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State of the Science Summit on A Summer of Progress: Updates from ASCO

Robert L. Talley, MD, hematologist/medical oncologist, Centerpoint Medical Center, Sarah Cannon Cancer Institute, discusses the CAPTIVATE trial in patients with chronic lymphocytic leukemia (CLL).

Ibrutinib (Imbruvica) can certainly be used long-term, says Talley. It is a very effective agent and may result in long-term responses, but it has to be given continuously, explains Talley. Many of the currently available biologic agents and monoclonal antibodies are expensive, which has prompted concerns over rising healthcare costs.

The frontline combination of ibrutinib and venetoclax (Venclexta) in patients with CLL was limited to 12 cycles. At the end of 12 combined cycles, there was a randomization for placebo versus ibrutinib alone. The combination demonstrated an 100% objective response rate. The complete remission rate was 36% in 11 patients with available bone marrow data.

Both agents are very effective alone and work quite differently, but complement each other when combined, says Talley. Ibrutinib has the ability to decrease the tumor lysis risk, which allows for better safety with venetoclax, Talley concludes.

Dr. Talley on the CAPTIVATE Trial in CLL

Joseph Stilwill, MD, medical oncologist, Sarah Cannon Research Institute, discusses adjuvant advances in the treatment of patients with melanoma.

The most exciting advances in treating patients with melanoma have been in the adjuvant setting, says Stilwill. This includes patients with 

-positive melanoma as well as the overall population. BRAF and MEK inhibition in addition to anti—PD-1 therapy have shown significant benefit in the adjuvant setting. These therapeutic advances are not only more efficacious than previous agents, but are less toxic than prior adjuvant therapies.

Updates from the 2018 ASCO Annual Meeting confirmed what physicians knew to be true in practice. Stilwill says that completion lymph node dissection is most likely not necessary for most patients with sentinel lymph node positive disease. Additionally, updates from the 2018 ASCO Annual Meeting showed that the 8th edition of the American Joint Committee on Cancer Staging System holds up to external validation, says Stilwill.

Dr. Stilwill on Adjuvant Advances in Melanoma

Jodie Barr, DO, hematologist/oncologist, Lawrence Memorial Hospital, discusses systemic therapies for patients with neuroendocrine tumors (NETs).

Therapeutic options for NETs have been limited in the past, says Barr. There is a lot that physicians do not yet know about the biology of these tumors, as they are a very heterogeneous group of malignancies.

The E2211 study looked at the combination of capecitabine and temozolomide (Temodar) compared to temozolomide alone. The trial serves as a foundation for future confirmatory studies, especially for those patients with more aggressive disease, says Barr.

The NETTER-1 trial looked at Lutathera (lutetium Lu 177 dotatate). The agent was initially studied in midgut NETs and showed a significant response rate and decreased the risk of death by approximately 79%. The results of the trial have armored physicians with another treatment option to combat the disease.

Telotristat ethyl (Xermelo) has helped with symptom management, especially for those patients with refractory diarrhea. Genetic sequencing has also furthered the standard of care in an effort to further personalize medicine, states Barr.

Dr. Barr on Systemic Therapies for Patients With Neuroendocrine Tumors

Denise A. Yardley, MD, senior investigator of breast cancer research, Sarah Cannon Research Institute, discusses the role of biosimilars in the treatment of patients with breast cancer.

In the wake of the results from the LILAC study that was presented at the 2018 ASCO Annual Meeting, many experts are questioning the potential role of biosimilars in the treatment of breast cancer. The phase III trial showed an equivalent pathologic complete response rate between trastuzumab (Herceptin) and the biosimilar ABP 980. Although there has already been an approval for 1 trastuzumab biosimilar, MYL-1401O (Ogivri; trastuzumab-dkst), biosimilars have yet to been used in the clinic for the treatment of patients with cancer.

Yardley says that biosimilars are a moving target. Clinicians are still trying to figure out how biosimilars will fit into practice. There have been multiple studies on trastuzumab biosimilars in particular, but clinicians still widely prefer the originator drug to the idea of a biosimilar, Yardley says.

Denise A. Yardley, MD, senior investigator of breast cancer research, Sarah Cannon Research Institute, discusses the role of biosimilars in the treatment of patients with breast cancer.
 

State of the Science Summit on A Summer of Progress: Updates from ASCO | Conference

Dr. Talley on the CAPTIVATE Trial in CLL

Dr. Stilwill on Adjuvant Advances in Melanoma

Dr. Barr on Systemic Therapies for Patients With Neuroendocrine Tumors

Dr. Yardley on the Role of Biosimilars in Breast Cancer