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Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019
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Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
The American Society of Clinical Oncology (ASCO) 2019 Annual
Meeting was held May 31–June 4 at McCormick Place in Chicago. With
more than 39,000 attendees from around the world, this year's
theme was Caring for Every Patient, Learning From Every
Patient. ASCO President Monica Bertagnolli, MD, said she
selected this theme "to help address how we can provide every
patient with equal access to the highest quality of care."
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
Among the highlights this year:
Medicaid expansion has dramatically cut racial disparities in
time to cancer treatment
Pembrolizumab is a new front-line standard of care in head and
neck cancer
CDK4/6 inhibitor improves survival in metastatic breast cancer
"Impressive" results in previously untreated non-small cell
lung cancer
Proton beam easier to take; same outcome as photon
chemoradiotherapy
Enzalutamide a good first-line option for metastatic prostate
cancer
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
ACA Medicaid Expansion Reduces Disparities in Cancer Care
Previously reported racial disparities in receiving timely cancer
treatment between black and white patients almost completely
vanished in states where access to Medicaid was expanded under the
Affordable Care Act (ACA), according to late-breaking research
presented during the plenary session. Black patients were able to
receive treatment in a more timely manner as a result of being
able to receive Medicaid coverage, which in turn provided more
equity in care. "This study extends prior evidence regarding
effects of ACA expansions on insurance coverage and general access
for cancer patients," said study author Amy J. Davidoff, PhD, MS,
senior research scientist in health policy and management at the
Yale School of Public Health and a member of the Yale Cancer
Center, New Haven, Connecticut. "National healthcare coverage
policy may reduce disparities in cancer care," the authors
concluded. To date, 37 states (and Washington, DC) have
implemented Medicaid expansion.
Image courtesy of ASCO
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
New First-Line Option in Head and Neck Cancer: 'Practice Changing'
First-line therapy options for head and neck cancer should now
include immunotherapy with pembrolizumab (Keytruda,
Merck) alone or in combination with chemotherapy (CT), said
experts discussing results of the KEYNOTE-48 trial. This regimen,
they noted, represents a practice change. Currently, immunotherapy
for head and neck cancer is approved only for second-line use,
after a patient has progressed on CT. The new data, from the
protocol-specified final analysis of KEYNOTE-48, showed superior
overall survival (OS) with pembrolizumab alone or with CT across
patients with two separate PD-L1 cut-offs compared with the
control group given CT alone. "These data support pembrolizumab
plus platinum-based CT and pembrolizumab monotherapy as new
first-line, standard-of-care therapies for relapsed/metastatic
head and neck squamous cell carcinoma (R/M HNSCC)," said presenter
Danny Rischin, MD, from the Peter MacCallum Cancer Centre,
Melbourne, Australia.
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
First CDK4/6 Inhibitor to Improve Survival in Metastatic Breast Cancer
In the MONALEESA-7 trial, the CDK4/6 inhibitor ribociclib (Kisqali,
Novartis) plus standard-of-care endocrine therapy significantly
improved overall survival (OS) in premenopausal women with
advanced hormone receptor-positive (HR+) breast cancer compared
with endocrine therapy alone, reported lead study author Sara
Hurvitz, MD, director, Breast Cancer Clinical Research, UCLA
Jonsson Comprehensive Cancer Center, Los Angeles. It's the first
time that a CDK4/6 inhibitor (or any targeted therapy) has been
shown in combination with endocrine therapy to significantly
improve OS among women with HR+/HER2-negative metastatic disease.
The estimated OS rate at 42 months was 70.2% for women in the
combination therapy group vs 46% for women in the endocrine
therapy-only group (hazard ratio for death, 0.71; P =
.009). ASCO President Monica Bertagnolli, MD, called the results
"striking and wonderful" and observed that the 42-month data
amount to 3.5 years, which is "a lot" of time in advanced breast
cancer.
