2017 ASCO Annual Meeting

Dr Thomas speaks with ecancer at ASCO 2017 about a double-blind randomised study which investigated a natural plant based balm that attempts to act as an antidote to severe nail toxicity during chemotherapy. The balm consists of various natural essential oils that contain anti-inflammatory and anti-oxidant properties, and the findings showed a very positive outcome and boost for quality of life.

Dr Gyawali speaks with ecancer Medical Reporter Will Davies at ASCO 2017 about his conference highlights.

Prof Andtbacka speaks with ecancer at ASCO 2017 about results from a phase II multicenter trial combining intralesionally injected HF10, an oncolytic Herpes virus, with anti-CTLA4 targeted therapy to treat metastatic or unresectable melanoma He describes the encouraging response rates from the small trial group, with 41% overall response at 24 weeks, significantly more than trials using ipilimumab alone, with many patients experiencing a durable response. Prof Andtbacka notes pending analysis of patients responses to assess if age and immune senescence may influence these outcomes, and highlights further trials testing HF10 alongside other immune agents, including a similar trial ongoing in Japan.

Prof Andtbacka speaks with ecancer at ASCO 2017 about results from the '264 study, the first such investigation combining the oncolytic virus T-VEC with checkpoint inhibition to treat melanoma. He describes a response rate of 38% among the 98 patients receiving T-VEC and ipilimumab, with overall survival data yet to mature. Adverse events associated with T-VEC compared to ipilimumab monotherapy as a control include a higher rate of fatigue and chills, with 28% of patients have a grade ≥3 adverse event compared to 18%. Prof Andtbacka goes on to outline further possible combinations for T-VEC based on the tolerability response rates of this trial, including use of a PD-1 antibody.

Dr Rummel speaks with ecancer at ASCO 2017 about 10 years of data gathered from across German clinics from patients with indolent lymphoma who were treated with bendamustine rituximab as a first line therapy. Compared to alternative R-CHOP regimens, the bendamustine data shows equivalent overall survival at 10 years, with less patients relapsing, later.

Prof Conte speaks with ecancer at ASCO 2017 about the outcomes of the ShortHER trial, a non-inferiority assessment of 9 weeks trastuzumab with chemotherapy for HER2 breast cancer compared to standard therapy of a year. He outlines the patients recruited, including those with multiple positive nodes, and describes survival rates at 5 years. Statistical analysis of patient survival and response shows that the shorer course fell marginally short of the boundaries for non-inferiority, when considering all patients including those with 4 positive nodes, though notes that the reduced course also featured sparing of cardiac toxicity, and confidence in its non-inferiority can be scored at 78%. Taking these results into consideration, a shorter course of trastuzumab may be considered safe and efficacious for low-risk HER2 breast cancer patients (

Dr Bartlett speaks with ecancer at ASCO 2017 about targeted sequencing in endocrine refractory breast cancer using specimens from a clinical trial of around 4,500 cases. He mentions the ability to integrate both point mutation data, gene expression and copy number variation, where it is possible to identify pathways which are associated with hormone refractory cancers. This may give the capability to stratify patients by these pathways for future therapeutic development.

Dr Li talks to ecancer at ASCO 2017 about results from a phase II basket trial looking at Ado-trastuzumab emtansine in patients with HER2 mutant lung cancers. Human epidermal growth factor receptor 2 (HER2, ERBB2) mutations occur in 2% of lung cancers, resulting in receptor dimerisation and kinase activation with in vitro sensitivity to trastuzumab. Ado-trastuzumab emtansine is a HER2 targeted antibody drug conjugate linking trastuzumab with the anti-microtubule agent emtansine. Ado-trastuzumab emtansine is active and well tolerated in pts with HER2 mutant lung cancers.

Prof Long speaks with ecancer at ASCO 2017 about 5 year survival updates for BRAF melanoma patients treated with trametinib and dabrafenib. She also reports on results from a trial of treating brain metastases with combined PD-1 and CTLA-4, reaching a PFS at 6 months of 47%. Prof Long comments on the addition of radiotherapy to treat brain metastases, noting the work of Dr Ines Silva in establishing radionecrosis.

Prof Esteva speaks with ecancer at ASCO 2017 about his work, recently published in The Lancet Oncology, about the possible utility of trastuzumab biosimilars. He describes the combination of CTP6 with chemotherapy as having a similar safety profile, efficacy and pathologic response as trastuzumab, and considers the staging of neoadjuvant therapy for recently diagnosed breast cancer.

