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Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

The American Society of Clinical Oncology (ASCO) 2017 Annual Meeting was held June 2 to 6 at the McCormick Place in Chicago. With nearly 40,000 attendees, it's billed as the largest cancer meeting in the world, and some of the clinical results presented this year will immediately change clinical practice, experts here predicted.

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

Among the highlights this year:

  • First-line abiraterone added to androgen deprivation therapy — a new standard in advanced prostate cancer
  • Larotrectinib: unprecedented high response rate in multiple tumor types
  • Less is more: a chemo break for low-risk stage III colon cancer
  • 24-hour online symptom reporting helps cancer patients live longer
  • Olaparib: a new standard for BRCA-mutated breast cancer?
  • Psychological care not part of routine cancer care but should be
  • Biliary tract cancer data "will change practice overnight"

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

Abiraterone: Now Upfront for Advanced Prostate Cancer?

New results with first-line use of abiraterone (Zytiga, Janssen) are set to transform the upfront treatment of advanced prostate cancer "practically overnight," according to Richard Schilsky, MD, chief medical officer at ASCO. Currently, the drug is approved for use after failure of androgen deprivation therapy (ADT), but the new data show substantial benefit when used earlier, in combination with ADT. Data from the STAMPEDE study in nearly 2000 patients show that when abiraterone (with prednisolone) was added to ADT, it improved the 3-year survival rate to 83%, compared with 76% with ADT alone. Results from the LATITUDE trial in nearly 1200 men show that abiraterone (plus prednisolone) added to ADT more than doubled median progression-free survival to 33 months, compared with 14.8 months with ADT alone. Results from both trials were simultaneously published online in the New England Journal of Medicine. "These data will propel abiraterone into first-line use," Dr Schilsky predicted.

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

"Striking Results" in All Cancer Types: Larotrectinib

A novel targeted drug that shows remarkable responses in every cancer type tested to date has been hailed as the "first oral tumor-agnostic therapy." The investigational drug, larotrectinib (Loxo Oncology), is selective for tropomyosin receptor kinase (TRK) fusions, which are found across a range of different cancer types, including both rare and common cancers. The drug has shown unprecedented high response rates in 17 tumor types that have been tested to date. "We believe that the dramatic response of tumors with TRK fusions to larotrectinib supports widespread genetic testing in patients with advanced cancer to see if they have this abnormality," said David Hyman, MD, from Memorial Sloan Kettering Cancer Center in New York City. He presented results from 55 patients with TRK fusions enrolled in three ongoing phase 1 and phase 2 clinical trials. All patients (12 children and 43 adults) had locally advanced or metastatic cancer, including colon, lung, pancreatic, thyroid, salivary, and gastrointestinal cancers, as well as melanoma and sarcoma.

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

Less Is More: Patients With Colon Cancer Get a Chemo Break

Most patients with low-risk stage III colon cancer will likely have their oxaliplatin-based adjuvant chemotherapy regimen cut in half, on the basis of findings of the largest prospective trial on the issue to date. The IDEA collaboration pooled results from six prospective studies involving nearly 13,000 patients to show similar efficacy and dramatically reduced side effects with only 3 months compared with 6 months of oxaliplatin and intravenous 5-fluorouracil or oral capecitabine adjuvant therapy. The result: a consensus statement released by the IDEA investigators that "I hope will make inroads into guidelines in clinical practice," said IDEA investigator Axel Grothey, MD, from the Mayo Clinic Cancer Center in Rochester, Minnesota. For the 60% of patients who have low-risk tumors, "we do not recommend more than 3 months of chemotherapy with an oxaliplatin-based regimen," he said. "That applies to 20,000 patients per year in the US, and you can easily see that translates to hundreds of thousands of patients worldwide."

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

If This Were a Drug, the Price Would Be $100,000

Use of a web-based tool that allowed patients with metastatic cancer to self-report symptoms to their care team at all hours of the day was associated with a 5-month improvement in overall survival compared with usual care, according to a study conducted at Memorial Sloan Kettering Cancer Center in New York City and featured in the plenary session. Median overall survival was 31.2 months in the web tool users group (n = 441) and 26.0 months in the usual care group (n = 325; P = .03), reported lead study author, Ethan Basch, MD, a medical oncologist who was at Memorial Sloan Kettering at the start of the study. Median follow-up was 7 years. "If this were a drug that had a survival advantage of this magnitude, it would be retail priced at $100,000s," commented Harold Burstein, MD, PhD, from Dana Farber Cancer Institute in Boston, Massachusetts, and an ASCO expert.

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

Olaparib: A New Standard for BRCA-Mutated Breast Cancer?

The poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor olaparib (Lynparza, Astra Zeneca) significantly improved progression-free survival (PFS) in women with human epidermal growth factor receptor 2 (HER2)–negative metastatic breast cancer with a germline BRCA mutation when compared with standard therapy. The drug is already approved for use in BRCA-mutated ovarian cancer and is now likely to also have BRCA-mutated breast cancer added to its indications. At a median follow-up of 14 months, PFS was 2.8 months longer and the risk for disease progression or death was 42% lower with olaparib monotherapy than with chemotherapy. "This is the first phase 3 randomized trial in breast cancer that shows PARP inhibitors are superior to chemotherapy for HER2-negative metastatic breast cancer patients who have a BRCA mutation," said presenter Mark E. Robson, MD, medical oncologist at Memorial Sloan Kettering Cancer Center in New York City. "This study is proof of the principle that breast cancers with defects in a specific DNA damage repair pathway are sensitive to a targeted therapy designed to exploit that defect."

