The Annual Meeting of the American Society of Clinical Oncology (ASCO), now in its 56th year, took place under a new virtual format on 29–31 May 2020. Opening the meeting, ASCO President Howard A. “Skip” Burris III highlighted that although COVID-19 had changed the format of this year’s ASCO 2020, the collective determination to make progress against cancer was as strong as ever.
ASCO President Howard A. “Skip” Burris III
Dr Burris explained that the COVID-19 pandemic has changed the way patients with cancer receive care and has encouraged healthcare professionals in the oncology community and their patients to weigh the risks and benefits of delaying treatment.
Dr Burris highlighted that data on how COVID-19 was impacting patients was being collected through the new ASCO Registry and CancerLinQ database, which this year crossed a milestone of 2.5 million patients.
As ever, this year’s ASCO meeting aimed to enable clinicians to understand how and when to integrate novel research into patient care. Dr Burris noted that the galvanising theme of the ASCO20 Virtual Scientific Program – “Unite and Conquer: Accelerating Progress Together” – would take on even more resonance given the extraordinary times as ASCO’s global audience learnt about new developments in cancer care.
The world is grappling with a pandemic and we are all readjusting to a new reality, but it cannot stop us. We, the ASCO Community, are absolutely unwilling to let anything stop us in the fight against cancer.”
Howard A. “Skip” Burris III, ASCO President
Metastatic Colorectal Cancer
PFS duration in patients with mCRC treated with pembrolizumab versus standard therapy
High-level microsatellite instability (MSI-H) metastatic colorectal cancer (mCRC) typically demonstrates a poor response to conventional chemotherapy. Defects in DNA mismatch repair resulting in MSI generate a high tumour mutation burden (TMB), a wealth of tumour neoantigens and increased immune cell infiltration, offering up a novel means of controlling MSI-H mCRC through the use of immune checkpoint inhibitor therapy. Thierry André, Sorbonne University and Saint-Antoine Hospital, Paris, France, presented data from the Phase III KEYNOTE-177 study which demonstrated that among patients with mCRC featuring MSI-H, first-line treatment with single-agent pembrolizumab doubled progression-free survival (PFS) compared with chemotherapy-based therapy and also reduced the incidence of severe toxicities by two-thirds (Abstract LBA4; NCT02563002).
The median PFS reached 16.5 months with pembrolizumab versus 8.2 months with standard therapy. In addition, 48% of patients who received pembrolizumab remained alive and free of progressive disease at 2 years compared with only 19% of patients who received chemotherapy (modified FOLFOX or FOLFIRI) plus or minus bevacizumab or cetuximab. Overall survival (OS) data are still awaited.
“Data from KEYNOTE-177 demonstrate that the majority of those 5% of patients with mCRC selected by MSI-H status benefited greatly from pembrolizumab compared with standard-of-care.”
Thierry André, Sorbonne University and Saint-Antoine Hospital, Paris, France
Michael J. Overman, The University of Texas MD Anderson Cancer Center, Houston, USA, highlighted the practice-changing nature of these data, along with the need to test all patients with mCRC for mismatch repair or microsatellite status. However, Dr Overman noted that pembrolizumab displayed a higher rate of disease progression than chemotherapy which suggested that almost one-third of patients were demonstrating intrinsic resistance to PD-1-based therapy and therefore not benefitting from pembrolizumab. Thus, identifying patients with biomarkers of resistance remains critical to allow these individuals to avoid ineffective treatment.
Median PFS in elderly patients with mCRC
Data on first-line treatment efficacy in elderly patients with mCRC are limited, with many analyses adopting a cut-off of 65 years of age, and specific evidence with anti-epidermal growth factor receptors (EGFRs) remains low. While FOLFOX-panitumumab is one option for RAS wild-type (wt) treatment-naïve patients with mCRC, data from the Phase II PANDA study suggest that fluorouracil/leucovorin plus panitumumab for up to 12 cycles followed by panitumumab maintenance until progressive disease might be a reasonable treatment option in elderly patients with mCRC presenting with RAS/BRAF wt tumours according to Sara Lonardi, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy (Abstract 4002; NCT02904031). Phase III studies are now warranted.
“Large prospective randomised studies in molecularly selected elderly mCRC patients are feasible with multicentre collaborative efforts.”
Sara Lonardi, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
In response to the COVID-19 pandemic, ASCO completely reimagined and reinvented its 2020 Annual Meeting by delivering a successful virtual meeting. This virtual platform still had the aim of achieving an engaging and educational meeting experience for participants from around the world. Delegates were able to view data, clinical experiences, patient perspectives and best practices that will hopefully stimulate new ways of thinking and ultimately translate into optimal patient care within the oncology field.
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