ESMO 2019 – Meeting Preview
We will be reporting directly from the annual congress of the European Society for Medical Oncology (ESMO) in Barcelona, Spain, from September 27 to October 1.
Long-term experience with immunotherapy and PARP inhibitors will be in the spotlight of Europe’s key oncology meeting in 2019. With the theme “Translating science into better cancer patient care”, ESMO 2019 will inform oncologists world-wide about seminal studies, this year with a focus on cancers of the lung, breast, ovary and genitourinary tract. More than 2,200 abstracts have been accepted for presentation, including 99 late breaking abstracts, 154 proffered papers and 220 posters that will be discussed in Barcelona.
medonline.ch will fill you in on current news from Barcelona starting from September 27, and will discuss with Swiss colleagues which studies presented at ESMO 2019 are practice-changing.
Presidential Symposia
A definite highlight will be the three Presidential Symposia, where key study endpoints will be presented. Again, the program has a focus on immunotherapy, with long-term data for lung cancer being expected, as well as early data for newer therapeutic areas such as breast cancer, esophageal squamous cell carcinoma and urothelial carcinoma. Furthermore, the three PARP inhibitors niraparib, olaparib, and veliparib will be spotlighted for ovarian cancer, breast cancer and prostate cancer, as well as CDK4/6 inhibitors for breast cancer. At ASCO 2019, an OS benefit for patients treated with a CDK4/6 inhibitor, palbociclib, has been reported for the first time, now, ESMO will show whether talso abemaciclib and ribociclib treatment result in longer OS.
Gynecological cancers (Presidential Symposium I, Saturday, September 28, 4:30–6:20 p.m.)
- The phase III trial PRIMA investigates first-line treatment with niraparib in patients with platinum-sensitive ovarian cancer. A press release in July1 already reported a significant progression free survival (PFS) improvement that was independent of biomarker status (e.g. BRCA or homologous recombination deficiency HRD; González Martín A et al. #LBA1).
- The phase III trial PAOLA-1/ENGOT-ov25 tested olaparib treatment during standard first-line maintenance therapy in patients with advanced ovarian cancer pretreated with platinum-based chemotherapy and bevacizumab. According to a press release in August, the trial met its primary endpoint of PFS improvement2 (Ray-Coquard I et al. #LBA2_PR).
- The phase III trial VELIA investigates veliparib during first-line chemotherapy and maintenance therapy in patients with high-grade serous, epithelial ovarian, fallopian tube, or primary peritoneal cancer. The trial was headlined positive for PFS independent of biomarker status in July (Coleman R et al. #LBA3).
Lung cancer (Presidential Symposium I, Saturday, September 28, 4:30–6:20 p.m.)
- The final analysis of Part 1 of the phase III trial Checkmate 227 will reveal results for combined immune checkpoint inhibition with nivolumab and (low dose) ipilimumab versus platinum-doublet chemotherapy as first-line treatment in patients with advanced NSCLC. A press release in July already reported that combination immunotherapy led to an OS benefit in patients whose tumors express PD-L1 ≥1%3 (Peters S et al. #LBA4_PR).
- The final analysis of the phase III trial FLAURA will report OS of patients with EGFR-mutated NSCLC treated first-line either with osimertinib or an EGFR TKI. According to a press release in August, patients had an OS benefit with osimertinib, and PFS was improved in patients with brain metastases4 (Ramalingam S et al. #LBA5_PR).
Breast cancer (Presidential Symposium II, Sunday, September 29, 4:30–6:00 p.m.)
- The phase III trial MONARCH 2 investigated abemaciclib plus fulvestrant versus placebo/fulvestrant in pre-, peri-, or postmenopausal patients with advanced or metastatic HR-positive, HER2-negative breast cancer previously treated with endocrine therapy. Now, OS data will be presented that were reported to be positive according to a press release in July5 (Sledge G et al. #LBA6_PR).
- The phase III trial MONALEESA-3 tested ribociclib plus fulvestrant versus placebo/fulvestrant in postmenopausal patients with advanced or metastatic HR-positive, HER2-negative breast cancer either as first-line therapy or following up to one line of prior endocrine therapy in the advanced setting. At ASCO 2019, results from MONALEESA-7 had demonstrated OS improvement through ribociclib in peri- or premenopausal patients; a press release in July reported improved OS also in postmenopausal women6 (Slamon D et al. #LBA7_PR).
