ASCO Annual Meeting 2018: Treatment Changes for Pancreatic Cancer and Colorectal Cancer

2018 ASCO Annual Meeting; #ASCO18
June 4, 2018
Monika Sharda, ASCO staff

The theme of the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting is Delivering Discoveries: Expanding the Reach of Precision Medicine. Precision medicine has led to many advances in cancer care, but there is still much to learn in this growing field of research. Even more, as ASCO President Bruce E. Johnson, MD, FASCO, writes in this year’s Clinical Cancer Advances report, the promise of precision medicine “is only as good as our ability to make these treatments available to all patients.” While much of the cancer research at this year’s meeting will focus on precision medicine, there is also an ongoing effort to increase access to these treatments for all patients.

More than 32,000 oncology professionals from around the world will be at the ASCO Annual Meeting presenting and discussing the latest research in cancer treatment and patient care. While research will be released throughout the meeting from June 1 to June 5, some research studies were released today:

  • Chemotherapy combination lengthens lives of people with pancreatic cancer

  • Treatment before surgery may help people with pancreatic cancer live longer

  • Heated abdomen chemotherapy is not helpful for many people with advanced colorectal cancer

Watch a patient education video with Dr. Johnson explaining how the ASCO Annual Meeting changes patients’ lives.

Two studies show changes to pancreatic cancer treatment may work better

Pancreatic cancer is among the most difficult-to-treat cancers, even when the disease is found early enough that it can be surgically removed, called resectable. However, 2 new, separate studies are showing that changes to the current standard approach to resectable pancreatic cancer can help extend patients’ lives.

Chemotherapy combination lengthens lives of people with pancreatic cancer

The first study found that, following surgery, people with non-metastatic pancreatic ductal adenocarcinoma (PDAC) who received a new chemotherapy approach lived longer and were cancer-free longer than those who received the current standard chemotherapy.

Chemotherapy after surgery is called adjuvant chemotherapy. For PDAC, the current standard adjuvant chemotherapy is with the drug gemcitabine (Gemzar). PDAC is the most common type of pancreatic cancer, accounting for 90% of all pancreatic cancers.

The new chemotherapy regimen used in this study is called mFOLFIRINOX. It includes 4 drugs: oxaliplatin (Eloxatin), leucovorin (Wellcovorin), irinotecan (Camptosar), and 5-fluorouracil (5-FU; Adrucil). A similar regimen is already used as an initial treatment for metastatic pancreatic cancer.

Each of the 493 participants in this study, called PRODIGE 24/CCTG PA.6, had surgery to remove all or nearly all of the tumor. Three to 12 weeks after surgery, they then received either mFOLFIRINOX or gemcitabine for 6 months.

The median overall survival was about 54 months with mFOLFIRINOX and 35 months with gemcitabine. The median is the midpoint, which means half of patients lived longer and half lived for a shorter time. The people taking mFOLFIRINOX were also cancer-free about 9 months longer than those taking gemcitabine (almost 22 months with mFOLFIRINOX compared with nearly 13 months with gemcitabine).

Overall, patients receiving mFOLFIRINOX had more severe symptoms, but many were manageable. These include diarrhea, nausea, vomiting, and fatigue. The side effects of gemcitabine include headache, flu-like symptoms, swelling, and low white blood cell counts. Both treatments can cause low levels of white blood cells and fever.

“For the first time, our trial shows a large benefit from adjuvant FOLFIRINOX chemotherapy over standard chemotherapy with gemcitabine, showing we can help patients with pancreatic cancer live much longer. In addition, we were encouraged to see that the results were better than expected when we planned this trial.

— lead study author Thierry Conroy, MD
Institut de Cancerologie de Lorraine
Nancy, France

Treatment before surgery may help people with pancreatic cancer live longershare on twitter

The second clinical trial, called PREOPANC-1, showed that people with pancreatic cancer who received both chemotherapy with gemcitabine (Gemzar) and radiation therapy before surgery lived longer than those who did not.

