Here is ecancer’s speedy recap on the presentations from the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting that packed the biggest punch with regards to anticancer agents, complete with soundbites from our video collection.
Non-small cell lung cancer
Long-term survival data from the phase Ib KEYNOTE-001 trial (NCT01295827) sent shockwaves through the conference, with a 5-year survival rate of 23.2% observed in chemotherapy-naïve patients with metastatic non-small cell lung cancer (NSCLC) receiving pembrolizumab.
Dr David Graham, Levine Cancer Institute, explained, “in previous years, we would see a person with metastatic NSCLC and unfortunately have to paint a pretty gloomy picture: their chances of being alive 5 years down the road would be 5% or sometimes less.”
“Now as we look at these data with patients appropriately treated with pembrolizumab, one in four or more are going to be around 5 years from now.”
And that wasn’t the only positive news in lung cancer research …
In the phase II NEOSTAR trial (NCT03158129), pre-surgical combination therapy with checkpoint inhibitors nivolumab and ipilimumab resulted in a third of patients with early-stage, resectable NSCLC achieving ≤ 10% viable tumour cells at surgery.
Dr Tina Cascone, University of Texas MD Anderson Cancer Center, said, “maybe this combination deserves further evaluation, most likely in association with other therapies.”
In the plenary session, investigators of the ENZAMET trial (NCT02446405) reported that the non-steroidal anti-androgen (NSAA) enzalutamide increased survival of men with metastatic hormone-sensitive prostate cancer versus other NSAAs, when used alongside standard-of-care therapy.
After 3 years of treatment, 80% of men in the enzalutamide group versus 72% in the comparator group were alive.
Meanwhile, in the TITAN trial (NCT02489318), patients with advanced prostate cancer receiving the androgen receptor inhibitor apalutamide had a 33% reduced risk of death versus those receiving standard-of-care therapy alone.
Apalutamide also delayed disease progression and increased time to chemotherapy.
In a discussion for ecancer, Prof Rob Jones, University of Glasgow, said, “it’s very clear that ADT [androgen deprivation therapy]alone is no longer the standard of care for anybody with newly diagnosed metastatic prostate cancer. You should consider other treatment for everybody.”
The MONALEESA-7 trial (NCT02278120) challenged delegate perceptions that overall survival was not a feasible outcome in metastatic breast cancer trials.
In this phase III trial, premenopausal women with hormone-receptor positive, HER2-negative, advanced breast cancer received endocrine therapy plus either CDK 4/6 inhibitor ribociclib or placebo.
The primary endpoint of progression-free survival favoured ribociclib. More excitingly, survival at 42 months was 70% with ribociclib versus 46% with placebo.
Dr Sara A. Hurvitz, UCLA Jonsson Comprehensive Cancer Center, said, “the fact that we have demonstrated that treatment with this agent has a carry-over benefit that actually extends [women’s] lifespan is really practice changing.”
A doubling of time to progression with olaparib versus placebo (median 7.4 vs 3.8 months, respectively) was seen in the phase III POLO trial (NCT02184195) in patients with chemotherapy-treated, BRCA-positive, metastatic pancreatic cancer.
Although only a low percentage of patients with pancreatic cancer have a BRCA 1 or 2 germline mutation, the marker may be very important for outcome.
Speaking to ecancer, Prof Heinz-Josef Lenz, USC Norris Comprehensive Cancer Center, said the results were “amazing in metastatic pancreatic cancer”, for which patient survival has historically been under a year.
The spotlight was once again shone on pembrolizumab with the release of data from KEYNOTE-062 (NCT02494583), a phase III trial in advanced gastric or gastroesophageal junction cancer.
In patients with programmed death ligand 1 (PD-L1)-positive, HER2-negative disease, the checkpoint inhibitor was noninferior to chemotherapy for the primary endpoint of overall survival. More impressively, 39% versus 22% of patients with high PD-L1 levels were alive at 2 years, respectively.
Speaking to ecancer, Asst. Prof Bishal Gyawali, Queen’s University Cancer Research Institute, raised concerns: “pembrolizumab has already received accelerated approval for this indication and this is supposed to be a confirmatory trial … why was a noninferiority design acceptable?”
Results of the phase II EV-201 trial (NCT03219333) of enfortumab vedotin brought hope of a new treatment option for patients with locally advanced or metastatic urothelial cancer who have progressed on chemotherapy and immunotherapy.
The new agent targeting nectin-4 produced responses in 44% of patients in the single-arm trial. Investigator Prof Daniel Petrylak, Yale Cancer Centre, confirmed that a randomised phase III trial is now underway.
Speaking at the ASCO press conference, Dr Robert Dreicer, UVA Cancer Centre, said, “I look at this data as effective therapy. I would support accelerated approval and hope the Food and Drug Administration (FDA) shares that.”