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Top News From ASCO 2015: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Charles Cherney; Megan Brooks  |  June 12, 2015

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Slide 1

The 2015 annual meeting of the American Society of Clinical Oncology (ASCO) was held May 29 to June 2 at McCormick Place in Chicago. This year's theme was Innovation and Illumination – Transforming Data Into Learning.

Slide 2

Immunotherapy, and particularly the programmed cell death (PD) inhibitors, continue to generate buzz in the oncology community. Several new studies were presented at the meeting, which, for the first time, featured a plenary discussion on cancer drug costs and value. Other highlights included:

  • Nivolumab in Lung Cancer Shows Unprecedented Survival
  • Another Sea Change in Melanoma: Immune Combo Triumphs
  • Upfront Chemo: New Caution or Option in Prostate Cancer?
  • Elective Neck Dissection: New Standard of Care?
  • Shaving Margins After Breast Cancer Surgery Cuts Risk
Slide 3

Nivolumab in Lung Cancer Shows Unprecedented Survival

The immunotherapy nivolumab (Opdivo) has beaten chemotherapy in another subset of patients with lung cancer in the second phase 3 trial to show improvement in survival compared with docetaxel. The latest results — from the CheckMate 057 study of 582 patients with advanced nonsquamous nonsmall cell lung cancer (NSCLC) who had progressed on platinum-doublet chemotherapy — were hailed as practice-changing. Nivolumab is the new standard of care for patients with previously treated NSCLC, said Roy Herbst, MD, PhD, chief of medical oncology at the Yale Cancer Center in New Haven, Connecticut, who acted as discussant for the study.

Image from iStock

Slide 4

Another Sea Change in Melanoma: Immune Combo Triumphs

Two cancer immunotherapies proved far better than one in slowing the progression of advanced melanoma in a phase 3 study reported by Jedd Wolchok, MD, PhD, from the Memorial Sloan Kettering Cancer Center in New York City. The results likely represent yet another sea change in the treatment of this disease because, to date, single-agent immunotherapy with ipilimumab (Yervoy) has been the gold standard in the first-line treatment of non-BRAF-mutated disease. This study demonstrated that patients were free of disease for twice as long with nivolumab (Opdivo) alone as with ipilimumab alone, and for nearly four times as long as with the combination. But the two drugs together are more toxic than either single agent, and the combination would be very expensive (nearly $300,000), cautioned study observers.

Slide 5

Upfront Chemo: New Caution or Option in Prostate Cancer?

Two large trials of prostate cancer showed that adding upfront chemotherapy to hormone therapy significantly improves overall survival, leading to calls for practice change. The Radiation Therapy Oncology Group (RTOG) 0521 study of high-risk localized (ie, nonmetastatic) disease and the STAMPEDE trial of men with newly diagnosed advanced prostate cancer (the majority of which was metastatic) both showed an improvement in overall survival when upfront docetaxel was added to standard therapy (androgen suppression, usually with radiotherapy). However, one expert is dismayed at the "hype" that has surrounded the studies of upfront docetaxel, and cautioned that the data need to be analyzed in detail before practice changes are made.

Image from iStock

Slide 6

Whole-Brain Radiotherapy: Risks Worth Benefit?

Whole-brain radiotherapy (WBRT) should be avoided in patients with a limited number of brain metastases because it does not prolong survival, it reduces quality of life, and it causes cognitive decline, according to the phase 3 N0574 study. "We expect that it will be reserved for palliation of symptomatic metastases in patients for whom stereotactic radiosurgery [SRS] is not possible," said investigator Jan C. Buckner, MD, from Mayo Clinic in Rochester, Minnesota. For newly diagnosed brain metastases amenable to SRS, "we recommend initial treatment with SRS alone and close monitoring to better preserve cognitive function and quality of life," added lead investigator Paul D. Brown, MD, from the University of Texas M.D. Anderson Cancer Center in Houston. But discussant Andrew Lassman, MD, from Columbia University in New York City, countered that WBRT boosts survival "in the appropriate context" and that deferring it "leads to a rapid and more numerous occurrence of brain metastases, which also cause neurocognitive injury."

Slide 7

Elective Neck Dissection: New Standard of Care?

Optimal management of the neck in early oral cancers has been a matter of debate, but the results of a large randomized phase 3 trial have now settled the question, the investigators say. An interim analysis of the first 500 patients showed that elective neck dissection (END) improved overall survival by 12.5% in absolute numbers compared with therapeutic neck dissection. END also reduced the relative risk for death by 36% and recurrence by 55%. END "should be the standard of care for early node-negative squamous cell cancers," said lead study author Anil D'Cruz, MBBS, professor and chief, Department of Head and Neck Surgery, Tata Memorial Centre, Mumbai, India.

Slide 8

Shaving Margins After Breast Cancer Surgery Cuts Risk

Routine shaving around the cavity after partial mastectomy cuts rates of positive margins and re-excisions, a new study shows. And patients who undergo shaving do not experience worse cosmetic results compared with patients who do not, reported lead investigator Anees B. Chagpar, MD, from the Yale Cancer Center in New Haven, Connecticut. "Before we embarked upon the trial, I was not an advocate of doing routine cavity shave margins, but I think given the data we have — where a very simple technique can reduce positive margins and reduce re-excisions by 50% without any detriment in cosmetic outcome or increase in complication rates — certainly has changed my own personal practice and the practice of many surgeons at Yale," said Dr. Chagpar.

