By Peggy Peck, Editor-in-Chief, BreakingMED

CHICAGO – What is the best way to treat hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer? Is low dose chemotherapy a better choice when the patient is old and frail? Did the Affordable Care Act open the door for early diagnosis and treatment of cancer? What will happen if the ACA goes away? Is it possible to match every childhood cancer to a targeted therapy?

Those are some of the questions that will be asked and, if not answered, at least discussed and possibly debated when an estimated 32,000 clinical oncologists and cancer researchers from around the world meet here for the 55th Annual Meeting of the American Society of Clinical Oncology, May 31-June 4.

The “First Course”

This year, the ASCO meeting planners accepted more than 2,400 abstracts for presentation here — which works out to close to 500 research presentations daily — and another 3,200 abstracts were accepted for online publication. In recognition of the information overload potential, on May 15 ASCO lifted the embargo on almost all of the abstracts that will be presented in oral or poster sessions, and that same day highlighted five of the studies during a web-based press briefing — a selection that offered a little something for everyone:

  • Another trip to the Women’ s Health Initiative well (the NIH-sponsored study best known for debunking that estrogen will protect your heart and prevent cancer) for almost 20 years of follow-up to a dietary initiative that missed its primary endpoint, but is now being heralded as the first randomized clinical trial to provide evidence that a dietary intervention can reduce a postmenopausal woman’s risk of dying from breast cancer.
  • An early look at the National Cancer Institute’s pediatric MATCH program reporting that 24% of the 400 screened participants have cancers with genetic markers that “match” to investigational targeted therapies, a match rate that is more than double the expected rate.
  • A study from researchers in Edinburgh that focused more on the art than the science of medicine by studying frail, elderly patients with esophageal cancer and comparing a low-dose chemotherapy regimen with more toxic triple dose regimens. The low dose regimen produced the best overall treatment utility — and happier patients.
  • A very preliminary study of entrectinib that promotes cancer cell death in tumors with NTRK1/2/3, ROS1, or ALK gene fusions or mutations. The drug, which was tested in children with central nervous system cancers, found very encouraging and durable response rates — including a complete response in a patient with neuroblastoma.
  • A look at the thalidomide analogue lenalidomide for treating a precursor to multiple myeloma in the hope of preventing progression to full-blown multiple myeloma offered promising results but raised questions about treating “healthy” patients with a drug that has toxic side-effects.

Top of the List?

When asked by BreakingMED to share what is at the top of her “must” see list at this year’s ASCO, Ingrid A. Mayer, MD, MSCI, Ingram Professor of Cancer Research and Co-Leader, VICC Breast Cancer Research Program at Vanderbilt University Medical Center, emailed this response: “The oral presentation sessions for early breast cancer and metastatic breast cancer; several important studies will be presented and/or updated.”

A likely item included in that checklist is a study that will lead-off the Saturday Late-Breaking Clinical Trials session: “LBA1008: Phase III MONALEESA-7 trial of premenopausal patients with HR+/HER2− advanced breast cancer (ABC) treated with endocrine therapy ± ribociclib: Overall survival (OS) results.”

Overall survival is still the gold standard in cancer trials, and ribocicilib targets CDK4/6 —a buzz-worthy target in breast cancer research. Interest in the OS results from the MONALEESA-7 study has been building since the San Antonio Breast Cancer Symposium 2017 meeting when the MONALEESA-7 progression-free survival data demonstrated a significant benefit.

Alpelisib is an investigational agent that’s gained some interest in this same population —HR+/HER2- cancers, but aimed at a different target, PIK3CA—but results from the SOLAR-1 alpelisib phase III trial did not make the cut for presentation as a late-breaker at ASCO, most likely because top line results were released last August and were featured in abstracts at SABCS 2018 . But running ahead of ASCO, SOLAR-1 findings were published May 16 by The New England Journal of Medicine.

In SOLAR-1, alpelisib, added to fulvestrant, doubled progression-free survival (11 months versus 5.7 months) in breast cancer patients HR+/HER2- whose cancers had a PIK3CA mutation.

Patients Take Center Stage

ASCO meetings traditionally have a theme, and the theme this year is “Caring for Every Patient, Learning from Every Patient.”

That theme is reflected in many of the other 11 studies on this year’s list of the chosen dozen selected as late-breakers:

  • An analysis of electronic health records looking at the relationship between the Affordable Care Act-related Medicaid expansion and racial disparities in receiving timely cancer treatment. (Abstract LBA1, Plenary)
  • A randomized, phase III trial evaluating the impact of adding enzalutamide to standard initial treatment for metastatic hormone-sensitive prostate cancer. (Abstract LBA2, Plenary)
  • A randomized, phase III trial exploring maintenance therapy with the PARP inhibitor olaparib among people with pancreatic cancer who had an inherited BRCA gene mutation. (Abstract LBA4, Plenary)
  • An analysis looking at whether private insurance and regional income impacts survival for people with multiple myeloma. (Abstract LBA107)
  • A study looking at the potential impact of new strategies to expand patient eligibility for clinical trials for advanced non-small cell lung cancer. (Abstract LBA108)
  • A randomized, phase III trial comparing laparoscopic surgery to open surgery in people whose colorectal cancer had metastasized to the liver. (Abstract LBA3516)
  • A phase III trial evaluating pembrolizumab with or without chemotherapy versus chemotherapy for advanced gastric or gastroesophageal junction cancers. (Abstract LBA4007)​
  • A single arm, phase II clinical trial exploring enfortumab vedotin monotherapy in patients wiht locally advanced or metastatic forms of urothelial cancer. (Abstract LBA4505)​
  • An analysis of the National Cancer Database looking at the correlation between the Affordable Care Act and early-stage ovarian cancer diagnoses and time to treatment. (Abstract LBA5563)
  • Five-year survival data from the KEYNOTE-001 trial looking at the safety and effectiveness of pembrolizumab in metastatic non-small cell lung cancer. (Abstract LBA9015)

And, the #MeToo movement is not overlooked as ASCO’s featured presentations includes this: A survey of gynecologic oncologists examining sexual harassment and gender bias. (Abstract LBA10502)

Read the full ASCO 2019 RoundUp


Peggy Peck, Editor-in-Chief at BreakingMED, a service of @Point of Care, LLC, which provides daily medical news reports curated to serve the unique needs of busy physicians and other healthcare professionals.