Zosia Chustecka

Disclosures

May 30, 2015

Potentially practice changing news released today at the American Society of Clinical Oncology (ASCO) 2015 Annual Meeting will have an impact on the treatment of prostate cancer and melanoma.

"Today's data show that increasing the aggressiveness of treatment with chemotherapy can make a big difference in prostate cancer. In contrast, scaling back surgery strategies for some melanoma patients can spare them from debilitating side effects, with little risk to their survival," Don S. Dizon, MD, a gynecologic oncologist at the Massachusetts General Hospital Cancer Center, in Boston, Massachusetts, commented in an ASCO statement.

The new data will be released by ASCO at early morning press briefings, but the presentations of the data will take place on various days.

The results come from several large phase 3 studies, as follows:

  • Chemotherapy up front improves overall survival in prostate cancer (RTOG 0521 study, abstract LBA5002, and also STAMPEDE study, abstract 5001, both presented on May 31). These two studies join a third that have all shown that adding chemotherapy with docetaxel (multiple brands) to standard treatment with hormonal ablation and radiotherapy results in survival benefits ― so will there now be a paradigm shift to the use of chemotherapy much earlier in the course of the disease?

  • Complete lymph node surgery in melanoma does not improve survival (DECOG trial, abstract LBA9002, presented on May 30). These results will likely change a longtime standard and will spare patients from undergoing unnecessary surgery. "I think that our study is the beginning of the end of a general recommendation of complete lymph node dissection for patients with positive sentinel nodes," said senior study author Claus Garbe, MD, a professor of dermatology at the University of Tübingen, in Germany.

  • Improved survival in liposarcoma and leiomyosarcoma with eribulin (Halaven, Eisai Inc). Eribulin is currently marketed for the treatment of breast cancer. The drug improved overall survival by 2 months in comparison with standard therapy with dacarbazine (multiple brands) (abstract LBA10502, presented on June 1). This is significant, says lead study author Patrick Schöffski, MD, MPH, head of the Department of General Medical Oncology, University Hospitals Leuven, in Belgium, because "patients whose disease progresses despite two or more lines of treatment have a very poor prognosis."

  • Anastrozole trumps tamoxifen in ductal carcinoma in situ in postmenopausal women (LBA500, presented on June 1), but only just. The 10-year breast cancer–free survival rates were higher in the anastrozole group than in the tamoxifen group (93.5% vs 89.2%). "The good news is tamoxifen [multiple brands] and anastrozole [Arimedex, AstraZeneca Pharmaceuticals LP] are both very effective, but it seems that women have better chances of staying well with anastrozole," said lead study author Richard G. Margolese, MD, professor of surgical oncology at the Jewish General Hospital, McGill University, in Montreal, Canada.

  • Palbociclib slows progression of the most common breast cancer (ie, hormone receptor–positive, HER2-negative breast cancer, which occurs in 75% of women). "This relatively easy- to-take new drug can substantially delay the point when women need to start chemotherapy, making this an exciting new approach," said lead study author Nicholas C. Turner, DPhil, consultant medical oncologist at the Royal Marsden, London, United Kingdom. Palbociclib (Ibrance, Pfizer Inc) was recently approved in the Unites States.

In addition, on Saturday, new data will be released for several new drugs that are in late development for the treatment of hematologic cancers, including the following:

  • Daratumumab in multiple myeloma (abstract LBA8512, to be presented on June 2). The novel anti-CD38 antibody appears effective as a stand-alone therapy for heavily treated multiple myeloma.

  • Pacritinib in myelofibrosis (PERSIST-1 study, abstract LBA7006, presented on May 30). The new JAK–inhibitor appears to be more effective than current therapies for myelofibrosis, especially for patients who have low platelet counts.

Also being presented today at the meeting are the results from the Australian study on the vitamin B derivative nicotinamine in skin cancer. This study showed that for patients who already had skin cancer, risk for further skin cancer (basal cell carcinoma and squamous cell carcinoma, and also actinic keratosis) was significantly reduced by taking the oral supplement, which is widely available and inexpensive (ONTRAC study, abstract 9000, presented on May 30).

"This is the first clear evidence that we can reduce skin cancers using a simple vitamin, together with sensible skin protection," commented senior study author Diona Damian, MBBS, PhD, professor of dermatology at the Dermatology University of Sydney, in Australia. She was speaking prior to the meeting at a press cast that highlighted this study, as reported at the time by Medscape Medical News.

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