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A good sign that we are recovering pre-pandemic normality is that this year, after two virtual appointments, the American Congress of Oncology has returned to face-to-face. ASCO 22, as it is known (for the acronym of the American Society of Clinical Oncology), has not disappointed bringing together the best of cancer medicine and research presenting the latest advances In the area.
And, as has become customary in recent years, the Spanish presence has been noticeable, with more than remarkable participation in some of the most relevant works of this edition. The first of these –which was presented at the plenary session– is the Destiny study against metastatic breast cancer, revolutionary not only because of the spectacular results obtained with a new combination of drugs (trastuzumab deruxtecan), but also because, thanks to it, the classification of tumors established until now changes radically.
And it is that, today, breast tumors that were not HER2 positive were considered negative. However, and as has been shown in the study, even in low expression, this type of cancer also responds to drugs directed at this mutation. As a consequence, the number of patients who can benefit from these treatments rises by 30%. There is nothing.
This is explained by Aleix Prat, president of the Solti research group, head of the Medical Oncology Service at Hospital Clínic, Barcelona, and co-author of the study, published simultaneously in the “New England Journal of Medicine”: “HER2 is a protein. When it is highly expressed in the tumor we call that cancer HER2-positive and if the protein has low expression, HER2-negative. Now, we have found that there are tumors that are HER2-negative but have some HER2 expression. It is not zero. They are called HER2-low tumors. The study shows that a drug that attacks this protein works not only on positive tumors, which represent 20% of all breast cancers, but also on HER2-low tumors, which account for 50%».
6 more months to live
And not only that. In addition, the results obtained in the phase 3 trial are very good and indicate that this new combination achieves superior and clinically significant progression-free survival and overall survival in patients with unresectable HER2-low breast cancer and / or metastatic. The conjugated antibody, developed by Daiichi Sankyo Laboratories and AstraZeneca, improved median survival by more than six months in all patients evaluated.
“The study shows that the trastuzumab deruxtecan is much more effective than conventional chemotherapy in patients with breast cancer with low levels of HER2 who have already received prior treatment. The new drug increases not only the control of the disease but also the possibility of living”, says Prat.
Given these data, the expectations that are opened are many. And not only for the patients in the study, who had already received a median of three treatments and these no longer worked (that is, they are a group of patients with a very poor prognosis and where only conventional chemotherapy was available to treat them, with quite good results). poor), but also for the future, since its use in this case is in metastatic cancer but, given the good results, they plan to apply it in earlier stages, as confirmed by Prat: «The objective now is to see the efficacy of this drug in earlier stages of the disease. We are optimistic, but studies are needed, which are already underway.
Sarcoma de Ewing
Another of the papers presented at the ASCO plenary session was Reecur against Ewing’s sarcoma, a rare tumor that forms in the bone that mainly affects adolescents and young adults. Their current five-year survival rate for primary and recurrent refractory cases is only 15%.
“It defines what is the best treatment against this tumor today,” explains Isabel Echavarría, scientific secretary of the Spanish Society of Medical Oncology (SEOM). And it is that, “prior to this trial, a direct comparison of the most commonly available regimens was not available to help guide treatment options.” Thus, it is the first to provide comparative toxicity and survival data for the four most commonly used chemotherapy regimens in primary and recurrent refractory Ewing’s sarcomas.
The study showed that high-dose ifosfamide prolonged median event-free survival by 5.7 months compared to 3.7 months for topotecan plus cyclophosphamide. Median overall survival was 16.8 months for ifosfamide versus 10.4 months for topotecan plus cyclophosphamide. In addition, a greater survival difference was observed for patients younger than 14 years than for those older than this age.
“Data showing the impact of ifosfamide in improving overall survival for patients with recurrent and primary refractory Ewing’s sarcoma may change clinical practice,” said lead author Martin McCabe, senior clinical professor of pediatric oncology and the teenager at the University of Manchester, UK.
CART in multiple myeloma
On the other hand, the Cartitude-1 study, phase 1b/2, which evaluates the efficacy and safety profile of Carvykti (ciltacabtagén autoleucel; cilta-cel), a CAR-T therapy that includes two single-domain antibodies against the antigen of B cell maturation (BCMA), has demonstrated its effectiveness against multiple myeloma. The study included patients with this relapsed or refractory blood cancer, who had received at least three lines of treatment, including an immunomodulatory agent (IMiD), a proteasome inhibitor (PI), and an anti-CD38 antibody, or who were doubly refractory to an IMiD and a PI and who had received a PI, an IMiD, and an anti-CD38 as part of prior therapy.
“These latest results further reinforce the value of cilta-cel as a welcome new addition to the way we treat and ultimately prolong remission in patients who have received three drug groups, where the need for innovation it is still high –says María Victoria Mateos, associate doctor of Hematology at the Salamanca Hospital–. Being the majority of patients who achieve negativity of minimal residual disease, and with median progression-free survival not reached, These data show that a single infusion can produce profound and long-lasting responses. in a highly pretreated patient population.
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