OBR Daily Commentary - ESMO / ECC Conference Coverage

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Two Immunotherapy Drug Combination Offers Chemotherapy-Free Option for Advanced NSCLC

(ESMO 2019) Sept 28, 2019 - New data have shown that first-line treatment with a combination of two immunotherapy drugs improves overall survival in a subset of patients with advanced non-small cell lung cancer (NSCLC) compared to chemotherapy (1). The data from the CheckMate-227 trial, reported at the ESMO Congress 2019, suggest that the combination of nivolumab plus low-dose ipilimumab could offer a chemotherapy-free option for first-line treatment of patients with advanced NSCLC. Nivolumab, a PD-1 antibody, and ipilimumab, an anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) antibody, are immune checkpoint inhibitors with distinct but complementary mechanisms of action.

H. Jack West, MD (Posted: October 01, 2019)

quotesThe impact of the CheckMate-227 trial remains to be seen. While it was positive for an overall survival benefit, this was observed in the patients with PD-L1 expression 50%, but not in the patients with PD-L1 expression in between. This pattern doesn't give us a lot of confidence. At the same time, the OS benefit was compared to chemo alone, while the current standard of care is now chemo/pembro in most of these patients (certainly those with PD-L1 <1%), in whom there was a significant survival benefit seen in the KEYNOTE-189 and KEYNOTE-407 trials for patients with advanced non-squamous and squamous NSCLC, respectively. I expect that the appeal of a non-chemotherapy regimen will have some appeal to patients and oncologists, but we should recognize that non-chemo doesn't mean non-toxic. I expect that nivo/ipi will be a minor player compared to our current standards, likely used in <10% of patients in front line advanced NSCLC.quotes

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Front-Line Osimertinib Improves Overall Survival in EGFR-Mutation Positive NSCLC

(ESMO 2019) Sept 28, 2019 - First-line osimertinib significantly lengthens overall survival compared to older generation EGFR-TKIs in patients with Ex19del/L858R EGFR mutated advanced non–small cell lung cancer (NSCLC), according to late breaking results of the FLAURA trial presented at the ESMO Congress 2019 in Barcelona, Spain. (1) The primary endpoint of progression free survival (PFS) was previously reported. (2) Survival data are now mature: the median overall survival with osimertinib was 38.6 months versus 31.8 months with first generation EGFR-TKIs, with a hazard ratio of 0.799 (p=0.0462). More than half (54%) of patients in the osimertinib group were alive at three years compared to 44% in the standard care group.

H. Jack West, MD (Posted: October 01, 2019)

quotesAn important result that should satisfy the holdouts who were waiting on a demonstrated improvement in overall survival while considering the potential utility of a sequential approach. The trial has a few flaws, most notably not requiring a baseline MRI and not requiring treatment of detected brain mets -- both factors that clearly benefit the osimertinib arm -- and the rate of subsequent therapies is conspicuously lower than expected. Nevertheless, the efficacy, tolerability, and CNS activity of osimertinib are all very favorable, and the biggest limitation in its global use is the aggressive pricing, which precludes its availability for many EGFR mutation-positive patients around the world and makes it a financial challenge for many of those who can access it.quotes

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Mesothelioma Trial Suggests Immunotherapy as an Alternative to Chemotherapy

(ESMO 2019) Sept 30, 2019 - Patients with mesothelioma may gain similar benefit from immunotherapy as chemotherapy, and good responders may provide important clues to novel treatment for the thousands of new cases each year.

H. Jack West, MD (Posted: October 01, 2019)

quotesOverall, the results with immunotherapy for mesothelioma as presented at ESMO 2019 are quite disappointing. No improvement in progression-free survival or overall survival compared to nearly completely ineffective chemotherapy. quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Associate Clinical Professor, Medical Oncology Executi...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics Professo...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Steven Spielberg Family Chair in Hematology Oncology P...

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Stephen M. Schleicher, M.D., MBA

Community Oncology, Medical Oncologist, OneOncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Health Policy
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William McGivney, PhD

National Health Policy Expert...