Advertisement


Alfredo Carrato, MD, PhD, on Pancreatic Cancer: Nab-Paclitaxel, Gemcitabine, and FOLFOX for Metastatic Disease

2022 ASCO Annual Meeting

Advertisement

Alfredo Carrato, MD, PhD, of Alcala de Henares University in Spain, discusses phase II results from the SEQUENCE trial, which showed that nab-paclitaxel, gemcitabine, and modified FOLFOX showed significantly higher clinical activity than the standard nab-paclitaxel and gemcitabine in the first-line setting of patients with untreated metastatic pancreatic ductal adenocarcinoma (Abstract 4022).



Transcript

Disclaimer: This video transcript has not been proofread or edited and may contain errors.
It's a pleasure for me to show the results of the SEQUENCE trial. The SEQUENCE trial was a randomized phase two trial in pancreatic cancer patients, metastatic ones on first line and we tried to increase the efficacy of the regimens used for treating these patients. So the rational that there were two subtypes of pancreatic cancer, the basal one responded better to Nab-Paclitaxel Gemcitabine and the classical one better to FOLFIRINOX. So as it was impossible to give both regimens at the same time for toxicity issues, we decided to give them sequentially first Nab-Paclitaxel Gemcitabine, and then not FOLFIRINOX, FOLFOX because we thought that the oxaliplatin was the main drug of the combination. And on top of that, we had that Nab-Paclitaxel was given up front and it was depleting this trauma and allowing the drugs to get in touch more efficiently with the tumor cells. So we performed a phase I trial, and we were surprised because we were expecting some neurological toxicity, but no neurologic toxicity appeared and it was safe at full doses and it was published at the European General Cancer two years ago. Then we designed this randomized phase two trial, trying to increase 50% the survival of patients at one year. It was from 35% to 50%, more or less. So with these things in mind, we designed a trial in which 78 patients per arm were needed and the safety results showed that neutropenia and thrombocytopenia were higher in the experimental arm, significantly higher, 47% and 26% and the efficacy at 12 months hypothesis was met. We found that 55.5% of patients were alive at one year in the experimental arm and only 35% in the control arm, which was Nab-Paclitaxel and gem without FOLFOX. So we looked for other efficacy parameters, like time to progression free survival, overall survival, and all of them were positive. In favor of the experimental arm. We reached a median overall survival of 13.2 months versus 9.5 months in the control arm. The hazard ratio was lower to 0.65 and this was real good surprise because we have discovered a new treatment option for our patients and pancreatic cancer patients have few good news. In the last 20 years, just two trials demonstrated an increase in efficacy rates. One of them was the Nab-Paclitaxel Gemcitabine and now against this regimen, we have demonstrated a superiority in efficacy. So we are happy about that and because our patients will live longer and have another option for treatment. This is only for a core zero and one patients, it's only for well fit patients, not for performance status, middle, core two, or very old patients but when you have these patients, this regimen provides excellent results.

Related Videos

Colorectal Cancer
Genomics/Genetics

Michael J. Overman, MD, and Smitha Krishnamurthi, MD, on RAS Wild-Type Metastatic Colorectal Cancer: Refining Treatment Strategy

Michael J. Overman, MD, of The University of Texas MD Anderson Cancer Center, and Smitha Krishnamurthi, MD, of the Cleveland Clinic, review three abstracts, all of which enrolled patients with newly diagnosed RAS and BRAF wild-type metastatic colorectal cancer with left-sided primary tumors. The discussion centers on what the study results indicate about the use of an EGFR therapy and weighing the risk to quality of life from rash, in particular (Abstracts LBA3503, LBA3504, LBA3505).

Prostate Cancer
Genomics/Genetics

Neal D. Shore, MD, on Germline Genetic Testing and Its Impact on Prostate Cancer Clinical Decision-Making

Neal D. Shore, MD, of the Carolina Urologic Research Center, discusses his study findings, showing that germline genetic testing influenced care for patients with prostate cancer. Men whose genetic test was positive for a pathogenic germline variant received more recommendations for changes to follow-up and treatment, and for testing and counseling of relatives, than did patients with negative or uncertain test results (Abstract 10500).

 

Lung Cancer

Apar Kishor Ganti, MD, on SCLC: Comparing Quality of Life With Once- and Twice-Daily Thoracic Radiotherapy

Apar Kishor Ganti, MD, of the University of Nebraska Medical Center, discusses results from the CALGB 30610 study, which showed a similar clinical benefit for once- and twice-daily radiotherapy administered to patients with limited-stage small cell lung cancer. While both regimens were well tolerated, patients who received radiotherapy once daily had better quality-of-life scores at week 3 and slightly worse scores at week 12. Patients believed the once-daily regimen was more convenient (Abstract 8504).

Lung Cancer

Maxwell Oluwole Akanbi, MD, PhD, on Lung Cancer: The Effect of Screening on the Incidence of Advanced Disease

Maxwell Oluwole Akanbi, MD, PhD, of McLaren Regional Medical Center, discusses the study he conducted, using the SEER database, to evaluate the impact of lung cancer screening recommendations on low-dose CT scanning. The data suggest that guidelines from the U.S. Preventive Services Task Force led to a more rapid decline in the incidence of advanced disease in the United States, especially among minority populations (Abstract 10506).

Colorectal Cancer

Michael J. Overman, MD, and Jeanne Tie, MBChB, MD, on Colon Cancer: Guiding Adjuvant Chemotherapy With ctDNA

Michael J. Overman, MD, of The University of Texas MD Anderson Cancer Center, and Jeanne Tie, MBChB, MD, of Peter MacCallum Cancer Centre, discuss results from the DYNAMIC trial, in which a circulating tumor DNA (ctDNA)-guided approach reduced the use of adjuvant chemotherapy without compromising recurrence-free survival in patients with stage II colon cancer (Abstract LBA100).

Advertisement

Advertisement




Advertisement