31 mei 2019: 

Komende week is er weer ASCO 2019. Hier een aantal aanbevolen abstracten over spijsverteringskanker zoals alvleesklierkanker, darmkanker en maagkanker door artsen die zelf voor ASCO werken. Klik op de nummers voor de abstracten.

Published in Oncology

Expert Opinion / Conference Coverage · May 27, 2019

ASCO 2019: Abstract Recommendations From Dr. Axel Grothey for Gastrointestinal Cancer

Session: Gastrointestinal (Colorectal) Cancer
Saturday June 1, 2019; 3:00 PM–6:00 PM

3501 Prospective pooled analysis of four randomized trials investigating duration of adjuvant (adj) oxaliplatin-based therapy (3 vs 6 months {m}) for patients (pts) with high-risk stage II colorectal cancer (CC). T Iveson, AF Sobrero, T Yoshino, et al

Take-Home Message

  • In total, 3273 patients with high-risk stage II colon cancer received 3 months versus 6 months of adjuvant therapy with either CAPOX or FOLFOX. Noninferiority was not established for the shorter duration of therapy for the overall group, but was seen with CAPOX.
  • This trial confirms the results of the IDEA stage III collaboration that 3 months of CAPOX can be a substitute for 6 months of CAPOX in the adjuvant setting. For FOLFOX, a longer duration of therapy is needed to maintain efficacy.

3504 FOxTROT: an international randomised controlled trial in 1052 patients (pts) evaluating neoadjuvant chemotherapy (NAC) for colon cancer. MT Seymour, D Morton

Take-Home Message

  • Some 1052 patients with T3-4/ N0-2/ M0 colon cancer were randomized 2:1 to neoadjuvant FOLFOX or surgery first. Key findings included no increased perioperative morbidity, significant downstaging, fewer postoperative complications, and fewer incomplete resections with neoadjuvant chemotherapy.
  • Neoadjuvant FOLFOX can be an option in select patients with colon cancer. The identification of stage III disease by imaging is still a challenge; the rate of incomplete resection in this study overall was remarkably high

3507 Randomized phase III study comparing FOLFOX + bevacizumab versus FOLFOXIRI + bevacizumab (BEV) as 1st line treatment in patients with metastatic colorectal cancer (mCRC) with ≥3 baseline circulating tumor cells (bCTCs). J Sastre, JM Vieitez, M Auxilidora Gomez-España, et al

Take-Home Message

  • Patients with metastatic colorectal cancer (mCRC; N=349) and ≥3 circulating tumor cells/ 10 mL at baseline were randomized to FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab. Progression-free survival was longer with the triplet compared with the doublet regimen (12.4 vs 9.3 months; P=.0004). There was no major difference in response rate (59% vs 52%) and overall survival (21.7 vs 17.6 months; P=0.86).
  • This trial confirms that, in patients with mCRC and aggressive tumor biology (here, level of circulating tumor cells) an upfront chemotherapy triplet could be indicated. Beyond circulating tumor cells (which I don’t think will be established as standard of care in the workup of mCRC), high levels of ctDNA, right-sidedness, and the presence of a BRAF V600E mutation are also factors which could warrant an upfront more active regimen, like a chemotherapy triplet.

3508 Updated results of TRIBE2, a phase III, randomized strategy study by GONO in the first- and second-line treatment of unresectable mCRC. C Cremolini, C Antoniotti, S Lonardi, et al

Take-Home Message

  • In this study, 679 patients with metastatic colorectal cancer (mCRC) were randomized to FOLFOXIRI plus bevacizumab versus sequential therapy of FOLFOX plus bevacizumab followed by FOLFIRI plus The main updated result is improved overall survival for upfront use of the chemotherapy triplet (27.6 vs 22.6 months; HR, 0.81; P=.033).
  • This Italian study again shows that the use of an upfront chemotherapy triplet can be a worthwhile, yet commonly underutilized, choice as first-line treatment of mCRC. I would recommend this regimen for patients with mCRC and aggressive tumor characteristics.

Session: Gastrointestinal (Noncolorectal) Cancer
Sunday June 2, 2019; 9:45 AM–12:45 PM

4000 APACT: phase III, multicenter, international, open-label, randomized trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) for surgically resected pancreatic adenocarcinoma. MA Tempero, M Reni, H Riess, et al

Take-Home Message

  • In this study, 866 patients with resected pancreas cancer were randomized to gemcitabine versus gemcitabine/ nab-paclitaxel as adjuvant therapy. Disease-free survival was 18.8 versus 19.4 months (HR, 0.88; P=0.18). Overall survival was 36.2 versus 40.5 months (HR, 0.82; P=.045—nominal).
  • These are surprising results given the adjuvant data with FOLFIRINOX, which showed a dramatic improvement over gemcitabine alone. Subgroup analyses might identify a group of patients who can benefit from gemcitabine/ nab-paclitaxel; but, right now, gemcitabine–capecitabine would be the standard of care as adjuvant therapy for patients who cannot tolerate FOLFIRINOX.

