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Top News From ECC 2015: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Liam Davenport; Megan Brooks; Jana Madzigon  |  October 9, 2015

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Slide 1

New results for immunotherapy, including long-term efficacy findings and clinical benefit in rare cancers, greeted attendees at the European Cancer Congress (ECC) 2015, held September 25 to 29 in Vienna, Austria.

Slide 2

ECC 2015 marked the end of an era — the last time the European Cancer Organization (ECCO) and the European Society for Medical Oncology (ESMO) will collaborate on this meeting. Among the clinical highlights:

  • Nivolumab shines as second-line treatment for renal cell carcinoma
  • Radiotherapeutic cousin of octreotide yields impressive PFS in midgut NET
  • Low-dose aspirin extends survival time in GI tract cancers
  • Global lack of access to cancer surgery called a "crisis"
  • Surgery worth it in advanced throat cancer
  • No need to delay cancer treatment in pregnant women
  • Oncotype DX trial: Some breast cancers don't need chemo
Slide 3

Finally, Drug Improves Survival in Pretreated Kidney Cancer

Pretreated renal cell carcinoma patients lived nearly 6 months longer when they received the immunotherapy drug nivolumab (Opdivo, Bristol-Myers Squibb) than when they received the standard treatment of everolimus (Afinitor, Novartis). This is the first time an overall survival benefit has been seen in a clinical trial of second-line treatment for renal cell carcinoma. "Nivolumab has set a new benchmark," said Cora Sternberg, MD, from the San Camillo Forlanini Hospital in Rome, Italy. The phase 3 results "are significant and clinically meaningful," and "are likely to change the treatment of patients with advanced kidney cancer whose disease has progressed on previous treatment," added senior author Padmanee Sharma, MD, from the University of Texas MD Anderson Cancer Center in Houston.

Slide 4

'Most Impressive' PFS Ever Seen in Midgut NET

Patients with midgut neuroendocrine tumors (NETs) who fail standard treatment with the somatostatin analogue octreotide might achieve long-lasting benefit with the lutetium-labeled octreotate 177Lu-DOTATATE (Lutathera, Advanced Accelerator Applications). In the NETTER-1 phase 3 trial, progression-free survival (PFS) was significantly longer in patients who received the radiotherapy in addition to standard octreotide (hazard ratio, 0.2; P < .001), which translates to an 80% reduction in the risk for disease progression or death. This agent "appears to be a major advance" for this patient population, said lead investigator Philippe Ruszniewski, MD, from Beaujon Hospital in Clichy, France. In fact, this is "the most impressive PFS we have ever seen" in such patients, added discussant Enrique Grande, MD, from Ramón y Cajal University Hospital in Madrid, Spain.

Slide 5

Aspirin Nearly Doubles Survival in GI Cancers

Low-dose daily aspirin almost doubles survival in patients with a range of gastrointestinal (GI) tract cancers, Dutch prescribing data on nearly 1400 GI patients indicate. Five-year overall survival was better in the 8.3% of patients who took aspirin daily after diagnosis than in those who did not take aspirin (75% vs 42%), reported Martine Frouws, MD, from Leiden University Medical Centre in the Netherlands. An analysis by tumor type demonstrated a significant benefit of daily low-dose aspirin for esophageal, stomach, colon, and rectal cancers. These data "tell us that not only can aspirin prevent disease, but low-dose aspirin is important as an adjunct therapy for gastrointestinal cancers," Nadir Arber, MD, head of the Integrated Cancer Prevention Center at Tel Aviv Sourasky Medical Center in Israel, said in a statement.

Slide 6

Cancer Surgery Crisis: Urgent Action Needed

There is a huge shortfall in the worldwide provision of cancer surgery, according to a major analysis presented here and published simultaneously in the Lancet Oncology as part of a Commission on Access to Cancer Services. Worldwide, less than 25% of cancer patients have access to safe, affordable surgery, but in low-income countries, up to 95% do not receive basic surgical care. "The good news is that surgery is effective and surgery is cost-effective. The bad news, unfortunately, is that only one in five surgery patients will receive the appropriate surgical treatment," coauthor Riccardo Audisio, MD, president of the European Society of Surgical Oncology, said during a press briefing. According to the Commission, a combination of research, improvements to surgical systems, and the incorporation of surgery into national cancer plans is needed to tackle the crisis.

Slide 7

Surgery Boosts Survival Chances for Advanced Throat Cancer

Surgery improves survival in patients with advanced oropharyngeal and hypopharyngeal cancers, according to Taiwanese registry data. "We found that primary surgery was associated with better overall cancer survival in most subset analyses, which suggests that surgery may provide a survival benefit," said Chih-Tao Cheng, MD, from the Koo Foundation Sun Yat-Sen Cancer Center in Taipei City, Taiwan. However, only about half of all patients opted for surgery. "Many patients do not agree to surgery because of a fear of functional impairment, such as the impact on speech and swallowing. This study suggests that avoiding surgery may significantly reduce their chance of survival," Dr Cheng said in a statement.

