Catch up on highlights from the 2022 ASCO Congress

Day Two Highlights: Later line breast and precision colon cancer treatments

By Dawn O'Shea

Heavily pre-treated HR+/HER2- advanced breast cancer

Amidst the packed programme on Day 2, Prof Hope Rugo from the University of California, San Francisco, presented the eagerly awaited results of the phase 3 TROPiCS-02 study of sacituzumab govitecan (SG) in patients with heavily pre-treated, endocrine-resistant hormone receptor-positive/HER2-negative advanced breast cancer⁴.

Sacituzumab improved PFS by 5.5 months compared to 4 months with standard chemotherapy. More significantly, three times as many patients were alive and without disease progression at 12 months compared to chemotherapy⁴.

Dr Jane Lowe Meisel, Associate Professor of Haematology and Medical Oncology at Emory University in Atlanta, commented on the findings: “We’ve all been eagerly awaiting the results of this trial.”

“As clinicians, we have seen how dramatic SG works in triple-negative breast cancer patients and, as Dr Rugo points out, these oestrogen-positive, endocrine-resistant patients are an area of great unmet need.”

Dr Jane Lowe Meisel added that even though the PFS difference was slight, it is essential to look at the landmark analyses; “A one in five chance of not having progression at one year is pretty huge.” 

Precision treatment of stage II colon cancer

Meanwhile, Dr Jeanne Tie from the Peter McKellen Cancer Centre and the Walter and Eliza Hall Institute in Melbourne, Australia, presented the findings of the DYNAMIC trial. The trial found that blood levels of circulating tumour DNA (ctDNA) can help guide post-surgery treatment in patients with stage II colon cancer⁵. 

The study randomised 455 patients to ctDNA-guided treatment, physician-chosen treatment (PCT), or standard care. All participants underwent ctDNA testing at four and seven weeks. ctDNA-positive patients received chemotherapy, while CT-negative patients received PCT. Controls received standard care⁵.

At three years, ctDNA had almost halved the number of people who received chemotherapy post-surgery, from 28% to 15%. Additionally, three-year cancer-free survival and OS were comparable in ctDNA-positive (86.4%) and ctDNA-negative patients (92.5%) without chemotherapy⁵.

“For oncologists, how best to manage patients with stage II colon cancer after surgery remains a clinical dilemma,” Dr Tie said. “ctDNA assessment after surgery allows a more precise prediction of relapse and patient selection for post-surgical therapy.”

Other topics covered on Day 2 included the treatment of high-risk myelodysplastic syndromes, the possible use of KRAS targeted treatment for upper gastrointestinal malignancies, and clinical controversies in the treatment of testicular cancer.

References

1. Spira AI, Riely GJ, Gadgeel SM, Heist RS, Ou S-HI, Pacheco JM, et al. KRYSTAL-1: Activity and safety of adagrasib (MRTX849) in patients with advanced/metastatic non–small cell lung cancer (NSCLC) harboring a KRASG12C mutation. Presented at the ASCO Annual Meeting 2022, 3 June. Chicago, IL, USA. 9002. Available at: https://meetings.asco.org/abstracts-presentations/208088. Accessed 7 June 2022.
2. Akinboro O. Outcomes of anti–PD-(L)1 therapy with or without chemotherapy (chemo) for first-line (1L) treatment of advanced non–small cell lung cancer (NSCLC) with PD-L1 score ≥ 50%: FDA pooled analysis. Presented at the ASCO Annual Meeting 2022, 3 June. Chicago, IL, USA. 9000. Available at: https://meetings.asco.org/abstracts-presentations/208075. Accessed 7 June 2022.
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4. Rugo HS, Bardia A, Marmé F, Cortes J, Schmid P, Loirat D, et al. Primary results from TROPiCS-02: A randomized phase 3 study of sacituzumab govitecan (SG) versus treatment of physician’s choice (TPC) in patients (Pts) with hormone receptor–positive/HER2-negative (HR+/HER2-) advanced breast cancer. Presented at the ASCO Annual Meeting 2022, 4 June. Chicago, IL USA. LBA1001. Available at: https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.17_suppl.LBA1001. Accessed 10 June 2022.
5. Tie J, Cohen J, Lahouel K, Lo SN, Wang Y, Wong R, et al. Adjuvant chemotherapy guided by circulating tumor DNA analysis in stage II colon cancer: The randomized DYNAMIC trial. Presented at the ASCO Annual Meeting 2022, 4 June. LBA100. Available at: https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.17_suppl.LBA100. Accessed 10 June 2022.
6. Modi S, Jacot W, Yamashita T, Sohn J, Vidal M, Tokunaga E, et al. Trastuzumab deruxtecan (T-DXd) versus treatment of physician’s choice (TPC) in patients (pts) with HER2-low unresectable and/or metastatic breast cancer (mBC): Results of DESTINY-Breast04, a randomized, phase 3 study. Presented at the ASCO Annual Meeting 2022, 5 June. LBA3. Available at: https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.17_suppl.LBA3. Accessed 10 June 2022.
7. Yoshino T, Watanabe J, Shitara K, Yasui H, Ohori H, Shiozawa M, et al. Panitumumab (PAN) plus mFOLFOX6 versus bevacizumab (BEV) plus mFOLFOX6 as first-line treatment in patients with RAS wild-type (WT) metastatic colorectal cancer (mCRC): Results from the phase 3 PARADIGM trial. Presented at the Journal of Clinical Oncology 2022, 5 June. LBA1. Available at: https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.17_suppl.LBA1. Accessed 10 June 2022.
8. McCabe M, Kirton L, Khan M, Fenwick N, Strauss SJ, Valverde C, et al. Phase III assessment of topotecan and cyclophosphamide and high-dose ifosfamide in rEECur: An international randomized controlled trial of chemotherapy for the treatment of recurrent and primary refractory Ewing sarcoma (RR-ES). Presented at the ASCO Annual Meeting 2022, 5 June. LBA2. Available at: https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.17_suppl.LBA2. Accessed 10 June 2022.