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Audio Journal of Oncology

Reporting from the Annual Meeting of the American Society of Clinical Oncology, Chicago May31–June 2, 2013

 

 

 

SARAH:

The Audio Journal of Oncology with Oncology Times and MDFM from AudioMedica.com: Cancer news from around the world with Peter Goodwin.

 

MUSIC

 

PETER:

Hello. And with me is Sarah Maxwell. In this edition we’re reporting from the 2013 meeting of the American Society of Clinical Oncology held in Chicago:

 

SARAH:

The first effective treatment for advanced melanoma of the eye was announced by Dr Richard Carvajal told Audiomedica.com how the new MEK-inhibitor: selumetinib doubled progression free survival in a study with nearly a hundred patients who had the MEK-sensitive gene mutations commonly found in this disease:

 

Richard Carvajal

“The bottom line is for the primary endpoint of progression free survival, we saw that treatment with a MEK inhibitor more than doubled the progression free survival, it was improved from seven weeks with chemotherapy to 15.9 weeks with selumetinib. There was a trend towards improved survival despite the fact that 80% of patients who were randomised to chemotherapy crossed over to the investigational drug. And we also saw dramatic responses with a response rate of 15% which although modest is really remarkable when you look at the response rate in prior clinical trials.

Right now for this disease, for which there was no positive trial ever conducted before, we can say that MEK inhibition now represents a new treatment opportunity for patients. However, can we do this clinically right now is a little bit unclear, for uveal melanoma patients, I think clinical trial participation is still important.”

 

SARAH:

Richard Carvajal from Memorial Sloan-Kettering Cancer Center who told AudioMedica.com he regarded this first success as proof of principle that you can use MEK inhibition to treat uveal melanoma and he’s doing further research.  

 

PETER

Commenting after the ASCO meeting, Dr Lynn Schuchter, from the University of Pennsylvania told us the big shift in median progression free survival reported in the study was a remarkable achievement which could pave the way to developing new treatments.

 

MUSIC

 

PETER:

Your patients with colorectal cancer could do better if you added cetuximab first-line to their chemotherapy, provided they had the KRAS wild-type gene, rather than adding bevacizumab, though both of these agents are active and licensed. 

 

SARAH:

Yes. This comes from the German phase III FIRE-3 study presented at ASCO in Chicago. The point is that cetuximab, an anti-epidermal growth factor receptor agent, is active only in patients with KRAS wild type tumors; while bevacizumab, an anti vascular endothelial growth factor, should work in all colorectal cancers. So there’s a temptation to use bevacizumab because all patients will respond to it, but Professor Volker Heinemann told AudioMedica.com they wanted to know if cetuximab could do better for those patients who could theoretically respond to it. 

 

Volker Heinemann

 “The finding was that, with regard to the primary end point, that was objective response rate – there was no difference in the ITT, the intention to treat population- while in patients assessable for efficacy we found a significant difference between the cetuximab and bevacizumab arms, assessable means that patients needed to have received at least three cycles of treatment and needed to have at least one imaging after baseline

And in this population the cetuximab-based treatment was superior to the bevacizumab-based treatment by about 10 per cent.”

 

PETER

 

And Dr Heinemann thought this could make a big difference in daily practice improving outcomes by choosing the right drug for each patient:

 

Volker Heinemann

 “We look at 25 months in patients receiving folfiri plus bevacizumab as compared to 28.7 months in patients receiving folfiri plus cetuximab”

 

PETER

Professor Volker Heinemann from Munich University talking with AudioMedica.com at the American Society of Clinical Oncology in Chicago

 

SARAH:

Also attending the press briefing where these results were announced in Chicago was Dr. Richard Goldberg.  He told us he would not be changing his practice on the basis of the FIRE-3 study results alone, but he was looking forward to the Cancer and Leukemia Group B 80405 study (http://clinicaltrials.gov/ct2/show/NCT00265850) also comparing cetuximab head to head with bevacizumab with results soon to be announced:

 

RICHARD GOLDBERG

“We believe now that there are subsets of colorectal cancer and they are identifiable by understanding the mutations that each individual’s cancer has, and that will translate into a more strategic picking of treatment regimens.”

 

SARAH:

Richard Goldberg Physician-in-Chief at Ohio State University Comprehensive Cancer Center in Columbus Ohio

 

MUSIC

 

PETER:

Hopes were raised at the Chicago meeting of ASCO for keeping patients with advanced lung cancer free from disease and alive longer.