- The phase III trial KEYNOTE-522 investigated pembrolizumab in combination with chemotherapy during neoadjuvant and during adjuvant maintenance therapy in patients with early triple-negative breast cancer. At ESMO 2019, data will be presented for the primary study endpoint of pathological complete remission that was met according to a press release7 (Schmid P et al. #LBA8_PR).
- The phase III trial Brocade-3 tested the PARP inhibitor veliparib in combination with chemotherapy with carboplatin or paclitaxel compared to placebo in patients with HER2-negative, metastatic or locally advanced unresectable BRCA-associated breast cancer (Dieras V et al. #LBA9).
Gastrointestinal cancers (Presidential Symposium III, Monday, September 30, 4:30–6:15 p.m.)
- The phase III trial ClarIDHy investigated the IDH1 inhibitor ivosidenib compared to placebo in previously treated patients with advanced, unresectable cholangiocarcinoma with an IDH1 mutation. In May the company reported the study had met its primary endpoint of a PFS improvement 8 (Abou-Alfa G et al. #LBA10_PR).
- The phase III trial ATTRACTION-3 compared nivolumab with docetaxel or paclitaxel in patients with advanced esophageal squamous cell carcinoma who had been refractory to or intolerant of one prior therapy with fluoropyrimidine or a platinum-based drug. A press release from January indicated that the compound achieved an extended OS versus chemotherapy9 (Cho BC et al. #LBA11).
Genitourinary cancers (Presidential Symposium III, Monday, September 30, 4:30–6:15 p.m.)
- The phase III trial PROfound investigated the PARP inhibitor olaparib versus standard of care treatment with enzalutamide or abiraterone in patients with metastatic castration resistant prostate cancer (mCRPC) with homologous recombination repair gene mutations (HRRm) who had progressed on prior new endocrine anticancer treatments. According to a press release in August, the trial met its primary endpoint of a radiographic PFS improvement10 (Hussain M et al. #LBA12_PR).
- The phase IV trial CARD compares treatment with cabazitaxel and an alternative androgen receptor (AR)-targeted agent in men with mCRPC progressing after docetaxel and an AR-targeted agent (DeWit R et al. #LBA13).
- The phase III, three-arm trial IMvigor130 investigated atezolizumab alone or combined with platinum-based chemotherapy versus platinum-based chemotherapy plus placebo in previously untreated patients with locally advanced or metastatic urothelial carcinoma. A press release in August indicated a PFS improvement in patients treated with the atezolizumab/chemotherapy combination11 (Grande E et al. #LBA14_PR).
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What do Swiss opinion leaders say?
We are going to discuss if and how the studies presented at ESMO 2019 will change clinical practice. We look forward to daily summaries and discussions with
- Richard Cathomas, MD, Kantonsspital Graubünden
- Prof. Olivier Michielin, MD, PhD, Centre hospitalier universitaire vaudois Lausanne
- Prof. Reinhard Dummer, MD, Universitätsspital Zürich
- Prof. Solange Peters, MD, PhD, Centre hospitalier universitaire vaudois Lausanne
Special tracks at ESMO 2018
ESMO Young Oncologists Track: Young clinicians from the ESMO Young Oncologists inform newcomers such as medical students and young doctors about the daily clinical practice and career planning. In the YO Mentorship sessions, opinion leaders share their experience and vision in an informal setting, encouraging open conversation with mentors and peers (pre-registration required). The YO Clinical Case Discussions session features a round tables discussion on clinical cases of colorectal cancer, toxicity of immunotherapy and melanoma (pre-registration required). Furthermore, a “Boxing Session” offers debates on medical controversies in order to train discussion skills of young oncologists. These sessions are also an excellent opportunity to get in touch with colleagues.12
ESMO Public Policy Track und Special Sessions: Political initiatives and public policy have an impact on medical oncologists in their daily practice, as well as on the treatment and care of cancer patients. In the Public Policy Track, a wide range of topics from hospital organization to artificial intelligence to universal health coverage are covered in short talks and subsequently discussed.13
ESMO Patient Advocacy Track: This track has been part of the ESMO congress program since 2016. It is dedicated to the education of patient advocates in recent developments in oncology, providing them with updated information required for current decision making processes in the health system, and supporting them to be competent partners for patients in oncology-related decisions.14
EONS12: The annual congress of the European Oncology Nursing Society is now integrated into the ESMO conference. Three days from September 28 to 30 are dedicated to topics such as symptom management, patient safety and improvement of the cooperation between doctors and nurses in order to achieve improved integrated patient care.15
About the European Society for Medical Oncology
ESMO is the world’s leading medical oncology organization. With 18,000 members consisting of oncology specialists from 150 countries world-wide, ESMO is the reference organization for education and information in oncology. ESMO is dedicated to the optimal care of patients with cancer, by fostering integrated cancer care, promoting oncologists in their professional environment, and advocating for sustainable cancer care world-wide.
