Advertisement


Rainer Fietkau, MD, on Pancreatic Cancer: Initial Trial Results on Sequential Chemotherapy and Chemoradiotherapy

2022 ASCO Annual Meeting

Advertisement

Rainer Fietkau, MD, of Germany’s University Hospital Erlangen, discusses phase III findings of the CONKO-007 trial, which examined the role of sequential chemotherapy and chemoradiotherapy administered to patients with nonresectable locally advanced pancreatic cancer following standard-of-care chemotherapy (Abstract 4008).



Transcript

Disclaimer: This video transcript has not been proofread or edited and may contain errors.
So CONKO-007 study compared in a randomized Phase III trial the effect of chemoradiotherapy or chemotherapy following induction chemotherapy. We included the patients with nonresectable locally advanced pancreatic cancer. Following three months of induction therapy, restaging was performed and patients with new detected metastasis or insufficient dosage of chemotherapy were included. 525 patients were included. 366 patients were randomized. Important, we had the following feature of the study. Nonresectability was confirmed a panel of five experienced surgeons. This was checked again following the whole therapy and surgery was recommended if an R0 resection seems to be possible. And, we succeeded, that in both arms about 36% of the patients were then treated with surgery. We think that this high number was due to the fact that surgery was often recommended in the second surgical evaluation. The primary end point, the R0 resection, was evaluated in the 122 patients with resection. Following chemoradiotherapy, more R0 resections were possible. The rate of R1 resections was significantly lower. The OS rate of CRM negative tumor was significantly higher. Furthermore, we found significantly more complete remissions following chemoradiotherapy. In a second analysis, for all randomized patients nearly all statistically different parameters remained significant. Complete remission rate, R1 resection rate, CRM positive or negative status, all in favor of chemoradiotherapy. Only the R0 resection rate was no more statistically different, but this did not translate into a better overall progression free survival or overall survival. But what is very important, is the effect of additional surgery. None of the patients without surgery survived five years, but 17.5% with additional surgery. Of course, these are no randomized data and are biased by patient selection, but it may show the important role of surgery of these patients. Moreover, the best survival data we achieved for CRM or R0 resected patients was a five year survival rate of 35 to 27%. We found some hints that chemoradiotherapy improves this long term survival of surgically treated patients. Five year survival following chemoradiotherapy is 24% compared to 20% following chemotherapy alone. Of course, these results are not statistically different but may be a hint how the better R0 resection rate may potentially translate into a better survival. In conclusion, we found that additional chemoradiotherapy to chemotherapy improves significantly the R0 resected rate, in surgically treated group but not in all randomized patients. Additional chemoradiotherapy improves the rate of R0 CRM negative resected significantly and very importantly, 36% of all randomized patients can be treated additionally with surgery, the five year survival of 17.5% compared to 0% without surgery. Overall this concept of induction chemotherapy, additional chemoradiotherapy and surgery, is visible, with a five year survival rate of 9.6% and selects a favorable subgroup of patients that has an impressive long term survival rate of up to 26%. And the next steps in our analysis will be a further evaluation of prognostic parameters to select better patients who will benefit most from surgery and chemoradiotherapy.

Related Videos

Breast Cancer

Nancy Davidson, MD: In It for the Long Haul: Outcomes in Hormone Receptor–Positive Breast Cancer

Nancy Davidson, MD, of the Fred Hutchinson Cancer Research Center, reviews results from four abstracts about the importance of long-term follow-up in studies of adjuvant endocrine therapy for hormone receptor–positive breast cancer. Because the natural history of hormone receptor–positive breast cancer is long, an effort is underway to improve selection of patients by clinical parameters or biomarkers, refine the endocrine therapy background, and administer more effective combinations of endocrine therapy with other agents.

Pancreatic Cancer

Pamela L. Kunz, MD, on Pancreatic Neuroendocrine Tumors: A Final Analysis of Temozolomide or Temozolomide Plus Capecitabine

Pamela L. Kunz, MD, of the Yale University School of Medicine, discusses new findings from the ECOG-ACRIN E2211 trial, which showed the longest progression-free survival and highest response rates with temozolomide plus capecitabine reported to date for patients with pancreatic neuroendocrine tumors. The presence of a deficiency of MGMT, the drug-resistance gene, was associated with greater odds of an objective response (Abstract 4004).

Prostate Cancer

Alicia K. Morgans, MD, MPH, and Michael S. Hofman, MBBS, on Prostate Cancer: New Data on Lutetium-177–PSMA-617 (LuPSMA) vs Cabazitaxel

Alicia K. Morgans, MD, MPH, of Dana-Farber Cancer Institute, and Michael S. Hofman, MBBS, of Peter MacCallum Cancer Centre, University of Melbourne, discuss follow-up results on LuPSMA vs cabazitaxel in patients with metastatic castration-resistant prostate cancer progressing after docetaxel treatment. The findings suggest that LuPSMA is a suitable option for this population, with fewer adverse events, higher response rates, improved patient-reported outcomes, and similar overall survival compared with cabazitaxel (Abstract 5000).

Hepatobiliary Cancer
Immunotherapy

Akihiro Ohba, MD, on Biliary Tract Cancer: New Findings on Fam-Trastuzumab Deruxtecan-nxki

Akihiro Ohba, MD, of Japan’s National Cancer Center Hospital, discusses phase II data from the HERB trial on fam-trastuzumab deruxtecan-nxki, which showed activity in patients with HER2-expressing unresectable or recurrent biliary tract cancer (Abstract 4006).

Multiple Myeloma

Paul G. Richardson, MD, on Multiple Myeloma: New Data on Lenalidomide, Bortezomib, and Dexamethasone, With or Without ASCT

Paul G. Richardson, MD, of Dana-Farber Cancer Institute, discusses phase III findings from the DETERMINATION trial, which showed that, for patients with newly diagnosed multiple myeloma, lenalidomide, bortezomib, and dexamethasone (RVd) with or without autologous stem cell transplant (ASCT) and lenalidomide maintenance to disease progression resulted in the longest median progression-free survival reported for each approach, and a highly significant difference in progression-free survival in favor of early transplant. While overall response rates were similar, rates of MRD favored early transplant also, but toxicity was greater and quality of life was transiently but significantly diminished. No overall survival advantage has been observed to date (Abstract LBA4).

Advertisement

Advertisement




Advertisement