Lung Cancer Alliance News
American Society of Clinical Oncologists (ASCO) Annual Meeting 2006
The ASCO Annual Meeting is considered a premier educational and scientific event; bringing together nearly 30,000 national and international participants in the oncology community. In 2006, the ASCO Annual Meeting was held June 2-6 in Atlanta, Georgia. Brief summaries of notable presentations are below. It's also possible to view the ASCO Abstract listed with the sumary and other Meeting Information at ASCO.
Emerging Angiogenesis Inhibitors
How Do Primary Care Docs Treat People With Advanced Lung Cancer?
Do Women Respond Differently Than Men to Avastin?
Role of Estrogen in Lung Cancer
Lung Cancer Surgery for People Over Age of 65
Medical Therapy for Brain Metastases
Cisplatin Chemotherapy after Surgery Improves Survival
Meta Analysis of Carboplatin vs Cisplatin in Advanced NSCLC
Other News Coverage from ASCO
Angiogenesis Inhibitors in Lung Cancer
Phase II results of three anti-angiogenesis drugs were presented: 1) ZD6474 (Zactima) 2) Sunitinib (Sutent) 3) Sorafenib (Nexavar) – these three drugs are all generally anti-angiogenesis inhibitors like bevacizumab (Avastin), but Avastin is given intravenously and these are oral drugs, which may have a benefit in terms of side effects. Also, these drugs each inhibit more multiple receptors than does Avastin.
1) Zactima inhibits angiogenesis and EGFR. Zactima was compared to Iressa, looking at Progression Free Survival (PFS). The median PFS with Zactima was 11 weeks versus 8.1 weeks with Iressa, representing a 36% increase in this measure. Also was a higher Objective Response (tumor shrinkage), 8% versus 1%. In the study design, they allowed people who progressed to switch to the other regimen and they didn’t find any cross-reactions. Overall survival for Zactima was 6.1 months vs. Iressa’s 7.4 months. The reasons could have had to do with study design and/or small number of people in the study. The side effects weren’t different between Zactima and Iressa. Overall Zactima was active as a single agent and more study is needed (true for all 3 drugs). (Natale-Abstract 7000)
2) Sutent inhibits a number of different receptors re: angiogenesis. Study’s main outcome was Objective Response, i.e. tumor shrinkage. Study done with people with previously treated advanced lung cancer. Adverse events were evident, 38% of participants discontinued on the drug. There were 3 deaths, although probably only 1 was truly study related. A majority of participants had tumor shrinkage. Progression free survival (PFS) was 11.3 weeks, overall survival was 23.9 weeks. The response rates were comparable to previously approved agents, according to Dr. Socinski, who presented these data. In this Phase II study, Sutent wasn’t compared to another treatment. That will likely be done in a Phase III study. (Socinski-Abstract 7001)
3) Sorafenib was tested as a single agent in advanced non-small-cell lung cancer. Sorafenib inhibits many different receptors. The primary endpoint was Response, as in the Sutent trial. Sorafenib wasn’t compared to another drug in this Phase II study. People with brain metastases and squamous cell carcinoma participated in this study. This is notable because in the Avastin trial, researchers had to exclude people with these because of risks of bleeding and other side effects. Outcome was Progression Free Survival (PFS) of 2.7 months (about 10.8 weeks). Median overall survival 6.7 months (about 26.8 weeks), which is similar to Iressa and Tarceva. 59% of patients had clinical benefit. Were no serious side effects, 8% did have bleeding. A Phase III is currently recruiting patients. (Gatzmeier-Abstract 7002)
Summary – all these trials showed these drugs worked alone, that is, not in combination with chemotherapy. But, it is most likely that they will be used in combination with chemotherapy and/or biologics, if approved. All three drugs are hitting multiple targets, which makes things complicated. Dr. Roy Herbst compared the outcomes of these trials to Phase I/II data of Tarceva plus Avastin, which had higher PFS (6.2 months-Herbst RS et al. JCO April 10, 2005). The drugs reported on at ASCO 2006 may not provide a large advantage in survival, but would likely have many fewer side effects than chemotherapy (Abstracts 7000-7002).
Press Coverage of These Abstracts:
Zactima (Pharmaceutical Business Review Online)
Sutent (Bloomberg)
Sutent-2 (cancerpage.com)
How Do Primary Care Docs Treat Patients With Advanced Lung Cancer?