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
1-in-4 NSCLC Patients Alive at 5 Years After Pembrolizumab
Almost one quarter of patients with previously untreated
non-small cell lung cancer (NSCLC) survive for up to 5 years with
pembrolizumab (Keytruda, Merck), with even higher rates in patients with high expression of programmed death ligand 1
(PD-L1), according to long-term data from the KEYNOTE-001 trial,
reported by Edward B. Garon, MD, David Geffen School of Medicine
at the University of California, Los Angeles, in Santa Monica. The
trial is now the longest running efficacy and safety follow-up of
pembrolizumab in advanced NSCLC. In general, NSCLC is a disease in
which patients have been considered to be "very unlikely" to live
for 5 years after diagnosis, Garon noted. The 5-year overall
survival rate of 15% with pembrolizumab is therefore "certainly
encouraging," and the 25% survival seen in patients with PD-L1
expression ≥ 50% was "particularly impressive." With the safety
data showing no unanticipated late toxicity, Garon believes that
"pembrolizumab has potential to improve long-term outcomes for
both treatment-naïve and previously treated patients with NSCLC."
Image from Science Source
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
Less Toxicity With Proton Beam vs Photon Chemoradiotherapy
A comparative effectiveness study of proton beam vs traditional
photon chemoradiotherapy in 1483 patients with nonmetastatic
cancer found similar survival outcomes regardless of radiotherapy
type, but significantly fewer adverse events with proton beam
therapy. "The future is here — if the side effects are much lower,
then you can potentially intensify therapy," said lead author
Brian Baumann, MD, of the Perelman School of Medicine, University
of Pennsylvania, Philadelphia. "The real take-home message here is
that the 90-day toxicity is lower," he said. Grade 3 and higher
toxicity usually requires hospitalization. Proton beam therapy was
associated with a significant reduction in those events with a
relative risk (RR) of 0.31, he explained. "They were 69% less
likely to have a grade 3 or over event. I think this is meaningful
because patients care about toxicity, there are a lot of
associated costs of side effects, and reducing toxicity improves
quality of life," Baumann added.
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
Novel Drug for Advanced Urothelial Cancer: Enfortumab Vedotin
A novel antibody–drug conjugate – enfortumab vedotin (EV, Seattle
Genetics) – showed promising activity in the phase 2 EV-201 study
of patients with advanced and metastatic urothelial cancer who had
failed previous therapies. Comprised of a monocloncal antibody
that targets Nectin-4, an antigen expressed on 97% of urothelial
cancers, EV also has a conjugate that releases a
microtubule-disrupting agent that causes cell cycle arrest and
apoptosis. The novel mechanism of action has already earned the
product a Breakthrough Therapy Designation from the Food and Drug
Administration (FDA) for use in locally advanced or metastatic
urothelial cancer that has progressed during or following immune
checkpoint inhibitor therapy. Daniel P. Petrylak, MD, professor of
medicine (medical oncology) and urology at Yale Cancer Center, New
Haven, Connecticut, presented the preliminary findings which
include an objective response rate of 44%.
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
Enzalutamide Joins Initial Tx List for Metastatic Prostate Cancer
The oral androgen receptor inhibitor enzalutamide (Xtandi,
Pfizer/Astellas) is an effective first-line treatment option for
men with metastatic prostate cancer, according to results of the
phase 3 ENZAMET trial. Enzalutamide significantly improved overall
survival (OS) in comparison with a conventional nonsteroidal
antiandrogen (NSAA) when both were added to standard of care
(either a luteinizing hormone-releasing hormone analogue or
surgical castration) in this setting, reported lead author
Christopher Sweeney, MD, of Dana Farber Cancer Institute, Boston,
Massachusetts. The overall survival rate at 3 years, which was the
primary outcome, was 80% in the enzalutamide arm and 72% in the
NSAA arm (hazard ratio [HR], 0.67; P = .002). Enzalutamide also
substantially improved time to progression compared to NSAA (P
< .001). At an ASCO press conference, Sweeney said enzalutamide
plus standard of care "represents an appropriate option for men
with metastatic prostate cancer commencing testosterone
suppression."
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
Olaparib Delays Progression in BRCA Pancreatic Cancer
Patients with metastatic pancreatic cancer and a germline BRCA gene mutation could see their disease progression slowed or even halted with olaparib (Lynparza, AstraZeneca), suggest the
results from the phase 3 POLO trial. Olaparib is an inhibitor of
poly (ADP-ribose) polymerase (PARP) enzymes that is already
approved for use in ovarian and breast cancer in patients with
germline BRCA mutations. In the POLO trial of patients
with pancreatic cancer, those given olaparib had a median
progression-free survival of 7.4 months vs 3.8 months with
placebo, equating to a 47% reduction in the risk of disease
progression or death. An objective response was seen in more than
twice as many olaparib patients than placebo patients and the
median duration of response was over 2 years. After first-line
platinum-based chemotherapy, olaparib "should become a new
standard of care" in these patients, said Hedy L. Kindler, MD, of
the University of Chicago. The findings were "truly remarkable,"
with the potential to see "a change in patients' disease
trajectory," she commented.
