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

1 juni 020: ASCO 2020

Hier een aantal aanbevolen abstracten over spijsverteringskanker waaronder darmkanker en maagkanker door artsen / oncologen uit de praktijk die vaak ook voor ASCO werken. Klik op de nummers voor de abstracten. 

Aanbevolen door Axel Grothey, MD

Plenary Session: Gastrointestinal Cancer—Colorectal and Anal

LBA4 Pembrolizumab Versus Chemotherapy for Microsatellite Instability-High/Mismatch Repair Deficient Metastatic Colorectal Cancer: The Phase 3 KEYNOTE-177 Study. T Andre, K-K Shiu, TW Kim, et al

Take-Home Message

  • Based on the press release, this study will confirm superior progression-free survival for first-line single-agent pembrolizumab compared with standard chemotherapy with or without biologics in MSI-H/ MMR-D metastatic colorectal cancer.

Session: Gastrointestinal Cancer—Colorectal and Anal

4000 A phase II, multicenter, open-label study of trastuzumab deruxtecan (T-DXd; DS-8201) in patients (pts) with HER2-expressing metastatic colorectal cancer (mCRC): DESTINY-CRC01. S Siena, M Di Bartolomeo, KPS Raghav, et al

Take-Home Message

  • Trastuzumab deruxtecan (T-DXd) showed relevant activity with a high response rate of >45% in heavily pretreated patients with HER2-positive (HER2 IHC 3+/ HER2 IHC 2+ and FISH+) metastatic colorectal cancer.
  • Responses were also seen in patients pretreated with HER2-targeted agents. Patients with HER2 2+ and HER2 1+ cancers showed no responses.

4001 Encorafenib plus cetuximab with or without binimetinib for BRAF V600E metastatic colorectal cancer: Updated survival results from a randomized, three-arm, phase III study versus choice of either irinotecan or FOLFIRI plus cetuximab (BEACON CRC). S Kopetz, A Grothey, E Van Cutsem, et al

Take-Home Message

  • Encorafenib plus cetuximab has emerged as standard of care in the second-/ third-line setting of BRAF V600E–mutated metastatic colorectal cancer.
  • The addition of binimetinib does not enhance the efficacy over the targeted doublet in the overall patient population.

4003 Celecoxib in addition to standard adjuvant therapy with 5-fluorouracil, leucovorin, oxaliplatin (FOLFOX) in stage III colon cancer: Results from CALGB/SWOG 80702. JA Meyerhardt, Q Shi, CS Fuchs, et al

Take-Home Message

  • The addition of celecoxib did not statistically improve disease-free or overall survival when added to adjuvant FOLFOX in stage III colon cancer, even though there was a numeric trend in favor of celecoxib.

4004 Overall survival (OS) and long-term disease-free survival (DFS) of three versus six months of adjuvant (adj) oxaliplatin and fluoropyrimidine-based therapy for patients (pts) with stage III colon cancer (CC): Final results from the IDEA (International Duration Evaluation of Adj chemotherapy) collaboration. AF Sobrero, T Andre, JA Meyerhardt, et al

Take-Home Message

  • For the overall patient population with stage III colon cancer, 3 and 6 months of adjuvant therapy were associated with almost identical 5-year overall survival rates.
  • As in the prior disease-free survival analysis, a strong regimen effect was observed, demonstrating that 3 months of CAPOX is appropriate for the vast majority of patients. However, with FOLFOX, in particular for high-risk cancers, 6 months of adjuvant therapy should be considered

4005 A randomized phase II/III trial comparing hepatectomy followed by mFOLFOX6 with hepatectomy alone for liver metastasis from colorectal cancer: JCOG0603 study. Y Kanemitsu, Y Shimizu, J Mizusawa, et al

Take-Home Message

  • After resection of colorectal cancer liver metastases, the 3-year disease-free survival rate with observation alone was 41.5%; with adjuvant FOLFOX, it was 52.1%. Still, the study missed its primary endpoint, conceivably because the trial was underpowered.
  • This study will not and should not change the current standard of care, which is perioperative chemotherapy for resectable liver metastases.

4006 Short-course radiotherapy followed by chemotherapy before TME in locally advanced rectal cancer: The randomized RAPIDO trial. G Hospers, RR Bahadoer, EA Dijkstra, et al

Take-Home Message

  • This trial did not truly test short-course radiation (5x5 Gy) versus chemoradiation as neoadjuvant therapy, since the 5x5 Gy arm received additional chemotherapy before resection in the form of a total neoadjuvant therapy (TNT) approach, compared with the chemoradiation arm, which received adjuvant chemotherapy. Not unexpectedly, the TNT arm showed higher pCR rate (27.7% vs 13.8%) but also lower probability of distant metastases at 3 years.
  • This trial highlights the trend toward TNT, but it still leaves the question regarding the optimal radiation modality open.

4007 Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiation in patients with locally advanced rectal cancer: Final results of PRODIGE 23 phase III trial, a UNICANCER GI trial. T Conroy, N Lamfichekh, P-L Etienne, et al

Take-Home Message

  • This trial tested a total neoadjuvant therapy (TNT) approach with FOLFIRINOX as neoadjuvant chemotherapy plus conventional chemoradiation followed by surgery and adjuvant chemotherapy. The TNT approach led to higher pCR rate (27.5% vs 11.7%), with improvement in the primary endpoint of 3-year disease-free survival.
  • This again highlights that TNT is emerging as the standard of care for rectal cancer.

4008 Preliminary results of the organ preservation of rectal adenocarcinoma (OPRA) trial. J Garcia-Aguilar, S Patil, JK Kim, et al

Take-Home Message

  • This trial tested the sequence of treatment components within the total neoadjuvant therapy (TNT) approach: chemotherapy followed by chemoradiation or chemoradiation followed by chemotherapy. No formal comparison between the two arms was preplanned. Both approaches led to high organ preservation rates between 43% and 58%, with a numeric advantage of chemoradiation followed by chemotherapy.
  • A detailed analysis of the timing of staging evaluation and recurrence patterns will need to be performed to fully appreciate these results.

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