The annual American Society of Clinical Oncology (ASCO) meeting was held last week in Chicago, bringing together thousands of oncology professionals from around the world to discuss the most current cancer research and treatments. Here are some of the most recent developments:
Much of the excitement at this year’s conference focused on two immunotherapy treatments showing great promise in treating multiple types of cancers. Rather than targeting a tumor directly, immunotherapy works by recruiting the body’s own immune cells to target the cancer.
Although the first evidence of clinical benefit of these agents was seen in melanoma, many other tumor types have now been shown to respond to this immunotherapy approach.
In January 2015, when it was announced that the immunotherapy treatments produced a significant improvement in overall survival when compared with chemotherapy as a second line therapy, the FDA gave approval for the first immunotherapy for lung cancer in March 2015 (three months ahead of schedule).
One type of immunotherapy drug that received particular attention at the conference binds to a molecule on immune cells called PD-1. This effectively stops one of the ways cancer cells avoid being destroyed.
Nivolumab versus Docetaxel in Advanced Squamous Cell Non Small Cell Lung Cancer
Data from a clinical trial presented at this year’s conference compared one of these ‘anti-PD-1′ drugs named opdivo (nivolumab) to chemotherapy for patients with advanced NSCLC lung cancer. Those receiving the immunotherapy treatment who expressed the PD-L1 biomarker survived several months longer than those on chemotherapy, with fewer side effects. Read more.
Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma
Another clinical trial used a combination of different immunotherapy drugs to treat patients with advanced melanoma. In this case, Opdivo (nivolumab) was combined with another drug known as Yervoy (ipilimumab), that activates the immune system in a different way. With the combined approach, 57% of the patients in the study responded to the treatment, as opposed to only 19% who were given ipilimumab alone. The downside was an increase in side effects (diarrhea and elevated liver enzymes) with the combination treatment. Cost is another concern, because combining the drugs would cost around $295,000 per patient over nearly one year. Read more.
Immunotherapy Results for Other Cancer Types
Many more studies presented at this year’s ASCO conference looked into various combinations of immunotherapy treatments in several cancer types:
Liver Cancer:Read more.
Stomach Cancer: Read more.
Head and Neck Cancer: Read more.
New Targeted Therapy Drugs for Breast Cancer
In a trial from the Mount Vernon Cancer Center in England involving 417 women, the targeted drug Perjeta was seen to shrink tumors in 30 % of HER-2 positive breast cancer cases, avoiding the need for a mastectomy. In some cases, the drug eradicated tumors up to 4 inches (10cm) across. Read more.
A second promising trial presented in Chicago with the drug palbociclib halted the growth of tumors in women with advanced breast cancer. The study on 521 women led by doctors at London’s Royal Marsden Hospital found that palbociclib (Ibrance, Pfizer Inc), which was granted accelerated approval in February 2015 on the basis of phase 2 data which showed a significant improvement in progression-free survival,added an average of five months longer survival compared to standard treatments. Read more.
Another drug used for breast cancer, eribulin (Halaven, Eisai Inc), has shown promise in the treatment of sarcomas. The manufacture announced in February 2015 that the drug had demonstrated a survival benefit and that it intends to apply for approval for certain hard to treat sarcomas, such as leiomyosarcoma and adipocytic sarcoma.
Targeted Therapy for Colon Cancer
Metastatic Colon Cancer SIRFLOX: Randomized phase III trial comparing first-line mFOLFOX6 ± bevacizumab (bev) versus mFOLFOX6 + selective internal radiation therapy (SIRT) ± bev in patients (pts) with metastatic colorectal cancer (mCRC).
The SIRFLOX study was presented at ASCO, showing promising results from injecting tiny radioactive spheres into the liver of metastatic colon cancer patients in order to halt the growth of tumors. Read more.
New Ways of Treating Cancer Discussed at ASCO
First Line Chemotherapy in Prostate Cancer: The current standard of care is to use hormonal therapy first, with radiotherapy added in appropriate cases, and to then move on to chemotherapy only after the disease has become castration resistant. But two new studies have suggested that adding chemotherapy at a much earlier stage in the disease course has a survival advantage. One of these studies, CHAARTED, was presented last year and another study showing a survival benefit from the earlier use of chemotherapy, STAMPEDE, was presented this week at ASCO.
Hope for the Near Future
There continues to be increased interest in immunotherapy, and particularly the programmed death (PD) inhibitors, such as nivolumab (Opdivo, Bristol-Myers Squibb Company) and pembrolizumab (Keytruda, Merck & Co, Inc). Both these drugs have already been launched, but there are similar drugs coming through the pipeline, including MPDL3280A (Genentech/Roche), MEDI4736 and MED10680 (Medimmune Inc), avelumab (Merck Serono), pidilizumab (CureTech), and others.
Merck and Amgen are expanding their collaboration to test a combination of their immunotherapies, Keytruda (pembrolizumab) and T-VEC (talimogene laherparepvec), in patients with head and neck cancer. The Phase 1 trial will involve patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) and investigate whether the two drugs could offer a new treatment option. T-VEC works by replicating in tumor cells and activates the immune system to destroy tumors, while Keytruda blocks the interaction between PD-1 and PD-L1 and PD-L2 to activate the immune system to attack tumors. Read more.
Rare Lung Disease LAM Gets Hope from New Drug
The FDA granted approval for Pfizer’sRapamune, an immunosuppressant, to treat a rare, progressive lung cancer called lymphangioleiomyomatosis (LAM). Rapamune is the first drug approved to treat this disease. FDA approval was based on data from a randomized trial of 89 patients which showed that those who received the drug for one year had stabilization of lung function. Read more.
New Therapy for Multiple Myeloma
Early results of a pilot clinical trial for re-lapsed Multiple Myeloma patients were presented at ASCO. The trial, conducted at the University of Pennsylvania, is testing a promising approach to cancer treatment known as chimeric antigen receptor (CAR) T-cell therapy.
CAR T-cell therapy has generated impressive results when used to treat certain kinds of leukemia and lymphoma. During his ASCO talk, Principal Investigator Dr. Garfall reviewed results for the first five patients treated in the Penn trial. He reported that four of the first five patients responded to treatment. Three of the five continue to maintain disease control, and one of the patients achieved a complete response with no sign of minimal residual disease. All patients in the trial first underwent a stem cell transplant as part of the trial and were then administered a single infusion of CTL019 after their transplant. Read more.
Multi Media Resources: Multiple Myeloma Trials and Beyond from The Journal Oncology, Video Included
Sagar Lonial, MD, professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine in Atlanta and director of its translational research, B-cell malignancy program discusses results from the recent multiple myeloma trials and the hope for the future. Read more.