1st june 2015
ASCO 2015 - Female cancers
Two communications at the ASCO Conference reported advances in treatment of women with breast or ovarian cancer.
On Saturday, 30th May, Dr Alexandra Leary presented data on the effect of chemotherapy on ovarian tumours and the implications for determination of the best strategy to eradicate residual tumour cells.
Dr Suzette Delaloge is the principal French investigator of ExteNET, a large phase III international registration study. This was presented as an oral communication on Monday, 1st June and shows a substantial reduction in the risk of relapse with adjuvant therapy in women with Her2+ breast cancer.
how to determine the best therapeutic strategy after chemotherapy
Treatment of advanced ovarian cancer depends on the chemotherapeutic use of platinum salts to supplement surgery. The current approach involves tumour analysis at the time of diagnosis. Response rates are high (80%) but, unfortunately, the majority of patients relapse because of the development of resistance to treatment.
Dr Alexandra Leary, oncologist in the Gustave Roussy Department of Medical Oncology, has studied the effects of chemotherapy on ovarian tumours to characterise better those cells which escape from treatment.
The study presented on Saturday, 30th May addressed the exploration of genetic damage and changes in the local cellular immune response (which help in analysis of recruitment of the immune system to the tumour site) in ovarian tumours following chemotherapy administered before surgery (neo-adjuvant).
Dr Leary has shown that chemotherapy has effects on the tumour genomic profile, especially for genes which are involved in repair of damage resulting from the treatment. Potential targets, such as BRAF and RAS were over-expressed in the tumour after chemotherapy. In addition, chemotherapy may increase the migration of immune system cells into the tumour. Studies of the effect on PD-L1 expression are ongoing. These data might be used in the future to help in choice of drugs to be used after chemotherapy, immunotherapy or targeted therapy to eradicate the residual cancerous cells which might cause relapse.
Targeted therapy reduces the risk of early relapse in women with Her2-positive breast cancer.
Dr Suzette Delaloge, oncologist in the Department of Medical Oncology and Chair of the Gustave Roussy Breast Disease Committee led the ExteNET study in France. This phase III international randomised multicentre study recruited a total of 2,821 patients with aggressive but localised breast cancer expressing the Her2 receptor.
Neratinib, a pan-HER tyrosine kinase inhibitor, was administered for a year as a delayed adjuvant in these women, who were treated according to the best current standards but whose cancer remained at risk of relapse. They will be followed for 5 years. The first results after two years of follow-up are very encouraging. They show a substantial diminution in the risk of invasive relapse, the principal end-point of the study. This is the first proof of concept that a tyrosine kinase inhibitor is potentially capable of increasing the cure rate in the early stage and not only of prolonging survival in late-stage disease.