Timothy Wassenaar’s poster showed that in a study of primary care doctors using hypothetical scenarios, the doctors were less likely to refer people w/ advanced lung cancer diagnoses to oncologists than people with advanced breast cancer. They also knew more about the benefits of chemo in advanced breast cancer than in advanced lung cancer and more about benefits of adjuvant chemotherapy in lung cancer. The researchers concluded these primary care doctors would treat and refer lung cancer patients less aggressively than breast cancer patients. Clearly, more education of these doctors is needed. (Wassenaar-Abstract 7041)
Press Coverage of this Abstract
Additional coverage
Do Women Respond Differently Than Men to Avastin?
A further analysis of the ECOG 4599 trial, the Phase III trial of Avastin presented in 2005, looked at women. Women didn’t show a survival benefit when adding Avastin to chemotherapy, but did show a progression-free survival and response rate benefit. (Brahmer-Abstract 7039)
Role of Estrogen in Lung Cancer
There’s research underway about the role of estrogen receptors in lung cancer. One way to test the theory that estrogen plays a role in lung cancer is to compare lung cancer in pre- and post-menopausal women. Estrogen levels decrease at menopause. These researchers looked at survival in women from the Nastional Cancer Institute’s widely respected SEER database. Premenopausal women with squamous cell carcinoma (SCC) or bronchoalveolar (BAC) had poorer survival than did post-menopausal women. But, women with adenocarcinoma who were pre-menopausal did not have poorer survival than post- menopausal. And adenocarcinoma is more common among pre-menopausal women. Consequently, estrogen might have more of an effect in SCC and BAC, but does seem to have a role in lung cancer. (Oton -Abstract 7038)
Lung Cancer Surgery for People Over Age of 65
Elderly people who have surgery for lung cancer can also benefit from adjuvant chemotherapy. This research was done in Canada. Overall Survival with adjuvant chemotherapy was 66%, without was 46% with no difference in building up of toxicity or side effects. The study compared people over and under 65 years of age. More in the over-65 group didn’t complete the treatment and/or more refused treatment. According to ASCO Daily News for Monday, June 5, “Researchers concluded that adjuvant platinum-based chemotherapy can be safely given to elderly patients, without significant risk of increased toxicity.” (Pepe-Abstract 7009)
Press Coverage of This Abstract
Medical Therapy for Brain Metastases
There was a presentation regarding Pharmacyclics’ drug Xcytrin (Motexafin gadolinium) which, if approved, would be first medical therapy for brain metastases from lung cancer. It would used in combination with Whole Brain Radiation Therapy (WBRT). In a Phase III study, researchers found it improved time to deficits in important brain functions (time to neurologic progression) affecting daily living more than WBRT alone. The time interval that this therapy began after diagnosis of brain metastases appeared to be important. In some study sites in Europe, people were given chemotherapy as treatment for brain metastases before being given the study treatment (Xcytrin plus WBRT or WBRT alone). Therefore, different results appeared in Europe and N. America. In the North America group that got Xcytrin plus WBRT, the drug delayed effects of brain metastases 15 months. The difference in time to neurologic progression in the study population overall was 15.37 months versus 10.03 months. This difference was not statistically significant. This means that gaining approval from the FDA will be difficult, despite the fact that this agent seems to have good potential. (Mehta 7014)
Cisplatin Chemotherapy after Surgery Improves Survival
Results were presented of the Lung Adjuvant Cisplatin Evaluation (LACE). LACE was an analysis of 5 randomized clinical trials, including 4,584 patients. These were completely resected patients. Conclusion; Adjuvant cisplatin based chemotherapy improves survival in NSCLC. The benefit depends on stage and is greatest in patients with stages II and III. (7008)
Nat'l Cancer Institute summary
Meta Analysis of Carboplatin vs Cisplatin in Advanced NSCLC
Nine trials were identified and databases obtained.
2,960 patients were randomized, 1,489 received cisplatin and 1,479 received carboplatin.
Conclusion: Cisplatin based chemotherapy is superior to carboplatin based in terms of response rate but the increased response does not translate to overall survival benefit. Selected patients may obtain slightly more benefit from cisplatin based chemotherapy. (7011)
Other News from ASCO
Antisoma posts positive data on cancer drugs; rights regained from Roche (Source: Forbes)
ImClone decides on Erbitux lung cancer trial (Source: Reuters)
Lucanix Phase II Clinical Data At ASCO - Lung Cancer (Source: Medical News Today)
New Data on Lung Cancer Trials with Targretin(R) is Presented at ASCO (Source: Biowire)
New drug class shows promise for non-small lung cancer (Source: cancerfacts.com)
Researchers Announce New Predictor for Lung Cancer Treatment and Survival (Source: University Hospitals of Cleveland)
Updated Analysis in Second-Line Treatment of Lung Cancer Trial Confirms Similar Survival for Alimta(R) and Docetaxel (Source: Eli Lilly)
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