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2021-06-06| R&DTechnology

Day 2 ASCO 2021 Roundup: Focus on Equity in Cancer Care, Highlights from Breast Cancer and Gastrointestinal Cancer Studies

by GeneOnline
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The second day of the ASCO 2021 virtual annual meeting started with an opening ceremony where the guest speakers’ address and presidential address focussed on equity in cancer care.

Dr. Lori Pierce, the President of ASCO, emphasized that equality in cancer care is not sufficient. According to her, the biggest hindrance in achieving equity, i.e., patients having similar outcomes, regardless of their circumstances, is the structural racism that exists in healthcare.

National Cancer Institute Director Dr. Norman E. Sharpless spoke about the National Cancer Act, which celebrates its 50th anniversary this year. He stressed that NCI will be looking to recruit more Black and Hispanic scientists and fund investigators from more diverse backgrounds to accomplish the goal of diversifying trials and improving outcomes.

Dr. Julio Frenk, President of the University of Miami, said that although the COVID-19 pandemic exposed the frailty of healthcare infrastructure, it also enabled unprecedented scientific collaboration. To overcome another health crisis in the future, he appealed for three things:

  1. A global health care network that can collect and share data on emerging diseases, ensuring transparent communication.
  2. A technology platform facilitating the quick development of disease-fighting tools like vaccines, diagnostics tests, etc.
  3. A rapid deployment force made up of international public health foot soldiers who can use the resources at their disposal when outbreaks happen.

Dr. Rhea Boyd, Chief Medical Officer of San Diego, underscored the importance of actively calling out racism to put an end to it. With the help of statistics, she pointed out how institutionalized racism is scarcely discussed in the literature.

 

Breast Cancer Updates

Kisqali plus Faslodex Combo Provides Long-Term Survival Benefits for Patients with Advanced Breast Cancer

The combination therapy of Faslodex (fulvestrant), a selective estrogen receptor degrader, and Kisqali (ribociclib), a small molecule cyclin-dependent kinase 4/6 inhibitor, received FDA approval for the treatment of postmenopausal women with HR-positive, HER-negative advanced breast cancer in 2018.

Dr. Massimo Cristofanilli from Northwestern University presented data analyzing the long-term benefits of the combination therapy versus Faslodex alone. The updated results, at the median follow-up of 73.3 months, showed that combination therapy continues to provide superior overall survival compared to Faslodex alone (34.8 vs. 28 months).

This prolonged survival was observed on patients with no prior chemotherapy and on a subgroup of patients that received previous chemotherapy with nonvisceral disease. Additionally, they looked at the benefits of the combination therapy in patients with mutations associated with a worse prognosis (ESR1, PIK3CA, and TP53).

In all the groups, Faslodex plus Kisqali provided a greater benefit to patients with these mutations. The largest benefit was observed in patients with PIK3CA mutation, where the OS was almost 10 months longer with the combination treatment.

 

Herceptin Plus Endocrine Therapy was as Effective as First-line Treatment and had Fewer Adverse Effects

Treatment for metastatic breast cancer with hormone receptor and HER2-positive is often treated with combination therapy of Herceptin (trastuzumab), an anti-HER2 receptor antibody, plus chemotherapy. However, patients often experience adverse effects.

The sysucc-002 Phase 3 clinical trial set to investigate the efficacy and toxicity of Herceptin with endocrine therapy versus Herceptin and chemotherapy. The trial enrolled 392 people randomized 1:1. Dr. Zhong-Yu Yuan from the Sun Yat-sen University Cancer Center presented the results of the trial. Both therapies had similar progression-free survival and overall survival rates, suggesting Herceptin plus endocrine therapy were not inferior to Herceptin plus chemotherapy.

Interestingly, patients with more than 24 months disease-free interval benefit more from the endocrine therapy. Crucially, Herceptin plus endocrine therapy had fewer adverse effects and the chemotherapy group. This could improve the quality of life of patients with metastatic breast cancer.

