Game-Changers: 11 Key Abstracts in ASCO Lineup

Maurie Markman, MD
Published: Monday, Jul 18, 2011
purified DNA under UV light

Purified DNA, fluorescing orange under ultraviolet (UV) light, is extracted and used for molecular biology studies. The purified DNA, in a cesium chloride gradient, binds to the ethidium bromide dye which absorbs UV light and makes the DNA fluoresce orange. This visualization of a single band of DNA aids in the isolation and extraction of the DNA for future molecular biology studies.

Abstracts presented at the 2011 American Society of Clinical Oncology (ASCO) Annual Meeting will have a major impact on both standard-of-care disease management and the future of clinical trials in multiple settings. While it is certainly not possible to adequately discuss the more than 4000 abstracts presented at this important congress, this commentary will highlight a few of the reports that have the potential to change the paradigm for disease management.

1

Melanoma

Vemurafenib Response Impressive

A number of commentators have noted that this was the “year of melanoma treatment.” In fact, in the plenary session, 2 paradigmchanging randomized phase III trials involving patients with advanced melanoma were presented. In the first report, investigators randomized patients with metastatic melanoma and a documented activated BRAF mutation to either vemurafenib, an inhibitor of mutated activated BRAF, or dacarbazine. The vemurafenib-treated patient population experienced a strikingly higher objective response rate (48.4% vs 5.5%), progression-free survival (hazard ratio [HR] 0.26, P <0.0001) and overall survival (HR 0.37, P <0.0001). Abstract LBA4

2

Ipilimumab Data Confirm Potency

In the second plenary abstract dealing with melanoma, investigators compared dacarbazine with dacarbazine plus ipilimumab, a novel immunotherapy strategy, in a phase III randomized study as primary treatment of either unresectable stage III or metastatic stage IV melanoma. Treatment on the ipilimumab-containing regimen resulted in a higher objective response rate (15.2% vs 10.3%), and improved progression-free response (median 2.8 vs 2.6 months, HR 0.76; P = 0.006) and overall (median 11.2 vs 9.1 months, HR 0.72, P = 0.0009) survival. Three-year overall survival was almost doubled (20.8% vs 12.2%) in the ipilimumab arm. Of note, the duration of response in those individuals randomized to the ipilimumab regimen increased from a median of 8.1 months observed in the dacarbazine arm to 19.3 months. Abstract LBA5

3

GIST

Extended Imatinib Outcomes Are Dramatic

In the realm of gastrointestinal stromal tumors (GIST), a potentially paradigm-changing study explored the impact of 12 months versus 36 months of adjuvant imatinib in a high-risk patient population who received the agent in the adjuvant setting following surgical resection. The study revealed a statistically significant improvement in both 5-year relapse-free survival (65.6% vs 47.9%; HR 0.46; P <0.0001) and 5-year overall survival (92% vs 81.7%; HR 0.45; P <0.019) associated with the extended treatment program. The data not only provide strong support for the superiority of the extended adjuvant treatment program, but also raise the provocative question of whether such treatment should be continued for longer than 3 years. Abstract LBA1


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