martes, 19 de septiembre de 2017
Early Breast Cancer 2017: St. Gallen International Expert Consensus Conference
Editor's Choice
De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017
G. Curigliano H. J. Burstein E. P. Winer M. Gnant P. Dubsky S. Loibl M. Colleoni M. M. Regan M. Piccart-Gebhart H.-J. Senn ... Show more
Annals of Oncology, Volume 28, Issue 8, 1 August 2017, Pages 1700–1712, https://doi.org/10.1093/annonc/mdx308
Published:
21 June 2017
Abstract
The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer. Treatments were assessed in light of their intensity, duration and side-effects, seeking where appropriate to escalate or de-escalate therapies based on likely benefits as predicted by tumor stage and tumor biology. The Panel favored several interventions that may reduce surgical morbidity, including acceptance of 2 mm margins for DCIS, the resection of residual cancer (but not baseline extent of cancer) in women undergoing neoadjuvant therapy, acceptance of sentinel node biopsy following neoadjuvant treatment of many patients, and the preference for neoadjuvant therapy in HER2 positive and triple-negative, stage II and III breast cancer. The Panel favored escalating radiation therapy with regional nodal irradiation in high-risk patients, while encouraging omission of boost in low-risk patients. The Panel endorsed gene expression signatures that permit avoidance of chemotherapy in many patients with ER positive breast cancer. For women with higher risk tumors, the Panel escalated recommendations for adjuvant endocrine treatment to include ovarian suppression in premenopausal women, and extended therapy for postmenopausal women. However, low-risk patients can avoid these treatments. Finally, the Panel recommended bisphosphonate use in postmenopausal women to prevent breast cancer recurrence. The Panel recognized that recommendations are not intended for all patients, but rather to address the clinical needs of the majority of common presentations. Individualization of adjuvant therapy means adjusting to the tumor characteristics, patient comorbidities and preferences, and managing constraints of treatment cost and access that may affect care in both the developed and developing world.
St Gallen Consensus, early breast cancer, radiation therapy, surgery, systemic adjuvant therapies
Topic:radiation therapy cancer chemotherapy regimen ductal carcinoma in situ immunologic adjuvants pharmaceutical adjuvants neoadjuvant therapy postmenopause premenopause surgical procedures, operative neoplasms breast cancer systemic therapy adjuvant therapy her2 positive consensus.
Issue Section:
SPECIAL ARTICLES
viernes, 15 de septiembre de 2017
Lung Cancer Durvalumab
Durvalumab Boots PFS Even in Stage 3 Lung Cancer
Liam Davenport
September 09, 2017
MADRID, Spain — Immunotherapy could be the new standard of care in patients with stage III, locally advanced non-small cell lung cancer (NSCLC) who have failed chemoradiotherapy, after a trial showed that the anti-programmed death ligand 1 (PD-L1) inhibitor durvalumab (Imfinzi, AstraZeneca) is effective in this hard-to-treat population.
Up to 35% of patients with NSCLC present with stage III, locally advanced disease that is, in the majority of cases, unresectable.
At present, the standard of care in this group is platinum-based doublet chemotherapy and concurrent radiotherapy, yielding a median progression-free survival (PFS) of 8 to 10 months, with only 15% of patients alive at 5 years.
The new results, from the PACIFIC study, showed that giving durvalumab after chemoradiotherapy doubled PFS over placebo, increasing it by 11 months.
Moreover, just less than half of durvalumab-treated patients were still alive 18 months after starting treatment.
This is the first randomized controlled trial of an immunotherapy in this clinical setting, noted lead author Luis Paz-Ares, MD, PhD, Medical Oncology, Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and CNIO, Madrid, Spain.
The study was presented during a Presidential Symposium at the European Society for Medical Oncology (ESMO) 2017 Congress, and simultaneously published in the New England Journal of Medicine.
In an ESMO press release, Dr Paz-Ares said that the improvement in PFS "was consistent across all patient subgroups that were analysed," and that the toxicity increase seen in the durvalumab group was "slight."
Liam Davenport
September 09, 2017
MADRID, Spain — Immunotherapy could be the new standard of care in patients with stage III, locally advanced non-small cell lung cancer (NSCLC) who have failed chemoradiotherapy, after a trial showed that the anti-programmed death ligand 1 (PD-L1) inhibitor durvalumab (Imfinzi, AstraZeneca) is effective in this hard-to-treat population.
Up to 35% of patients with NSCLC present with stage III, locally advanced disease that is, in the majority of cases, unresectable.
At present, the standard of care in this group is platinum-based doublet chemotherapy and concurrent radiotherapy, yielding a median progression-free survival (PFS) of 8 to 10 months, with only 15% of patients alive at 5 years.
The new results, from the PACIFIC study, showed that giving durvalumab after chemoradiotherapy doubled PFS over placebo, increasing it by 11 months.
Moreover, just less than half of durvalumab-treated patients were still alive 18 months after starting treatment.
