ESMO 2018: Meeting Highlights

Immuno-oncology Advances Continue to Hold Hope for Hard to Treat Cancers

With immunotherapy showing striking success in a small proportion of cancer patients, more than 1000 trials are looking at new indications or using it in combination. Merck reported results on several of its Keynote series of trials at ESMO, with positive signs for pembrolizumab on its own in kidney cancer (abstract #871P), and alongside chemotherapy in head and neck cancer (abstract #LBA8_PR).

In triple negative breast cancer, Roche presented data on its phase 3 study of atezolizumab and Abraxane (IMPassion130; abstract #LBA1_PR). This showed those on the combination lived longer than patients on Abraxane alone (interim Overall Survival data). It’s the first data showing survival benefit in breast cancer with immunotherapy.

There were promising results from two trials of PARP inhibitors. In AstraZeneca’s SOLO-1 trial, 60% of women with ovarian cancer taking olaparib were tumor free more than three years later. Just 27% of the patients on placebo were tumor free after three years (abstract #LBA7_PR, press release).

Clovis shared encouraging preliminary data from the TRITON2 study (abstract #793PD). Eleven of 23 evaluable patients with BRCA mutations had a confirmed PSA response to the PARP inhibitor, rucaparib (47.8%). Five of 11 patients had a confirmed response according to RECIST 1.1 criteria (45.5%).

Tissue-Agnostic Cancer Drugs Show Promise

ESMO provided the forum for updates on a new class of tissue-agnostic cancer drugs. Loxo Oncology presented data from their trial of larotrectinib (abstract #409O), which targets tropomyosin kinase (TRK) fusions seen in solid tumors. At one year, 69% of the responses seen in patients were ongoing, 58% of patients remained progression-free and 90% of patients were alive.

Roche is targeting another common gene fusion ROS-1 with the drug entrectinib.  Following promising results in lung cancers, they presented data showing benefit in patients with solid tumors featuring NTRK fusions (abstract #LBA17). 57.4% of 54 patients had a positive response to treatment after 15.5 months, with median survival of 20.9 months.

Imaging Enhances Clinical Trials

Imaging-based outcomes and endpoints were a core component of several clinical studies presented throughout the congress.

Several studies evaluated PET imaging to predict prognosis and treatment response in different cancers. Applications ranged from predicting inadequate debulking surgery in ovarian cancer (abstract #996P) to determining levels of carcinoembryonic antigen in esophageal cancer (abstract #426P).

Many studies were adding MRI alongside or instead of CT scans to improve screening, staging, risk stratification and measuring treatment response.

In one study, texture features determined by diffusion-weighted MRI were able to stratify esophageal cancer into three risk groups to predict outcome after chemo-radiotherapy (abstract #638P). In another, adding MRI to CT to look for lung metastases in the brain picked up brain metastases in an additional 4.5% of patients, according to one study (abstract #1365PD).

Complete responses seen on an MRI was also found to predict a positive pathological response to chemotherapy in triple-negative breast cancer (abstract #230P). MRI was also better than CT in identifying disease progression in women with bone metastases (abstract #321P).

There were also several examples of integrating different data with imaging. One study combined genomics features with MRI radiomics in oral cancer (abstract #1053PD), while another analyzed 53BP1 levels, immune score and texture analysis of MRI images to predict response to chemotherapy in bowel cancer (abstract #499P).

The number of presentations and posters of clinical research featuring imaging modalities cements its role as a tool that can enhance trial outcomes. We look forward to seeing how these many advances presented at ESMO 2018 translate into clinical benefits in the coming months and years.