Image from Science Source

Slide 8

Huge Shortfall in Radiotherapy, Investment Would Save Lives

Up to 60% of cancer patients will require radiotherapy at some point, but worldwide, currently only 40% to 60% have access to radiotherapy services, according to a report presented here and published simultaneously in the Lancet Oncology. Even in some higher-income countries, there is inadequate access to radiotherapy facilities and equipment, and services are virtually absent in some low-income countries. "The building of radiotherapy capacity will require large initial investment," said Mary K Gospodarowicz, MD, from the Princess Margaret Cancer Centre in Toronto, who is cochair of the Union for International Cancer Control Global Task Force on Radiotherapy for Cancer Control. "However, the treatment is more cost-effective than chemotherapy and surgery for treating cancer, and the health and economic benefits will be realized in just 10 to 15 years," she said.

Image courtesy of University Health Network

Slide 9

Cancer Treatment Should Not Be Delayed During Pregnancy

Children with prenatal exposure to cancer and cancer therapies appear to have normal development at 18 and 36 months, according to a study presented here and published simultaneously in the New England Journal of Medicine. Chemotherapy did not have any clear adverse effects on growth in the postnatal period, cognitive or cardiac function, or mental and physical development. The number of chemotherapy cycles during pregnancy appeared to be unrelated to outcomes. "Our results show that fear of cancer treatment is no reason to terminate a pregnancy, that maternal treatment should not be delayed, and that chemotherapy can be given," said lead author Frederic Amant, MD, from University Hospitals Leuven in Belgium. But Hatem A. Azim Jr, MD, from the Jules Bordet Institute in Brussels, cautioned against the use of chemotherapy during the first trimester. "We can usually wait until the second trimester," he said.

Slide 10

Oncotype DX Trial: Some Breast Cancers Don't Need Chemo

The prospective TAILORx study confirms that the popular 21-gene assay for breast cancer recurrence risk (Oncotype DX, Genomic Health) can identify women with early-stage disease who can skip chemotherapy. The study, presented here and published simultaneously in the New England Journal of Medicine, involved 10,253 women with hormone-receptor-positive, HER2-negative breast cancer and no disease spread to the lymph nodes. Those with a recurrence risk score considered low were treated with an aromatase inhibitor, tamoxifen, or both for 5 years, with no chemotherapy. "There was outstanding survival with endocrine therapy alone. The test provides us with greater certainty of who can safely avoid chemotherapy," said Kathy Albain, MD, from Loyola University in Chicago, Illinois.

Image from iStock

Slide 11

Meta-analysis Supports Ovarian Suppression in Breast Cancer

An updated meta-analysis supports the use of a luteinizing hormone-releasing hormone analogue (LHRHa) during chemotherapy for breast cancer to suppress ovarian function temporarily and preserve fertility. "In breast cancer patients, we believe there is now sufficient evidence to suggest that the administration of LHRHa could be considered a potential standard strategy to preserve ovarian function, and might also play a role in increasing the likelihood of pregnancy after chemotherapy," said lead author Matteo Lambertini, MD, a medical oncologist at the IRCCS AOU San Martino-IST in Genoa, Italy. The meta-analysis, which included 12 randomized trials, was presented in a poster session here, and was published simultaneously in the Annals of Oncology.

Slide 12

Atezolizumab: Another Immunotherapy Active in Lung Cancer

The investigational anti-PDL1 immunotherapeutic atezolizumab (Genentech) has shown promise in two phase 2 studies of patients with advanced non-small-cell lung cancer (NSCLC). During a discussion of results from the BIRCH and POPLAR studies, Martin Reck, MD, from Hospital Grosshansdorf in Germany, noted that atezolizumab is the second checkpoint inhibitor to show better efficacy and tolerability than standard second-line chemotherapy in patients with pretreated NSCLC. Along with the other drugs in this class, this immunotherapy approach "is set to substantially change treatment strategies for patients with refractory lung cancer," he said. "In particular, the option for long-lasting responses and stabilization, in combination with an attractive tolerability profile, will impact clinical practice," he added.

Image courtesy of iStock

Slide 13

Cabozantinib in Kidney Cancer: Longest PFS Yet

In the METEOR study of patients with advanced renal cell carcinoma, treatment with cabozantinib (Cometriq, Exelixis) led to improvement in progression-free survival (PFS), with a strong trend toward better overall survival, although the data are still immature. Median PFS was 7.4 months with cabozantinib and 3.8 months with everolimus (hazard ratio, 0.58; P < .0001), reported Toni Choueiri, MD, from Harvard Medical School and the Dana-Farber Cancer Institute in Boston, Massachusetts. This is the longest PFS seen to date in the second-line setting, Dr Choueiri noted. The results, presented here and published simultaneously in the New England Journal of Medicine, were hailed as practice-changing. Cabozantinib is currently approved for use in the treatment of medullary thyroid cancer.

Slide 14

'Distressing' Differences in Survival Across Europe

Although survival for cancer patients in Europe has improved in recent years, there are substantial variations among countries and regions, particularly for hematologic malignancies, reveals a series of outcomes analyses of more than 10 million patients. Five-year relative cancer survival is typically lower in Eastern Europe than in Central and Northern Europe, reported Milena Sant, MD, from the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy. The findings from the EUROCARE 5 study, which were presented here and published simultaneously in the European Journal of Cancer, can help identify regions with poor cancer survival, where "action is needed to improve patient outcomes," she said.

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