ASCO GI 2020 was held in San Francisco January 23-25. Numerous studies involving Phase 1/2 evaluations of new drugs in gastrointestinal (GI) malignancies were reported. All of the drugs investigated were said to have tolerable safety profiles and encouraging efficacy thus leading to recommendations for future Phase 3 studies.
That said, I would like to highlight some specific emerging trends to take away from the meeting which struck me as newsworthy for both oncology clinicians and researchers.
Twenty-five abstracts dealt with cell free tumor DNA (ctDNA) analyzed from peripheral blood samples in individuals with GI malignancies. These studies focused on ctDNA as specific liquid biomarkers, which allow monitoring for tumor recurrence, treatment response, and tumor progression, which greatly outperforms current standards of care (i.e., MRD detection). Several abstracts presented suggest ctDNA will supplement or replace cancer screening studies. Validation studies are underway with these assays and their applications to affirm sensitivity, specificity, and clinical benefit as well as cost effectiveness.
Abstracts: # 5, 15, 18, 29, 48, 66, 68, 194,195, 203, 207, 230, 238, 243, 244, TPS261, 283, 451, 579, 645, 730, 753, 758, 763, 799, 833
PARP Inhibition in Locally Advanced or Metastatic Pancreatic Cancer
Nine abstracts addressed the use of PARP inhibitors in pancreatic cancer. All of these abstracts found significant efficacy in patients with BRCA2, BRCA1, or PALB mutations, and acceptable toxicity profiles.
Abstracts: # 472, 476, 639, 648, 653, 686, 709, 750
TKI Plus Checkpoint Inhibition in GI Malignancies
Numerous Phase 1/2 studies addressed the combination of TKI and immunotherapy agents in a variety of GI tumors. Several also combined checkpoint inhibitors with standard chemotherapies. Encouraging efficacy signals were identified along with reasonable safety parameters for which Phase 3 trials were recommended.
Abstracts: # 101, 133, 153, 218, 278
Colorectal Cancer in Young Adults
Seven abstracts addressed the recent epidemiologic findings of dramatically increasing numbers of young individuals with colorectal cancer. These abstracts defined specific clinical and genomic prognostic factors which may differentiate colorectal cancer in young individuals from that of older individuals. Interestingly macrobiotic factors may place a significant role in the changing demographics of colorectal cancers.
Abstracts: #64, 82, 85, 72, 256, 257, 805
Real World Evidence in GI Malignancies
Forty abstracts dealt with real world evidence (RWE) regarding GI malignancies. Additional abstracts utilizing data from the National Cancer Database (NCDB) or from traditional cancer registries were also reported. Clearly the use of electronic medical records (EMRs) is offering the medical community the opportunity to better access and analyze real world patient data regarding many health conditions including gastrointestinal cancers.
Abstracts: #64, 82, 85, 72, 256, 257, 805
Role of Checkpoint Inhibitors in Hepatocellular Cancer
Presentations and discussions strongly affirmed findings that patients with hepatocellular cancer responding to checkpoint inhibitors often have very long durations of response—particularly those patients achieving a complete response (CR). Thus, most patients with advanced hepatocellular cancer should be exposed to these agents during their course of treatment.
Additionally, several discussions focused upon data presented last month at ESMO ASIA concerning the surprisingly high rates of response to bevacizumab + atezolizub and unprecedented durations of response. This treatment combination (Bev + Atezo) may be practice changing if/when incorporated into NCCN guidelines.
Abstracts: # 476, 513, 564
NETest in Neuroendocrine Carcinomas
Validation studies were presented (3 abstracts) of a transcriptome based testing (NETest) which boasts very high specificity and sensitivity for neuroendocrine malignancies. This NETest should be cost effective and will largely replace serum chromogranin measurement and reduce the frequency of imaging studies.
Abstracts: # 605, 606, 625, 631
Targetable Mutations in Biliary Tract Cancers
Several abstracts defined excellent responses in Phase 1/2 studies of patients with primary biliary tract malignancies possessing either IDH mutations or FGFR2 fusions.
Abstracts: # 538, 539, 579
Synchronous Colorectal Cancers and Upper GI Malignancies
Abstracts from China and Japan identified very significant propensities for synchronous primary malignancies of the GI tract. Evaluation of the lower GI tract in patients with upper GI malignancies identified an incidence of potentially curable colorectal malignancies in over 5% of such patients. An additional 46% of studied patients were found to have synchronous resectable colorectal adenomas.
Abstracts: # 290, 337
Role of the Microbiome
Last, but not least, several abstracts and presentations began to scratch the surface as to the role of the microbiome in the causation, promotion and treatment of malignancies of the gastrointesintal tract. Everyone appears excited by the plethora of necessary investigation that is needed to determine the role of the microbiome both intratumorally and externally that may fundamentally alter our approach to GI cancers.
Abstracts: # 4, 171, 241, 744
by Dean Gesme, MD
Immediate Past President, Minnesota Oncology
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