ASCO 2020: Practice-changing studies in breast, lung, colorectal, and other cancers

Thursday, June 11, 2020

What were the practice-changing studies presented at the 2020 ASCO Annual Meeting? Podcast host David H. Henry, MD, and retired oncologist Alan P. Lyss, MD, reviewed 12 studies and assessed their potential impact on treatment.

Breast cancer

Three-year follow-up of neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2-blockade for HER2-positive breast cancer (TRAIN-2): A randomized phase III trial. (Abstract 501)

  • The addition of anthracyclines did not improve event-free or overall survival.
  • The results suggest patients can avoid the toxicities of anthracycline regimens without compromising efficacy, Dr. Henry said.

KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. (Abstract 1000)

  • Pembrolizumab improved responses, particularly in patients with higher PD-L1 expression.
  • Dr. Lyss noted that pembrolizumab was combined with a “broad range” of chemotherapy regimens in this study.

A randomized phase III trial of systemic therapy plus early local therapy versus systemic therapy alone in women with de novo stage IV breast cancer: A trial of the ECOG-ACRIN Research Group (E2108). (Abstract LBA2)

  • Early local therapy did not improve disease-free survival or overall survival.
  • “We probably should not be recommending planned treatment for the intact primary tumor in most women who have stage IV breast cancer,” Dr. Lyss said.

Bladder cancer

Maintenance avelumab + best supportive care (BSC) versus BSC alone after platinum-based first-line (1L) chemotherapy in advanced urothelial carcinoma (UC): JAVELIN Bladder 100 phase III interim analysis. (Abstract LBA1)

  • Avelumab maintenance prolonged overall survival, although 12% of patients discontinued the treatment due to toxicity.
  • Because avelumab “meaningfully prolongs overall survival … using it upfront makes a lot of sense,” Dr. Lyss said.

Colorectal cancer

Pembrolizumab versus chemotherapy for microsatellite instability-high/mismatch repair deficient metastatic colorectal cancer: The phase 3 KEYNOTE-177 study. (Abstract LBA4)

  • Pembrolizumab improved responses and progression-free survival.
  • All patients with colorectal cancer should be tested for microsatellite instability-high status “because these results really do influence practice immediately,” Dr. Lyss said.
  • He suggested that pembrolizumab should probably be used as first-line treatment for these patients even though overall survival results are not yet available.

Short-course radiotherapy followed by chemotherapy before TME in locally advanced rectal cancer: The randomized RAPIDO trial. (Abstract 4006)

  • Short-course radiotherapy followed by consolidative chemotherapy and surgery significantly reduced the rate of treatment failure.
  • Dr. Lyss called the pathologic complete response rate “impressive” and said it may contribute to a higher rate of rectal preservation.

A randomized phase II/III trial comparing hepatectomy followed by mFOLFOX6 with hepatectomy alone for liver metastasis from colorectal cancer: JCOG0603 study. (Abstract 4005)

  • There was no improvement in overall survival with mFOLFOX6.
  • “The take-home to me … is this is probably not a necessary strategy and certainly not standard of care,” Dr. Henry said.

Hodgkin lymphoma

KEYNOTE-204: Randomized, open-label, phase III study of pembrolizumab (pembro) versus brentuximab vedotin (BV) in relapsed or refractory classic Hodgkin lymphoma (R/R cHL). (Abstract 8005)

  • Pembrolizumab improved progression-free survival.
  • Dr. Henry marveled that pembrolizumab bested brentuximab vedotin, which previously produced impressive results in patients with relapsed/refractory Hodgkin lymphoma.

Lung cancer

Nivolumab + ipilimumab versus platinum-doublet chemotherapy as first-line treatment for advanced non-small cell lung cancer: Three-year update from CheckMate 227 Part 1. (Abstract 9500)

  • Nivolumab plus ipilimumab improved overall survival but increased toxicity and treatment discontinuation.
  • The combination is “not for the faint hearted” but is appropriate for certain patients, Dr. Lyss said, noting there is “room for clinical judgement.”

Osimertinib as adjuvant therapy in patients (pts) with stage IB–IIIA EGFR mutation positive (EGFRm) NSCLC after complete tumor resection: ADAURA. (Abstract LBA5)

  • Osimertinib improved disease-free survival compared with placebo.
  • It isn’t clear how osimertinib will impact overall survival, but “we should be using this drug” once it’s approved, Dr. Lyss said.

Smoking cessation (SC) and lung cancer (LC) outcomes: A survival benefit for recent-quitters? A pooled analysis of 34,649 International Lung Cancer Consortium (ILCCO) patients. (Abstract 1512)

  • Quitting smoking can improve overall survival in lung cancer patients, even if they quit as little as 2 years prior to diagnosis.
  • “Somewhat counterintuitively, convincing patients to quit smoking at any point in their trajectory, even just prior to their diagnosis, seems to make a difference in survival,” Dr. Lyss said.

Ovarian cancer

Final overall survival (OS) results from SOLO2/ENGOT-ov21: A phase III trial assessing maintenance olaparib in patients (pts) with platinum-sensitive, relapsed ovarian cancer and a BRCA mutation. (Abstract 6002)

  • Olaparib maintenance improved overall survival and time to next treatment.
  • Significant benefits were seen in the olaparib arm in spite of a high rate of crossover, Dr. Henry noted.

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Dr. Henry, of Penn Medicine in Philadelphia, reported having no financial disclosures relevant to this episode.

Dr. Lyss was a community-based medical oncologist and clinical researcher for more than 35 years before his recent retirement. He is a columnist for MDedge Hematology/Oncology. He has no other conflicts of interest.

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David Henry, MD
David Henry, MD, FACP, is a clinical professor of medicine at the University of Pennsylvania and vice chairman of the department of medicine at Pennsylvania Hospital in Philadelphia. He received his bachelor’s degree from Princeton University and his MD from the University of Pennsylvania, then completed his internship, residency, and fellowship at the Hospital of the University of Pennsylvania. After 2 years as an attending in the U.S. Air Force, he was drawn to practicing as a hem-onc because of the close patient contact and interaction, and his belief that, win or lose with each patient, one can always make a difference in their care and lives. Follow Dr. Henry on Twitter: @davidhenrymd. Dr. Henry reported being on the advisory board for Amgen, AMAG Pharmaceuticals, and Pharmacosmos. He reported institutional funding from the National Institutes of Health and FibroGen.