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ASCO 2020 VIRTUAL MEETING
SPOTLIGHT ON LUNG, BREAST AND HEPATOCELLULAR CANCER
By: Kirsty LEE | Last updated: 30th June 2020 | In: ASCO 2020 Annual Meeting, Breast Cancer, Chemotherapy, China, Conferences, Endocrine Therapy, Gastrointestinal Cancer, ImmunoOncology, Immunotherapy, Lung Cancer, Oncology, Targeted Therapies
This year, ASCO 2020 was held as a virtual conference due to the COVID-19 pandemic. This is a summary of key trials presented at ASCO, focusing primarily on breast cancer, liver cancer, and lung cancer.
However, one major result not in these three categories presented at ASCO 2020 were the final results of the KEYNOTE-177 study investigating pembrolizumab (Keytruda®) versus chemotherapy for MSI-H/dMMR mCRC.1Andre T, et al. J Clin Oncol 38: 2020 (suppl; abstr LBA4).
Pembrolizumab as first-line treatment doubled PFS (median 16.5 months vs. 8.2 months), a clinically meaningful and statistically significant improvement (HR=0.60; 95% CI: 0.45-0.80; P=0.0002). Fewer treatment-related AEs were also observed with pembrolizumab.1Andre T, et al. J Clin Oncol 38: 2020 (suppl; abstr LBA4).
ASCO 2020 Keywords
ABC, AE, Alecensa, alectinib, ALK, apatinib, atezolizumab, Avastin, bevacizumab, capecitabine, carboplatin, CDK4/6, CDK46, cisplatin, CNS metastases, coronavirus, CPS, CRC, crizotinib, dMMR, donafenib, durvalumab, EGFR, ELM4-ALK, ES-SCLC, etoposide, gBRCAm, gPALB2m, HER2-negative, HER2-positive, Herceptin, HR-positive, Imfinzi, Keytruda, Lynparza, MBC, mCRC, mesothelioma, MPM, MSI, MSI-H, Nexavar, nivolumab, NSCLC, olaparib, Opdivo, osimertinib, PARP, PARPi, PD-1, PD-L1, pembrolizumab, sBRCAm, SCLC, sorafenib, Tagrisso, talazoparib, Talzenna, Tecentriq, TNBC, trastuzumab, tucatinib, Xalkori, Xeloda
A number of breast cancer trials were of note at ASCO 2020
Results of KEYNOTE-355 were presented, and pembrolizumab (Keytruda®) in combination with chemotherapy showed clinically meaningful improvement in PFS vs. chemotherapy alone (mPFS 9.7 vs 5.6 mo; HR=0.65; 95% CI: 0.49-0.86; P=0.0012) in patients with previously untreated locally recurrent inoperable or metastatic TNBC whose tumours expressed PD-L1 (CPS ≥10).2Cortes J, et al. J Clin Oncol 38: 2020 (suppl; abstr 1000).
A meta-analysis of CDK4/6 inhibitors confirmed the PFS benefit of CDK4/6i plus ET in HR+/HER2- MBC (pooled HR=0.55; 95% CI: 0.50-0.59; P<0.00001) and demonstrated an OS benefit when all RCTs of all 3 CDK4/6i were included (pooled HR=0.75; 95% CI: 0.68-0.84; P<0.00001).[mfn referencenumber=3]Kunwor R, et al. J Clin Oncol 38: 2020 (suppl; abstr 1060).[/mfn]
Two PARP inhibitors also displayed promising results – olaparib (Lynparza®) displayed activity in patients with MBC and sBRCA1/2 or gPALB2 mutations in a proof-of-principle study4Tung NM, et al. J Clin Oncol 38: 2020 (suppl; abstr 1002)., and talazoparib (Talzenna®) could be of clinical benefit to HER2 ABC patients who were selected based on their gBRCA mutational status.5Litton JK, et al. J Clin Oncol 38: 2020 (suppl; abstr 1018).
Lastly, in the HER2CLIMB trial, tucatinib in combination with trastuzumab (Herceptin®) and capecitabine was also shown to double the intracranial confirmed ORR (47.3% vs. 20.0%) in patients with heavily previously treated HER2+ MBC with brain metastases.6Lin NU, et al. J Clin Oncol 38: 2020 (suppl; abstr 1005). This combination has the potential to become the new standard of care in patients with HER2+ MBC, with and without brain metastases.6Lin NU, et al. J Clin Oncol 38: 2020 (suppl; abstr 1005).
Positive results were reported in ES-SCLC, NSCLC and MPM lung cancers
Two trials reported positive results for first-line treatment of ES-SCLC.
Durvalumab (Imfinzi®) + EP also demonstrated improvement in OS vs. EP alone (HR=0.75; 95% CI: 0.62-0.91; nominal P=0.0032; median 12.9 vs. 10.5 mo), with consistent safety profiles.7Paz-Ares LG, et al. J Clin Oncol 38: 2020 (suppl; abstr 9002).
Pembrolizumab (Keytruda®) + EP significantly improved PFS in the ITT population vs placebo + EP (HR=0.75; 95% CI: 0.61-0.91; P=0.0023; median 4.5 vs. 4.3 mo), with no unexpected toxicities observed.8Rudin CM, et al. J Clin Oncol 38: 2020 (suppl; abstr 9001).
Another PD-1 inhibitor, nivolumab (Opdivo®), reported an mPFS of 4.1 months and mOS of 13.3 months in a retrospective real-world study of MPM patients in Japan, suggesting it could be used as a standard second-line treatment for MPM.9Mikami K, et al. J Clin Oncol 38: 2020 (suppl; abstr 9052).
