New Developments in Cancer Research 2017
Advances in Cancer Treatment Presented at the 2017 American Society of Clinical Oncology Annual Meeting
CAR T-Cell Therapy Sends Multiple Myeloma into Lasting Remission
In an early clinical trial, 33 out of 35 people (or 94%) had clinical remission of multiple myeloma upon receiving a new type of immunotherapy – chimeric antigen receptor (CAR) T cells targeting the B-cell maturation antigen protein, or BCMA. Most had only mild side effects.
CAR T-cell therapy is custom-made for each person, as each person’s own T cells are collected, genetically reprogrammed in a lab, and injected back into them. The reprogramming involves inserting an artificially designed gene into the T-cell genome, which helps the genetically reprogrammed cells find and destroy cancer cells throughout the body.
Alectinib Halts Lung Cancer Growth More Than a Year Longer Than Crizotinib
Findings from a phase III clinical trial point to a more effective initial treatment for people with ALK-positive non-small cell lung cancer. Compared to the current standard of care crizotinib (Xalkori), the newer ALK inhibitor alectinib (Alecensa) halted cancer growth for a median of 15 months longer, caused fewer severe side effects, and was especially beneficial in controlling and preventing brain metastases.
Although most people with non-small cell lung cancer initially benefit from crizotinib, the cancer typically starts growing again within a year. Alectinib is a more potent, next-generation inhibitor of ALK. It was initially approved in 2015 for advanced non-small cell lung cancer that worsens despite crizotinib.
Early Research Suggests First Immunotherapy for Mesothelioma on the Horizon
Malignant pleural mesothelioma, or MPM, is a rare cancer, but its incidence has been rising. People with MPM have a median life expectancy of only 13 to 15 months. All survivors relapse despite initial chemotherapy, more than 50% of them within 6 months after stopping treatment. There are currently no effective therapeutic options for people with MPM. Early findings from an ongoing phase II clinical trial show that immunotherapy may slow the growth of MPM after relapse. At 12 weeks, cancer had not worsened in 44% of participants who received nivolumab (Opdivo) and in 50% of those who received nivolumab with ipilimumab (Yervoy).
Adding a Second HER2 Blocker May Lower Chance of Invasive Breast Cancer for Some Women
A phase III clinical trial of women with HER2-positive breast cancer suggests adding a second HER2 targeted medicine, pertuzumab (Perjeta), to standard of care trastuzumab (Herceptin) after surgery may help, although the benefit is modest. While the prognosis for people who receive standard of care trastuzumab is already favorable, those in the study who received pertuzumab and trastuzumab had a 19% lower chance of developing invasive breast cancer than those who received trastuzumab alone.
While trastuzumab targets only HER2, pertuzumab blocks HER2 and HER3. Using both antibodies establishes a more complete blockade of cancer cell growth signals and may lower the chance of treatment resistance.
Research Suggests Possible New Treatment for EGFR-Positive Non-Small Cell Lung Cancer
Findings from a phase III clinical trial point to a potential new treatment for people newly diagnosed with advanced, epidermal growth factor receptor (EGFR)-positive non-small cell lung cancer. Compared to the EGFR inhibitor gefitinib (Iressa), one of the standard targeted medicines for this disease, second-generation EGFR inhibitor dacomitinib delayed cancer growth by a median of 5.5 months more.
Due to its chemical properties, dacomitinib blocks EGFR more effectively than first-generation inhibitors, such as gefinitib and erlotinib, and this explains its ability to keep tumor growth in check longer. On the other hand, this also leads to stronger suppression of the normal EGFRs in healthy tissues, causing more side effects such as skin rash, acne, and diarrhea. Another second-generation EGFR inhibitor, afatinib, is already FDA approved as an initial treatment for EGFR-positive non-small cell lung cancer. Dacomitinib is not yet approved for any indication.
Global Study Sets New Risk-Based Standard to Personalize Chemotherapy for Colon Cancer after Surgery
After surgery for lymph-node positive colon cancer (stage III), some people may only need half of the long-standing standard course of chemotherapy. In an analysis of six clinical trials, researchers found that 3 months of chemotherapy was nearly as effective as 6 months in people with relatively lower recurrence risk and caused fewer side effects, particularly nerve damage.
Nerve damage, which is a key side effect of oxaliplatin, one of the chemotherapies in the regimen, can result in permanent numbness, tingling, and pain. The longer a person receives oxaliplatin, the greater the chance for severe and long-lasting nerve damage. Nerve damage was substantially less common in people receiving the shorter course of chemotherapy.
Olaparib Slows Growth of BRCA-Related Metastatic Breast Cancer
Findings Suggest PARP Inhibitors Could Play an Important Role in Breast Cancer Treatment
Findings from a phase III clinical trial may introduce PARP inhibitors as a new type of treatment for breast cancer. Compared to standard chemotherapy, the oral targeted medicine olaparib (Lynparza) reduced the chance of progression of advanced, BRCA-related breast cancer by 42%, delaying progression by about 3 months. Olaparib is already FDA approved for use in women with BRCA-related ovarian cancer.
“Olaparib will probably be best used early in the course of metastatic breast cancer. It helps preserve patient quality of life, offers the chance to postpone the need for I.V. chemotherapy, and avoids side effects like hair loss and low white blood cell counts,” says lead study author Mark E. Robson, MD.
