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Top News From ASCO 2016: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks  |  June 20, 2016

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Slide 1

The American Society of Clinical Oncology (ASCO) 2016 Annual Meeting was held June 3 to 7 at the McCormick Place in Chicago. This year's theme was Collective Wisdom: The Future of Patient-Centered Care and Research, which emphasizes the need to combine knowledge from various disciplines, cancer types, treatment approaches, and big data technologies in order to make progress, according to ASCO.

Slide 2

There were several practice-changing presentations, including:

  • Adjuvant temozolomide a new standard of care in glioma
  • Gemcitabine plus capecitabine a step forward in pancreatic cancer
  • Big difference in right- vs left-side colorectal cancer
  • Extend letrozole therapy for 10 years?
  • Daratumumab combo new standard for multiple myeloma
  • Novel web app ups survival in lung cancer patients
Slide 3

"Huge" Survival Benefit, New Standard of Care in Glioma

Interim results from the CATNON trial fueled talk about a new standard of care in glioma after the analysis showed a "huge difference" in survival when temozolomide was added to radiotherapy. "It completely took us by surprise," said lead author Martin van den Bent, MD, from Erasmus MC Cancer Center in Rotterdam, the Netherlands. Previous trials in glioma have not shown any difference 5 to 6 years after randomization, but in this study, there was a significant difference even at 2 years, and at 5 years the difference was "huge," he said. The trial involved 745 patients with grade 3 anaplastic glioma without the 1p19q deletion that is associated with better prognosis and chemosensitivity. After a median follow-up of 27 months, 43% of patients treated with both temozolomide and radiotherapy were alive after 5 years, compared with 24% treated with radiotherapy alone. "Adjuvant temozolomide clearly improves survival," Dr van den Bent said.

Slide 4

In Pancreatic Cancer, a "Step" Means a New Standard of Care

Results from the phase 3 European Study Group for Pancreatic Cancer (ESPAC)-4 trial will likely lead to a change in practice for this deadly cancer, experts here agreed. In ESPAC-4, patients underwent surgery and were then treated with chemotherapy. The estimated 5-year survival rate was better in those treated with the combination of gemcitabine plus capecitabine than in those treated with gemcitabine alone (28.8% vs 16.3%). And the combination was not significantly more toxic than the monotherapy. The standard of care worldwide for adjuvant treatment has been gemcitabine alone, said investigator John P. Neoptolemos, MD, from the University of Liverpool in the United Kingdom. That has now changed, he said: "[Combination chemotherapy] is now the standard of care." The results are a "small step forward for a group of patients who desperately need better treatment options," said Richard Schilsky, MD, chief medical officer of ASCO.

Slide 5

Big Difference in Right vs Left Side

There is a big difference in colorectal cancer when it occurs on the right side as opposed to the left side, a large data analysis shows. Survival was significantly longer for patients with primary tumors that originated on the left side of the colon (in the descending colon, sigmoid colon, and rectum) than for patients with primary tumors that originated on the right side of the colon (in the cecum and ascending colon). The median overall survival was 19.4 months for patients with right-sided tumors and 33.3 months for patients with left-sided tumors. "While previous studies had suggested that tumor location may impact clinical colorectal cancer outcomes, the effect we observed in this analysis appears to be far greater than we expected," said lead author Alan Venook, MD, from the University of California, San Francisco. "These findings will likely change the way we approach colorectal cancer treatment and research, even as we seek to more deeply understand the biology," he said.

Image courtesy of Wikipedia

Slide 6

What Will You Tell Breast Cancer Patients About MA-17R?

