'Revolutionary' Data to Be Presented at ESMO 2018

Liam Davenport

October 11, 2018

MUNICH — Landmark trials that could change the face of management for head and neck cancer, triple-negative breast cancer, renal cell carcinoma, and ovarian cancer will be presented at the leading European oncology conference, but these are just a few of the oncology topics that will be covered.

The European Society for Medical Oncology (ESMO) 2018 Congress will be held in Munich, Germany, from October 19 to 23. Nearly 20,000 attendees from over 130 countries worldwide are expected, making this one of the largest medical events ever hosted by the Bavarian city.

Under the tagline "Securing access to optimal cancer care," ESMO 2018 will also look at patient advocacy and nurse–physician collaboration, alongside the rich and varied scientific program that characterizes the meeting.

In all, more than 2050 abstracts will be presented over 5 days, covering, for example, immunotherapy, future technologies, biomarkers, basic and translational research, and prevention.

Solange Peters, MD, PhD, ESMO 2018 Scientific Chair, from the Oncology Department, Lausanne University Hospital, Switzerland, told Medscape Medical News that, despite the huge variety of topics covered, there are some major themes that emerge from the program.

"Year after year, we are expanding our knowledge of the use of immunotherapy and extending its application through to early lines of treatment," she said.

Describing this as "an achievement," she said that immunotherapy has been shown to be a strategy that not only offers improvements over traditional chemotherapy but also emerging data show that it can be used in ever-increasing types of cancer.

"For example, at this meeting we take immunotherapy to head and neck cancer in the frontline, we go to renal cell carcinoma, and we go to breast cancer, which is really something that, before this meeting, was considered to be a disease that does not respond," she commented.

Peters continued: "We're extending our knowledge about how to make better use of immunotherapy in every single indication, and this year, I would say we're moving these strategies through to many disease types, although still not all."

In parallel, molecular characterization and personalized oncology continue to be refined in diseases such as lung and breast cancer, "where we are starting to use PI3 kinase, checkpoint, CD4/6, and HDAC inhibitors," she said.

Many of the "most exciting" abstracts are included in the three Presidential Sessions held on Saturday, Sunday, and Monday afternoons (October 20-22).

In contrast to previous years, the topics of this year's Presidential Sessions are heterogenous, she commented, but nevertheless underline what is new and changing in terms of the standard of care.

"Starting with immunotherapy, I think the most exciting data come from head and neck cancer," Peters said.

To date, there have been some contradictory data over the use of immunotherapy in late lines of treatment for this cancer.

This could all change, however, with the presentation of the KEYNOTE-048 study of pembrolizumab for the first-line treatment of recurrent or metastatic squamous cell cancer of the head and neck.

In this study, researchers are attempting to reproduce the findings seen in lung cancer, Solange commented. "It's interesting because it's paralleling what we had in lung cancer before, which is reassuring by the way, because they are very similar diseases, based on smoking habits, mutation burden, and so on."

"This is extremely exciting, and this could completely change the frontline strategy for these patients. Remember, frontline treatment for metastatic head and neck is very heavy, so it really could make management easier and more efficacious," she said.

Although she expects there to be other similar studies in the future, she emphasized that this is the first trial of immunotherapy in head and neck frontline.

The other "complete revolution" expected at ESMO 2018 is in breast cancer, with the presentation of the IMpassion130 study of atezolizumab in combination with nab-paclitaxel compared with placebo with nab-paclitaxel in previously untreated metastatic triple-negative breast cancer.

"This is the first time something significant could be shown with immunotherapy in breast cancer," Peters said. "Until now, the entity of breast cancer was considered refractory to immunotherapy, one of the diseases where checkpoints were poorly active."

She pointed out that triple-negative disease was always going to be the most promising subset of breast cancer to tackle with the approach, but the new data could be "a signal that immunotherapy might work in some breast cancers."

"This is something that is completely a new paradigm," she added.

