Zosia Chustecka

May 31, 2014

CHICAGO — News coming out today here at the 2014 Annual Meeting of the American Society of Clinical Oncology® (ASCO) focuses on results achieved with new targeted agents. A quick summary is provided here, but detailed reports with reactions to the news will be posted soon, so please check back to Medscape Oncology throughout the day.

"Cancer relapses and treatment resistance have always been among the most daunting challenges in cancer care," commented Gregory Masters, MD, medical oncologists at the Helen F. Graham Cancer Center in Newark, Delaware. "The good news is that genomic medicine is helping to overcome these challenges by revealing new ways to target a cancer cell's inner workings," he commented at today's ASCO press briefing.

Ibrutinib in CLL Results "Will Change Practice"

New results with ibrutinib (Imbruvica, Pharmacyclics) in patients with relapsed chronic lymphocytic leukemia (CLL) "will significantly change clinical practice," predicted ASCO expert Olatoyosi Odenike, MD, who is associate professor of medicine in the section of hematology/oncology at the University of Chicago.

Ibrutinib was recently granted an accelerated approval in the United States for use in CLL in patients who have already tried at least 1 previous therapy. The new data support use of ibrutinib before anything else in this setting of relapsed CLL, said lead investigator John Byrd, MD, professor of medicine at the Ohio State University Comprehensive Cancer Center.

The data come from the RESONATE study, which will be presented on Tuesday, June 2 (abstract LBA7008) and simultaneously published online in the New England Journal of Medicine. This study compared ibrutinib with ofatumumab (Arzerra, GlaxoSmithKline), which was recently granted a full approval and is often used as a standard therapy in CLL, especially in older patients who cannot tolerate intensive chemotherapy.

"With ibrutinib, 80% of patients were still in remission at 1 year, twice as many as we would expect with standard therapy," Dr. Byrd commented.

Ramucirumab in NSCLC

Another of the highlighted studies featured the new antiangiogenesis agent ramucirumab (Cyramza, Lilly) in the treatment of non-small cell lung cancer (NSCLC), which could be the next indication for this drug. It was recently approved in the United States for gastric cancer.

In patients with advanced NSCLC who had relapsed after initial therapy, addition of ramucirumab to docetaxel in second-line treatment improved the median overall survival to 10.5 months, compared with 9.1 months with docetaxel alone. These results come from the REVEL trial, which will be presented at the meeting on Monday, June 2 (abstract LBA8006).

Although the overall survival was extended by just a month, lead researcher Maurice Pérol, MD, head of thoracic oncology at the Cancer Research Center of Lyon in France, said: "This survival improvement is significant because patients with advanced NSCLC typically have a very short survival time following second-line therapy." He also noted that this is the first time in about 10 years that an improvement in the outcome of such patients has been reported.

Lenvatinib in Differentiated Thyroid Cancer

As recently as a year ago, patients with differentiated thyroid cancer that has become resistant to standard radio-iodine therapy had no effective treatment options. "It's remarkable that now we have 2 active drugs in this setting, both of them tyrosine kinase inhibitors," commented Martin Schlumberger, MD, professor of oncology at the University Paris-Sud in France.

He will be presenting results with the investigational agent lenvatinib (under development by Eisai) from the SELECT study on Monday, June 2 (abstract LBA6008). Nearly two-thirds of patients showed tumor shrinkage, and the median progression-free survival with lenvatinib was 18. 3 months, compared with 3.6 months on placebo (so disease progression was delayed by 14.7 months).

"We are confident that, based on our findings, lenvatinib will eventually become a standard treatment for radio-iodine-resistant thyroid cancer," Dr. Schlumberger commented in a statement.

Eisai said that it intends to file the results from the SELECT study for approval in the United States, Europe, and Japan.

Sorafenib (Nexavar, Bayer) recently became the first drug for this indication in more than 40 years when it was approved in the United States in November 2013.

New Combo for Ovarian Cancer

Two investigational drugs used together have shown promising activity in ovarian cancer, specifically in patients with recurrent platinum chemotherapy-sensitive high-grade serous or BRCA-mutation-related disease.

The 2 products are cediranib, an antiangiogenesis agent, and olaparib, a PARP inhibitor; both are oral products and both are under development at AstraZeneca. In a small study presented today (abstract LBA5500), the combination was significantly more active in this patient population than olaparib alone.

Neither of the drugs is approved yet for ovarian or any other cancer, but the combination showed significant activity, which suggests that "this could potentially be an effective alternative to standard chemotherapy," said lead study author Joyce Liu, MD, MPH, from the Dana-Farber Cancer Institute in Boston. However, further studies are needed, she added.

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