The MA.17R study, featured at the plenary session and published in the New England Journal of Medicine, will likely generate questions from postmenopausal patients who are or have been receiving adjuvant antiestrogen therapy. The trial showed that extending treatment with an aromatase inhibitor (letrozole 2.5 mg daily) to 10 years, after an initial 5 years of therapy with an aromatase inhibitor/tamoxifen, improves disease-free survival but not overall survival. The disease-free survival rate for the additional 5 years was 95% with letrozole and 91% with placebo, an absolute improvement of 4% for patients on treatment. This translated into a 34% reduction in the relative risk for disease recurrence or occurrence of a contralateral breast cancer in the treatment group. However, there were more bone fractures in the letrozole group than in the placebo group (14% vs 9%), and more cases of new-onset osteoporosis (11% vs 6%). Oncologists interviewed by Medscape Medical News had different opinions on what they will be telling their patients about taking an aromatase inhibitor for potentially 10 years.

Slide 7

Age Not an Issue: Chemo Also for Elderly Glioblastoma

Elderly patients with glioblastoma multiforme should be treated with temozolomide added on to radiotherapy, as is the standard of care for this cancer, according to results from an international phase 3 trial. "Although glioblastoma disproportionately affects older patients, there are no clear guidelines for treating these patients, and practice varies globally," said lead investigator James R. Perry, MD, from the Sunnybrook Health Sciences Centre in Toronto. In previous studies, median age was 54 years, and even the trial that established the standard of care excluded patients older than 70 years. In the new trial, only patients older than 65 years were enrolled; median patient age was 73 years, and 41% were 71 to 75 years and nearly 30% were older than 75 years. The results show that the addition of temozolomide to radiotherapy improves overall survival and should be considered a standard of care also in elderly patients, the researchers conclude.

Slide 8

Daratumumab Combo: New Standard of Care in Multiple Myeloma

A three-drug regimen that includes the novel agent daratumumab (Darzalex) was declared a new standard of care for relapsed multiple myeloma after a presentation during the plenary session. This is "one of the most exciting presentations of the entire meeting," said Richard Schilsky, MD, ASCO chief medical officer. The presentation revealed initial findings from the pivotal phase 3 CASTOR trial of 498 patients with relapsed or refractory multiple myeloma who were randomized to daratumumab added to bortezomib (Velcade) plus dexamethasone or a two-drug regimen of bortezomib plus dexamethasone. The median progression-free survival was not reached in the three-drug daratumumab group, but was 7.16 months in the two-drug group (hazard ratio, 0.39). This hazard ratio is "unprecedented in randomized studies that compare novel treatments in refractory multiple myeloma," said lead author Antonio Palumbo, MD, from the University of Torino in Italy. "This translated to a 61% reduction in the risk of progression or death," he reported.

Slide 9

Transplant Still Best Upfront Option in Myeloma

With new therapies for multiple myeloma getting ever better, is transplant still necessary? For now, it seems the answer is yes. In the first large trial to compare a targeted therapy regimen that includes bortezomib (Velcade) with transplant, upfront autologous stem cell transplant (ASCT) showed a significant reduction in the risk for progression, reported lead study author Michele Cavo, MD, from the University of Bologna in Italy. Although median progression-free survival has not yet been reached, patients in the ASCT group had a 24% lower risk for disease progression at any future time point than those in the bortezomib group. "These preliminary results support the upfront use of high-dose chemotherapy and transplantation, and it continues to be the best treatment option for fit patients with newly diagnosed myeloma, even in the era of novel agents," Dr Cavo said.

Image courtesy of Wikipedia

Slide 10

High-risk Neuroblastoma: Intensified Therapy Ups Survival

In high-risk neuroblastoma, an intensified "tandem" myeloablative autologous stem cell transplant (ASCT) treatment has improved survival so much that researchers are looking ahead to survivorship issues. "We now have an increasing number of survivors from high-risk neuroblastoma," said Julie R. Park, MD, from Seattle Children's Hospital and the University of Washington School of Medicine. "In 1990, only 30% of children were alive at 5 years; now, with our current data, 60% will be. We're now embarking on very specific survivorship studies for these children to really start to understand the long-term risks," she said. Dr Park presented results from the Children's Oncology Group phase 3 ANBL0532 trial. Although the trial did not show a statistically significant overall survival advantage with tandem over single ASCT, there was "an early signal that we think will translate ultimately into overall survival. The results will change the way we treat high-risk neuroblastoma in North America," Dr Park predicted.

