. Our article on antibody-drug conjugates in lung cancer explains this group of treatments.
What OptiTROP-Lung06 Found
The trial included 455 people. The new combination kept the cancer under control for much longer: about 15 months on average, compared with about 5.7 months with pembrolizumab and standard chemotherapy, roughly two and a half times as long.
Early signs suggest that people may also live longer, but this is not yet confirmed and needs longer follow-up. Severe side effects, especially low blood counts, were less common than with standard chemotherapy. Mouth sores were common with sac-TMT and were mostly mild.
The trial was carried out in China, and the results were presented at ESMO 2026 and published in the New England Journal of Medicine.
What OptiTROP-Lung06 Means for Patients
This is a strong sign that targeted “smart chemotherapy” could replace standard chemotherapy in first treatment for some people. It now needs confirming in trials that include patients worldwide, and several international trials of sac-TMT with pembrolizumab are under way.
Sac-TMT is not licensed in the UK, and it has so far been submitted for approval only in China. For now, it can only be given within clinical trials outside China. If you are starting treatment for advanced lung cancer, your oncologist can tell you whether a clinical trial may be suitable for you.
What These Trials Mean for You
Both trials point in the same direction: treatment for lung cancer is becoming more precise. It is increasingly guided by the features of each person’s cancer, both at diagnosis and when the cancer changes.
Neither treatment is yet available in routine care in the UK. Results from congresses such as ESMO usually take time to reach patients, as they first need regulatory approval and, for the NHS, a funding decision. In the meantime, these results may open doors to clinical trials, and they underline the value of thorough testing at each stage.
A specialist consultation offers time to review your test results, a second opinion on your treatment plan and input from a multidisciplinary team, and it can work alongside NHS care. Preparing a few questions to ask your oncologist can help you make the most of each appointment.
Conclusion
SAFFRON showed that, for EGFR lung cancer that has grown on osimertinib because of MET, two tablets can work better than chemotherapy, which makes re-testing at progression more important than ever. OptiTROP-Lung06 showed that a targeted antibody-drug conjugate may one day replace standard chemotherapy in first treatment for some people. Neither treatment is yet approved in the UK, but both are important steps forward.
If you or someone close to you has lung cancer and would like to discuss these results or treatment options, Dr Papadatos-Pastos sees patients privately at several London clinics and offers both in-person and virtual consultations.
Support and Follow-Up Care
Dr Papadatos-Pastos and his team provide ongoing support beyond medical treatment.
Patients receive clear communication, psychological care and access to nutrition, physiotherapy and symptom-management services.
Regular follow-up ensures early detection of recurrence and long-term wellbeing.
Book a Consultation
If you or someone close to you has been diagnosed with lung cancer, early consultation with a specialist can make a real difference. Appointments are available at several London clinics.
Faq
Answers to Common Questions
Patients and families often have questions about new results from ESMO 2026. Here are short answers to the questions we hear most often.
SAFFRON is a clinical trial for people with EGFR-positive advanced lung cancer that had grown on osimertinib because of a second growth signal called MET. It compared osimertinib plus savolitinib, a tablet that blocks MET, with standard chemotherapy. The two-tablet combination shrank tumours more often, controlled the cancer for longer and helped people live longer.
It is reasonable to ask whether the cancer will be re-tested, with a new biopsy or a blood test, to find out why it is growing. This can show changes such as MET that may point to a different treatment or a clinical trial.
No. Savolitinib is not licensed in the UK. The combination of savolitinib and osimertinib has been submitted for approval in the United States, and it may be available within clinical trials.
OptiTROP-Lung06 is a clinical trial for people starting treatment for advanced non-squamous non-small cell lung cancer with no targetable gene change and no PD-L1. It replaced standard chemotherapy with sac-TMT, an antibody-drug conjugate, alongside the immunotherapy pembrolizumab. The new combination controlled the cancer about two and a half times as long.
An antibody-drug conjugate is a targeted treatment that combines an antibody, which recognises a protein on cancer cells, with a chemotherapy drug. It carries the chemotherapy straight to the cancer cells, with less effect on healthy cells.
Not in routine care in the UK. Both treatments still need regulatory approval, and for the NHS a funding decision. They may be available within clinical trials, and your oncologist can advise whether a trial may be suitable for you.
