The MedSIR Project Development team attended the 2019 annual meeting of the European Society of Molecular Oncology.
ESMO is one of the most important professional organizations for medical oncology in the world. Although it has European roots, its reach is global, especially when considering that its main goal is to erase boundaries in cancer care, whether between countries or specialties.
Nearly 22,000 oncology stakeholders from all over the world attended the conference in Barcelona, Spain, and the MedSIR team was no exception.
It was a great opportunity to meet our scientific collaborators, business partners, and friends, and catch up with the latest news and developments in oncology, that will convert science into better cancer patient care. We would like to summarize the highlights of this year´s ESMO that have the potential to change the practice of cancer care, as shown below.
Immunotherapy has changed the treatment paradigms for melanoma, lung cancer, bladder cancer, and renal cancer. Now, immune checkpoint inhibitor therapy is revolutionizing triple-negative breast cancer (TNBC), which represents one of the most aggressive types of breast cancer. According to results of the KEYNOTE-522 trial in early TNBC, the addition of pembrolizumab to chemotherapy significantly improves pathologic complete response rates. The estimated event-free survival rate was 91.3% for the pembrolizumab group versus 85.3% for the placebo arm, with an overall 37% improvement regardless of programmed cell death ligand 1 (PD-L1) status.
Moving to the luminal subtype, the MONALEESA-3 trial showed that the combination of ribociclib plus fulvestrant compared to fulvestrant alone induces a clinically meaningful improvement in overall survival (OS) in postmenopausal women with hormone receptor-positive (HR+), human epidermal growth factor 2-negative (HER2-) ABC, both in endocrine sensitive as well as those with endocrine resistant disease.
Finally, according to the results from the BROCADE 3 study, patients with HER2- ABC with a germline BRCA1/2 mutation showed improved progression-free survival (PFS) and a durable benefit with the addition of the poly (ADP-ribose) polymerase (PARP) inhibitor veliparib to carboplatin/paclitaxel compared with patients receiving placebo plus carboplatin/paclitaxel.
For lung cancer, the most relevant results presented during the congress involved the use of targeted therapy and immunotherapy in non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), respectively.
In NSCLC, updated results for the FLAURA trial were presented, highlighting the potential of osimertinib as the frontline treatment for EGFR-positive patients. The results communicated an improve in median OS by 6.8 months with osimertinib compared to previous-generation TKI inhibitors like erlotinib and gefitinib. The median OS in the osimertinib arm was 38.6 months, among the highest reported for EGFR-mutated patients, and the clinical relevance of the results is highlighted when considering that the advantage in OS was clear even when many patients crossed over from the control group to receive osimertinib at progression.
Regarding SCLC, new results with more mature data were presented for the IMpower133 trial, further confirming that the addition of atezolizumab to carboplatin plus etoposide in first-line SCLC improves both PFS and OS, regardless of biomarker status. These results confirm the role of immunotherapy in combination with platinum-based chemotherapy as an attractive new therapeutic opportunity for patients with advanced SCLC.
New data from targeted treatment and immunotherapy are likely to change the clinical practice also in prostate cancer. The PROFound trial demonstrated a benefit in using olaparib compared to standard hormonal agents such as abiraterone or enzalutamide in men with metastatic castration-resistant prostate cancer (mCRPC) and whose tumors harbor DNA damage response defects.
Additionally, both RADICALS-RT and ARTISTIC studies found no evidence that adjuvant radiotherapy (RT) improves event-free survival compared to early salvage RT, thus sparing patients from RT-related side effects.
Lastly, an interim analysis from the CheckMate 9KD trial assessing the combination of nivolumab and docetaxel showed encouraging clinical activity in patients with mCRPC, with a safety profile consistent with those of the individual agents.
ESMO 2019 marks a significant step forward for patients with ovarian cancer, the most lethal gynecological tumor. After surgery, the current standard of care for advanced ovarian cancer patients is chemotherapy plus bevacizumab, followed by bevacizumab alone, but hopefully PARP inhibitors are improving long-term outcomes. In PAOLA-1/ENGOT-ov25 trial adding the PARP inhibitor olaparib to bevacizumab as maintenance after first-line platinum-based chemotherapy provided a significant and clinically meaningful PFS benefit for advanced ovarian cancer patients, irrespective of BRCA mutations.
According to data from the VELIA/GOG-3005 trial, veliparib added to carboplatin/paclitaxel as induction therapy and continued as maintenance significantly extended PFS in women with high-grade serous epithelial ovarian cancer.
It was a fantastic conference, and we already look forward to the following ESMO annual meeting next year. See you all in 2020 in Madrid, Spain!
Authors: Roldán Cortés, Andrea Malfettone, Eloy Moreno.