Chemotherapy and radiation therapy given together may be called chemoradiotherapy. Starting treatment with surgery, followed by chemotherapy, is currently the standard of care for this type of pancreatic cancer. Treatment given before surgery may be called pre-operative or neoadjuvant treatment.

The 246 participants in the study had pancreatic cancer that could be surgically removed. They were randomly assigned to two groups. The first group received surgery first, while the second group received chemotherapy plus radiation therapy for 10 weeks before having surgery. Both groups received chemotherapy after surgery. Overall, the total amount of chemotherapy given was the same for people in both groups. Those who received chemotherapy plus radiation therapy before surgery received part of the chemotherapy before surgery and the rest after.

The researchers found that those who received chemotherapy plus radiation therapy before surgery had a median overall survival that was about 3 months longer than those who did not. The median is the midpoint, which means that half of all patients lived longer and half lived for a shorter time. Out of the people who received treatment before surgery, 42% lived for longer than 2 years compared with 30% for those who did not receive treatment before surgery.

Sometimes, pancreatic cancer can worsen very quickly and the tumor cannot be fully removed during surgery. In this study, the tumor was fully removed in 63% of the people who had chemotherapy and radiation therapy before surgery compared with 31% of those who did not have treatment before surgery.

“This is the first randomized clinical trial to show that pre-operative treatment improves outcomes for people with early stages of pancreatic cancer who can have surgery. We believe that this may be a practice-changing trial.”

lead study author Geertjan Van Tienhoven, MD, PhD
Academic Medical Center
Amsterdam, Netherlands

What does this mean? Since pancreatic cancer is often hard to treat, finding new options that help patients live longer is an important step in improving pancreatic cancer care. These studies suggest treatment changes that may benefit people with surgically removable pancreatic cancer who are healthy enough to receive combination chemotherapy after surgery and/or who may wish to consider receiving chemotherapy plus radiation therapy before surgery.

Heated abdomen chemotherapy is not helpful for many people with advanced colorectal cancer

New research suggests that survival rates are similar for people with peritoneal carcinomatosis who receive heated chemotherapy directly into the abdomen during surgery and those who do not receive the chemotherapy. Peritoneal carcinomatosis is a type of metastatic colorectal cancer in which there are metastatic tumors on the lining of the abdominal cavity, or peritoneum.

The heated chemotherapy, called hyperthermic intra-peritoneal chemotherapy (HIPEC), plus surgery is a treatment  used when all of the tumors can be removed. Previous research has shown that HIPEC plus surgery helps patients live longer when compared with systemic chemotherapy alone and can cure up to 16% of people with this type of disease. Systemic chemotherapy is given through a patient’s bloodstream to reach cancer cells throughout the body.

This clinical trial, called PRODIGE 7, included 265 participants. All participants had stage IV colorectal cancer with peritoneal carcinomatosis and no cancer in other parts of the body. The patients were randomly divided into 2 groups, receiving either surgery plus HIPEC or surgery alone. About 96% of the participants also received systemic chemotherapy before surgery, after surgery, or both. The type of systemic therapy was chosen by each person’s doctor.

The median overall survival was similar for both groups. The median is the midpoint, which means that half of patients lived longer and half lived for a shorter time. Those who received HIPEC lived for a median of almost 42 months compared with about 41 months for those who did not receive HIPEC. The median time until the cancer came back was about 13 months with HIPEC and about 11 months without HIPEC.

After the first 30 days, participants in both groups experienced a similar number of side effects. However, after 60 days, the number of side effects for those who received HIPEC almost doubled (nearly 13% vs. 24%).

What does this mean? This study suggests that many people with peritoneal carcinomatosis may be able to avoid this potentially unnecessary treatment.share on twitter

“When this approach was introduced more than 15 years ago, it was the first effective treatment for metastatic tumors on a patient’s abdomen, but we didn’t know whether delivering heated chemotherapy during surgery was an important component of the treatment or not. This is the first randomized study assessing the role of this special type of chemotherapy in advanced colorectal cancer, and it shows that it does not provide added benefit over surgery.

lead study author Francois Quenet, MD
Regional Cancer Institute
Montpellier, France

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