Sunday, March 26, 2023
"Patients. Pathways. Progress" was the theme of the American Society of Clinical Oncology (ASCO®) 2011 Annual Meeting, held once again in Chicago, Illinois, from June 3 to 7. More than 32,000 clinicians, researchers, and top experts in cancer gathered to hear the latest in research and advancements.
This year marks the 40th anniversary of the signing of the National Cancer Act, which launched the "war on cancer." Topics dominating the headlines at ASCO® this year include:
• Two promising new therapies for melanoma: ipilimumab and vemurafenib
• Two potentially practice-changing studies on breast cancer
• The first new drug for myelofibrosis that offers symptom relief
• Survival benefits of tweaking treatment regimens for neuroblastoma, ALL, and GIST
• "Surprising" findings on flaxseed for hot flashes
• A call to step up efforts to improve care for cancer survivors
"Time to Celebrate"; New Metastatic Melanoma Agent Wows ASCO: An early look at data from an ongoing trial of the targeted therapy vemurafenib (PLX4032, Plexxicon/Roche) generated considerable excitement at the conference. At 6 months, the drug dramatically improved progression-free and overall survival compared with standard chemotherapy in previously untreated patients with advanced melanoma. Lead investigator Paul Chapman, MD, from Memorial Sloan-Kettering Cancer Center in New York City, reported the study findings. Vemurafenib targets the V600E mutations in the BRAF gene. An estimated 40% to 60% of melanoma patients have this type of BRAF mutation, which does not occur in normal cells.
First-Line Ipilimumab Also Improves Overall Survival: Ipilimumab (Yervoy, Bristol-Myers Squibb), approved recently in the United States as second-line therapy for advanced melanoma, is also effective as first-line therapy in melanoma, a phase 3 international study of 502 patients showed. Jedd Wolchok, MD, from Memorial Sloan-Kettering Cancer Center in New York City, reported that the rate of complete or partial response was significantly better with ipilimumab than with placebo (15.2% vs 10.3%; P = .09). The median duration of response was 19.3 months vs 8.1 months (P = .03), respectively. Prolonged survival has occurred in some patients who have now been followed up for 4 years, he said. Management of drug toxicity has improved.
Exemestane — A New Option for Breast Cancer Prevention: The aromatase inhibitor exemestane offers a new option for breast cancer prevention in postmenopausal women at high risk for the disease — one that appears to be safer and more effective than tamoxifen and raloxifene, conference attendees heard. Data from the Mammary Prevention (MAP).3 trial show that the drug more than halved the risk for invasive breast cancer (65% reduction). The lack of adverse effects with exemestane in this study is a big deal, said MAP.3 investigator Rowan Chlebowski, MD, from Harbor-UCLA Medical Center in Torrence, California, because it might help to overcome the reluctance that healthy women have about using selective estrogen-receptor modulators for prevention.
Practice-Changing Radiation Study in Early Breast Cancer? Women with early breast cancer and 1 to 3 positive nodes should be offered radiation treatment to their regional lymph nodes, in addition to standard whole-breast radiation, according to a study presented here — findings that could be "practicing changing," said study chief Timothy J. Whelan, BM, BCh, from McMaster University in Hamilton, Ontario, Canada. Women with 1 to 3 positive nodes have constituted a gray zone of uncertainty in terms of regional nodal irradiation. However, Sandy Anderson, MD, from Fox Chase Cancer Center in Philadelphia, Pennsylvania, is not yet convinced. "Clinicians need to weigh the toxicity of regional nodal radiation against the toxicity of further axillary dissection...for each individual patient," she said.
First Drug for Myelofibrosis Offers Symptom Relief: Ruxolitinib (Incyte) may become the first drug for the treatment of myelofibrosis. In 2 phase 3 trials, the drug had a significant effect on symptoms, including a significant reduction in the enlarged spleen of these patients. "Patients responded very quickly to ruxolitinib — within 2 to 4 weeks," said Alessandro Vannucchi, MD, from the University of Florence, Italy, who was the principal investigator of 1 of the trials. "This therapy has the potential to change the treatment landscape," he added. These data have just been submitted to the US Food and Drug Administration, with a request for priority review.
High-Dose Methotrexate Improves Survival in High-Risk ALL: A regimen of high-dose methotrexate bested the standard protocol of escalating doses of the drug in patients with high-risk B-precursor acute lymphoblastic leukemia (ALL). Five-year event-free survival for patients who received high-dose methotrexate was 82% compared with 75% for those receiving escalating doses. "We feel that it is the standard of care to receive high-dose methotrexate in this population," said lead author Eric C. Larsen, MD, director of the Maine Children's Cancer Program at Maine Medical Center in Portland. He hopes to see it incorporated into practice guidelines.
Can New Standard of Care in Neuroblastoma Be Used in the US? A high-dose myeloablative regimen significantly improved outcomes in a study of patients with high-risk neuroblastoma — so much so that the European investigators say it should be the new standard of care. The data were reported at the plenary session here. "The results are important for patients with this extremely difficult-to-treat disease," said principal investigator Ruth Ladenstein, MD, MBA, associate professor of pediatrics at the University of Vienna, Austria. Until now, the best outcome in neuroblastoma has hovered around the 50% survival threshold, but the new regimen tested has pushed this survival rate up to 60%.
