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Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019
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Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
The ever-expanding role of immunotherapies and developments in precision medicine in a variety of tumor types took center stage at the European Society for Medical Oncology (ESMO) Congress 2019, held September 27 to October 1 in Barcelona, Spain. This is one of the largest oncology meetings in the world, and one of the "best places" to discuss the science that "really matters for our patients," commented Pilar Garrido, MD, PhD, ESMO press & media affairs committee chair and associate professor of medical oncology at Universidad de Alcalá, Madrid,
Spain.
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
The meeting featured about 2200 abstracts, including 92
late-breaking abstracts. Among the highlights this year:
Metastatic melanoma: Major improvement in survival
with ipilimumab plus nivolumab
Advanced NSCLC: Hope for chemotherapy-free
treatment for all comers
Ovarian cancer: Strong justification for making
PARP inhibitors first-line therapy
Skip radiotherapy after prostate cancer?
Advanced HR+/HER2- breast cancer: CDK4/6
inhibitors yield survival benefit
Triple negative breast cancer: Immunotherapy
active in early stage disease
"Unprecedented" results in advanced
cholangiocarcinoma
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
One in Two Patients With Metastatic Melanoma Alive After 5 Years
One out of two patients with metastatic melanoma treated
with the combination of ipilimumab (Yervoy,
Bristol-Myers Squibb) and nivolumab (Opdivo,
Bristol-Myers Squibb) are still alive after 5 years, according to updated
results from the longest running trial of the dual immunotherapy. "This is a
major improvement on what we have seen historically," said principal
investigator James Larkin, FRCP, PhD, of the Royal Marsden NHS Foundation
Trust, London, UK. Larkin presented the new survival data from the CheckMate
067 trial, which randomly assigned 945 patients to receive the combination of
ipilimumab and nivolumab, nivolumab, or ipilimumab. The 5-year overall
survival rates were 52% for the combination of nivolumab and ipilimumab, 44%
for nivolumab, and 26% for ipilimumab. Progression-free survival at 5 years
mirrored overall survival data: 36% for the combination, 29% for nivolumab
alone, and 8% for ipilimumab alone. "The two drugs together definitely have a
role in treating metastatic melanoma and will be the choice for some
patients. For others, the decision may be to give the drugs in sequence,"
Larkin said.
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
Could All Patients With Advanced NSCLC Go Chemo-Free?
Combination immunotherapy improved overall survival
compared with chemotherapy in patients with untreated advanced non-small cell
lung cancer (NSCLC), even in the absence of programmed death ligand 1 (PD-L1)
expression. This offers hope for chemotherapy-free treatment for all comers,
say researchers. The new data come from the final analysis of part 1 of the
large CheckMate 227 trial. Patients were randomly assigned to nivolumab plus
ipilimumab, chemotherapy alone, nivolumab alone, or nivolumab plus chemotherapy.
In patients with PD-L1 expression ≥ 1%, median overall survival
improved by 21%, from 15 months to 17 months, with combined immunotherapy vs
chemotherapy. The nivolumab/ipilimumab combination was also associated with a
survival benefit in patients with PD-L1 expression < 1% and in all
patients combined, with the effect lasting beyond the 2-year treatment
period. The results are "practice changing," as it is the first trial to show
combined nivolumab and ipilimumab prolongs survival over chemotherapy in
treatment-naive metastatic NSCLC, said lead investigator Solange Peters, MD,
PhD, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
PARP Inhibitors Move Into First-Line for Ovarian Cancer
The landscape of ovarian cancer treatment is changing
rapidly, as PARP inhibitors (PARPi) move into the first-line treatment space.
Three new clinical trials with three different drugs show substantial benefit
when a PARPi is used in patients with newly diagnosed ovarian cancer, leading
experts to urge clinicians to use these drugs upfront in the treatment of
these patients. The new results are with niraparib (Zejula,
GlaxoSmithKline), olaparib (Lynparza,
AstraZeneca/MSD), and veliparib (AbbVie). "We are witnessing a paradigm shift
in the first-line treatment for advanced ovarian cancer," concluded Ana
Oaknin, MD, from the Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain,
after reviewing the new data here during a presidential symposium. "There is
a robust reduction in the risk of progression...that strongly justifies
moving PARPi to first-line," she said. "The only opportunity to 'cure' our
patients with advanced ovarian cancer is with first-line therapy," she added.