 

SARAH:

That’s right, Peter. The meeting heard results from a phase II GALAXY-1 study in which patients with advanced non small-cell lung cancer were randomised to have the drug ganetespib, a heat-shock protein inhibitor, added to their docetaxel therapy after prior chemotherapy. 

 

Suresh Ramalingam

“Ganetespib belongs to what we refer to now a second generation of HSP90 inhibitors, it’s a drug that affects a number of key proteins and has shown activity as single agent in specific molecular subsets of non-small cell lung cancer.

The study that we did was a randomised phase II trial. The goal was to see which subset of patients benefit from a combination of ganetespib with docetaxel. This was for patients with advanced stage lung adenocarcinoma, we randomised them to the combination or control arm of docetaxel. 250 patients were enrolled and it was a one-to-one randomisation. What we saw was that patients that got the combination had an improved progression free survival and improved overall survival. Even more important and interesting, was the fact that patients that came in, greater than six months from the time of diagnosis, had almost a hazard ratio of point six, for pfs and overall survival with very significant ‘p’ values and these were 70% of all patients enrolled to the trial, suggesting that this group derived the maximal benefit from the combination therapy.”

 

SARAH:

Dr Suresh Ramalingam from Emory University in Atlanta who told AudioMedica.com his group are now pressing on with a randomised phase III trial to provide final data to hopefully confirm this promising improvement.

Dr. Robert Pirker at the University of Vienna told us he was cautious about reading too much into the findings yet, but he too was optimistic that the broad action of ganetespib could be a step forward:

 

Robert Pirker

“The step forwards here is that we have a targeted treatment that targets not only one protein but targets several proteins so you might have a broader efficacy that might translate into a better clinical outcome”

 

SARAH:

Robert Pirker, Programme Director for Bronchial Carcinoma at the University of Vienna

 

MUSIC

 

PETER:

Long-held dogma about using axillary dissection in early breast cancer is about to be overturned, that’s according to research from the Netherlands presented at the 2013 ASCO meeting.

 

SARAH:

Yes. Scientific appraisal is winning the day according to Dr Emiel Rutgers who gave us the latest from the EORTC AMAROS study comparing dissection with axillary radiotherapy. That was in patients with sentinel node-positive early breast cancer with no clinical evidence of nodal spread.

Out of nearly 5 000 patients with stage T 1-2 clinically node negative breast cancer about 1 400 of them were sentinel node positive and were allocated to either surgical axillary clearance or radiotherapy.  Recurrence was extremely low and equivalent in both groups: 

 

 EMIEL RUTGERS

“But more interestingly, the side effects, and one of the most important side effects of axillary treatment, axillary surgery is lymphoedema, obstruction of the lymph flow from the arm. And what we have seen is that in the patients who had surgery, 28%, one in four had after five years still treatment and garments for those lymphedema.”

 

SARAH:

This rate of lymphedema was halved in the patients who were treated with radiotherapy, and Dr Rutgers thought the evidence was already looking good for the long term.  This led him to one firm conclusion: 

 

EMIEL RUTGERS

“The bottom line message is that in early breast cancer maxillary clearance, complete maxillary dissection is obsolete!”

  

SARAH:

Emiel Rutgers from the Netherlands Cancer Institute talking with AudioMedica.com in Chicago at the ASCO meeting.

 

PETER:

And Dr Pat Price visiting Professor of Oncology at Imperial College in London and Chairperson of the UK’s Action Radiotherapy gave us her thoughts on Dr Rutger’s study:

 

SARAH:

Yes. Pat told us she thought the reduction of lymphedema was a startling improvement in this specifically-defined subgroup of patients:

 

Pat Price

 “Lymphedema is a huge problem, long term, for patients, and takes up a lot of healthcare costs. And also the worry about lymphedema for patients, who have to avoid scratches and take more care of there arm: so lymphedema, since we’ve been doing more clearances, has become a bigger problem. So if we can reduce this, this will be fantastic for women,”

           

SARAH:

Pat Price from London who added that althouth there was a shortage of knowledge about long term effects she, like Dr. Rutgers, thought the balance would likely be in favor of radiotherapy.

 

PETER:

And that’s all for now from AudioMedica.com’s quick look at the 2013 Meeting of the American Society of Clinical Oncology held in Chicago.

 

This edition of the Audio Journal of Oncology was made jointly with Oncology Times and MDFM. You can get more on this from OT itself and you’ll find ongoing audio and video coverage from us at www.audiomedica.com

 

Sarah Maxwell and I will be back with more soon.  Until then from me, Peter Goodwin, goodbye.

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