Slide 11

"Comparable" Efficacy and Safety for Trastuzumab Biosimilar

A biosimilar to trastuzumab (Herceptin), now known as Myl-1401O (Mylan NV), has efficacy and safety comparable to the branded product, according to the large randomized phase 3 HERITAGE trial. The trial found that response rates in breast cancer patients treated with trastuzumab were comparable to those in patients treated with Myl-1401O. At 24 weeks, objective response rates were 69.6% with Myl-1401O and 64.0% with trastuzumab. "This is one of the first trials with biosimilars in oncology to demonstrate similar efficacy, safety, and immunogenicity against the reference product," said lead study author Hope S. Rugo, MD, from the University of California, San Francisco. "Myl-1401O has the potential to meet the need for an affordable treatment option for patients with HER2-positive cancers," said Dr Rugo.

Slide 12

Largest Liquid Biopsy Study: Compares With Tissue Sampling

An analysis of circulating tumor (ct)DNA in more than 17,000 liquid biopsies reveals genetic mutations similar to those found with traditional tissue biopsy. The researchers assessed the Guardant360 liquid biopsy assay in more than 50 types of advanced cancer, including lung, breast, and colorectal. When results were compared with mutation patterns seen in 9077 tissue biopsies in The Cancer Genome Atlas (TCGA), "the detection of key cancer mutations in plasma ctDNA occurred at expected frequencies and distribution," noted Philip Mack, PhD, from the UC Davis Comprehensive Cancer Center. In 49% of patients, these biomarkers were associated with targeted FDA-approved drugs, and in 27%, the liquid biopsy picked up "actionable resistance targets," meaning resistance mutations for which there are approved medications, he said. The findings "provide important evidence on the road to demonstrating the clinical utility of liquid biopsies," said Richard Schilsky, MD, ASCO chief medical officer.

Slide 13

Web App Ups Lung Cancer Survival by 7 Months

A web-based application that prompts lung cancer patients to complete a symptom chart weekly on a smartphone, tablet, or computer improved overall survival by 7 months, compared with standard follow-up care, according to results from a prospective phase 3 trial. The key to the intervention is that it allowed "earlier detection of relapse" and, thus, early supportive care in the study patients, 90% of whom had stage III or IV disease, and all of whom had received previous first-line chemotherapy, said Fabrice Denis, MD, PhD, from the Institut Inter-regional de Cancérologie Jean Bernard in Le Mans, France. The technology automatically triggers an email alert to the physician (which leads to a clinic visit) upon the detection of any anomaly in the data stream from the patient. This system a "tremendous advance," said Patricia Ganz, MD, from the University of California, Los Angeles. "If we had a drug that provided this level of survival benefit, wouldn't we want to go out and use it?" she asked.

Slide 14

Letting Go: No Reduction in Aggressive Care for Advanced Cancer

Aggressive care is still given to most patients with incurable metastatic cancer, reported Ronald Chen, MD, from the University of North Carolina at Chapel Hill. ASCO issued a strong recommendation against cancer treatments in late metastatic disease, encouraging instead a shift to palliative symptom relief in its first set of Choosing Wisely recommendations issued in 2012. But the study by Dr Chen's team, which involved 28,371 patients from the HealthCare Integrated Research Database, suggests that the ASCO recommendation has had no influence on clinical practice. "The responsibility is with physicians to do a better job clarifying the goals of care with their patients and further understanding the patient's goals and priorities," Dr Chen said. "Toward the very end of life, this is especially important because continued aggressive treatment would likely cause side effects but be unlikely to significantly extend a patient's life. This type of discussion can help reduce the overuse of aggressive care and, frankly, we probably have to have the discussion repeatedly because as the cancer progresses and the end of life gets closer, these goals may change," he added.

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