 

Tumor Microenvironment Plays a Crucial Role in Response to Cancer Immunotherapy

Dr. Leisha Emens from the University of Pittsburg presented the results of the Impassion 130, the first randomized Phase 3 clinical trial testing the efficacy of immunotherapy against metastatic triple-negative breast cancer (mTNBC). The trial compared the combination of the chemotherapy nab-paclitaxel with Tecentriq (atezolizumab), an anti-PD-L1 antibody, versus nab-paclitaxel alone.

The study determined that patients with PD-L1-expressing immune cells on more than 1% of tumor area had an improved progression-free survival (PFS) and overall survival (OS) with the combination therapy than chemotherapy alone (25.4 vs. 17.9 months). Additionally, they found that PD-L1 expression was not the only factor affecting response to therapy.

They observed that tumors with high levels of infiltrated CD8-expressing T cells (inflamed) and tumors with isolated clusters of CD8-expressing T cells (excluded) had improved PFS and OS. Additionally, molecular subtypes played a role in response to therapy. In particular, the basal-like immune activated (BLIA) subgroup had an improved OS and PFS. This provides important information that can be used to screen for patients more likely to respond to therapy.

 

Gastrointestinal Cancer Updates

Camrelizumab Plus Chemotherapy Registers Superior OS and PFS in Patients with Untreated Advanced or Metastatic ESCC

Esophageal squamous cell carcinoma (ESCC) is the most common subtype of esophageal cancer and ranks sixth in the world’s leading causes of cancer-related deaths. The fatality of esophageal cancer is due to its rapid progress to advanced or metastatic state at the time of diagnosis, with a median survival of 8-10 months and an expected five-year survival rate of less than 5%.

Doublet chemotherapy is the current standard first-line therapy for advanced or metastatic ESCC. Earlier, Jiangsu HengRui Medicine’s Camrelizumab, a humanized anti-PD-1 monoclonal antibody, has shown promise in previously treated advanced or metastatic ESCC. Today, Dr. Rui-hua Xu from the Sun Yat-Sen University Cancer Center presented data from the Phase 3 ESCORT-1st study, which evaluated the efficacy and safety of camrelizumab plus chemotherapy combo in patients with untreated advanced or metastatic ESCC.

In the trial, 298 patients were treated with a camrelizumb-chemotherapy combo and 297 patients with placebo-chemotherapy. Results showed that the camrelizumab plus chemotherapy combo significantly improved OS and PFS compared to placebo plus chemotherapy.

 

First-line Nivolumab Plus Chemo Combo Demonstrates Superior Survival in Advanced Gastric Cancer

Patients with gastric cancer, the third most common cause of cancer mortality, have a five-year survival rate of 32%, decreasing to just 5% in aggressive or metastatic forms. Besides traditional treatments like surgery, chemotherapy, and radiation, immunotherapies like ramucirumab, pembrolizumab, and trastuzumab have been approved for some advanced gastric cancers. Nevertheless, there are very few drugs for this condition.

In April 2021, following the success of the Phase 3 CheckMate -649 trial, the FDA approved BMS’s Opdivo (nivolumab), a PD-1 inhibitor, in combination with fluoropyrimidine- and platinum-containing chemotherapy for treating patients with advanced or metastatic gastric cancer, gastroesophageal junction (GEJ) cancer, and esophageal adenocarcinoma, regardless of PD-L1 expression status.

Today, Dr. Markus H. Moehler from the Johannes Gutenberg University Mainz presented the expanded safety and efficacy results from the CheckMate-649 trial. Results show that Nivolumab plus chemo combo demonstrated a superior OS benefit and clinically meaningful PFS improvement in all randomized patients at the 12-month minimum follow-up. Patients in the combination therapy arm had decreased risk of symptom deterioration on treatment vs. those in the chemo arm.

By Rajaneesh K. Gopinath and Daniel Ojeda

Related Article: Day 1 ASCO 2021 Roundup: Combating Lung Cancer, Hematologic Malignancies and Advanced Solid Tumors

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