Image courtesy of Emory University
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
Lenalidomide Delays Onset of Multiple Myeloma
New findings suggest that early treatment of smoldering multiple
myeloma, a precursor to myeloma, can delay progression to
full-blown disease. The current standard of care is observation
until the patient becomes symptomatic. In the E3A06 trial,
patients who received early treatment with lenalidomide (Revlimid,
Celgene) had 3-year progression-free survival of 91% compared with
66% for those who were followed with observation. "It's pretty
clear that smoldering myeloma is a heterogeneous group of
patients," commented lead author Sagar Lonial, MD, professor and
chair, Department of Hematology and Medical Oncology, Emory
University School of Medicine, Atlanta, Georgia. "What's really
interesting is that every risk group appeared to benefit from
early intervention. No trial has ever demonstrated a benefit for
prevention from smoldering to myeloma," he added.
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
Score One for Minimally Invasive Cancer Surgery
Minimally invasive surgery for colorectal cancer liver metastases
is equivalent with open surgery in terms of overall survival,
according to a study from Norway. Median overall survival was 81
months in the open surgery arm (n = 147) and 80 months in the
laparoscopic surgery arm (n = 133; P = .91), reported
lead study author Asmund Avdem Fretland, MD, Oslo University
Hospital. The 5-year overall survival was 56% among the open
surgery arm and 57% among the laparoscopic surgery arm. The
minimally invasive approach was also comparable to the open
approach for recurrence-free survival, with a 5-year rate of 31%
in the open surgery arm and 29% among the laparoscopic surgery arm
(P = .73). In addition, 30-day outcomes were superior with
the minimally invasive surgery approach in terms of complications,
hospital stays, and quality of life. Overall, "laparoscopic
surgery was better for patients at no additional cost to society,"
Fretland noted.
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
'Surgery Is Never Elegant When Women Are in the OR'
Monica Morrow, MD, has a gravitas that comes with 30-plus years
of surgery at one of the world's most famous and scrutinized
cancer centers, Memorial Sloan Kettering in New York City. She was
one of five participants in the ASCO Voices session, a popular
hour-long storytelling session in the midst of the 5-day data
blizzard, now in its second year. After telling stories about her
journey through residency that garnered big laughs from the huge
crowd, Morrow said it was through a mixture of "logic and
serendipity" that she embarked on a career that she still finds
"exciting and invigorating. All of us who deal with cancer
patients are privileged to encounter our fellow human beings at
some of the darkest and some of the happiest moments of their
life. I have really been impressed by the fortitude and the grace
with which my patients deal with some pretty awful situations. And
it's taught me about what's actually important in life. And
hopefully made me a better person."
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
Sexual Harassment Reported by 64% of Gynecologic Oncologists
A survey of members of the Society of Gynecologic Oncology based
in the United States found that nearly two thirds (64%) of
respondents reported experiencing some type of sexual harassment
during training or practice. The rate was 71% among women and 51%
among men, and most incidents went unreported. Women were also
more likely than men to say that gender affected career
advancement (34% vs 10%) and played a role in setting their salary
(42% vs 6%). "Sexual harassment is a form of discrimination that
includes gender harassment, unwanted sexual attention, and sexual
coercion," said lead study author Marina Stasenko, MD, a fellow in
gynecologic oncology at Memorial Sloan Kettering Cancer Center in
New York City. "Through our study we hope to increase awareness
and acknowledgment of sexual harassment and gender inequalities
within gynecologic oncology, hopefully leading to future
interventions to address these disparities," she said.
Top News From ASCO 2019: Slideshow
Zosia Chustecka; Megan Brooks; Nick Mulcahy; Roxanne Nelson; Liam Davenport; Fredy Perojo | June 18, 2019 | Contributor Information
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Roxanne Nelson
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Bellingham, Washington
Liam Davenport
Freelance Journalist
Nice, France
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