J. Blokken PhD, PharmD

Immunotherapy as frontline treatment for advanced hepatocellular cancer

For more than a decade, systemic treatment of advanced hepatocellular carcinoma (HCC) remained limited to the use of the tyrosine kinase inhibitor sorafenib, with lenvatinib being a non-inferior alternative to this standard of care. Recently, however, results of the phase III IMbrave 150 trial, demonstrated that the combination of atezolizumab and bevacizumab is associated with a significantly better progression-free and overall survival than sorafenib in the frontline treatment of patients with advanced HCC. This finding will have a dramatic impact on the treatment paradigm for these patients. In addition to atezolizumab-bevacizumab, several other immunotherapy-based treatment regimens are being evaluated in the treatment of advanced HCC.

Highlights in gynaecological cancers

In this overview, the key highlights from ESMO 2020 with respect to gynaecological cancers will be discussed. In advanced endometrial cancers, data were presented on the use of letrozole in combination with palbociclib. In addition, to this, promising clinical efficacy was seen for the antibody-drug conjugate tisotumab vedotin in the treatment of patient with recurrent or metastatic cervical cancer. Also in cervical cancer, a study was presented on the optimal management of cervical cancer patients with intraoperatively detected positive pelvic lymph nodes. In ovarian cancers, several updates were presented of pivotal trials evaluating PARP inhibitors. In addition, results if the phase III INOVATYON trial indicate that platinum-based regimens should remain the standard of care for patients with recurrent ovarian cancer who experienced disease progression within six-twelve months after their last line of platinum-based therapy. Finally, results were presented of the IMagyn050 trial assessing the efficacy and safety of bevacizumab in combination with atezolizumab in the treatment of patients newly diagnosed stage III-IV ovarian cancer.

Highlights in melanoma

At ESMO 2020, most attention in the melanoma field went to studies addressing the benefit of immunotherapy, alone or in combination with other drugs. First of all, updates on the use of immunotherapy in the adjuvant setting were provided for the Keynote-054 and the CheckMate 238 trials. In the advanced melanoma setting, several studies investigating combinations of immunotherapy with targeted agents will be addressed. In addition to this, the ILLUMINATE-204 trial investigates the potential of combining immunotherapy with intratumoral therapy. Similarly, a second study describes the value of local therapy in the treatment of solitary melanoma after progression upon checkpoint inhibitors. Finally, vaccination strategies with an IDO/ PD-L1 peptide vaccine and adjuvant dendritic cell vaccination will be discussed.

Highlights in respiratory oncology

At ESMO 2020, again many interesting studies in the field of respiratory oncology were presented. For non-metastatic non-small cell lung cancer (NSCLC), there was a focus on neoadjuvant immunotherapy, adjuvant treatment with osimertinib and post-operative conformal radiotherapy. When addressing metastatic NSCLC, much attention went to combination strategies such as combining EGFR and VEGF inhibitors, an EGFR-MET antibody plus a tyrosine kinase inhibitor or VEGF and PD-1 inhibitor combinations. In addition, the question was raised on whether immunotherapy can cure metastatic NSCLC. Finally, this overview will describe important results in the field of non-metastatic and metastatic small-cell lung cancer (SCLC).

Highlights in gynaecological cancers

Summary

The highlights in gynaecologic cancers from ASCO 2020 include data on the role of secondary cytoreductive surgery for women with recurrent ovarian cancer as well as several abstracts on the use of PARP-inhibitors in patients with platinum-sensitive relapsed ovarian cancer. In addition, several presentations focused on novel therapeutic strategies for patients with ovarian cancer, including immune-checkpoint inhibitors and the antibody-drug conjugate mirvetuximab soravtansine. Finally, the effectivity of sequential chemoradiation and the combination of the anti-PD1 antibody camrelizumab with the VEGF-targeting agent apatinib in patients with cervical cancer will be discussed.

(BELG J MED ONCOL 2020;14(5):227-32)

Highlights in geriatric oncology

Summary

Cancer is primarily a disease of older adults, and as a result improving the care for older patients with cancer is becoming increasingly important. In this respect, the 2020 virtual ASCO meeting featured a fascinating and very important session entitled “You’re only old once: improving outcomes for older adults with cancer.” In this session, positive results were presented of four randomised controlled trials evaluating whether or not geriatric assessment has the potential to improve treatment outcomes in older patients with cancer. Three of these trials focused on the geriatric management of patients receiving chemotherapy or other cytotoxic agents, while a fourth study evaluated to what extent perioperative oncogeriatric management could improve the outcome of patients undergoing surgery for gastrointestinal cancer. Overall, all these studies indicate that an integrated geriatric oncology assessment provides an important clinical benefit to older cancer patients.

(BELG J MED ONCOL 2020;14(5):218-21)

Highlights in melanoma

Summary

Over the last decade, the treatment of advanced melanoma underwent a dramatic improvement. Initially, immune checkpoint inhibitors and targeted agents proved their worth in the treatment of advanced, unresectable melanoma patients. More recently, however, interest grew in combining both these therapeutic approaches in patients with BRAF mutant advanced melanoma. During ASCO 2020, results were presented of two clinical trials evaluating this strategy. Following the initial successes in the unresectable melanoma setting, immune checkpoint inhibition and targeted therapy were also evaluated as adjuvant therapy in patients with resected stage III melanoma. At ASCO 2020, updated results were presented of two pivotal trials in this setting, while other studies looked into the potential benefit of using immune checkpoint inhibitors as neoadjuvant therapies, rather than in the postoperative setting. In addition to this, immunotherapy also proved to have potential in the treatment of patients with mucosal melanoma, or leptomeningeal disease.

(BELG J MED ONCOL 2020;14(5):209-15)