Zosia Chustecka

June 05, 2016

CHICAGO — Today's news showcases the best clinical data selected for presentation at the Plenary Session at the annual meeting of the American Society of Clinical Oncology (ASCO).

Progress in multiple myeloma is one of the topics, with a study that is described as "one of the most exciting presentations of the entire meeting," by Richard Schilsky, MD, ASCO chief medical officer and former chief of the section of hematology–oncology at the University of Chicago. At present, bone marrow transplant is still the standard of care for multiple myeloma, but this is being called into question as the newer drugs push responses ever higher, he explained.

Some of the best responses ever seen will be presented from the CASTOR study, showing that the combination of daratumumab (Darzalex) with bortezomib (Velcade), given with dexamethasone, achieved about a 60% reduction in death or progression in patients with relapsed or refractory multiple myeloma, when compared with bortezomib with dexamethasone (abstract LBA4).

"The results are preliminary but promising," Dr Schilsky told Medscape Medical News.

Daratumumab has recently been approved for use as a single agent in refractory myeloma, after showing "unpresented responses" in that setting. These new results support its use in combination, he added.

Also presented at the plenary session will be results showing:

  • Improved 3-year overall survival in children with high-risk neuroblastoma who received tandem myeloablative autologous stem cell transplant using peripheral blood stem cell as consolidation therapy (abstract LBA3)

  • Improved survival shown in elderly patients with glioblastoma multiforme who received chemotherapy with temozolomide, as well as radiotherapy (abstract LBA2); such chemoradiation is already standard of care, but this study shows that it can be used even in elderly patients (age range, 65 - 95 years; median, 73 years)

  • Additional benefit from an additional 5 years of endocrine therapy in postmenopausal women with early-stage breast cancer, on top of the current standard of care, which is 5 years of therapy; the results from the MA.17R study show small but significant improvement in disease-free survival from the additional 5 years therapy with letrozole (abstract LBA1), but there is a price to be paid in terms of adverse effects (abstract LBA506)

Also highlighted in today's press briefings will be data from the IMvigor210 study, showing responses for atezolizumab (Tecentriq) as first-line therapy in cisplatin-ineligible locally advanced/metastatic urothelial carcinoma (abstract LBA4500).

These data have already resulted in US Food and Drug Administration (FDA) approval, just a few days ago, and atezolizumab has been hailed as the first drug for metastatic bladder cancer in 30 years. However, this is an accelerated approval based on overall response rates, and the FDA is waiting for data on overall survival.

Atezolizumab has a slightly different mechanism of action from the drugs already available, as it acts as an inhibitor of the programmed cell death ligand (PDL-1), whereas nivolumab (Opdivo) and pembrolizumab (Keytruda) are PD-1 inhibitors. Whether this small difference in pharmacology will translate into clinical differences has yet to be seen.

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