In NSCLC patients, 5-year OS and updated safety data was reported from the ALEX study, investigating alectinib (Alecensa®) vs. crizotinib (Xalkori®) in untreated advanced ALK+ NSCLC. 5-year survival rate was 62.5% with alectinib vs. 45.5% with crizotinib, and in patients with and without CNS mets at baseline, the OS HR was 0.58 (95% CI: 0.34-1.00) and 0.76 (95% CI: 0.45-1.26), respectively.10Peters S, et al. J Clin Oncol 38: 2020 (suppl; abstr 9518).
With EGFR+ NSCLC, osimertinib (Tagrisso®) as an adjuvant therapy after complete tumour resection showed a DFS HR of 0.17 (95% CI: 0.12-0.23; P<0.0001) in Stage II-IIIA patients. 2-year DFS rate was 90% with osimertinib vs. 44% with placebo, and the safety profile was consistent with the known safety profile of osimertinib.11Herbst RS, et al. J Clin Oncol 38: 2020 (suppl; abstr LBA5).
A few trials on HCC also reported favourable results
In a phase II/III trial, donafenib as a first-line therapy was found to significantly improve OS over sorafenib in advanced HCC (mOS in full analysis set 12.1 vs. 10.3 mo; HR=0.831; 95% CI: 0.699-0.988; P=0.0363), with a favourable safety and tolerability profile.12Bi F, et al. J Clin Oncol 38; 2020 (suppl; abstr 4506).
In second-line treatments, apatinib significantly prolonged OS (mOS 8.7 vs. 6.8 mo; HR=0.785; 95% CI: 0.617-0.998; P=0.0476) and PFS (mPFS 4.5 vs. 1.9 mo; HR=0.471; 95% CI: 0.369-0.601; P<0.0001) over placebo in Chinese patients with pretreated advanced HCC.[mfn referencenumber=13]Li Q, et al. J Clin Oncol 38; 2020 (suppl; abstr 4507).[/mfn]
A network meta-analysis of first-line treatments for unresectable HCC also found greater OS and PFS benefits with first-line atezolizumab (Tecentriq®) + bevacizumab (Avastin®) compared to other treatments approved for this indication.14Vogel A, et al. J Clin Oncol 38; 2020 (suppl; abstr 4585).
Abbreviations
ABC=advanced breast cancer
AE=adverse event
ALK=anaplastic lymphoma kinase
ASCO=American Society of Clinical Oncology
CDK4/6i=cyclin-dependent kinase 4/6 inhibitor
CI=confidence interval
CNS=central nervous system
CPS=combined positive score
DFS=disease-free survival
dMMR=mismatch repair deficient
EGFR=epidermal growth factor receptor
ES-SCLC=extensive-stage small cell lung cancer
EP=etoposide plus platinum
HER2=human epidermal growth factor receptor 2
HR=hazard ratio
HR+=hormone receptor positive
ITT=intention-to-treat
MBC=metastatic breast cancer
mCRC=metastatic colorectal cancer
mOS=median overall survival
mPFS=median progression-free survival
MPM=malignant pleural mesothelioma
MSI-H=microsatellite instability-high
NSCLC=non-small cell lung cancer
ORR=overall response rate
OS=overall survival
PARP=poly (ADP-ribose) polymerase
PD-1=programmed cell death protein 1
PD-L1=programmed death ligand 1
PFS=progression-free survival
RCT=randomized controlled trial
TNBC=triple negative breast cancer
References
- Andre T, et al. J Clin Oncol 38: 2020 (suppl; abstr LBA4).
- Cortes J, et al. J Clin Oncol 38: 2020 (suppl; abstr 1000).
- Kunwor R, et al. J Clin Oncol 38: 2020 (suppl; abstr 1060).
- Tung NM, et al. J Clin Oncol 38: 2020 (suppl; abstr 1002).
- Litton JK, et al. J Clin Oncol 38: 2020 (suppl; abstr 1018).
- Lin NU, et al. J Clin Oncol 38: 2020 (suppl; abstr 1005).
- Paz-Ares LG, et al. J Clin Oncol 38: 2020 (suppl; abstr 9002).
- Rudin CM, et al. J Clin Oncol 38: 2020 (suppl; abstr 9001).
- Mikami K, et al. J Clin Oncol 38: 2020 (suppl; abstr 9052).
- Peters S, et al. J Clin Oncol 38: 2020 (suppl; abstr 9518).
- Herbst RS, et al. J Clin Oncol 38: 2020 (suppl; abstr LBA5).
- Bi F, et al. J Clin Oncol 38; 2020 (suppl; abstr 4506).
- Li Q, et al. J Clin Oncol 38; 2020 (suppl; abstr 4507).
- Vogel A, et al. J Clin Oncol 38; 2020 (suppl; abstr 4585).
Disclaimer
This article is not medical advice. Patients should seek personal assessment by a licenced specialist. Physicians are recommended to read the full publication(s) as cited in the article before making medical decisions. This article does not supersede nor replace the published article(s).
© Copyright 2020 MediPaper Medical Communications Ltd. – ASCO 2020 ASCO20 virtual meeting NSCLC SCLC lung cancer breast cancer hepatocellular cancer HCC colorectal cancer CRC
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© Copyright 2018 MediPaper Medical Communications Ltd. – ASCO 2020 ASCO20 virtual meeting NSCLC SCLC lung cancer breast cancer hepatocellular cancer HCC colorectal cancer CRC
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