Tom Feys MBA, MSc

Highlights in thoracic oncology

ESMO 2017 featured the presentation of several practice changing studies in the field of lung cancer. With respect to immunotherapy, durvalumab showed a benefit for patients with Stage III non-small cell lung cancer (NSCLC) when taken after chemotherapy-radiation. This represents the first major study showing an immunotherapy benefit for patients with lung cancer that is not Stage IV.¹ A second key immunotherapy study showed that stage IV NSCLC patients who continued to take nivolumab beyond 1 year had a significantly longer progression-free survival (PFS) than patients who took the drug for 1 year.²

Also in the field of targeted therapy, ESMO 2017 may have induced a paradigm shift. In the phase III FLAURA study, the third-generation EGFR tyrosine kinase inhibitor (TKI) osimertinib, which is already approved for recurrent NSCLC patients harboring an EGFR^T790M mutation, was associated with a superior PFS to the current standard of care EGFR-targeted drugs. This was especially the case for patients with brain metastases.³ More positive data in NSCLC patients with brain involvement came from the ALUR trial and from a secondary analysis of the ALEX study, showing that alectinib can significantly decrease central nervous system (CNS) progression of NSCLC, both in the first-line and in the second-line setting.^4,5

In addition to this, the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib was shown to be an effective first treatment for BRAF^V600E mutated NSCLC.⁶

A final study worth mentioning in this introduction consists of the IFCT-0302 trial which demonstrated that frequent CT scans after surgery for early-stage lung cancer surgery did not improve survival. This should inform follow-up recommendations and should give patients some peace of mind that they don’t necessarily need CT scans every six months.⁷

(BELG J ONCOL 2017;11(7):317–325)

Highlights in breast cancer

This report will discuss a selection of key studies related to breast cancer discussed during the 2017 annual meeting of the American Society of Clinical Oncology. ASCO 2017 featured important new data generated with CDK4/6 inhibitors in patients with advanced breast cancer and included several abstracts considering the potential of PD-L1 inhibition for breast cancer. In addition to this, updates of several large phase III studies, including MARIANNE, ALLTO and APHINITY were presented. For a more complete overview of breast cancer news presented at ASCO 2017, we refer to the ASCO annual meeting website (https://meetings.asco.org/am/register-submit-abstracts).

Highlights in melanoma

The melanoma abstracts discussed in this highlights report will focus on three main themes. First, three abstracts will be discussed addressing adjuvant therapy in patients with high-risk melanoma. Secondly, long-term data were presented of a phase III study assessing pembrolizumab in ipilimumab-naïve advanced melanoma patients, followed by the 5-year overall survival (OS) data of a study with dabrafenib and trametinib in BRAF^V600 mutant metastatic melanoma. The third and last part of this summary will discuss the data of three clinical studies looking into the treatment of melanoma patients with brain metastasis. For a more complete overview of melanoma data presented at ASCO 2017 we would like to refer to the official congress website (www.am.asco.org).

Highlights from the 2017 Society of Gynecologic Oncology (SGO) annual meeting on women’s cancer

SUMMARY

From 12–15^th March, the Society of Gynecological Oncology hosted its 48^th annual meeting. The meeting continues to be one of the key educational and scientific events for physicians treating and caring for women with gynaecologic cancer. This summary will discuss some of the key studies presented during the meeting, with a focus on medical oncology. For a complete overview of abstracts presented in National Harbor we refer to the Society of Gynecological Oncology website: www.sgo.org.

(BELG J MED ONCOL 2017;11(3):134–137)

Highlights in oncology 2016

SUMMARY

Every year brings new knowledge and insights that help to direct research that ultimately leads to improved care for patients with cancer. This report, which is based on the clinical cancer advances 2017 article published by the American Society of Clinical Oncology, reviews the most important advances made in the different fields of oncology that are most likely to impact daily clinical practice.¹ Over the last few years, immunotherapy has become a new treatment option for patients with a growing number of cancer types. Building on the initial successes with immunotherapy, a key next step is to understand why currently fewer than half of patients benefit from immunotherapy and why the benefit, if it occurs, may be short lived. In 2016, several reports revealed early insights into patient and cancer characteristics that might predict whether immunotherapy could work well in an individual patient. Many studies also assess whether combining immunotherapy with other cancer treatments might extend the potential of this new group of therapies.

A second part of this report focuses on targeted therapies. The research into cancer biology is propelling rapid development of novel treatments targeting the key molecules that allow cancers to grow and spread. In 2016, this strategy resulted in new targeted therapies for patients with advanced lung, breast, and kidney cancer, as well as several hard-to-treat forms of blood cancer. In addition to this, new molecular technologies are emerging that can quickly pinpoint molecular changes in the tumour or free-floating cancer DNA in the blood.

(BELG J MED ONCOL 2017; 11(2):37–45)

The role of immunotherapy in non-metastatic non-small cell lung cancer

The progress that has been made in the last decades in the treatment of stage IV non-small cell lung cancer (NSCLC) has overall not been translated to the curative setting of stage I to III disease. In fact, the list of failed clinical trials aimed at improving the cure rates in this setting is long. The successes with immune checkpoint inhibition in stage IV NSCLC formed the basis to also study these agents in the curative NSCLC setting. Several studies are underway evaluating the potential of adjuvant immune checkpoint inhibition in stage II and IIIA disease and promising data have also been generated in the pre-operative setting. In addition to that, immune checkpoint inhibition is also being studied as consolidation treatment following chemoradiotherapy in locally advanced, unresectable NSCLC. The PACIFIC trial forms the first of these studies to yield results and showed that the PD-L1 inhibitor durvalumab significantly prolongs the progression-free survival (PFS) compared to placebo in patients with locally advanced, unresectable stage III NSCLC. More mature (overall survival, OS) results of this study are eagerly awaited as are the results of the other clinical studies evaluating immune checkpoint inhibitors in the curative NSCLC setting.

Highlights in thoracic oncology

Summary

The main focus of attention at ESMO 2016 in the filed of lung cancer was again the use of checkpoint inhibitors. Two studies evaluating a PD1-inhibitor in the first line treatment of metastatic non-small-cell lung cancer (NSCLC) were presented with conflicting results. In addition to this, positive results with the PD-L1 inhibitor atezolizumab were presented together with promising findings with neo-adjuvant nivolumab in the management of early stage NSCLC. ESMO 2016 also featured important data on (new) targeted agents. In this light, the results of the ASCEND-5 study, assessing the efficacy and safety of ceritinib in patients with advanced ALK+ NSCLC who progressed on prior crizotinib and chemotherapy, were presented. Also the final results of the phase III LUX-Lung 7 study, and of the IMPRESS trial will be discussed in this summary. Finally, data were presented with the MEK inhibitor selumetinib in advanced NSCLC.

(BELG J MED ONCOL 2016;10(8):319–24)