Research Blast: Highlights from 2018 European Society for Medical Oncology (ESMO)

On October 19-23, global leaders gathered in Munich, Germany for the 2018 European Society for Medical Oncology (ESMO) conference to advance the science of cancer care, understand where the research currently stands, and disseminate knowledge within the oncology field.

ESMO is the equivalent of the American Society of Cancer Oncology’s (ASCO) annual meeting in the United States and attracts thousands of practitioners, oncologists, researchers, and patient advocates from across the world.

What’s new in Colorectal Cancer (CRC) research?

That’s a great question! This past week, there were a few promising (and not so promising) results from ESMO 2018.

Remember, just because a study isn’t promising for cancer treatment, doesn’t mean it isn’t contributing to the larger body of research. To know what works, we also have to know what doesn’t work.

Based on what we’ve heard from our patient advocate community, we’ve highlighted the top five research studies from ESMO that are important for the CRC community to understand as they continue to push for the best available treatments in the search for a cure.

1. Checkmate 142: Immunotherapy may become first-line treatment for some.
   Back in July 2018, the U.S. Food and Drug Administration (FDA) approved the use of nivolumab (Opdivo) in combination with ipilimumab (Yervoy) for patients with microsatellite instability high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer (mCRC) who have progressed on a previous treatment of fluoropyrimidine, oxaliplatin, and irinotecan. This approval was based on positive findings from the Checkmate142 study, of which updated results were presented at ASCO 2018. Now, researchers are observing positive results in patients who haven’t received any prior treatment for MSI-H CRC. This could be the first time an immunotherapy combination is a first-line treatment option.
2. Preoperative Treatment with Nivolumab and Ipilimumab. Along these lines, another study presented at ESMO investigated whether neoadjuvant treatment (a treatment given before the primary mode of treatment) with nivolumab (Opdivo) and ipilimumab (Yervoy) in MSI-H patients would show response rates. Fourteen patients with early-stage CRC were treated with ipilimumab and nivolumab before surgery. Of the seven patients with dMMR CRC, 100 percent had a pathological response, meaning cancer could not be detected in tissue samples.
3. Phase II STARTK-2, Phase 1 STARTRK-1, and Phase 1 ALKA-372-001.Personalized medicine continues to make headlines as the future (or not so future) of cancer treatment. In this study, entrectinib shrank tumors in 57.4 percent of people with neurotrophic tropomyosin receptor kinase (NTRK) fusion-positive solid tumors. TRK Fusions are a biomarker we’re keeping an eye on. Briefly, it’s a genetic abnormality that occurs when one of the NTRK genes connects to another, unrelated gene, leading to uncontrolled TRK signaling and the potential for cancer. Because of the study results, entrectinib has been granted Breakthrough Therapy Designation (BTD) by the FDA to treat NTRK fusion-positive, locally-advanced or, metastatic-solid tumors. Specifically, to treat those patients who have either progressed following prior therapies or have no acceptable standard therapies.
4. Nuc-3373 Results: Researchers presented findings from a Phase I study investigating a drug called Nuc-3373, which also had data presented at ASCO 2018. Of 36 patients with metastatic cancer in the study, three achieved stable disease. This drug may have the potential to control the growth of cancer even in patients whose cancer has progressed on prior treatment with a fluoropyrimidine such as 5-FU or capecitabine. Additionally, researchers are hopeful that it will have administration advantages over 5-FU.
5. Reovirus with FOLFIRI/B in KRAS mutation: Original findings from this phase I study were presented at ASCO 2018, now researchers conducted a dose escalation study investigating a reovirus (Reo) in combination with FOLFIRI/B (irinotecan, flluorouracil, leucovorin, plus bevacizumab) in patients with KRAS mutations. Out of those that received the maximum tolerated dose of FOLFIRI/B and the reovirus, 50 percent had a partial response. The progression-free survival, or the length of time that the cancer didn’t grow, was 65.6 weeks and the overall survival, or the length of time individuals survived is 107.5 weeks. These findings exceeded researchers expectations.

Other notable highlights:

• Barriers to early clinical trial access for adolescents and young adults still exist.
• Taiho’s drug Lonsurf, which is approved for metastatic colorectal cancer, showed clinical benefit in metastatic gastric and gastroesophageal junction cancer patients.
• Challenges for cancer awareness and screening: Zorana Maravic from the Digestive Cancers Europe presented on the benefits and barriers of CRC screening.

Did you know Zorana was a panelist on global leadership at Fight CRC’s Call-on Congress this past year?!