Image from iStock

Slide 9

Drug Costs, Value Take Center Stage at ASCO for First Time

For the first time, the ASCO meeting put cost and value on the agenda, and a cost analysis has changed the conclusion of a major trial in colorectal cancer. Last year, the addition of bevacizumab (Avastin) and cetuximab (Erbitux) to chemotherapy was found to be equally effective, and the conclusion was that clinicians could use either. This year, however, a cost analysis showed that the bevacizumab regimen is half the cost of cetuximab, and so should be chosen on that basis. In a presentation on the cost of the new immunotherapy drugs, one estimate showed that a high-dose regimen with one of them could cost $1 million per year.

Image from iStock

Slide 10

Potential Practice Change in Management of DCIS

What's true in invasive cancer has been found to be true in its clinical precursor, ductal carcinoma in situ (DCIS): an aromatase inhibitor (AI) is more effective than tamoxifen in preventing disease recurrence. In a 3104-patient trial, the AI anastrozole (Arimidex) provided a significant improvement in disease-free survival compared with tamoxifen, reported lead author Richard Margolese, MD, from the Jewish General Hospital, McGill University, in Montreal. Anastrozole is the "safer and more effective drug," and is now the "preferred option," he said during an ASCO press briefing.

Slide 11

Palbociclib New Tool Against Endocrine Resistance?

PALOMA 3, the first phase 3 study of palbociclib (Ibrance), has inspired hope for the reversal of breast cancer endocrine resistance. Palbociclib, the first CDK4/6 inhibitor for breast cancer, received accelerated approval in the United States earlier this year on the basis of phase 2 data. The phase 3 trial, conducted in 521 estrogen-receptor (ER)-positive, HER2-negative breast cancer patients previously treated with hormone therapy, was stopped prematurely after an interim analysis showed that the drug more than doubled the duration of disease control and delayed progression by more than 5 months. "CDK4/6 inhibitors represent an important therapeutic advance in ER-positive metastatic breast cancer," noted study discussant Joseph A. Sparano, MD, from Montefiore Medical Center in Bronx, New York.

Slide 12

New Myelofibrosis Drug Works Even With Thrombocytopenia

A new drug for myelofibrosis, pacritinib (CTI BioPharma), can be used even in patients with very low platelet counts, according to phase 3 trial data that will be used for an approval submission. In the 327-patient trial, pacritinib was superior to best available therapy, which commonly included hydroxyurea and drugs that are used off-label. Ruxolitinib (Jakafi) was intentionally excluded because it is not considered safe in patients with very low platelet counts. "There is a huge unmet clinical need for patients with myelofibrosis. We were encouraged to see that pacritinib was safe and effective in the trial, even in patients with severely low blood counts (<50,000/uL)," said lead author Ruben A. Mesa, MD, deputy director of the Mayo Clinic Cancer Center in Scottsdale, Arizona.

Slide 13

Genomic Marker Predicts Response to Anti-PD-1 Antibody

A mismatch repair (MMR) deficiency has been identified as the first genomic marker to predict response to the immunotherapy pembrolizumab (Keytruda). In a group of patients with previously treated progressive metastatic colorectal cancer, 62% of those with MMR-deficient disease had an objective response, and disease control was 92% with pembrolizumab. In patients with other types of MMR-deficient tumors, the response and disease control rates were 60% and 70%, respectively. However, in patients with MMR-proficient tumors, the response rate was 0% and the disease control rate was 16%. "This is the first study to use genetics to guide immunotherapy," said lead study author Dung T. Le, MD, from the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center in Baltimore, Maryland.

Slide 14

Vitamin B Derivative Reduces Risk for Further Skin Cancer

An inexpensive vitamin B product significantly cuts the risk of developing further skin cancer in patients already diagnosed with nonmelanoma skin cancer, a new study shows. Patients who took nicotinamide 500 mg twice daily for 1 year had a 23% reduction in new diagnoses of nonmelanoma skin cancer, compared with those who took placebo. New diagnoses of basal cell carcinoma were reduced by 20%, squamous cell carcinoma by 30%, and actinic keratosis by 13%. "This is the first clear evidence that we can reduce skin cancers using a simple vitamin together with sensible skin protection," said senior study author Diona Damian, MBBS, PhD, from the Dermatology University of Sydney in Australia. This research is a "major advance" in prevention, commented ASCO President Peter Yu, MD.

Slide 15

Decreased Toxicity Lowers 'Cost of Cure' in Pediatric Cancer

For survivors of childhood cancer, the risk of dying from late effects of their disease — whether from a recurrence, a new cancer, or late toxicity from treatment — is significantly lower today than it was a few decades ago. Results of the Childhood Cancer Survivor Study, which analyzed more than 34,000 children diagnosed from the 1970s to the 1990s, suggest that cure rates for childhood cancers have improved significantly during the past 3 decades and that reductions in the toxicity of radiation and chemotherapy treatments have contributed to improved survival. "We've not only helped more children survive their primary cancer, we've also extended their overall lifespan by reducing the overall toxicity of treatment in more modern eras," said lead investigator Gregory T. Armstrong, MD, MSCE, from St. Jude Children's Research Hospital in Memphis, Tennessee.

Image from iStock

Slide 16

National Cancer Institute Spearheads Largest Precision Medicine Trial

The largest precision medicine trial in American history will begin enrolling patients with intractable cancers next month. The plan, promised in President Barack Obama's State of the Union address, will involve 2400 clinics across the country. The aim is to find treatments for cancers that have not responded to traditional therapies. "This is the largest, most rigorous precision oncology trial in history," James Doroshow, MD, deputy director of the National Cancer Institute, told reporters attending a news conference. The MATCH trial is designed to find evidence that treating patients on the basis of the molecular profile of their tumor, rather than tumor type, will have clinical benefit. Stay tuned.

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