Oncology Conference Highlights, Q4

January 17, 2019

Our team reviews 2018 conference highlights in oncology care, including studies from ASH, SABCS, and SIO.

2018 4th Quarter Conferences

It was a banner year for oncology conferences, with more participation than ever before.

Three important conferences took place in the last quarter of the year. The 60th American Society of Hematology (ASH) Annual Meeting and Exposition was held December 1–4 in San Diego, The Society of Integrative Oncology (SIO) 15th Annual Conference took place in Scottsdale, October 27–29, and the 2018 San Antonio Breast Cancer Symposium (SABCS) was December 4–8 this year.

ASH 2018

Key presentations at ASH 2018 included advances in treatment for diseases that have not benefited from progress over the past several years.

“Myeloma has been a disease that has been in stasis for decades,” said Mark Crowther, MD, MSc, ASH 2018 Educational co-chair. “We didn’t have effective treatments. We had a big advance 20 years ago with stem cell transplants [followed by] fine-tuning around the edges. And then suddenly there have been big advances in these two diseases, which have been seen as chronic, slow and progressive.”

Dr. Crowther expressed intrigue in novel precision therapies for acute myeloid leukemia (AML). In an abstract titled “Initial Report of the Beat AML Umbrella Study for Previously Untreated AML: Evidence of Feasibility and Early Success in Molecularly Driven Phase 1 and 2 Studies,” [1] Burd and colleagues presented data that bolstered the feasibility of an algorithm strategy for the treatment of AML in older patients who were previously untreated. “The Beat AML trial is a model for dynamic, mechanism-based clinical trials in blood cancers where genomic analysis may inform, accelerate, and improve drug development,” wrote the authors.

Chimeric antigen receptor (CAR) T-cell therapy was a focus of the conference as well. Julie Vose, MD, the Division of Hematology/Oncology Chief at University of Nebraska Medical Center, noted the significance of the five CAR T-cell therapy studies, which offer long-awaited hope for patients with several different types of aggressive blood cancers, including diffuse large B-cell lymphoma.[2-5]

Important discussions about brentuximab also took place at the conference. “Clearly, Steve Horwitz’s presentation on ECHELON-2 was a highlight,” said Bruce Cheson, MD, Deputy Chief, Division of Hematology/Oncology at Georgetown University. This study showed that adding brentuximab vedotin to chemotherapy resulted in a clinically significant improvement in progression-free and overall survival in patients who have CD30-expressing peripheral T-cell lymphoma (PTCL).[6]

“Also, the ALLIANCE and ECOG chronic lymphocytic lymphoma trials[7,8] are practice changing,” he added. Results of these trials support the use of ibrutinib as standard-of-care or first-line treatment in elderly patients with chronic lymphocytic lymphoma.

SIO 2018

The SIO 2018 annual conference continued SIO’s mission of advancing the field by focusing on findings that can guide strategy in the clinical practice of oncology. “Many interesting studies were presented,” said Santosh Rao, MD, medical director of integrative medicine at Banner MD Anderson Cancer Center and co-chair of SIO 2018.

One of the most important goals of integrative oncology, especially in light of the opioid crisis, has been non-pharmacologic approaches to cancer pain. Acupuncture, in particular, has garnered attention. In a presentation on this discipline, Piulson and colleagues provided evidence of its safety in the treatment of lymphedema in breast cancer survivors.[9]

In another important presentation, Romero et al identified potentially beneficial genotypes involved in neuro-transmission, thermo-regulation, and inflammation that may predict response to acupuncture for hot flashes in breast cancer survivors.[10] “If confirmed by future studies, these findings can inform the development of personalized acupuncture for managing hot flashes in BC [breast cancer] survivors,” the authors concluded.

Deleemans et al presented research on bright white light therapy, offering evidence that it may reduce cancer-related fatigue in patients.[11] In particular, an ANOVA analysis revealed a significant effect of time on cancer-related fatigue, as scores on measures of fatigue decreased from pre- to post-intervention.

Two other important studies presented at the meeting-one by Chen et al on Quxie capsules,[12] and one by Deng et al on yoga and cognitive function[13]-are summarized in more detail in the “Integrative Oncology” section on page 7 of this issue.

SABCS 2018

The San Antonio Breast Cancer Symposium (SABCS) is, by its own description, “designed to provide state-of-the-art information on the experimental biology, etiology, prevention, diagnosis, and therapy of breast cancer and premalignant breast disease, to an international audience of academic and private physicians and researchers.” To this end, there was no shortage of excellent studies presented.