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
Skipping Radiotherapy After Surgery for Prostate Cancer
Radiotherapy can be withheld after surgery for prostate
cancer and given only if there are signs of biochemical recurrence of
disease, instead of being given automatically to all patients, according to
new advice from prostate cancer radiation experts discussing new data. These
new data include the first results from the largest trial to compare salvage
with adjuvant radiotherapy (RADICALS-RT), and also the results of a
prospective meta-analysis of three such studies (ARTISTIC). They show that
withholding radiotherapy and monitoring men after prostatectomy and giving
early salvage radiotherapy when the first signs of biochemical recurrence are
seen produces early outcomes that are similar, or even slightly better, than
giving adjuvant radiotherapy to all patients. Chris Parker, MD, from the
Royal Marsden NHS Foundation Trust and the Institute of Cancer Research,
London, UK, who presented results from RADICALS-RT, said the results have
already changed clinical practice at his institution. "This is our new policy
— early salvage radiotherapy at the first sign of a rise in PSA,"
he said.
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
Disappointment Over Immunotherapy in Mesothelioma
In patients with malignant pleural mesothelioma who had
progressed after first-line chemotherapy, immunotherapy with pembrolizumab (Keytruda, Merck)
appears to offer no survival advantages over standard chemotherapy, according
to the PROMISE-meso study. Despite "nearly four times more patients"
responding to immunotherapy than standard chemotherapy, "unfortunately these
responses did not delay progression or improve survival," noted study
investigator Sanjay Popat, MD, PhD, Royal Marsden Hospital NHS Foundation
Trust, London, UK. However, although pembrolizumab "was not superior to
chemotherapy, survival was similar, and so pembrolizumab may represent an
alternative." As in other immunotherapy trials in other cancer types, some of
the mesothelioma patients had long responses, which suggests some patients
could "preferentially receive this treatment over chemotherapy," he said.
Popat also suggested that, learning from lung cancer trials, combining
immunotherapy with chemotherapy could have a beneficial effect.
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
Now With Survival Benefit, CDK4/6 Inhibitors in Breast Cancer
Final results from the MONARCH 2 and MONALEESA-3 trials
show consistent overall survival benefits with the cyclin-dependent kinase
4/6 (CDK4/6) inhibitors abemaciclib (Verzenio, Lilly)
and ribociclib (Kisqali, Novartis). The new data
establish the foundation for adding these drugs to endocrine therapy in the
treatment of patients with hormone receptor positive, human epidermal
receptor negative (HR+/HER2-) advanced breast cancer. The results from
MONARCH 2 show that after a median follow-up of approximately 4 years (47.7
months), patients lived significantly longer with the combination of
abemaciclib and fulvestrant. Median overall survival was 46.7 months with the
combination and 37.3 months with fulvestrant alone (hazard ratio [HR],
0.757). This is a statistically significant and clinically meaningful
improvement in overall survival, said first author George Sledge, MD,
Stanford University School of Medicine, California. A similar benefit was
seen with the combination of ribociclib and fulvestrant in MONALEESA-3. After
a median follow-up of 39.4 months, median overall survival was not reached
with the combination of ribociclib and fulvestrant; it was 40.0 months for
patients who received fulvestrant alone (HR, 0.724).
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
Immunotherapy Active in Early Stage Triple Negative Breast Cancer
Adding immunotherapy to chemotherapy in patients with
early stage triple negative breast cancer (TNBC) substantially increases the
likelihood that patients will have no residual disease by the time they
undergo surgery, according to results of the phase 3 KEYNOTE-522 study, in which
the immune checkpoint inhibitor pembrolizumab (Keytruda, Merck) was added to
chemotherapy, the current standard of care. A pathological complete response
occurred in almost 65% of patients given pembrolizumab plus chemotherapy
versus only 51% of those given chemotherapy alone, reported Peter Schmid, MD,
PhD, St Bartholomew's Breast Cancer Centre, Barts Health NHS Trust, London,
UK. The benefit was seen in patients positive and negative for PD-L1
expression. TNBC accounts for 15% of breast cancer cases, but unlike other
types of breast cancer, the disease has an "unmet medical need" as the only
medical treatment is chemotherapy, commented Fabrice André, MD, PhD,
Institut Gustave Roussy, Villejuif, France. Within this context, the new
results "could have a major impact on treatment for these patients," he said.
