Breast, Lung, & Ovarian Cancer Data to Star at ESMO 2019

Liam Davenport

September 23, 2019

BARCELONA, Spain — Potentially practice-changing results in breast, lung and ovarian cancer are expected at this year's European Society for Medical Oncology (ESMO) annual meeting, with the ever-expanding role of immunotherapies and developments in precision medicine also taking center stage.

The ESMO Congress 2019 runs from September 27 to October 1, and will feature about 2200 abstracts, 92 of which will be late-breaking abstracts that are still under embargo.

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," says Pilar Garrido, MD, PhD, associate professor of medical oncology at Universidad de Alcalá, Madrid, Spain, and ESMO Press & Media Affairs Committee Chair.  

This year, ESMO has partnered with the European Association for Cancer Research, with a collaborative session between the two organizations taking place on the first day (September 27, Valencia Auditorium, 2:00-3.30 PM).

The European Oncology Nursing Society also returns in 2019 with two dedicated sessions: one on the challenges of CAR T cell therapy (on September 28), and a journey through the wealth of research methods available when studying patient-related outcomes (on September 29).

This will be complemented by an entire track dedicated to health policy, which will show how ESMO is collaborating with health authorities on issues such as medicine shortages and price/value of cancer drugs.

The focus, however, will be on the scientific program. Garrido said conference attendees will see "many advances" in immunotherapy, with the use of "very innovative strategies" and the growth of precision medicine.

She commented that "stars" at this year's meeting, in terms of tumor types, will be breast cancer, ovarian, and lung cancer.

New Breast Cancer Data

For breast cancer, the second Presidential Symposium (September 29, Barcelona Auditorium, 4.30-6:00 PM), will feature two presentations on advanced and endocrine-resistant disease, both of which will reveal long-awaited overall survival data, she said. These are the MONARCH-2 trial with abemaciclib (Verzenio, Eli Lilly) plus fulvestrant (abstract LBA-6) and the MONALEESA-3 trial with ribociclib [Kisqali, Novartis] and fulvestrant (abstract LBA-7).  

Change in Standard of Care in Ovarian Cancer?

Ovarian cancer will see several key studies that Garrido believes "will potentially change the standard of care."

The PAOLA-1 trial investigated maintenance therapy with olaparib (Lynparza, AstraZeneca) plus bevacizumab in newly diagnosed patients with advanced ovarian cancer treated with platinum-based chemotherapy (abstract LBA-2). PAOLA-1 will be presented in the first Presidential Symposium (September 28, Barcelona Auditorium, 4.30-6.20 PM).

"The key point of this study," Garrido said, "is that this potential double maintenance strategy is for all patients, regardless of BRCA1/2 mutation status."

"We will have to see the data," she says, "but it's a potential way of expanding the use of, in this case, olaparib to a broader population."

New Data in Lung Cancer

Two studies on lung cancer — one investigating when to use immunotherapy, and the other focused on precision medicine — will also be presented at the first Presidential Symposium.

The FLAURA trial was undertaken in patients with non-small cell lung cancer (NSCLC) with an EGFR mutation, which Garrido said represents around 10% to 13% of white patients.

"We already knew that osimertinib (Tagrisso, AstraZeneca), which is the experimental arm of this study, was positive in the first-line setting for progressive disease, but this year we will hear the overall survival results [abstract LBA-5]," she explained.

"Based on a press release from the company, it seems that the study is positive, but we need to know the magnitude of benefit."

This, Garrido said, is necessary "to know if we can finish the debate about sequencing or, if the magnitude is not good enough, we will continue debating".

The other trial, CheckMate 227, investigated immunotherapy compared with chemotherapy when used first-line in patients with advanced NSCLC. In this trial, immunotherapy was a combination of nivolumab (Opdivo, Bristol-Myers Squibb) plus low-dose ipilimumab (Yervoy, Bristol-Myers Squibb), and this was compared to platinum-based chemotherapy.

Results from this trial on the use of tumor mutational burden as a means of selecting patients have already been presented at ASCO 2018. Garrido said that analysis showed results for progression-free survival and response that were "pretty interesting," but she noted that overall survival was negative.

"This year, we will have the results based on the other biomarker, programmed death-ligand 1 (PD-L1), which is already implemented in clinical trials," she noted. These new data will reveal whether combination immunotherapy can be used instead of chemotherapy in some subsets of patients (abstract LBA-4).

Rare Cancers in Spotlight

The third Presidential Symposium (September 30, Barcelona Auditorium, 4:30-6:15 PM), will feature a presentation on the ClarIDHy trial of ivosidenib (Tibsovo, Agios Pharmaceuticals) vs placebo in advanced cholangiocarcinoma (bile duct cancer) with an IDH1 mutation, which is a very uncommon form of the tumor (abstract LBA11).

Garrido explained that "if the study is positive and the results are good enough, it is possible that we could have an option for 1 out of 6 patients with this type of advanced disease." These patients currently "have very few options, so it's really interesting," she added.

The same session will also see the results of IMvigor130, which compared atezolizumab (Tecentriq, Genentech) and placebo against a backdrop of platinum-based chemotherapy in untreated locally advanced or metastatic urothelial carcinoma (bladder cancer) (abstract LBA14).

Garrido also highlighted a study to be presented during a Proffered Paper– Sarcoma session on September 30 (Malaga Auditorium, 2:25-4:40 PM).

INVICTUS is a double-blind, placebo-controlled phase 3 trial in which patients with gastrointestinal stromal tumors were given the investigational agent ripretinib (previously known as DCC-2618, Deciphera Pharmaceuticals) as at least fourth-line therapy (abstract LBA87).

"Again, based on a press release from the company, it seems that the INVICTUS study demonstrates some benefit in this setting," Garrido said. This would be an option "for a small subset of patients that need this kind of research."

Among the sessions that cover issues other than new clinical data is a symposium focusing on burnout and related psychological support for oncologists (September 30, Toledo Auditorium, 8.30-10 AM).

A team of Medscape Medical News journalists will be reporting from the meeting, posting updates on the new data — and reactions to it — as they become available. Medscape Oncology also has a booth (#416) in the exhibition hall.  

Garrido reports having speaker and/or advisory roles for AbbVie, AstraZeneca, Blueprint Medicines, Boehringer Ingelheim, Bristol-Myers Squibb, Janssen, Gilead, Guardant Health, Pfizer, Lilly, Novartis, MSD, Roche, Rovi, Sysmex, and Takeda; and institution financial interests related to clinical trials with Roche, Lilly, MSD, Novartis, Takeda, Blueprint Medicine, AstraZeneca, Bristol-Myers Squibb, Janssen, Boehringer Ingelheim, and AbbVie.

European Society for Medical Oncology (ESMO) 2019 Annual Meeting

For more from Medscape Oncology, follow us on Twitter:  @MedscapeOnc


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.