ASCO 20018 GASTROINTESTINAL (NO COLORECTAL) Critical review Stefano Cascinu Modena Cancer Center Modena, Italy
ASCO 20018
GASTROINTESTINAL (NO COLORECTAL) Critical review
Stefano Cascinu
Modena Cancer Center Modena, Italy
Stefano Cascinu
Conflict of interest disclosure:
• Consultant or Advisory Board: Celgene; Baxalta; Bayer; Amgen
• Research grant: Merck; Bayer; Celgene
• Honoraria: Celgene; Bayer; Amgen
Something new?
Pancreatic Cancer
– Adjuvant chemotherapy: GI PRODIGE 24/CCTG PA.6
– Preoperative chemoradiotherapy: PREOPANC-1
– Metastatic disease: PRODIGE 35-PANOPTIMOX;
Gastric/Esophageal cancer
– Adjuvant: S-1/docetaxel;
– Advanced: S-1/CDDP vs S-1/CDDP/Docetaxel
– 2° line:
• Trastuzumab and paclitaxel
• Pembrolizumab vs paclitaxel
Biliary tract cancer
– Advanced: S-1/GEM vs S-1/CDDP
Neuroendocrine tumours
– Temozolamide vs TEM/cape
Modified after 30 patients: Irinotecan 150 mg (diarrhea ¾)
Non noto il numero di pazienti valutati/inseriti (12 settimane per iniziare)
Follow up mediano 33.6 mesi: N° eventi 314 (>90%)
GEM: eccezionale risultato
N° eventi <50%
Differenza a 3 aa: 15%
1° domanda: RT per una malattia sistemica (30% dei pazienti
già metastatici)?
2° domanda: forse però evita chirurgie inutili e aumenta R0?
E il ruolo
dell’irinotecan nel
FOLFIRINOX?
PFS2: ?
Neurotossicità =
Dose cumulativa
Braccio A: 1.020
Braccio B: 680
Effetto della
reintroduzione?
27 su 52 a 6 mesi
Something new?
Pancreatic Cancer
– Adjuvant chemotherapy: GI PRODIGE 24/CCTG PA.6
– Preoperative chemoradiotherapy: PREOPANC-1
– Metastatic disease: PRODIGE 35-PANOPTIMOX;
Gastric/Esophageal cancer
– Adjuvant: S-1/docetaxel;
– Advanced: S-1/CDDP vs S-1/CDDP/Docetaxel
– 2° line:
• Trastuzumab and paclitaxel
• Pembrolizumab vs paclitaxel
Primary
endpoint:
3-year RFS
?
CLASSIC Trial ACTS_GC trial, Sasako JCO 2012
Trial Agent N° pat RR (%) PFS (median) OS (median)
TYTAN Lapatinib 130 27 5.5 11
Paclitaxel 131 9 4.4 8.9
Gatsby TDM-1 224 21 2.9 8.6
Placebo 117 20 2.7 7.9
Combined positive
score: number of
PDL-1 positive
cells ( tumor,
lymphocytes and
macrophages) in
relation to total
tumor cells
MSI; EBV?
KEYNOTE-059: Response according to MSI
Fuchs CS et al. ASCO 2017
JAVELIN Gastric 300: Avelumab as Third Line Treatment for Gastric or GEJ Adenocarcinoma
JAVELIN Gastric 300, a pivotal phase III open-label,
multicenter trial of avelumab vs physician’s choice
(paclitaxel/irinotecan) as a third-line treatment of
unresectable, recurrent, or metastatic gastric
adenocarcinoma.
371 patients (147 sites)
It did not meet its primary endpoint of
demonstrating superior overall survival (OS)