Onc Daily: Liver Cancer Breakthrough,
Medicaid Expansion

Sharon Worcester

May 14, 2020

Here are the most important stories that Medscape Oncology's editors picked for you to read today:

"Momentous" Data on Liver Cancer Combo

First-line combination therapy with atezolizumab (Tecentriq, Genentech/Roche) and bevacizumab (Avastin, Genentech/Roche) represents a long-sought breakthrough for the treatment of advanced liver cancer, according to results from the IMbrave 150 study, published in the New England Journal of Medicine.

The combination significantly improved median survival, overall survival, and progression-free survival, compared with standard sorafenib treatment in patients with unresectable liver cancer.

"The combination of atezolizumab plus bevacizumab has become the new benchmark for first-line therapy in advanced hepatocellular carcinoma,” Robin K. Kelly, MD, of the University of California, San Francisco writes in the accompanying editorial.  

"These data are momentous, since they identify not only the first therapy to improve survival beyond sorafenib, but also the first successful combination regimen and the first positive randomized, phase 3 trial of immune checkpoint inhibition in this challenging cancer," Kelly writes.

Medicaid Expansion Linked With Reduced Cancer Mortality

Cancer deaths declined by 29% in states that expanded Medicaid after implementation of the Affordable Care Act, compared with 25% in states that did not, according to study results to be presented at the 2020 American Society of Clinical Oncology's virtual annual meeting and highlighted in a pre-meeting press briefing.

In 2017, that translated to 785 fewer cancer deaths in states with Medicaid expansion.

Overall, age-adjusted cancer mortality declined during the entire study period (1999–2017), from 66.9 to 48.8 per 100,000 people, but mortality was consistently worse in states without Medicaid expansion.

"This study provides interesting evidence supporting an association between the adoption of Medicaid expansion and decreased cancer mortality," Deborah Marshall, MD, MAS, a research fellow at the Tisch Cancer Institute at Mount Sinai Health System in New York City, told Medscape Medical News. "With multiple states continuing to opt out of Medicaid expansion, these data are important and timely."

Updated Overview of NSCLC

The Medscape reference team has updated the detailed information on Non-Small Cell Lung Cancer (NSCLC) to include two new drugs recently approved by the FDA. They include capmatinib (Tabrecta, Novartis) for treatment of adults with metastatic NSCLC with exon 14 skipping, and also selpercatinib (Retevmo, Lilly), for patients with RET fusion-positive NSCLC. Both are the first agents for these specific indications.

Precision Medicine for Prostate Cancer

In a study published in the New England Journal of Medicine that may change practice, olaparib (Lynparza, AstraZeneca) improved progression-free survival in men with prostate cancer who tested positive for DNA repair gene alterations, including BRCA1, BRCA2, or ATM mutations.

Patients who received olaparib also had better measures of response and patient-reported outcomes than those who received a physician's choice of enzalutamide (Xtandi, Astellas/Pfizer) or abiraterone (Zytiga, Janssen).

When earlier results of the phase 3 PROfound study were presented at the European Society for Medical Oncology annual congress last fall, trial discussant Eleni Efstathiou, MD, PhD, from MD Anderson Cancer Center in Houston, Texas, called it a "landmark trial.”

"These data show that, like breast and lung cancers, prostate cancer is not one but many different diseases, and we need to start identifying different groups of patients and treating them with targeted therapy," she said at the time.

Sharon Worcester is a reporter for MDedge, part of the Medscape Professional Network. She has more than two decades of experience reporting on healthcare.

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

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