At the end of May, specialists from the field of oncology from all over the world shared their newest findings at the annual American Society of Clinical Oncology (ASCO) meeting. While this time in a virtual setting, high quality research was presented. Especially the topic of personalized medicine around immunotherapies and targeted drugs have been a hot subject during the ASCO 2020 meeting and have been presented during the plenary sessions. Let us guide you through the 9 highlights to remember from ASCO 2020.
Gastrointestinal & genito-urinary tumors
Within this indication space, we identified 3 key results during ASCO 2020:
1. Merck & Pfizer showed their results of a randomized Phase III trial, called JAVELIN Bladder 100, where they used avelumab, an immune checkpoint inhibitor that is targeting the programmed cell death 1 ligand 1 (PD-L1). Patients with locally advanced or metastatic urethral cancer previously treated with platinum-based chemotherapies, were given either avelumab in combination with best supportive care (n=350) or best supportive care alone (n=350). The overall survival (OS) was significantly prolonged when using avelumab in all randomized patients and patients that had been tested positive for PD-L1.
2. Additionally, in a phase II study TROPHIMMUN, Merck & Pfizer reported that avelumab showed to be effective for approximately half of the patients (n=15) with gestational trophoblastic tumors that were resistant to mono-chemotherapy. This is the first trial of immunotherapy in this indication space and could constitute a new treatment option for these patients.
3. Merck & Co./MSD reported on pembrolizumab in metastatic colorectal cancer (mCRC) patients. Pembrolizumab, a checkpoint inhibitor showed significant improvement of progression free survival in patients with mismatch repair deficient/microsatellite instability high metastatic colorectal cancer, compared to chemotherapy as a first line therapy. This is the first positive Head-to-Head Phase 3 Trial of a single-agent, anti-PD-1 therapy compared to chemotherapy as first-line treatment for patients with microsatellite instability high metastatic (MSI-H) colorectal cancer. This could result in a new standard of care for these patients.
Another time in the 2020 edition of ASCO, pembrolizumab is on our podium of flagged highlights, together with Tucatinib of Seattle Genetics:
4. About Pembrolizumab, another phase III study reported on a significantly improved progression free survival of patients with PD-L1-positive untreated metastatic triple negative breast cancer. These patients had been treated with pembrolizumab in combination with chemotherapy, compared to patients that were solely treated with placebo + chemotherapy, as investigated in a phase III study (KEYNOTE-355).
5. Seattle Genetics presented their data on the HER2CLIMB trial, in which Tucatinib, a human epidermal growth factor receptor 2 (HER2) kinase inhibitor, was added to treatment with Trastuzumab, another inhibitor of HER2, and capecitabine. This drug combination was given to patients with HER2-positive metastatic breast cancer with brain metastases that had been heavily pre-treated. The addition of Tucatinib has led to improved central nervous system (CNS) progression-free survival, improved overall survival reduced progression of brain metastasis.
Also within the field of prostate cancer, notably the segment of men with non-metastatic castration-resistant prostate cancer, good new opportunities have been reported during ASCO 2020 annual meeting:
6. Within a phase III trial (SPARTAN), Janssen reported that the overall survival of patients with non-metastatic castration-resistant prostate cancer increased when adding Apalutamide to ongoing androgen deprivation, compared to placebo with androgen deprivation.
7. Likewise, Bayer reported statistically significant improvement in overall survival seen in men with non-metastatic castration resistant prostate cancer treated with NUBEQUA (Darolutamide) plus androgen deprivation therapy. Along with the significantly improved efficacy the drug comes with high tolerability.
Non-small cell lung cancer (NSCLS)
Within the field of NSCLC much new data has been reported, also linked to the COVID-19 pandemic. However, the 2 following presentations are key:
8. Genentech presented a phase II trial (CITYSCAPE) around tiragolumab. Tiragolumab is a novel cancer immunotherapy designed to bind to TIGIT, an immune checkpoint protein expressed on immune cells. Both TIGIT and PD-L1 play an important role in immune suppression, and blocking both pathways could enhance anti-tumor activity. Treating patients with PD-L1-positive metastatic NSCLC using a combination of tiragolumab and atezolizumab showed to meaningfully increase ORR (Objective Response Rate) clinically and PFS (Progression free survival).
9. AstraZeneca reported on Osimertinib. Osimertinib is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor of the third generation and showed a significant effect on disease-free-survival in patients with stage IB/II/IIIA NSCLC that were positive for EGFR pathogenic variants, following tumor removal and chemotherapy.
Overall, ASCO 2020 has reported on some great developments in cancer therapies: from gastrointestinal and genito-urinary tumours to non-small cell lung cancer (NSCLC), breast cancer and prostate cancer. We look forward to their developments, which we hope will be presented at the European Society of Medical Oncology (ESMO) in September 2020.
About the authors
Volker, Great Explorer Oncology in Alcimed’s Healthcare team in Germany
Jana, Consultant in Alcimed’s Healthcare team in Germany
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