Dr Gyawali speaks with ecancer at ASCO 2017 about financial toxicity of cancer treatment. Financial toxicity of cancer treatment is now a well-recognised problem in cancer medicine leading to patient bankruptcy and even poor survival, including in high-income countries and countries with public health care systems. Many oncologists, despite acknowledging the severity of financial toxicity as a problem, resign the responsibility of reducing the costs of cancer treatment to the government, industry, and oncology societies.

Dr Shaw speaks with ecancer at ASCO 2017 about results from the ALEX trial of alectinib, a next-generation ALK inhibitor, for patients with lung cancer containing ALK mutations. She describes the significant benefits of alectinib over crizotinib, with progression free survival at 25.7 months compared to 10.4 months, fewer side effects and a reduced incidence of brain metastases. Overall, Dr Shaw encourages the use of alectinib as the new standard of care, and for doctors to discuss its use with patients currently receiving crizotinib.

Dr Mok presents results at an ASCO 2017 press briefing session from the ARCHER 1050 trial, a phase III trial of dacomitinib, a second-generation EGFR inhibitor, compared to gefitinib. He describes the increased efficacy of dacomitinib, boosting median PFS to 14.7 months compared to 9.2 months with gefitinib, but also that this stronger activity comes at the cost of more severe GI toxicities, requiring does modification.

Dr Scherpereel talks to ecancer at ASCO 2017 about early findings from his ongoing phase II clinical trial in France, MAPS-2, showing that immunotherapy may slow the growth of malignant pleural mesothelioma after relapse.

Dr Heeke speaks with ecancer at ASCO 2017 about the prevalence of haematology recombination deficiency among 53,000 tumour types.

Dr Zhao presents, at a press conference at ASCO 2017, findings from an early clinical trial looking at a new type of immunotherapy ̶ chimeric antigen receptor (CAR) T cells targeting B-cell maturation protein or BCMA. 33 out of 35 (94%) patients had clinical remission of multiple myeloma upon receiving CAR T-cell therapy.

Dr Scherpereel presents, at a press conference at ASCO 2017, early findings from his ongoing phase II clinical trial in France, MAPS-2, showing that immunotherapy may slow the growth of malignant pleural mesothelioma after relapse.

Dr Shaw presents, at a press conference at ASCO 2017, findings from a phase III clinical trial that point to a more effective initial treatment for patients with ALK-positive non-small cell lung cancer.

Dr Gunter von Minckwitz presents, at a press conference at ASCO 2017, findings from a phase III clinical trial of 4,805 women with HER2-positive breast cancer that suggests that adding a second HER2 targeted medicine, pertuzumab, to standard of care trastuzumab after surgery may help to lower the chance of invasive breast cancer to some women.

Dr Bartlett speaks with ecancer at ASCO 2017 about targeted sequencing in endocrine refractory breast cancer using specimens from a clinical trial of around 4,500 cases. He mentions the ability to integrate both point mutation data, gene expression and copy number variation, where it is possible to identify pathways which are associated with hormone refractory cancers. This may give the capability to stratify patients by these pathways for future therapeutic development.

Prof Hoskin speaks with ecancer at ASCO 2017 about improving mobility for patients with spinal cord compression with a single dose of radiotherapy in place of a longer course. Highlighting the burden of longer treatment for patients with poor prognosis, Prof Hoskin describes how a single 8 Gray dose of radiotherapy delivers relief and helps maintain patient mobility and independence equivalent to the lengthier course of 5 x 4 Gray. Prof Hoskin does note an increase in toxicity associated with the higher dose, noting that further trials of precision radiotherapy may help alleviate these side effects, and describes the differing international regimens.

Dr Sovak speaks with ecancer at ASCO 2017 about the findings presented at an earlier press conference, in which olaparib showed effectiveness in treating breast cancer patients whose tumours contained BRCA mutations. She describes the mechanism of actions of targeting DNA repair, and considers the wider application of PARP inhibitors across ovarian and prostate cancer.

