ASCO 2020: aanbevolen abstracten bij eierstokkanker en baarmoederhalskanker, vulvakanker en endometriumkanker (baarmoederkanker)

Raadpleeg ook literatuurlijst niet-toxische middelen en behandelingen specifiek bij eierstokkanker van arts-bioloog drs. Engelbert Valstar

27 mei 2020: Ascopost

Hieronder aanbevolen abstracten door Dr. Annette Hasenburg gepubliceerd op ASCO 2020 gerelateerd aan eierstokkanker, baarmoederhalskanker en 1 studie voor vulvakanker en 1 studie voor endometriumkanker (baarmoederkanker)

Klik op de vet gemaakte abstractnummers voor de abstracten:

Session: Gynecologic Cancer—Ovarian Cancer

6000 Randomized phase III study to evaluate the impact of secondary cytoreductive surgery in recurrent ovarian cancer: Final analysis of AGO DESKTOP III/ENGOT-ov20. A Du Bois, J Sehouli, I Vergote, et al

Take-Home Message

Patients with recurrent ovarian cancer after resection and ≥6 months without platinum-based therapy were randomized to receive second-line chemotherapy alone or cytoreductive surgery plus chemotherapy. The median overall survival (OS) was 53.7 months in the surgical group versus 46.2 months in those treated with chemotherapy alone (P = .03). In addition, both progression-free survival and time to start of first subsequent therapy favored the surgical arm. The OS benefit associated with surgery compared with chemotherapy alone exceeded 12 months in those with a successful complete resection; patients with incomplete resection had a shorter OS than the chemotherapy group.
Surgery among patients with recurrent ovarian cancer does confer a survival benefit and should be considered as a treatment option. However, the benefit is evident only in patients with complete resection, and hence careful patient selection is necessary.

6002 Final overall survival (OS) results from SOLO2/ENGOT-ov21: A phase III trial assessing maintenance olaparib in patients (pts) with platinum-sensitive, relapsed ovarian cancer and a BRCA mutation. J Korach, T Huzarski, S Pignata, et al

Take-Home Message

The authors report the final overall survival (OS) analysis for the SOLO2 trial of patients with platinum-sensitive relapsed ovarian cancer and a BRCA mutation treated with maintenance olaparib or placebo.
After a median follow-up of 65 months, olaparib showed significant OS benefit compared with placebo (HR, 0.74).

6004 Mirvetuximab soravtansine, a folate receptor alpha (FRα)-targeting antibody-drug conjugate (ADC), in combination with bevacizumab in patients (pts) with platinum-agnostic ovarian cancer. L Gilbert, A Oaknin, UA Matulonis, et al

Take-Home Message

Patients with FRα-positive ovarian cancer who were platinum-resistant or who could be appropriately treated with a non–platinum based doublet were treated with the FRα-targeting antibody–drug conjugate mirvetuximab soravtansine (MIRV) plus bevacizumab (BEV) in this phase Ib trial. The objective response rate was 43% overall and 61% in a subset of patients with high FRα-expressing tumors. The overall response rate was 61%. The most common grade 3+ treatment-related adverse events were hypertension and neutropenia, which were both observed in 10% of patients.
The combination of MIRV plus BEV has encouraging activity and manageable toxicity in patients with recurrent ovarian cancer, particularly those with high FRα-expressing tumors.

6012 Final survival analysis of NSGO-AVANOVA2/ENGOT-OV24: Combination of niraparib and bevacizumab versus niraparib alone as treatment of recurrent platinum-sensitive ovarian cancer—A randomized controlled chemotherapy-free study. MR Mirza, G-B Nyvang, B Lund, et al

Take-Home Message

Patients with high-grade serous or endometrioid platinum-sensitive relapsed ovarian cancer were randomized to receive niraparib alone or niraparib plus bevacizumab every 3 weeks in this phase II trial. Progression-free survival (PFS) was 12.5 months in the combination group and 5.5 months in the niraparib-only group (HR, 0.34; P < .0001). The PFS benefit was evident regardless of homologous recombination deficiency status.
The combination of niraparib plus bevacizumab has meaningful activity in patients with platinum-sensitive relapsed ovarian cancer and provides a consistent PFS benefit over niraparib alone. The study was not powered to detect any overall survival benefit.

