New Treatment Combinations Slow Progression of Prostate Cancer and Stomach and Gastroesophageal Junction Cancers: The ASCO Plenary Series

ASCO ® Plenary Series
February 5, 2024
ASCO Staff

The pace of progress in cancer research keeps getting faster and faster. However, the results of this research can take time to reach the medical community. The ASCO Plenary Series is a program developed by the American Society of Clinical Oncology (ASCO) to help speed the delivery of high-impact cancer research. In this series, cancer care providers gather online to learn about new, carefully selected research and discuss the study results with their colleagues.  

The February 2024 session in the ASCO Plenary Series features these studies:   

New treatment combination slows disease progression in patients with advanced multiple myeloma  

Who does this study affect: People with multiple myeloma that has not been stopped by treatment (called refractory) or has come back after treatment (called relapsed or recurrent).

What did this study find: Results from the phase 3 DREAMM-7 clinical trial have shown that a treatment combination using belantamab mafodotin (Blenrep) plus bortezomib (Velcade) and dexamethasone (multiple brand names) stops myeloma for nearly 2 additional years when compared to a current standard-of-care treatment.  

Multiple myeloma is a blood cancer of cells in the bone marrow, specifically the immune cells called plasma cells. If myeloma is not stopped by initial treatment, one of the current second-line treatment options is called DVd. DVd is a treatment regimen that uses daratumumab (Darzalex), bortezomib, and dexamethasone. Daratumumab is a  that binds to myeloma cells so they can be removed by the person’s own immune system. In the DREAMM-7 study, the researchers wanted to know if a combination of belantamab mafodotin, bortezomib, and dexamethasone (BVd) would be more effective at treating relapsed or refractory multiple myeloma than DVd. Belantamab mafodotin is medication called an antibody-drug conjugate. It uses an antibody to bind to a protein on myeloma cells called BCMA and then delivers chemotherapy directly to the myeloma cell.

This study included 494 people who received at least 1 previous treatment for multiple myeloma. Most of the patients were White (83%), and the remaining patients were Black (4%) or another race or ethnicity (13%). The median age of the participants was about 65 years, with half of them ranging in age from 18 to 65 years. The participants were divided into 2 groups. The 243 patients in the first group received BVd. The 251 patients in the second group received DVd.

The researchers followed the participants for a median of about 28 months (more than 2 years). The median is the midpoint, meaning half the participants were followed for less than 28 months and the other half for more than 28 months. The researchers found that those who received BVd had their disease stopped for a median of 36.6 months (more than 3 years), compared to a median of 13.4 months (more than 1 year) for those who received DVd. Participants in the BVd group had a 59% lower risk of the disease progressing than those in the DVd group. The disease responded to treatment in about 83% of patients in the BVd group and about 71% of patients in the DVd group.

Side effects were common in both treatment groups. Among those in the BVd group, the most common treatment-related side effects were thrombocytopenia (low platelet level) and blurry vision. Among those in the DVd group, the most common treatment-related side effect was also thrombocytopenia. Eye problems also occurred in participants in both treatment groups.  

What does this mean for patients? Second-line BVd appears to be more effective than DVd at stopping disease progression in people with multiple myeloma that has not been stopped by the first treatment.

“The DREAMM-7 findings demonstrate that BVd improved outcomes for patients with relapsed or refractory multiple myeloma while also having a manageable safety profile. These results support BVd triplet therapy as a potential new standard of care option for these patients.”

—   lead study author María-Victoria Mateos, PhD
Hospital Universitario de Salamanca
Salamanca, Spain

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Combination of fruquintinib and chemotherapy slows disease progression in people with advanced stomach and gastroesophageal junction cancer

Who does this study affect: People with advanced stomach or gastroesophageal junction adenocarcinoma that has already been treated with chemotherapy.

What did this study find: Results from the phase 3 FRUTIGA clinical trial have shown that a combination of fruquintinib (Fruzaqla) and paclitaxel (available as a generic drug) slows the growth of previously treated stomach and gastroesophageal junction cancer and helps patients live longer. Fruquintinib is a VEGF inhibitor, which is a type of targeted therapy called an angiogenesis inhibitor. These drugs slow the growth of the blood vessels that feed tumors. Paclitaxel is a type of chemotherapy.

Globally, stomach cancer is the fifth most commonly diagnosed cancer and the fourth leading cause of cancer deaths. The gastroesophageal junction is where the stomach and esophagus meet. Cancers that form in the gastroesophageal junction are rare and may be treated with therapies for stomach or esophageal cancer. These types of cancers are more common in Asia.

In this study, researchers wanted to see if second-line treatment with a combination of fruquintinib and paclitaxel had better outcomes than treatment with paclitaxel alone. There were 703 participants in this study, and 699 received at least 1 treatment dose. Participants were randomly assigned to receive either fruquintinib and paclitaxel (350 people) or a placebo and paclitaxel (349 people). All participants had advanced stomach cancer or gastroesophageal junction cancer that had progressed after receiving first-line treatment with chemotherapy. The median age of the participants was 57 for the fruquintinib group and 59 for the placebo plus chemotherapy group. Almost all of the participants were Asian, and about 70% were men and 30% were women.

The study found that the median progression-free survival (PFS) was significantly higher for the fruquintinib group (5.5 months) in comparison to the placebo plus chemotherapy group (2.7 months). PFS is a measure of how long a treatment stops cancer from growing or spreading. The median is the midpoint, meaning half of the people who received fruquintinib had their disease stopped for longer than 5.5 months and half had their disease stopped for less than 5.5 months.

For all participants, the disease responded to treatment in more people who received fruquintinib (42.5%) than in those who received placebo plus chemotherapy (22.4%). Those who received fruquintinib also lived longer (9.6 months) than those who received placebo plus chemotherapy (8.4 months).

The most common treatment-related side effects were neutropenia (60.0% for the fruquintinib group and 36.4% in the placebo plus chemotherapy group), leukopenia (42.9% and 23.5%), and anemia (11.7% and 10.6%). 

What does this mean for patients? For some people with advanced stomach or gastroesophageal cancer, first-line chemotherapy will not be effective. For these individuals, a combination of fruquintinib and paclitaxel delays cancer growth and helps them live longer when compared to second-line chemotherapy alone.

“The positive results of FRUTIGA further enrich the evidence for the effectiveness of the VEGFR signaling pathway acting on advanced gastric and gastroesophageal junction adenocarcinoma, which had been previously supported by the efficacy of ramucirumab. Fruquintinib plus paclitaxel could be a promising second-line treatment option for patients with advanced gastric and gastroesophageal junction adenocarcinoma that progressed on first-line chemotherapy.”

—   lead study author Rui-Hua Xu, MD, PhD
Sun Yat-sen University Cancer Center
Guangzhou, China

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