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

One RT Dose Enough for Metastatic Spinal Cord Compression

For patients with advanced metastatic cancer who develop spinal cord compression, one dose of radiotherapy is as effective as several doses delivered over multiple hospital visits. The results come from a phase 3 trial (SCORAD III) conducted in 688 patients, which compared a single 8-Gy dose with 20 Gy delivered in five fractions over 5 days, and show that the primary endpoint of ambulatory status at 8 weeks was similar in both groups. For patients with a shortened life expectancy, such as the participants in this trial (who had a median overall survival of 13 weeks), a single dose of radiotherapy should now become the standard of care, commented lead investigator, Peter Hoskin, MD, from the Mount Vernon Cancer Centre in Middlesex, United Kingdom. "For patients, this means fewer hospital visits and more time with family," he added. "This is a case where less is more," agreed ASCO expert Joshua Jones, MD, from the University of Pennsylvania in Philadelphia.

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

"Not Part of Routine Cancer Care" But Should Be

Three novel approaches for addressing fear in patients with cancer showed statistically significant efficacy in new clinical trials, ASCO attendees heard. The three trials were featured in a press conference, which may indicate some incremental progress in the status of psychological interventions in oncology, said one of the presenters, Gary Rodin, MD, a psychiatrist at the Princess Margaret Cancer Centre in Toronto, Ontario, Canada. However, Dr Rodin also said psychological care specifically is not duly valued by mainstream practice. "This is not seen as part of routine cancer care," he told an audience attending the Patient and Survivor Care session. Supportive care in general is not fully embraced, he also opined. But psychological care should be a cornerstone of practice, he argued, saying it is essential to quality of life. Agreed, said Paul Jacobsen, PhD, a psychologist at the Moffitt Cancer Center in Tampa, Florida. Psychological symptoms need to be "recorded in the medical record like lab values," he said. Furthermore, there is a need to routinely screen patients for distress and other symptoms "to make sure help gets to those who need it most."

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

Large Study Shows Reduced Oral HPV Infections With Vaccine

Human papillomavirus (HPV) vaccination is associated with an 88% reduction in rates of oral HPV infection, according to one of the first studies to investigate this association. The findings suggest that HPV vaccination may play an important role in the prevention of oropharyngeal cancer. "Our data indicate that HPV vaccines have tremendous potential to prevent oral infections," said senior study author, Maura L. Gillison, MD, PhD, from University of Texas MD Anderson Cancer Center in Houston. But she emphasized that although more than 90% of oropharyngeal cancers are caused by HPV-16 — one of the types for which HPV vaccines are currently available — the vaccine is indicated only for the prevention of cervical and anogenital infections and associated cancers. "There haven't been any clinical trials evaluating whether the currently approved HPV vaccines can prevent oral infections that lead to cancer, so that is not currently an indication," she explained.

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

Biliary Tract Cancer Data "Will Change Practice Overnight"

In the British BILCAP study, adjuvant capecitabine (Xeloda, Hoffman-LaRoche), used for 6 months after surgery for biliary tract cancer, improved median overall survival, a finding that will likely lead to "an overnight change in practice," said Richard Schilsky, MD, chief medical officer at ASCO, given that capecitabine is already available and widely used and clinicians are comfortable using this drug. Patients were randomly assigned to adjuvant therapy or observation. Capecitabine was taken orally at a dose of 1250 mg/m2 twice daily on days 1 to 14 every 21 days for 8 cycles. In the overall population of 447 patients, the difference in median overall survival (51 months on capecitabine vs 36 months on observation) did not reach statistical significance. However, some of the patients in the capecitabine group stopped taking the drug early. In the large subgroup of 430 patients who took capecitabine for 6 months as per the study protocol, the difference was statistically significant: The median overall survival was 53 months with capecitabine and 36 months with observation (hazard ratio, 0.75; P = .028).

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

Is APHINITY the End of the Line for Trastuzumab Add-ons?

Adding pertuzumab (Perteza, Genentech) to standard trastuzumab (Herceptin, Genentech) therapy in patients with early resected HER2-positive breast cancer led to only modest improvements and increased side effects in the APHINITY trial conducted in 4805 patients, which was published simultaneously in the New England Journal of Medicine (NEJM) . "APHINITY should be the last trial of its generation," wrote Kathy Miller, MD, from Indiana University Melvin and the Bren Simon Cancer Center, Indianapolis, in an NEJM editorial. "It simply is not feasible to add more and more therapy for patients with HER2-positive disease who are selected only on the basis of anatomy. The toxic effects (and cost) are too great for too many to benefit too few." Indeed, the cost implications of adding pertuzumab to the mix are "quite substantial," noted Carey Anders, MD, ASCO's discussant of the study, from the University of North Carolina at Chapel Hill. She noted that 1 year of pertuzumab therapy would increase the cost of standard trastuzumab plus chemotherapy from approximately $56,000 to $150,500.

Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

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Top News From ASCO 2017: Slideshow

Zosia Chustecka; Darbe Rotach; Allison Shelley; Nick Mulcahy; Roxanne Nelson; Kate Johnson; Megan Brooks | June 14, 2017 | Contributor Information

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