Top 10 Highlights from ASCO 2015

Whole-Brain Radiation Therapy Improves Brain Metastases But Not Survival:

A randomized study of 213 patients showed that the addition of whole-brain radiation therapy (WBRT) to stereotactic radiosurgery improved control of brain metastases in cancer patients, but did not result in a survival benefit. At 3 months, patients who underwent WBRT were more likely to experience cognitive decline compared with those who only received radiosurgery (91.7% vs 63.8%). Patients who received WBRT had a greater decline in immediate recall (30% vs 8%), delayed recall (51% vs 20%), and verbal communication (19% vs 2%).[2] Image source: Paul D. Brown, MD, the University of Texas MD Anderson Cancer Center, Houston, Texas

Genomic Marker Predicted Anti–PD-1 Response in Colorectal Cancer:

A phase II study found that 62% of colorectal cancer patients with mismatch repair deficiency responded to checkpoint blockade with the anti–programmed death 1 (PD-1) drug pembrolizumab. No patients with mismatch repair–proficient tumors responded to this treatment. Additionally, patients with mismatch repair deficiency in other tumors such as stomach, small bowel, endometrial, and bile duct had a 60% objective response rate. Mismatch repair is present in about 4% to 5% of cancers and can be easily determined with available commercial tests.[3] Image source: Dung T. Le, MD, Luis L. Diaz, MD, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland

Adjuvant Chemotherapy Improves Survival in High-Risk Localized Prostate Cancer:

The phase III RTOG 0521 trial showed a survival benefit in men with high-risk localized prostate cancer with the addition of docetaxel and prednisone to standard therapy (hormone and radiation therapy). The group who received adjuvant chemotherapy had a 93% 4-year overall survival rate compared with 89% among the standard therapy alone group. The 5-year disease-free survival rate was 73% in docetaxel-treated patients and 66% in patients treated with standard therapy alone (P = .05). Adjuvant docetaxel was also associated with a statistically significant reduction in distant metastases. Because of the slower progression of prostate cancer, the trial requires further follow-up.[4] Image source: Howard M. Sandler, MD, Cedars-Sinai Medical Center, Los Angeles, California

Progression of HR-Positive Breast Cancer Delayed With Palbociclib Plus Fulvestrant:

The combination of palbociclib plus the hormonal therapy fulvestrant more than doubled progression-free survival in women with previously treated hormone receptor (HR)-positive, HER2-negative metastatic breast cancer compared with fulvestrant alone. The trial was stopped after an interim analysis showed an increase of 5.4 months in progression-free survival in the combination arm compared with the control arm (9.2 months vs 3.8 months; hazard ratio = 0.422; P

Eribulin Improves Survival in Advanced Sarcoma:

A randomized trial showed that treatment with eribulin resulted in a survival improvement of 2 months in patients with two subtypes of soft-tissue sarcoma-leiomyosarcoma and liposarcoma-compared with patients treated with the standard therapy of dacarbazine. The trial is the first phase III trial to show a survival benefit of a novel therapy over the current standard for soft-tissue sarcoma patients. Patients treated with eribulin had a significant improvement in median overall survival compared with dacarbazine-treated patients (13.5 months vs 11.5 months; hazard ratio = 0.768; P = .0169). Median progression-free survival was 2.6 months in both arms.[6] Image source: Patrick Schöffski, MD, MPH, University Hospitals Leuven, Leuven, Belgium

Ibrutinib Improves on Standard of Care in CLL/SLL:

A phase III trial found that ibrutinib in combination with bendamustine and rituximab (BR) is superior to BR alone in patients with previously treated chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). The median progression-free survival was not yet reached with the combination therapy, compared with 13.3 months in the BR and placebo group (hazard ratio for progression or death = 0.203; P

Elective Dissection of Lymph Nodes Improves Survival in Early Oral Cancer:

A phase III study found that elective neck lymph node surgery for patients with early oral cancer reduced the risk of cancer recurrence and improved survival. The 3-year overall survival in patients who opted for surgery was 80% compared with 67.5% for those treated with a “watch-and-wait” approach (hazard ratio = 0.63; P = .01). Elective neck dissection also resulted in a 23.6% absolute increase in 3-year disease-free survival (69.5% vs 45.9%).[8] Anil D’Cruz, MBBS, MS, FRCS, discussing the results. Photo © ASCO/Scott Morgan 2015

Reduction in Late Mortality Improves Childhood Cancer Survival:

The Childhood Cancer Survivor Study evaluated data of long-term health outcomes in 5-year survivors of childhood cancer and found that modern treatments have reduced long-term mortality rates, in part due to refined treatment approaches that reduced mortality related to secondary cancers, as well as heart and lung disease. After an average follow-up of 21 years since diagnosis, all-cause mortality was cut in half-12.4% of patients diagnosed in the early 1970s died within 15 years of diagnosis as compared with only 6% of those diagnosed in the early 1990s.[9] Gregory T. Armstrong, MD, discussing the results. Photo © ASCO/Scott Morgan 2015

Anastrozole Trumps Tamoxifen in DCIS:

Treatment of postmenopausal women with ductal carcinoma in situ (DCIS) with the aromatase inhibitor anastrozole resulted in higher breast cancer–free survival rates compared with standard treatment with tamoxifen. The 10-year breast cancer–free survival rates were 93.5% in the anastrozole group compared with 89.2% in the tamoxifen group. Sixty-three women in the tamoxifen arm and 39 women in the anastrozole arm were diagnosed with invasive breast cancer (hazard ratio = 0.61, P = .02).The breast cancer–free survival in women ≥ 60 years was similar in both the anastrozole and tamoxifen treatment arms (92.2% vs 90.2%).[10] Image: Richard G. Margolese, MD, discussing the results.