Dr Luiz Raez speaks with ecancer at ASCO 2017 about new developments and discoveries in the field of personalised medicine, particularly in lung cancer patients. He mentions that the standard of care currently includes testing new lung cancer patients for molecular markers, and that in 20% of patients, markers are present, allowing for personalised therapy. The breadth and number of abstracts dealing with immunotherapy treatments at ASCO 2017 is promising for the field, he says.

Dr Fangusaro speaks with ecancer at ASCO 2017 about the results of a phase II multicentre prospective study of the efficacy of the MEK I/II inhibitor selumetinib in children with recurrent and refractory low-grade glioma. There was a 30-40% response rate in patients for whom multiple previous therapies had failed. He notes that selumetinib was fairly well tolerated by patients. The most common toxicities were Grade 1 and 2, and included nausea, diarrhoea, asymptomatic CPK elevation, rashes and paronychia. Other arms of the trial have been expanded based on results in the early groups. Dr Fangusaro is hopeful selumetinib will soon be used as a first-line therapy. The trial is conducted by the Paediatric Brain Tumour Consortium, an NCI funded group overseen by CTEP.

Prof Sakhun speaks with ecancer at ASCO 2017 about the hurdles to deploying new oncology initiatives in low income and low resource regions. Highlighting the forecast data on cancer incidence globally, she describes uneven distribution of funding, staff, and infrastructure as barriers to delivering adequate cancer care to a growing patient population. Prof Sakhun also highlights the changing distribution of patients, noting the burden of refugees on already-strained healthcare systems, and how tobacco control initiatives have slowed disease incidence in some nations while it increases in others. Prof Sakhun encourages political and social engagement by all stakeholders in healthcare, including co-operation between social and industry partners, to find international solutions for local problems.

Dr D'Angelo speaks with ecancer at ASCO 2017 about results from a phase II multicenter trial of nivolumab with or without ipilimumab for patients with metastatic sarcoma. She notes the success of those responding to treatment, with a manageable toxicity profile, and considers how response rates could be improved considering the frequency of treatment related adverse events.

Dr Grothey presents, at a press conference at ASCO 2017, analysis from six medical trials with over 12,800 patients, finding that 3 months of chemotherapy was nearly as effective as 6 months in patients with relatively lower recurrence risk and caused fewer side effects, particularly nerve damage.

Dr Rimassa speaks with ecancer at ASCO 2017 about the results of a phase III trial of tivantinib, an oral MET inhibitor, for patients with hepatocellular carcinoma who had relapsed following sorafenib. From this negative trial, she describes the side effects associated with tivantinib, and considers what sets these results apart from the positive indications of earlier phase II trials.

Prof Basch speaks with ecancer at ASCO 2017 about a web-based platform enabling metastatic cancer patients to report their experience of symptoms and side effects to medical staff between regular appointments. He describes how, through using these up-to-date records, care can be tailored at very low cost, with benefits from improved quality of life to longer duration of chemotherapy, culminating in improved overall survival for patients with access to the platform.

Prof Basch presents, at a press conference at ASCO 2017, findings from a randomised clinical trial of 766 patients showing that a simple, web-based intervention can have major benefits, including longer survival.

Prof Guarneri speaks with ecancer at ASCO 2017 about results from a phase III multicentre trial of trastuzumab in adjuvant setting with chemotherapy for 9 weeks vs 1 year for patients with HER2 breast cancer. The 5-year disease free survival rate was 87.5% for the long arm compared to 85.4% for the shorter arm. She notes that the shorter length of treatment with adjuvant trastuzumab significantly lowers risk of cardiac events. The reduced overall cost of shorter treatment may also lower barriers to treatment access.

Prof Ginsburg speaks with ecancer at ASCO 2017 about the session on global health initiatives in oncology. In her review of the extended education session, she highlights the presentations of Dr Peter Paul Yu on the ASCO Global Oncology Leadership Task Force, Dr Gilberto Lopes on guidelines for care stratified by resource accessibility, and Prof Mary K. Gospodarowicz on improving access to radiotherapy.

Dr Robson speaks with ecancer at ASCO 2017 about the growth-limiting application of olaparib, a PARP inhibitor, to treat BRCA breast cancer. He describes how, among 300 women included in the trial, disease progression was slowed by up to 3 months, reducing the chance of disease progression by 42%.

