Noted This Week

This week: Special content from the 2021 ASCO meeting and other news

June 4–10

At the American Society of Clinical Oncology (ASCO) 2021 Annual Meeting, researchers presented results indicating that the second-generation BTK inhibitor acalabrutinib (Calquence; AstraZeneca) has similar efficacy as ibrutinib (Imbruvica; Janssen) but is better tolerated in patients with previously treated chronic lymphocytic leukemia. In the phase III ELEVATE-RR trial, patients in both groups had a median progression-free survival (PFS) of 38.4 months. However, those treated with acalabrutinib were less likely to experience cardiac side effects, as well as grade 3 or higher adverse events (AE)—and were less likely to discontinue treatment or die due to AEs.

A pair of clinical trials suggest that Loxo Oncology’s TRK inhibitor larotrectinib (Vitrakvi) may be active in pediatric and adult patients with central nervous system (CNS) tumors and TRK fusions. In combined results from the NAVIGATE and SCOUT trials, the drug elicited responses in 10 of 33 patients, leading to a median PFS of 18.3 months; median overall survival (OS) was not reached. "These results support testing for NTRK gene fusions for all patients with CNS tumors, especially if there is no known driver," concluded Sébastien Perreault, MD, of CHU Sainte Justine in Montreal, Canada, who presented the results at the ASCO meeting.

At the ASCO meeting, researchers reported that Immunogen’s mirvetuximab soravtansine (IMGN853) plus bevacizumab (Avastin; Genentech) may benefit patients with recurrent ovarian cancer and high folate receptor alpha (FRα) expression. In a phase I/II trial, the combination elicited responses in 21 of 33 patients with FRα-high disease, and responses lasted for a median of 11.8 months; patients had a median PFS of 10.6 months. Mirvetuximab soravtansine is an antibody–drug conjugate that targets FRα in tumor cells and delivers tubulin-targeting maytansinoid DM4.

The PD-1 inhibitor toripalimab (Junshi Biosciences) plus chemotherapy may be an effective first-line treatment in patients with locally advanced, recurrent, or metastatic nasopharyngeal carcinoma. In the phase II JUPITER-02 trial, patients treated with the combination had a median PFS of 11.7 months and a 1-year PFS of 49%, compared with 8 months and 28%, respectively, in those who received chemotherapy alone. Findings were presented at the ASCO meeting.

"Over the last 20 years, we hit a glass ceiling in the first-line systemic treatment of advanced esophageal cancers, and apart from those cancers that were amplified for HER2, there was relatively little progress," said David Cunningham, MD, of the Royal Marsden NHS Foundation Trust in the UK, during the ASCO meeting. However, based on the results of the ESCORT-1st and CheckMate 648 studies, he said that a combination of immunotherapy and chemotherapy or dual immunotherapies should be deemed standard-of-care first-line treatment for esophageal squamous cell carcinoma.

Adding 177Lu-PSMA-617 to standard-of-care therapy may improve survival in patients with prostate-specific membrane antigen (PSMA)–positive metastatic castration-resistant prostate cancer who have received other therapies. In the phase III VISION trial, patients treated with the agent plus standard-of-care therapy had a median radiographic PFS of 8.7 months and a median OS of 15.3 months, compared with 3.4 months and 11.3 months, respectively, in those who received standard-of-care therapy alone. 177Lu-PSMA-617 is a radionuclide that targets PSMA-expressing cancer cells with beta radiation. Results were presented at the ASCO meeting.

A 70-gene signature may identify patients with inoperable invasive breast cancer who are unlikely to relapse. In the phase III MINDACT trial, 1,000 women classified by the MammaPrint signature as having an ultralow risk of recurrence had an 8-year distant metastasis-free interval of 97% and an 8-year breast cancer–specific survival of 99.6%. "These patients could be candidates for further de-escalation of treatments, thus further reducing overtreatment and the risk of side effects," concluded Josephine Lopes Cardozo, MD, of the Netherlands Cancer Institute in Amsterdam, who presented the results at the ASCO meeting.

Also at the ASCO meeting, researchers reported early signs of activity for CYT-0851 (Cyteir) in patients with relapsed/refractory hematologic malignancies and advanced solid cancers. In a phase I trial, three of 21 evaluable patients responded to the drug—including patients with diffuse large B-cell lymphoma, follicular lymphoma, and soft-tissue sarcoma—and 10 more patients experienced stable disease. CYT-0851 is a small-molecule inhibitor of RAD51-mediated homologous recombination.

Cardinal Health Nuclear & Precision Health Solutions announced that the radioactive diagnostic agent Lymphoseek has been approved by the FDA for use in children. In addition to adult use, the new indication will provide an efficient, accurate, and safe way to enhance lymphatic mapping and guide sentinel lymph node biopsies in children with melanoma, rhabdomyosarcoma, or other solid tumors.


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