Long-Term Imatinib Extends Survival in High-Risk GIST: Extended adjuvant treatment with imatinib (Gleevec) improves survival in patients with high-risk gastrointestinal stromal tumors (GIST). Imatinib administered for 3 years improved both relapse-free survival and overall survival in patients after surgery compared with 1 year of adjuvant treatment. The results are "very compelling," said lead author Heikki Joensuu, MD, professor of oncology at Helsinki University Central Hospital in Finland.
Oncologists, PCPs Need to Improve Care of Cancer Survivors: There are nearly 12 million cancer survivors in the United States today. Data from the first nationwide study of barriers between primary care practitioners (PCPs) and medical oncologists suggest a need for increased coordination between clinicians. Improved physician education and training in survivorship-care planning is also needed. "Medical oncologists perceive different physician-based barriers as problematic in follow-up care, compared with PCPs," commented lead author Katherine Virgo, PhD, MBA, managing director of health services research at the American Cancer Society in Atlanta, Georgia. "Education and cancer survivorship-care planning may be required to alleviate barriers," she added.
Mutation-Specific Therapy in Lung Cancer — This is the Future: The treatment of lung cancer is undergoing a revolution, Mark Kris, MD, chief of the thoracic oncology service at the Memorial Sloan-Kettering Cancer Center in New York City, told conference attendees. The future of lung cancer (and indeed all cancer) is one of personalized therapy, with drugs chosen according to the mutations found in the patient's tumor, rather than chemotherapy chosen for the organ where the tumor is located, he noted. That future for lung cancer has taken a step forward, in the form of the Lung Cancer Mutation Consortium, which involves 14 centers across the United States, said Dr. Kris, who unveiled details of the project.
"Surprising" Result in Flaxseed-for-Hot-Flashes Study: The dietary supplement flaxseed does not appear to curb hot flashes in postmenopausal women with or without breast cancer. In a phase 3 study, women reporting at least 28 hot flashes per week at entry ate either a daily flaxseed bar containing 410 mg of lignans or a placebo fiber bar. After 6 weeks, there was no significant difference between the 2 groups. In both groups, a little more than a third of the women experienced a 50% reduction in their hot flash scores. "The results were surprising," said study chief Sandhya Pruthi, PhD, from the Mayo Clinic in Rochester, Minnesota, noting that a pilot study had suggested that flaxseed use was associated with reduction in hot flashes.
Keep it Going? Pemetrexed Continuation Improves PFS in NSCLC: Results of the PARAMOUNT study demonstrate for the first time that using "continuation maintenance" therapy with the chemotherapy drug pemetrexed (Alimta, Eli Lilly) improves progression-free survival in patients with advanced nonsquamous non-small-cell lung cancer who received pemetrexed as part of their first-line chemotherapy regimen. "The results may support its use in this clinical context," said lead author Luis Paz-Ares, MD, PhD, from Seville University Hospital in Spain. The study is powered to provide overall survival findings, but the data are not yet mature, Dr. Paz-Ares noted.
Abiraterone in Prostate Cancer, Survival Gets Even Better: Abiraterone acetate (Zytiga, Cougar Biotechnology) significantly improves survival in men with metastatic castration-resistant prostate cancer, Howard I. Scher, MD, from Memorial Sloan-Kettering Cancer Center in New York City, announced here. Phase 3 data confirm that at a median follow-up of 12 months, overall survival with abiraterone was 14.8 months compared with 10.9 months with placebo plus prednisone (P < .001). At 20 months, overall survival is 15.8 months and 11.2 months, respectively (P < .0001). Median overall survival between the 2 groups increased from 3.9 to 4.6 months from the interim to the final analysis.
Bevacizumab Benefits Patients With Recurrent Ovarian Cancer: In a phase 3 study, there was a "statistically significant and clinically relevant benefit" when bevacizumab was added to chemotherapy in women with recurrent platinum-sensitive epithelial ovarian cancer, primary peritoneal cancer, and fallopian tube cancer. Lead investigator Carol Aghajanian, MD, from Memorial Sloan-Kettering Cancer Center in New York City, said bevacizumab plus standard chemotherapy (carboplatin and gemcitabine), followed by bevacizumab until disease progression, "should be considered a new option for recurrent platinum-sensitive ovarian cancer."
Bevacizumab First-Line Improves Survival in Ovarian Cancer: Adding bevacizumab (Avastin, Genentech) to standard chemotherapy might offer a survival benefit for women with newly diagnosed ovarian cancer. Study investigator Gunnar Kristensen, MD, PhD, from the Norwegian Radium Hospital in Oslo, reported that at a median follow-up of 28 months, there was a 15% overall reduction in mortality risk in patients receiving bevacizumab compared with those receiving standard chemotherapy. There was also a "substantial prolongation of time to progression," said Dr. Kristensen. "We have not made progress in at least 15 years with this disease," he noted. "The first new front-line treatment is bevacizumab."
Photography by Anne Ryan, Chicago, Illinois
Zosia Chustecka, News Editor, Medscape Oncology
London, United Kingdom
Zosia Chustecka has disclosed no relevant financial relationships.
Nick Mulcahy, Staff Journalist
Philadelphia, Pennsylvania
Nick Mulcahy has disclosed no relevant financial relationships.
Roxanne Nelson, Staff Journalist
Bellingham, Washington
Roxanne Nelson has disclosed no relevant financial relationships.
Martha Kerr, Medscape Conference News Editor
East Haddam, Connecticut
Martha Kerr has disclosed no relevant financial relationships.
Megan Brooks, Freelance Journalist
Weston, Connecticut
Megan Brooks has disclosed no relevant financial relationships.
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