References
1 GSK announces positive headline results in Phase 3 PRIMA study of ZEJULA (niraparib) for patients with ovarian cancer in the first line maintenance setting [press release]. London, UK: GlaxoSmithKline plc; July 15, 2019. https://bit.ly/2YTFO6h. Accessed September 12, 2019.
2 LYNPARZA® (olaparib) Phase III Paola-1 Trial Met Primary Endpoint as 1st-line Maintenance Treatment With Bevacizumab for Advanced Ovarian Cancer [press release]. Wilmington, DE: AstraZeneca Company; August 14, 2019. https://bit.ly/2lVqjw8. Accessed September 12, 2019.
3 Bristol-Myers Squibb Announces CheckMate -227 Part 1a Meets Co-Primary Endpoint of Overall Survival [press release]. Princeton, NJ: Bristol-Myers Squibb Company; July 24, 2019. https://bit.ly/2M5VxeW. Accessed September 12, 2019.
4 Tagrisso significantly improves overall survival in the Phase III FLAURA trial for 1st-line EGFR-mutated non-small cell lung cancer [press release]. AstraZeneca Company; August 9, 2019. https://bit.ly/2kBwcON. Accessed September 12, 2019.
5 Lilly’s Verzenio® (abemaciclib) Significantly Extended Life in Women with HR+, HER2- Advanced Breast Cancer in MONARCH 2 [news release]. Indianapolis, IN: Eli Lilly and Company; July 30, 2019. https://bit.ly/2Zkj9jJ. Accessed September 12, 2019.
6 Novartis Kisqali significantly prolongs life in women with HR+/HER2- advanced breast cancer now in two distinct phase III trials [press release]. Basel: Novartis; July 31, 2019. https://bit.ly/2GEKYvQ. Accessed September 12, 2019.
7 Merck’s KEYTRUDA® (pembrolizumab) in Combination with Chemotherapy Met Primary Endpoint of Pathological Complete Response (pCR) in Pivotal Phase 3 KEYNOTE-522 Trial in Patients with Triple-Negative Breast Cancer (TNBC) [press release]. Kenilworth, NJ: Merck; July 29, 2019. https://bit.ly/330fv0I. Accessed September 12, 2019.
8 Agios Announces the Randomized Phase 3 ClarIDHy Trial of TIBSOVO® (ivosidenib) Achieved its Primary Endpoint in Previously Treated IDH1 Mutant Cholangiocarcinoma Patients [press release]. Cambridge, MA: Agios Pharmaceuticals, Inc.; May 15, 2019. https://bit.ly/2YA7PyX. Accessed September 16, 2019
9 Opdivo (Nivolumab®) Demonstrates a Significant Extension in Overall Survival Versus Chemotherapy in Patients with Unresectable Advanced or Recurrent Esophageal Cancer in Phase III Clinical Study [press release]. Osaka, Japan: ONO Pharmaceutical Co., Ltd.; January 9, 2019. https://bit.ly/2D2P3bX. Accessed September 16, 2019
10 Lynparza Phase III PROfound trial in HRR* mutation-selected metastatic castration-resistant prostate cancer met primary endpoint [press release]. Kenilworth, NJ: AstraZeneca and MSD Inc.; August 7, 2019. https://bit.ly/2Ysn95a. Accessed September 16, 2019
11 Roche’s Tecentriq plus platinum-based chemotherapy reduced the risk of disease worsening or death in people with previously untreated advanced bladder cancer [press release]. Basel, SUI: AstraZeneca Company; August 5, 2019. https://bit.ly/2M2xnTs. Accessed September 16, 2019
12 https://www.esmo.org/Conferences/ESMO-Congress-2019/Programme/Young-Oncologists-Track
13 https://www.esmo.org/Policy/ESMO-Public-Policy-Track-and-Special-Sessions