ESMO 2018: Dr. Abou-Alfa Discusses Updates in GI Cancer

Ghassan K. Abou-Alfa, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses important data in gastrointestinal (GI) cancer that were presented at the 2018 ESMO Congress.

Tremendous progress has been made in the field of cholangiocarcinoma, particularly in patients with FGFR2 fusions, Abou-Alfa says. In updated results of a phase II trial, the selective pan-FGFR inhibitor infigratinib (BGJ398) demonstrated a manageable toxicity profile and clinically meaningful activity following chemotherapy in patients with intrahepatic cholangiocarcinoma. The overall response rate was 31.5%, with a disease control rate of 86.9%. Median duration of response was 5.4 months. He adds that while these data are encouraging, they will need to be confirmed in a large phase III trial.

In metastatic pancreatic cancer, findings from a phase III trial presented at the Congress demonstrated that adding an IGF1 inhibitor to the standard regimen of gemcitabine plus nab-paclitaxel had no added benefit in this patient population, Abou-Alfa adds. Overall survival for the triplet regimen was 8.9 months compared with 11.7 months for the doublet chemotherapy standard regimen. Although it did not result in a change in outcomes, he commends the research effort and the straightforwardness of the data. In some clinical trials, the interpretative nature of the results can lead to some challenges.

Arguably, the treatment paradigm of hepatocellular carcinoma (HCC) has had the most dramatic transformation of all the GI cancers. For a decade, there was only 1 approved agent, sorafenib (Nexavar), but the past year and a half has seen many positive trials, with several emerging TKIs and treatment strategies for these patients. Abou-Alfa adds that there are 2 additional TKIs that have been approved by the FDA in this space—regorafenib (Stivarga) for second-line treatment and lenvatinib (Lenvima) for frontline therapy. The CheckMate-459 study is evaluating sorafenib head-to-head with nivolumab (Opdivo), he adds.

The liver cancer space continues to evolve, Abou-Alfa says, but it still has a way to go. Data pertaining to TKI agents are expected in the future, as well as checkpoint inhibitors. The big item that is on his radar is the HIMALAYA study, which is evaluating the safety and efficacy of durvalumab (Imfinzi) in combination with tremelimumab as potential first-line treatment for patients with unresectable HCC. Another area of focus, Abou-Alfa adds, is the application of chimeric antigen receptor T-cell therapies to HCC.