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
FLAURA Establishes Osimertinib as First-line in EGFRm NSCLC
The final overall survival results from the FLAURA study
have now firmly established osimertinib (Tagrisso,
AstraZeneca) as front-line therapy in patients with epidermal growth factor
receptor-mutated (EGFRm)
NSCLC. FLAURA showed that median overall survival was 38.6 months for
patients on osimertinib and 31.8 months for patients receiving
first-generation EGFR tyrosine kinase inhibitors (TKIs) such as gefitinib (Iressa,
AstraZeneca) and erlotinib (Tarceva,
Genentech/Astellas Oncology). "The survival results are both statistically
significant and clinically meaningful with first-line osimertinib for EGFR-mutated
patients," commented lead investigator Suresh S. Ramalingam, MD, of the
Winship Cancer Institute of Emory University, Atlanta, Georgia. "This is the
first time a TKI has proven to extend survival relative to another TKI in
lung cancer therapy," he added. Discussant Pasi A. Jänne, MD, PhD,
of the Dana Farber Cancer Institute in Boston, Massachusetts, commented with
an improvement in median overall survival of 7 months, the results from
FLAURA are practice changing. In fact, he added, "in the United States,
practice has already changed."
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
First-line Immunotherapy Still Elusive in Advanced Liver Cancer
The promise of first-line immunotherapy remains unrealized
for patients with advanced hepatocellular carcinoma (HCC), but early
promising results look good for a combination. Nivolumab (Opdivo,
Bristol-Myers Squibb) used as first-line treatment in patients with advanced
HCC did not show a significant difference in overall survival compared with
the current standard of care, sorafenib (Nexavar,
Bayer/Onyx Pharmaceuticals). However, overall response rate was nearly double
with nivolumab vs sorafenib (15% vs 7%). Complete and partial response rates
were also higher for patients receiving nivolumab, reported Thomas Yau, MD,
of the University of Hong Kong, China. These results, from the CheckMate 459
trial, are "unlikely to change the current standard of care. However, it is
becoming more apparent that immunotherapy could have a role for the
first-line treatment of advanced HCC, and the differences in response rates
are clinically meaningful," said Angela Lamarca, MD, of the Christie NHS
Foundation Trust, Manchester, UK.
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
"Unprecedented Results" in Biliary Tract Cancer
Advanced cholangiocarcinoma may respond to a novel
gene-targeted therapy, even in cases that have progressed with standard
chemotherapy. The finding, which comes from trial data with ivosidenib (Tibsovo,
Agios Pharmaceuticals), was described as a "breakthrough" and "unprecedented"
by experts here. Ivosidenib is an oral, targeted, small-molecule inhibitor of
mutations in the isocitrate dehydrogenase–1 (IDH1) gene. It is approved in the United States for relapsed or
refractory acute myeloid leukemia in adults with IDH1
mutations who are chemotherapy naive. The new trial, conducted in patients
with cholangiocarcinoma and IDH1 mutations, showed ivosidenib
significantly improved progression-free survival and had a favorable trend in
overall survival in this patient subgroup, said lead author Ghassan K.
Abou-Alfa, MD, of Memorial Sloan Kettering Cancer Center, New York City. The
clinical implication, he added, is that "all patients with cholangiocarcinoma
should be tested for IDH1 mutation."
Top News From ESMO 2019: Slideshow
Zosia Chustecka; Darby Rotach; Alexander Castellino; Liam Davenport; Megan Brooks; Miquel Gonzalez | October 21, 2019 | Contributor Information
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Contributor Information
Zosia Chustecka
Medscape Oncology News Editor
London, England
Darby Rotach
Medscape Senior Photo Editor
New York City
Alexander Castellino
Freelance Journalist
New York City
Miquel Gonzalez
Freelance photographer
Amsterdam, The Netherlands
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