Pregnancy after Breast Cancer Does Not Increase Chance of Recurrence
Findings from a retrospective study offer reassurance to breast cancer survivors who are contemplating pregnancy. In the study, women who became pregnant after an early breast cancer diagnosis, including those with estrogen receptor (ER)-positive tumors, did not have a higher chance of cancer recurrence and death than those who did not become pregnant.
Abiraterone Delays Metastatic Prostate Cancer Growth, Extends Survival
Adding abiraterone acetate (Zytiga) plus prednisone to standard hormonal therapy for men newly diagnosed with high-risk, metastatic prostate cancer lowers the chance of death by 38%. In a phase III clinical trial, abiraterone also more than doubled the median time until the cancer worsened, from 14.8 months to 33 months.
Lead study author Karim Fizazi MD, PhD, says, “The benefit from early use of abiraterone we saw in this study is at least comparable to the benefit from docetaxel chemotherapy, which was observed in prior clinical trials, but abiraterone is much easier to tolerate, with many patients reporting no side effects at all.”
These findings are underscored by a second clinical trial showing a 3-year survival rate of 83% with standard therapy plus abiraterone, versus 76% with standard therapy alone.
New Drug Shows Durable Efficacy Across Diverse Pediatric and Adult Cancers
Larotrectinib Targets Rare Genetic Abnormality, TRK Fusions
Scientists may have developed the first targeted, oral, tumor-type agnostic therapy – a cancer medicine that works comparably well across many kinds of cancer, regardless of patient age. In clinical trials of adults and children with 17 different types of advanced cancer, larotrectinib treatment resulted in responses in 76% of patients. Response to larotrectinib has been durable, with 79% of responses ongoing 12 months after starting treatment.
Larotrectinib is a selective inhibitor of tropomyosin receptor kinase (TRK) fusion proteins, which are a product of a genetic abnormality when a TRK gene in a cancer cell fuses with one of many other genes. “TRK fusions are rare, but occur in many different cancer types,” says lead study author David Hyman, MD. “These findings embody the original promise of precision oncology: treating a patient based on the type of mutation, regardless of where the cancer originated.”
Psychological Intervention Lowers Survivors’ Fear of Cancer Recurrence
About 50% of all cancer survivors report moderate to high fear of recurrence. The fear can be so distressing that it negatively affects medical follow-up, mood, relationships, work, and quality of life. In a phase II randomized clinical trial, a psychological intervention called Conquer Fear substantially lowered fear of recurrence immediately after the intervention, as well as 3 and 6 months later. Moreover, general anxiety, cancer-specific distress, and quality of life were better in the psychological intervention group immediately after therapy.
A Single Radiation Treatment Sufficiently Relieves Spinal Cord Compression Symptoms
A common complication in people with metastatic cancer, spinal cord compression is a major detriment to quality of life. Radiation treatment is widely used to relieve pain and other symptoms, but there is no standard recommended schedule. Findings from a phase III clinical trial show that a single radiation treatment is as effective as a full week of radiation.
“Our findings establish single-dose radiotherapy as the standard of care for metastatic spinal canal compression, at least for patients with a short life expectancy,” says lead study author Peter Hoskin, MD, FCRP, FRCR. “For patients, this means fewer hospital visits and more time with family.”
Low Testosterone after Testicular Cancer Is Common, Linked to Chronic Health Problems
In a large study, 38% of testicular cancer survivors had low testosterone levels, known as hypogonadism. Compared to survivors with normal testosterone levels, survivors with low testosterone were more likely to have a range of chronic health problems, including high blood pressure, diabetes, erectile dysfunction, and anxiety or depression.
“Because testicular cancer occurs at a young age and is highly curable, many survivors may live upwards of five decades,” says lead study author Mohammad Issam Abu Zaid, mbbs. “Our findings underscore the need for clinicians to assess testicular cancer survivors for physical signs or symptoms of hypogonadism and to measure testosterone levels in those who [exhibit them].”
Chance of Colon Cancer Recurrence Nearly Cut in Half in People Who Eat Nuts
An observational study of people with stage III colon cancer showed that those who consumed two ounces or more of nuts per week had a 42% lower chance of cancer recurrence and 57% lower chance of death than those who did not eat nuts. A secondary analysis revealed the benefit of nut consumption was limited to tree nuts, which include almonds, walnuts, hazelnuts, cashews, and pecans, among others. There was no associated reduction in cancer recurrence and death among people who consumed peanuts or peanut butter.
Targeted Therapy Can Delay Recurrence of Intermediate-Stage Lung Cancer
The targeted therapy gefitinib appears more effective in preventing recurrence after lung cancer surgery than the standard of care, chemotherapy. In a phase III clinical trial, people with EGFR-positive, stage II-IIIA non-small cell lung cancer who received gefitinib went about 10 months longer without recurrence than those who received chemotherapy.
Oral Chemotherapy Extends Survival by More Than a Year in Biliary Tract Cancer
A phase III randomized clinical trial of people with biliary tract cancers showed that giving capecitabine after surgery extends survival by a median of 15 months compared to surgery alone. The finding could provide the basis for a new standard of care in the disease.
Visit the American Society of Clinical Oncology’s patient education website – Cancer.Net – for more research highlights from the 2017 Annual Meeting, as well as more information and resources for cancer survivors and their caregivers.
This article was published in Coping® with Cancer magazine, July/August 2017.