Gastrointestinal Cancers Symposium

GI2018 Wrap Up Daily News

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See CELESTIAL, Page 13 2018 Gastrointestinal Cancers Symposium Views Multidisciplinary Care Through Global Lens W hen more than 3,700 attend- ees gathered in San Francisco on January 18-20 for the 2018 Gastrointestinal (GI) Cancers Symposium, they were united by a collec- tive investment not only in researching and treating GI cancers, but also in trans- lating today's advancements into global improvements in patient outcomes. The theme of the Symposium, "Multidisci- plinary Care: Local Practice, Global Out- comes," was top of mind for faculty and attendees alike, as scientific and educa- tional sessions advocated for a 360-degree approach to treating patients with GI cancers around the world. "The 2018 GI Cancers Symposium was another successful meet- ing," Laura Dawson, MD, FRCPC, FASTRO, chair of the Sympo- sium's Steering Committee, said. "The differences in GI cancer ad- vances and challenges in research and clinical care worldwide were highlighted, and it was clear that we can all learn from each other and make the most progress for our patients by working together." More than 800 abstracts were presented at the Symposium, several of which will have practice-changing implications. Abstract 5, pre- sented by Charles S. Fuchs, MD, established the statistical benefit of ramucirumab added to standard chemotherapy for patients with pre- viously untreated metastatic gastric or gastroesophageal junction ade- nocarcinoma. Abstract 553, presented by Thierry André, MD—which was accompanied by a simultaneous article published in the Journal of Clinical Oncology 1 —established the enhanced clinical benefit and manageable safety of a combination of nivolumab and ipilimumab in patients with DNA mismatch repair-deficient/microsatellite insta- bility-high metastatic colorectal cancer. The research could represent a new standard of care for treating these patients, and will improve oncologists' understanding and approach to GI malignancies. Education Sessions provided valuable context for the Sympo- sium's science and brought global perspectives to the podium. Gen- eral Session 2, "Global Outlook on Gastric Cancer," compared Eu- ropean, South American, Asian, and North American perspectives on surveillance, risk factors, and early gastric cancer management, and General Session 5, "Emerging Options for Hepatocellular Carci- noma—A Global Perspective," assessed new and existing therapies through a global lens. "This year's focus on global perspectives on GI cancers brought a new level of diversity and interchange of ideas to the Symposium," Karyn Goodman, MD, MS, chair of the Program Committee, said. As the field of treating GI cancers continues to evolve, oncology professionals across the cancer care continuum and around the globe will continue to benefit from forums to connect, collaborate, learn, and question. The 2019 GI Cancers Symposium will take place January 17-19 in San Francisco. –Caroline Hopkins Reference: 1. Overman MJ, et al. J Clin Oncol. 2018;36 (suppl 4S; abstr 553). HCC: CELESTIAL Data May Change Practice T he phase III CELESTIAL trial met its primary end- point by demonstrating a survival advantage with cabozantinib in patients with advanced hepatocellular carci- noma (HCC) that progressed following prior systemic therapy (Abstract 207). Other outcomes included improvements in pro- gression-free survival (PFS) and objective response rate (ORR), as well as an acceptable safety pro- file, thus positioning cabozan- tinib for potential approval in the second-line setting in HCC. "Cabozantinib represents a new treatment option for pa- tients with advanced HCC after prior systemic anticancer thera- py," Ghassan K. Abou-Alfa, MD, of Memorial Sloan Kettering Cancer Center, said. Cabozantinib is an oral small- molecule inhibitor that targets several tyrosine kinases includ- ing VEGFR, MET, and AXL, each of which has been tied to a poor HCC prognosis and the devel- opment of resistance to antian- giogenic agents. Cabozantinib is currently approved for the treatment of advanced renal cell carcinoma. The global, randomized, dou- ble-blind, phase III CELESTIAL trial was designed to evaluate whether cabozantinib could confer benefit to patients with HCC progression following prior sorafenib—the standard of care for advanced disease—or other systemic therapies. Toward this end, previously treated patients with advanced HCC were first stratified by disease etiology (HBV, HCV, other), geographic region (Asia, other), and the presence of extrahepatic spread and/or macrovascular invasion RAINFALL Meets Primary Endpoint, but Ramucirumab Will Not Be Pursued for a First-Line Indication in G-GEJ Cancer R esults of the global, ran- domized, double-blind, placebo-controlled, phase III RAINFALL trial estab- lished the statistical benefit of ramucirumab, a monoclonal antibody targeting VEGFR-2, added to standard chemothera- py for patients with previously untreated metastatic gastric or gastroesophageal junction (G- GEJ) adenocarcinoma (Abstract 5). The findings revealed a sig- nificant 25% reduction in the risk of disease progression or death for the primary endpoint of progression-free survival (PFS). However, the reduction corresponded to only a 9-day improvement in median PFS, so the clinical benefit of frontline ramucirumab is debatable. "I wouldn't purport that ramucirumab should be a first- line therapy," said Charles S. Fuchs, MD, of the Smilow Can- cer Hospital and Yale New Ha- ven Health, who presented the RAINFALL findings. There are no plans to pursue regulatory approval of ramucirumab for a first-line indication. Ramucirumab is the only bio- logic with proven efficacy both as a single agent and in com- bination with paclitaxel in the second-line setting in metastatic G-GEJ adenocarcinoma based on results from the REGARD and RAINBOW trials, in which ramucirumab yielded modest but significant increases in over- all survival (OS). Investigators reasoned that ramucirumab might also confer benefit when used earlier in treatment-naive patients with metastatic G-GEJ adenocarcinoma, for which the standard of care in many parts of the world involves combination chemotherapy with a fluoropy- rimidine plus a platinum agent. To evaluate this hypothesis, RAINFALL was designed to com- pare ramucirumab with placebo in previously untreated patients with metastatic, HER2-negative G-GEJ adenocarcinoma who had an Eastern Cooperative Oncol- ogy Group performance status of 0 or 1. All patients received See RAINFALL, Page 7 T A R G E T I N G C A N C E R C A R E Novel Approaches for CRC Screening, Surveillance 3 Nivolumab ± Ipilimumab Shows Potential in dMMR/MSI-H mCRC 4 In Brief 5 TACE Plus Sorafenib in Unresectable HCC 5 CatuNeo Trial Fails to Meet Primary Endpoint 7 Gemcitabine/S-1 in Advanced Biliary Tract Cancer 12 INSIDE DAILY NEWS WRAP UP EDITION Gastrointestinal Cancers Symposium 2018 The 2018 Gastrointestinal Cancers Symposium featured a wide array of multidisciplinary topics of international interest for thousands of attendees. Dr. Charles S. Fuchs presents Abstract 5 during Oral Abstract Session A.

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