Dr Iveson speaks with ecancer at ASCO 2017 about results from the SCOT trial, a non-inferiority assessment of adjuvant oxaliplatin chemotherapy for 3 or 6 months to treat colorectal cancer. He describes how, by meeting these non-inferiority endpoints, 3 months of oxaliplatin can reduce cost for healthcare providers and improve patient quality of life, with less risk of peripheral neuropathy. The SCOT trial contributes to a larger international trial schema called IDEA, an international collaborative assessment of oxaliplatin with capecitabine or FOLFIRI at different fractions and staging. Findings within IDEA have identified high and low risk groups, Dr Iveson encourages to be considered eligible for 3 months CapOx.

Dr Neal Shore (Carolina Urologic Research Center, South Carolina, USA) chairs a discussion with Prof Karim Fizazi (Department of Cancer Medicine, Institut Gustave Roussey, France), Prof Kurt Miller (Benjamin Franklin Medical Centre, Berlin, Germany) and Prof Nicholas James (Institute of Cancer and Genomic Sciences, Queen Elizabeth Hospital, Birmingham, UK). Reflecting on the latest prostate cancer data presented at ASCO 2017, the panel covers: -The current challenges today in prostate cancer -Highlights from research presented at the 2017 ASCO Annual Meeting including STAMPEDE and LATITUDE -What does the latest research mean for the immediate management of prostate cancer? -Questions from the audience

Dr Robson presents, at a press conference at ASCO 2017, findings from a phase III clinical trial of around 300 women that may introduce PARP inhibitors as a new type of treatment for breast cancer.

Dr Dienstmann speaks with ecancer at ASCO 2017 about the changing face of cancer treatment in the age of personalised therapy. He describes the work of the ODYSSEY group in pursuing new targets in tumour biology, and how different staging of therapies can produce truly personalised therapy schedules by target and time. Dr Dienstmann goes on to consider the value of liquid biopsy capturing circulating tumour cells, and the future of combination therapies to do maximum damage to tumours without a compounded toxic profile.

Prof Mukherjee presents, at a press conference at ASCO 2017, his views on the past, present and future of personalising cancer care, describing recent advances as 'the adolescence of cancer'. In a talk which journeys from reflections on missed diagnoses, through genome sequencing and economics to courage in the face of disease recurrence, Prof Mukherjee considers the risk to patient wellbeing posed by overdiagnosis and a deluge of information lacking in context. He describes his view for the future of personalised therapy, with sequencing and surveillance throughout, but cautions against deepening economic disparities. Prof Mukherjee ends his presentation with a short vignette of a cancer researcher who is, herself, facing the return of her breast cancer.

Dr Razavi presents, at a press conference at ASCO 2017 a new, high-intensity genomic sequencing approach detected circulating tumour DNA at a high rate. The study followed 124 patients with advanced breast, lung, and prostate cancers, and observed their tumoural evolution using high-intensity genomic sequencing approaches comparing circulating tumour DNA to tumour biopsy data and white blood cell DNA. In 89% of patients, at least one genetic change detected in the tumour was also detected in the blood. Overall, 627 (73%) genetic changes found in tumour samples were also found in blood samples with this approach.

Dr Trédan presents, at a press conference at ASCO 2017 discussing the ProfiLER study; an ongoing clinical trial that uses genomic profiling of tumours to guide treatment decisions for patients with advanced cancer. To date, 2,676 patients have enrolled in the study, and 1,944 tumours were analysed, including colorectal, gynecologic, breast, brain, and head and neck cancer, as well as sarcoma. Actionable mutations were found in 1,004 (52%) of tumour samples; 609 patients had only one actionable mutation, and 394 had two or more (up to six), with the most common actionable pathway was the PI3K/mTOR pathway. Dr Trédan notes throughout that patient access to targeted drugs remains an issue, with only 7% of patients with an actionable mutation receiving it.

Prof James presents, at a press session at ASCO 2017, results from the STAMPEDE trial of abiraterone added to standard care in treating advanced prostate cancer. By completely stopping testosterone production, which can persist in the body even after androgen deprivation therapy, he describes a boost to survival at 3 years, and an overall 37% reduction of death compared to standard therapy alone.

Dr Hyman presents, at a press conference at ASCO 2017 about analysed data from 55 patients with TRK fusions enrolled in three ongoing phase I and phase II clinical trials treated with Larotrectinib; the first targeted, oral, tumour-type agnostic therapy. The medicine that works comparably well across many kinds of cancer, regardless of patient age.