4001 ARTIST 2: Interim results of a phase III trial involving adjuvant chemotherapy and/or chemoradiotherapy after D2-gastrectomy in stage II/III gastric cancer (GC). SH Park, DY Zang, B Han, et al

Take-Home Message

  • This is an interim analysis of 538 patients on ARTIST 2. The addition of oxaliplatin to S-1 as adjuvant therapy after surgery for gastric cancer improved disease-free survival; the addition of radiation therapy did not.
  • These data confirm again that, in patients with gastric cancer who had undergone a D2 lymphadenectomy, there is no role for postoperative radiation therapy.

4003 ABC-06 | A randomised phase III, multi-centre, open-label study of Active Symptom Control (ASC) alone or ASC with oxaliplatin / 5-FU chemotherapy (ASC+mFOLFOX) for patients (pts) with locally advanced / metastatic biliary tract cancers (ABC) previously-treated with cisplatin/gemcitabine (CisGem) chemotherapy. A Lamarca, DH Palmer, HS Wasan, et al

Take-Home Message

  • Patients (N = 182) with advanced biliary cancer after gemcitabine/ cisplatin were randomized to FOLFOX or active symptom control. FOLFOX improved overall survival in a meaningful way (HR, 069), more than doubling the 12-month overall survival rate (25.9% vs 11.4%).
  • This study is the first to establish a standard second-line therapy in biliary cancers after gemcitabine/ cisplatin in the first-line. Ongoing trials are evaluating the use of targeted agents in specific patient populations (IDH1, BRAF, FGFR fusions, HER2+) and further intensified chemotherapy like FOLFIRINOX.

4005 Prospective randomized phase II trial of pazopanib versus placebo in patients with progressive carcinoid tumors (CARC) (Alliance A021202). EK Bergsland, MR Mahoney, TR Asmis, et al

Take-Home Message

  • Patients (N = 121) with carcinoid tumors with signs of disease progression were randomized to pazopanib versus placebo. Progression-free survival was 11.6 versus 8.5 months (HR, 0.53; P=.0005).
  • Based on these data, pazopanib has emerged as a treatment option for patients with carcinoid tumors.

LBA4007 Pembrolizumab with or without chemotherapy versus chemotherapy for advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma: The phase III KEYNOTE-062 study. J Tabernero, E Van Cutsem, Y-J Bang, et al

Take-Home Message

  • Per press release, the study missed its primary endpoint.
  • It will be important to see if a subgroup of patients can be identified in whom immuno-oncology plus chemo provides benefit. This study adds to the list of failed trials of immuno-oncology agents in gastrointestinal cancers when tested in a randomized trial against active control.

Session: Plenary Session
Sunday June 2, 2019; 1:00 PM–4:00 PM

LBA4 Olaparib as maintenance treatment following first-line platinum-based chemotherapy (PBC) in patients (pts) with a germline BRCA mutation and metastatic pancreatic cancer (mPC): Phase III POLO trial. HL Kindler, P Hammel, M Reni, et al

Take-Home Message

  • Prior press release stated that the primary endpoint of clinically meaningful prolongation of progression-free survival with the PARP inhibitor olaparib was achieved in patients with a germline BRCA mutation.
  • The question will be if the results translate into a difference in overall survival and if the use of PARP inhibitors could be expanded beyond the germline BRCA–mutated population.

Session: Gastrointestinal (Noncolorectal) Cancer
Monday June 3, 2019; 3:00 PM–4:30 PM

4016 Rivaroxaban thromboprophylaxis in ambulatory patients with pancreatic cancer: Results from a prespecified subgroup analysis of the CASSINI study. S Vadhan-Raj, MG McNamara, M Venerito, et al

Take-Home Message

  • In a prespecified subgroup of 273 patients with pancreas cancer included in the 1080-patient CASSINI study of rivaroxaban as primary prophylaxis of VTE, VTE was reduced from 10.1% to 3.7% with rivaroxaban (HR, 0.35; P=.03). There was no increase in major bleeding.
  • The idea of prophylactic anticoagulation has been tested before in pancreas cancer. The use of an oral agent might be more feasible than LMWH. No difference in overall survival has been demonstrated so far.

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