ASCO 2020 Late-Breakers Showcase Impact of COVID-19 on Cancer and More

Several late-breaking abstracts dropped ahead of this weekend’s live broadcast of the virtual scientific program of the 2020 American Society of Clinical Oncology (ASCO) Annual Meeting. The studies cover new data from two cancer registries (CCC19 and TERAVOLT) assessing the impact of COVID-19 on patients with cancer, and results from the TROPHIMMUN trial and INFORM registry.

CCC19

Patients with cancer and COVID-19 had a heightened risk of dying if they had active disease, according to the first analysis of an ongoing COVID-19 and Cancer Consortium (CCC19) registry (Abstract LBA110).

Among 928 patients included in the analysis, 121 (13%) died at a median follow-up of 21 days. A multivariable logistic regression model that was partially adjusted revealed several factors associated with increased risk of death: older age, male sex, former smoking, high number of comorbidities , ECOG performance status great than 2, and active cancer.

For those with active cancer, having a stable or responsive disease was associated with a nearly two-fold increased risk (partially adjusted odds ratio [pAOR]=1.93; 95% CI, 1.06-3.5) and disease progression a nearly four-fold increased risk (pAOR=3.79; 95% CI, 1.78-8.08).

Receipt of azithromycin and hydroxychloroquine together was also associated with an increased risk of death. However, study presenter Jeremy Warner, MD, associate professor of medicine and biomedical informatics at Vanderbilt University Medical Center, cautioned that this finding is of “uncertain validity” due to a “high risk of residual confounding.”

“For example,” he said, “patients receiving this combination were more likely to have severe disease or more likely to be hospitalized.”

TERAVOLT

Prior receipt of chemotherapy, but not immunotherapy or tyrosine kinase inhibitors, was associated with increased risk of death for patients with thoracic malignancies and COVID-19, according to an updated analysis of the ongoing Thoracic cancERs international coVid 19 cOLlaboraTion (TERAVOLT) registry (Abstract LBA111).

Among 400 patients included in the analysis, 141 (35%) died at a median follow-up of 33 days. Most deaths (79.4%) were attributed to only COVID-19, while 10.6% were attributed to cancer. Most patients were hospitalized (78.3%).

A multivariate analysis revealed that age, ECOG performance status, use of steroids of greater than 10 mg per day, and prior receipt of chemotherapy were associated with increased risk of death. None of the therapies given to treat COVID-19 were significantly associated with outcomes.

TROPHIMMUN

Avelumab appeared to benefit patients with gestational trophoblastic tumors (GTT) resistant to monochemotherapy, according to data from cohort A of the TROPHIMMUN phase 2 trial (abstract LBA6008).

GTT are characterized by high levels of human chorionic gonadotropin (hCG), and among the 15 patients from cohort A who received avelumab after developing resistance to monochemotherapy, 7 achieved normal levels of hCG during treatment and one was achieved after.

No patients had disease relapse, which study presenter Benoit You, MD, PhD, Institut de Cancérologie des Hospices Civils de Lyon, interpreted as meaning these patients were “potentially cured.”

One woman who achieved normal levels of hCG went on to have a normal pregnancy and healthy baby, which is the first report of a patient achieving a normal pregnancy after treatment with immunotherapy.

No patients required dose reductions or delays, and common adverse events were fatigue (33%), nausea and vomiting (33%), infusion-related reactions (27%), thyroid disorder (20%), dry eyes (20%), and diarrhea (20%).

A phase 1/2 trial called TROPHAMET is ongoing to evaluate avelumab with methotrexate as a first-line treatment for patients with GTT.

INFORM

A 7-step treatment algorithm successfully identified molecular targets in children with relapsed cancers and matched them to targeted therapies; a subset of these patients even had a clinical benefit (abstract LBA10503).

Part of the INFORM registry, 526 children were evaluated with the treatment algorithm and 149 were matched to targeted drugs, of whom 20 had a very-high priority molecular target. Extremely high priority targets were primarily ALK, BRAF, and NRAS mutations and MET and NTRK-fusions.

The algorithm also identified 40 children with potential cancer predisposition syndrome, 17 of which were unaware of having the syndrome.

The subset of children with a very-high priority target had a significantly longer progression-free survival compared with the rest of the children (204.5 days vs 114 days; P=0.0093).

A set of biomarker-driven pediatric phase 1/2 trials, known as INFORM2, are underway.

By Christina Bennett, MS

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