6014 Concordance between CA-125 and RECIST progression (PD) in patients with germline BRCA-mutated platinum-sensitive, relapsed ovarian cancer treated with a PARP inhibitor (PARPi) as maintenance therapy after response to chemotherapy. A Tjokrowidjaja, CK Lee, M Friedlander, et al

Take-Home Message

This study included 275 patients with ovarian cancer to evaluate the concordance between CA-125 and RECIST progression (PD) and the utility of CA-125 as a surrogate biomarker of progression. There were 171 patients with documented RECIST PD, and 94% of these had a normal baseline CA-125 compared with 69% of those with both CA-125 and RECIST PD. There were 94 patients without CA-125 PD but with RECIST PD, and, in 69% of these, the CA-125 remained within the normal range. There was similar discordance between RECIST PD and CA-125 non-PD before and after 12 weeks.
Regular imaging is necessary in this population as the use of CA-125 alone is inadequate to detect progression.

6015 Characterization of patients (pts) with long-term responses to rucaparib in recurrent ovarian cancer (OC). EM Swisher, RS Kristeleit, AM Oza, et al

Take-Home Message

The authors pooled the results of two trials to describe the characteristics of patients with high-grade recurrent ovarian cancer with long-term responses to PARP inhibitor treatment. Long-term responses of >1 year were observed in 40 of the 138 reponders; 29 patients had a duration of response ≤20 weeks. In the subset of patients with BRCA mutations, 15% of long-term responders had BRCA homozygous deletion or rearrangement versus 0% of short-term responders. Upon further evaluation of the 95 patients with BRCA mutations and confirmed response, the median duration of resonse was 3.5 years in those with BRCA homozygous deletion or rearrangement versus 0.6 year in those with other mutation types (HR, 0.30; P = .024). Among 13 patients with BRCA wild-type tumors and a long-term response, 10 patients had high genome-wide loss of heterozygosity, indicating homologous recombination deficiency.
Features of patients with ovarian cancer and a long-term response to PARP inhibitors include BRCA homozygous deletion or rearrangement, BRCA1 hypermethylation, and RAD51C/D mutations.

6018 Association of chronotype and pain at baseline in ovarian cancer survivors participating in a lifestyle intervention (NRG/GOG 0225). TE Crane, A Miller, MB Skiba, et al

Take-Home Message

Ovarian cancer survivors were assessed to evaluate the association between chronotype determined using self-reported time to bed and patient-reported outcomes. Levels of pain were significantly higher in late chronotypes compared with early and mid-chronotypes. Total sleep duration was 6.77 hours in late chronotypes, 7.04 hours in mid-chronotypes, and 7.56 hours in early chronotypes (P < .05). There was a significant correlation between reported pain and CRP levels, indicating higher systemic inflammation. Physical activity levels were not associated with chronotype, and there was a trend towards a positive association between early chronotype and diet quality.
Further data are being analyzed to provide additional insight into the realtionship between circadian rhythm and both pain and key biomarkers in patients with treated ovarian cancer.

Session: Gynecologic Cancer—Cervical Cancer

6006 Long-term oncological safety of sentinel lymph node biopsy in early-stage cervical cancer. V Balaya, B Guani, L Magaud, et al

Take-Home Message

Patients with early-stage cervical cancer were randomized to undergo bilateral sentinel lymph node (SLN) biopsy alone or bilateral pelvic lymphadenectomy (BPL). No patients had positive SLN or non-SLN biopsies. Patients in the BPL group were more likely than those in the SLN group to have tumors >20 mm and to require postoperative radiochemotherapy. The 5-year disease-free survival and disease-specific survival (DSS) were not significantly different between the two groups. The only independent predictor of DSS was final FIGO stage.
Patients with early-stage cervical cancer and negative bilateral SLN biopsy can safely avoid full lymphadenectomy.

6007 Sequential chemoradiation versus radiation alone or concurrent chemoradiation in adjuvant treatment after radical hysterectomy for stage IB1-IIA2 cervical cancer (STARS Study): A randomized, controlled, open-label, phase III trial. H Huang, Y Feng, T Wan, et al

Take-Home Message

Patients with FIGO 2009 stage IB1–IIA2 cervical cancer with at least one adverse factor after radical hysterectomy were randomized to receive adjuvant radiation alone, concurrent chemoradiation, or sequential chemoradiation. The rate of disease-free survival at 3 years was 90.0% in the sequential chemoradiation group, 85.0% in the concurrent chemoradiation group, and 82.0% in the radiation-only group. In addition, sequential chemoradiation was associated with longer overall survival compared with radiation alone.
Sequential chemoradiation was associated with a higher disease-free survival rate and lower risk of cancer death compared with radiation alone in women with early-stage cervical cancer following surgical treatment.

