Targeted therapy and immunotherapy in oncology took center stage once again at Europe’s leading oncology meeting, as new data showed that the drugs are effective not only in the palliative setting but also in earlier stages of the disease. The European Society for Medical Oncology (ESMO) 2017 Congress, organized by ESMO in conjunction with the European Association for Cancer Research, took place September 8-12 in Madrid.
Alongside public policy sessions on issues such as escalating healthcare costs and global discrepancies in cancer outcomes, as well as patient advocacy sessions on how to involve patients in research, the program featured 1500 original abstracts submitted by researchers from across the globe. ESMO also had record attendance with over 23,000 attendees.
At this year’s conference, studies attempt to take targeted therapy and immunotherapy beyond the palliative setting of advanced disease. Compared with the data on the same compounds presented at the ESMO Congress last year in Copenhagen, the new data to be presented this year represent a kind of a revolution, because these compounds have been developed in order to prolong survival in the palliative setting.
One striking example is in the treatment of lung cancer. Data from the PACIFIC trial was presented during Presidential Symposium I. This study is examining the effects of the anti–programmed cell death ligand 1 (PD-L1) inhibitor durvalumab (Imfinzi, AstraZeneca) after radical radiochemotherapy in stage III non-small cell lung cancer (NSCLC). Whereas among patients with stage III disease, the cure rates following radiochemotherapy are typically less than 30%. The idea was to increase this cure rate, or the long-term benefit of the treatment, by consolidating it with durvalumab.
Another important field for adjuvant immunotherapy is that of melanoma.
At last year’s ESMO Congress, data presented showed that the immunotherapy ipilimumab (Yervoy, Bristol-Myers Squibb) used at a 10-mg/kg dose in high-risk patients might be a way to cure more melanoma after resection. However, the problem is it’s not reimbursed in most countries because of the cost of 10 mg/kg ipilimumab, but also because of the side effects.
However, this year’s e presentation of CheckMate 238 showed significant promise. This trial comparee standard adjuvant nivolumab (Opdivo, Bristol-Myers Squibb) treatment, given every 2 weeks, with adjuvant ipilimumab, 10 mg/kg. ”
One highly anticipated presentation by the lung cancer community was the latest central nervous system efficacy results from the ALEX study comparing alectinib (Alecensa, Genentech) with crizotinib (Xalkori, Pfizer) in patients with treatment-naive anaplastic lymphoma kinase (ALK)–positive advanced NSCLC. Data from the study presented at the American Society of Clinical Oncology (ASCO) 2017 Annual Meeting showed that alectinib was associated with a more than doubling of the median PFS compared with crizotinib.
For epidermal growth factor receptor (EGFR)–mutated disease, which is the most frequent form of NSCLC, Dr Peters said that “we still don’t know if it’s better to sequence the drugs, like in breast cancer, one after the other…or should you give the best drug first?”
At ESMO 2016, the FLAURA investigators will tackle that question by comparing osimertinib (Tagrisso, AstraZeneca), a third-generation EGFR tyrosine kinase inhibitor (TKI), with two first-generation EGFR TKIs. Data are to be presented during Presidential Symposium I. AstraZenca has already stated that this trial is positive, meaning that, again, it shows that, in terms of PFS, it’s better to give the best drug first as compared to the sequencing strategy.
Several trials presented at ESMO 2017 questioned daily practice and challenge received wisdoms over patient follow-up. Once such is a French trial from the Intergroupe Francophone de Cancerologie Thoracique. This study asked whether intensive follow-up of patients with lung cancer, involving routine clinic visits, chest radiography, chest computed tomography, and fiberoptic bronchoscopy to detect more small, potentially curable, recurrences and second cancers, is really necessary. However, because this level of follow-up is included in the ASCO recommendations, the researchers felt that a large randomized study was necessary to determine the survival impact of such a strategy.