This is the first randomized controlled trial of an immunotherapy in this clinical setting, noted lead author Luis Paz-Ares, MD, PhD, Medical Oncology, Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and CNIO, Madrid, Spain.
The study was presented during a Presidential Symposium at the European Society for Medical Oncology (ESMO) 2017 Congress, and simultaneously published in the New England Journal of Medicine.
In an ESMO press release, Dr Paz-Ares said that the improvement in PFS "was consistent across all patient subgroups that were analysed," and that the toxicity increase seen in the durvalumab group was "slight."
Renal Cell Carcinoma
Immunotherapy Changes First-Line Paradigm in Advanced RCC
Zosia Chustecka
September 11, 2017
New data are set to change the paradigm for the first-line treatment of advanced renal cell carcinoma (RCC), after a phase 3 trial showed significantly improved overall survival (OS) with immunotherapy in comparison to standard care with sunitinib (Sutent, Pfizer).
The data come from the CheckMate-214 study, which was stopped early by the data monitoring committee after it showed that patients with advanced RCC were living significantly longer when treated first line with the combination of nivolumab (Opdivo, Bristol-Myers Squibb) and ipilimumab (Yervoy, Bristol-Myers Squibb).
Until now, nothing has beaten sunitinib in a randomized phase 3 clinical trial, and it was "brave to choose it as a comparator," said Manuela Schmidinger, MD, from the Medical University of Vienna, Austria. She pointed out that this is the first phase 3 study to show a statistically significant OS benefit.
This new study changes the paradigm, and it establishes a new standard of care for the first-line treatment of advanced RCC, she commented. Dr Schmindinger was not involved in the study and acted as discussant after it was presented here in a presidential session at the European Society of Medical Oncology (ESMO) 2017 Congress.
Several others agreed with her. This is practice changing, commented Markus Joerger, MD, PhD, assistant professor of medical oncology and clinical pharmacology, St. Gallen Cancer Center, Switzerland, who chaired the ESMO press briefing at which the study was highlighted.
Reacting to the new findings, Maria de Santi, MD, the University of Warwick, United Kingdom, was enthusiastic. "This means that immunotherapy is not only a new option for these patients, it should become the standard of care," she told Medscape Medical News. The study was highly significant on two of three endpoints, she noted: response rate and OS. It did not reach the predetermined statistical significance for progression-free survival (PFS), but this is often seen with immunotherapy, she said.
Dr Maria de Santi
Dr De Santi also commented that immunotherapy should be considered to have trumped pazopanib (Votrient, GlaxoSmithKline), which is another standard of care in the first-line setting in advanced RCC. Although the current trial compared immunotherapy against sunitinib, she noted that pazopanib has shown similar efficacy, and she does not feel that a trial comparing immunotherapy with pazopanib used as the control was necessary.
Zosia Chustecka
September 11, 2017
New data are set to change the paradigm for the first-line treatment of advanced renal cell carcinoma (RCC), after a phase 3 trial showed significantly improved overall survival (OS) with immunotherapy in comparison to standard care with sunitinib (Sutent, Pfizer).
The data come from the CheckMate-214 study, which was stopped early by the data monitoring committee after it showed that patients with advanced RCC were living significantly longer when treated first line with the combination of nivolumab (Opdivo, Bristol-Myers Squibb) and ipilimumab (Yervoy, Bristol-Myers Squibb).
Until now, nothing has beaten sunitinib in a randomized phase 3 clinical trial, and it was "brave to choose it as a comparator," said Manuela Schmidinger, MD, from the Medical University of Vienna, Austria. She pointed out that this is the first phase 3 study to show a statistically significant OS benefit.
This new study changes the paradigm, and it establishes a new standard of care for the first-line treatment of advanced RCC, she commented. Dr Schmindinger was not involved in the study and acted as discussant after it was presented here in a presidential session at the European Society of Medical Oncology (ESMO) 2017 Congress.
Several others agreed with her. This is practice changing, commented Markus Joerger, MD, PhD, assistant professor of medical oncology and clinical pharmacology, St. Gallen Cancer Center, Switzerland, who chaired the ESMO press briefing at which the study was highlighted.
Reacting to the new findings, Maria de Santi, MD, the University of Warwick, United Kingdom, was enthusiastic. "This means that immunotherapy is not only a new option for these patients, it should become the standard of care," she told Medscape Medical News. The study was highly significant on two of three endpoints, she noted: response rate and OS. It did not reach the predetermined statistical significance for progression-free survival (PFS), but this is often seen with immunotherapy, she said.
Dr Maria de Santi
Dr De Santi also commented that immunotherapy should be considered to have trumped pazopanib (Votrient, GlaxoSmithKline), which is another standard of care in the first-line setting in advanced RCC. Although the current trial compared immunotherapy against sunitinib, she noted that pazopanib has shown similar efficacy, and she does not feel that a trial comparing immunotherapy with pazopanib used as the control was necessary.
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