6036 Gut microbiome diversity as an independent predictor of survival in cervical cancer patients receiving chemoradiation. TT Sims, MB Alam, T Karpinets, et al

Take-Home Message

Patients with cervival cancer receiving standard chemoradiation underwent evaluation of the fecal microbiome to identify independent gut microbial risk factors. BMI and fecal sample diversity were shown to be independent prognostic factors for recurrence-free and overall survival.
The diversity of the gut microbiome predicts overall survival in patients with cervival cancer receiving standard chemoradiation after accounting for BMI. Further studies are needed to evaluate the effect of gut microbiome diversity on treatment outcomes.

TPS6095 Phase Ib/II trial of tisotumab vedotin (TV) ± bevacizumab (BEV), pembrolizumab (PEM), or carboplatin (CBP) in recurrent or metastatic cervical cancer (innovaTV 205/ENGOT-cx8/GOG-3024). I Vergote, N Concin, MR Mirza, et al

Take-Home Message

Patients with recurrent/metastatic cervical cancer are being enrolled in this phase Ib/II trial to investigate the use of tisotumab vedotin (TV), an investigational antibody–drug conjugate. Preliminary data for TV monotherapy indicated a positive benefit-to-risk profile, and TV is now being investigated in combination with other conventional therapies.
The phase I dose-escalation part of the study will be used to identify to the optimal dose for phase II, where TV will be administered with bevacizumab, pembrolizumab, or carboplatin. The primary endpoint of the study will be the objective response rate.

TPS6096 ENGOT-cx11/KEYNOTE-A18: A phase III, randomized, double-blind study of pembrolizumab with chemoradiotherapy in patients with high-risk locally advanced cervical cancer. D Lorusso, N Colombo, RL Coleman, et al

Take-Home Message

Enrollment is currently ongoing for this randomized phase III trial of pembrolizumab versus placebo with concurrent chemoradiotherapy among patients with high-risk locally advanced cervical cancer. Treatment will be continued for 20 cycles or until progression or toxicity.
The two primary endpoints of the study are progression-free and overall survival.

e18025 Hormonal rehabilitation in patients with endothelial and cervical cancers. NV Chernikova, TI Moiseenko, AI Shikhlyarova, et al

Session: Clinical Science Symposium—Uterine Cancer

6010 A randomized phase II study of cabozantinib and nivolumab versus nivolumab in recurrent endometrial cancer. S Lheureux, D Matei, PA Konstantinopoulos, et al

Take-Home Message

Patients with recurrent endometrial cancer treated with at least one prior platinum-based chemotherapy were randomized to receive cabozantinib plus nivolumab (arm A) or nivolumab alone (arm B). An exploratory cohort of patients with carcinosarcoma or prior immunotherapy received combination treatment (arm C). The median progression-free survival was 5.3 months in arm A versus 1.9 months in arm B. The clinical benefit was signiifcantly greater in arm A than arm B. Among the arm C patients with carcinosarcoma (n = 9), there was 1 partial response and 4 patients had stable disease. Among arm C patients who had received prior immunotherapy (n = 20), there were 6 responses and 8 patients with stable disease. Most adverse events in arm A were grade 1 or 2.
The use of cabozantinib plus nivolumab improves progression-free survival compared with nivolumab alone in women with heavily pretreated recurrent endometrial cancer. Further study is ongoing to identify predictive immune biomarkers of response in the tumor samples.

Session: Gynecologic Cancer—Other Cancer

6090 Evaluation of treatment patterns and prognosis in correlation with age in patients with vulvar cancer: A subset analysis of the AGO-CaRE-1 study. K Prieske, LL Woelber, MZ Muallem, et al

Take-Home Message

The authors evaluated the impact of age on prognosis and treatment patterns among women with primary squamous cell vulvar cancer (VSCC). Women aged ≥70 years were more likely than younger patients to present with more advanced-stage tumors, larger tumor diameter, poorer ECOG status, higher tumor grade, and a higher rate of nodal involvement. These older women were also more likely than younger women to have HPV-negative tumors. Disease recurrence, especially isolated vulvar recurrence, was significanlty more common in women aged ≥70 years compared with younger women. Age was shown to be an independent prognostic factor for disease-free survival (DFS), with 2-year DFS decreasing as age increased. The hazard ratio for the risk for death or recurrence was 3.21 in women aged ≥70 years compared with women aged <50 years (P < .001).
Among women with VSCC, older women present with more advanced tumors and have poorer outcomes than younger patients. The delayed time to diagnosis may be due to self-awareness but also due to differences in tumor biology.

ASCO 2020, aanbevolen abstracten, eierstokkanker, olaparib, niraparib, BRCA 1, BRCA 2