Melanie Royce, MD, PhD, Director of the Multidisciplinary Breast Cancer Clinic and Programs at UNMCC, highlighted several studies of interest from SABCS.

In a study titled “Development and validation of a chemotherapy toxicity risk score for older patients with breast cancer receiving adjuvant/neoadjuvant treatment,” Magnuson and colleagues developed and validated a novel chemotherapy toxicity risk score (CARG-BC), which predicts toxicity for older patients with stage I, stage II, and stage III breast cancer. The CARG-BC score is linked to dose reduction, delay, hospitalizations, and so forth, and could play a role in adjuvant decision-making.[14] “Use of this tool may help identify which older patients are at higher risk for developing toxicities with neo/adjuvant chemotherapy and thus can be more carefully monitored for toxicities,” said Royce.

Turner et al discussed the PALOMA-3 trial in “Overall Survival with Palbociclib and Fulvestrant in Advanced Breast Cancer,” which found that palbociclib-fulvestrant resulted in longer overall survival than treatment with placebo-fulvestrant among patients who had sensitivity to previous endocrine therapy.[15]

In their presentation on “PHARE randomized trial: final results comparing 6 to 12 months of trastuzumab in adjuvant early breast cancer,” Pivot and colleagues found that 6 months of trastuzumab is non-inferior to 12 months of trastuzumab as adjuvant treatment in early breast cancer. “The findings are very similar to PERSEPHONE in design but opposite conclusions,” said Royce, “mainly due to predefined statistical boundaries of non-inferiority for each trial – the HR [hazard ratio] for both trials were similar: 1.08 vs. 1.07 for PHARE and PERSEPHONE, respectively.”[16]

Presenting on “Tailoring Adjuvant Endocrine Therapy for Premenopausal Breast Cancer,” Francis PA et al referenced the SOFT and TEXT trial, which found that the addition of ovarian suppression to tamoxifen resulted in significantly higher 8-year rates of both DFS and OS compared with tamoxifen alone. The use of exemestane plus ovarian suppression resulted in even higher rates of freedom from recurrence. The frequency of adverse events was higher in the two groups that received ovarian suppression than in the tamoxifen-alone group.[17] “This gives us a good idea on what to do with patients with the intermediate range recurrence scores; should we recommend chemo or not? This study at least suggests that worry probably should be more focused on the younger (age 50 or under) patients,” said Dr. Royce.

Finally, Dr. Royce pointed out a notable novel biomarker presented at SABCS. In a study titled “Clinical utility of Circulating Tumor Cells (CTC) count to choose between 1st line hormone therapy & chemotherapy in ER (estrogen receptor)+ HER2- metastatic breast cancer: Results of the phase III STIC CTC trial,” Bidard et al found that CTC is a clinically reliable and reproducible biomarker in women with estrogen receptor–positive, human epidermal growth factor receptor 2–negative disease, although more research needs to be conducted. Specifically, the researchers found that in patients with > 5 CTC/7.5mL, chemotherapy outperforms single agent endocrine therapy.[18]

Financial Disclosure:The authors have no significant financial interest in or other relationship with the manufacturer of any product or provider of any service mentioned in this article.

References:

