The 2017 ASCO Annual Meeting will soon unveil top-line findings across the field of oncology. Pivotal research in immunotherapy, targeted agents, and supportive care are among the much-discussed abstracts this year.
Key opinion leaders spoke with OncLive
to share the top-5 abstracts they find to be the most exciting and/or potentially practice-changing across breast cancer, lung cancer, genitourinary cancers, gastrointestinal cancers, hematologic malignancies, and supportive care.
H. “Jack” West, MD, thoracic oncologist, Swedish Cancer Institute at Swedish Medical Center Alectinib (Alecensa) versus crizotinib (Xalkori) in treatment-naive advanced ALK-positive non–small cell lung cancer (NSCLC): primary results of the global phase III ALEX study (LBA9008)
H. Jack West, MD
The open-label study (NCT02075840) randomized treatment-naïve patients with ALK
-positive NSCLC in a 1:1 ratio to alectinib or crizotinib. Progression-free survival (PFS) was the primary endpoint of the international study. Genentech (Roche), the developer of the second-generation ALK inhibitor alectinib, announced in April 2017 that the study had met its primary endpoint.
“Coming on the heels of the smaller, Japanese-only J-ALEX trial that demonstrated overwhelmingly clear superiority of alectinib over crizotinib in terms of extracranial and intracranial efficacy, as well as better tolerability with alectinib (at a lower dose of alectinib than is the current standard around the world), the ALEX trial results will change our standard of care for first-line treatment of ALK
-positive advanced NSCLC to alectinib if the results are even in the ballpark of the remarkable benefits seen with alectinib in the J-ALEX trial.”Gefitinib (Iressa) versus vinorelbine+cisplatin as adjuvant treatment in stage II-IIIA (N1-N2) NSCLC with EGFR-activating mutation (ADJUVANT): a randomized, phase III trial (CTONG 1104; Abstract 8500)
CTONG 1104 marks the first randomized trial to compare the EGFR tyrosine kinase inhibitor (TKI) gefitinib with vinorelbine/cisplatin—the standard of care in the adjuvant setting for patients with stage II-IIIA NSCLC with EGFR
mutations. Prior studies, including BR19 and RADIANT, have shown that EGFR TKIs have not demonstrated benefit in the adjuvant setting for patients with unselected resected NSCLC. In CTONG 1104, gefitinib significantly prolonged disease-free survival (DFS) versus standard chemotherapy.
“These provocative findings may be interpreted as supporting use of an EGFR TKI as adjuvant therapy, but many might favor an approach of giving sequential adjuvant chemotherapy, as an established standard of care with a demonstrated survival benefit, followed by EGFR TKI therapy. At the same time, this trial will raise the critical question of whether we need to see a significant improvement in overall survival (OS) before adopting a new therapy approach in the curative setting—especially when we are considering recommending years of treatment, with the attendant side effects and costs, for patients who may well already be cured without it.”Nivolumab (Opdivo) with or without ipilimumab (Yervoy) in advanced small cell lung cancer (SCLC): first report of a randomized expansion cohort from CheckMate-032 (Abstract 8503)
This phase I/II study is exploring multiple regimens of nivolumab with or without ipilimumab across several solid tumors, one of which is advanced SCLC. Following standard first-line platinum-based chemotherapy, patients with SCLC have a poor prognosis and limited treatment options. Early results demonstrated tolerability and efficacy for both the immunotherapy combination and nivolumab alone in patients with SCLC.
“Though only reporting results from a phase II trial, this presentation will have an outsized impact because nivolumab, with or without ipilimumab, is now being widely adopted as a leading treatment consideration in relapsed SCLC based on the inclusion of this option in the NCCN guidelines and the lack of enthusiasm felt for standard second-line topotecan. With immunotherapy more readily available than other potentially promising treatments only available in clinical trials, these results will be of great interest despite the lack of systematic evaluation of immunotherapy compared to better established standards in this setting.”Impact of atezolizumab (Tecentriq) treatment beyond disease progression in advanced NSCLC: results from the randomized phase III OAK study (Abstract 9001)