Another news-worthy presentation is the JAVELIN Renal 101 study of avelumab with axitinib versus sunitinib in advanced renal cell cancer.

This issue, she said, is "highly political in Europe," explaining that "the idea is to challenge the use of sunitinib (Sutent, Pfizer), which we still give frontline in renal cell carcinoma, with a good immunotherapy."

She continued, "We already have seen previously that you could use atezolizumab and bevacizumab frontline in renal cell carcinoma, and you could use the combination of ipilimumab and nivolumab (ipi/nivo), which was a nice trial presented last year at the ESMO meeting."

The political aspect of this, she explained, is that while the United States and Switzerland approved the ipi/nivo combination for the frontline treatment of renal cell carcinoma, the European Medicines Agency rejected the indication, "so it means that the best combination, which really has shown some survival benefits, is still not available for patients in Europe," Peters said.

Consequently, any trial examining the impact of frontline immunotherapy "is very important to support potential actors for patients in Europe, because at the time they don't have access."

A potential revolution in cancer care at ESMO 2018 could come from the presentation of the SOLO-1 trial of olaparib maintenance monotherapy in patients with BRCA-mutated ovarian cancer following first-line platinum-based chemotherapy.

Peters said that it has been "a long time" since there have been any good outcomes with novel strategies in ovarian cancer. If the hotly anticipated data match expectations, she believes the new data could “change the landscape of BRCA1-mutated ovarian cancer."

Elsewhere, the poster sessions will also see a huge diversity of important questions addressed during ESMO 2018, including one examining whether immunotherapy is safe for HIV patients with cancer.

Another poster will ask whether Twitter is a reliable source for cancer patients, and yet another will look at whether adolescents and young adults are fairly represented in clinical trials.

ESMO 2018 will also play host to the annual congress of the European Oncology Nursing Society (EONS11), which will run concurrently and, over 2 days, will examine symptom management and patient safety through better all-around care and nurse–physician collaboration to improve outcomes.

Patient advocacy will also be a key part of the meeting, beginning on Friday, October 19 with the session "Knowledge is power: Educating patients and advocates." Among other issues, the session will emphasize the central role of patients in ESMO's efforts to secure access to optimal cancer care.

Turning to some of the main themes of ESMO 2018, Peters said that the "hope" was to be able to use immunotherapy to move away from chemotherapy in tumors "which are sufficiently immunogenic, and typically sufficiently immunogenic means sufficiently abnormal in front of the immune system."

This includes, for example, lung cancer, head and neck carcinoma, bladder cancer, and melanoma, which are characterized by a high mutational burden.

"For these diseases, I hope we will reach a point where we do not get rid of chemo but we push chemo to salvage therapy in second- or third-line, but that's really about trying to select the more immunogenic diseases," she said.

Other cancers, such as breast and colorectal, have a low potential for immunotherapy, unless perhaps it is combined with chemotherapy or other anticancer agents to improve the presentation of the cancer to the immune system.

Despite all this progress in showing immunotherapy can be used as frontline monotherapy in several cancers, Peters said that market forces have led to the concept of personalized immunotherapy being severely weakened.

"At present, even in lung cancer, which is typically a disease where if you find good biomarkers if you select the patients well, you might imagine moving to strategies without chemo," she said.

"The market and competition between pharma companies have transformed personalized oncology into an all-comers combination, so that in lung cancer now we are allowed to give all patients a combination of checkpoint inhibition and chemo."

This, she said, is "very frustrating because you'd like to give only something like immunotherapy and be a little bit more chemo-sparing, but you are not there because the market was imposing a strategy for a large number of patients."

Peters added, "But my hope is that, with a little more flexibility for academic science to move, there will be a time when immunogenic disease might be treated without chemo for one, two, or three lines, but this requires more time."

"This requires some academic work, I'm quite sure about it, to be able to really identify the best strategy for each patient."

No relevant financial relationships were reported.

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