1. Burd A, Levine R, Shoben A, et al. Initial report of the beat AML umbrella study for previously untreated AML: evidence of feasibility and early success in molecularly driven phase 1 and 2 studies. Presented at the American Society of Hematology Annual Meeting and Exposition; Dec 1-4, 2018; San Diego. Abstract 559.
2. Ramos CA, Bilgi M, Gerken C, et al. CD30-chimeric antigen receptor (CAR) T cells for therapy of Hodgkin lymphoma (HL). Presented at the American Society of Hematology Annual Meeting and Exposition; Dec 1-4, 2018; San Diego. Abstract 680.
3. Nastoupil LJ, Jain MD, Spiegel JY, et al. Axicabtagene ciloleucel (Axi-cel) CD19 chimeric antigen receptor (CAR) T-cell therapy for relapsed/refractory large B-cell lymphoma: real-world experience. Presented at the American Society of Hematology Annual Meeting and Exposition; Dec 1-4, 2018; San Diego. Abstract 91.
4. Li AM, Hucks GE, Dinofia AM, et al. Checkpoint inhibitors augment CD19-directed chimeric antigen receptor (CAR) T-cell therapy in relapsed B-cell acute lymphoblastic leukemia. Presented at the American Society of Hematology Annual Meeting and Exposition; Dec 1-4; San Diego. Abstract 556.
5. Shah N, Alsina M, Siegel DS, et al. Initial results from a phase 1 clinical study of bb21217, a next-generation anti-BCMA CAR T therapy. Presented at the American Society of Hematology Annual Meeting; Dec 1-4, 2018; San Diego. Abstract 488.
6. Horowitz SM, O’Connor OW, Pro B. The ECHELON-2 trial: results of a randomized, double-blind, active-controlled phase 3 study of brentuximab vedotin and CHP (A+CHP) versus CHOP in the frontline treatment of patients with CD30+ peripheral T-cell lymphomas. Presented at the American Society of Hematology Annual Meeting; Dec 1-4, 2018; San Diego. Abstract 997.
7. Woyach JA, Ruppert AS, Heerema NA, et al. Ibrutinib alone or in combination with rituximab produces superior progression-free survival (PFS) compared with bendamustine plus rituximab in untreated older patients with chronic lymphocytic leukemia (CLL): results of Alliance North American Intergroup Study A041202. Presented at the American Society of Hematology Annual Meeting; Dec 1-4, 2018; San Diego. Abstract 6.
8. Shanafelt TD, Wang V, Kay NE, et al. A randomized phase III study of ibrutinib (PCI-32765)-based therapy vs. standard fludarabine, cyclophosphamide, and rituximab (FCR) chemoimmunotherapy in untreated younger patients with chronic lymphocytic leukemia (CLL): a trial of the ECOG-ACRIN Cancer Research Group (E1912). Presented at the American Society of Hematology Annual Meeting; Dec 1-4, 2018; San Diego. Abstract LBA-4.
9. Piulson L, Zhi I, Derito J, Bao T. Safety of acupuncture treatment for lymphedema in breast cancer survivors. Presented at the 15th International Conference of the Society for Integrative Oncology; Oct 27-29, 2018; Scottsdale, AZ.
10. Romero SAD, Li SQ, Orlow I, Mao J. Genetic predictors to acupuncture response for hot flashes: an exploratory study of breast cancer survivors. Presented at the 15th International Conference of the Society for Integrative Oncology; Oct 27-29, 2018; Scottsdale, AZ.
11. Deleemans J, Subnis A, Johnson JA, et al. A secondary analysis of the LITE study: associations among psychosocial outcomes and inflammatory markers in cancer survivors treated with bright light therapy. Presented at the 15th International Conference of the Society for Integrative Oncology; Oct 27-29, 2018; Scottsdale, AZ.
12. Chen D, Yang Y, Yang P. Quxie capsule inhibits the colon tumor growth partially mediated by modulating the gut microbiome and myosin11. Presented at the 15th International Conference of the Society for Integrative Oncology; Oct 27-29, 2018; Scottsdale, AZ.
13. Deng G, Benusis L, Hogn P, et al. Yoga and cognitive function in cancer survivors: a randomized controlled trial. Presented at the 15th International Conference of the Society for Integrative Oncology; Oct 27-29, 2018; Scottsdale, AZ.
14. Hurria A, Magnuson A, Gross CP, et al. Development and validation of a chemotherapy toxicity (Chemo Tox) risk score for older patients (Pts) with breast cancer (BC) receiving adjuvant/neoadjuvant treatment (Adjuvant Tx): a R01 and BCRF funded prospective multicenter study. Presented at the 2018 San Antonio Breast Cancer Symposium; Dec 4-8, 2018; San Antonio, TX. Abstract GS6-04.
15. Turner NC, Slamon DJ, Ro J, et al. Overall survival with palbociclib and fulvestrant in advanced breast cancer. N Engl J Med. 2018;379:1926-36.
16. Pivot X, Romieu G, Debled M, et al. PHARE randomized trial final results comparing 6 to 12 months of trastuzumab in adjuvant early breast cancer. Presented at the 2018 San Antonio Breast Cancer Symposium; Dec 4-8, 2018; San Antonio, TX. Abstract GS2-07.
17. Francis PA, Pagani O, Fleming GF, et al. Tailoring adjuvant endocrine therapy for premenopausal breast cancer. N Engl J Med. 2018;379:122-37.
18. Bidard FC, Jacot W, Dureau S, et al. Clinical utility of circulating tumor cells (CTC) count to choose between first-line hormone therapy & chemotherapy in ER+, HER2− metastatic breast cancer. Presented at the 2018 San Antonio Breast Cancer Symposium; Dec 4-8, 2018; San Antonio, TX. Abstract GS3-07.

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