Gabriel A. Brooks, MPH, MD, on Colorectal Cancer: Expert Perspective on the Need to Deintensify Oxaliplatin
2022 ASCO Gastrointestinal Cancers Symposium
Gabriel A. Brooks, MPH, MD, of the Norris Cotton Cancer Center, discusses key studies that, when synthesized, suggest the benefits of oxaliplatin may be less than often assumed. The toxicities are well described (especially neuropathy), and the agent should be used cautiously and sparingly beyond the third month of adjuvant treatment for patients with colon cancer and in the elderly or frail with metastatic disease.
Thierry André, MD, of Sorbonne University and Saint-Antoine Hospital, discusses phase II results from the GERCOR NEONIPIGA study, which suggests neoadjuvant therapy with nivolumab and ipilimumab may be associated with a high pathologic complete response rate in patients with localized microsatellite instability–high or mismatch repair–deficient esophagogastric adenocarcinoma. This study raises the question of whether surgery could be delayed or avoided for some patients (Abstract 244).
Ghassan K. Abou-Alfa, MD, MBA, of Memorial Sloan Kettering Cancer Center and Weill Medical College at Cornell University, discusses phase III results of the HIMALAYA trial, which showed the combination of a single priming dose of tremelimumab added to durvalumab is superior to sorafenib for patients with unresectable hepatocellular carcinoma (Abstract 379).
Heinz-Josef Lenz, MD, of USC Norris Comprehensive Cancer Center, discusses phase II results from the CheckMate 9X8 study, which compared nivolumab plus fluorouracil/leucovorin/oxaliplatin (mFOLFOX6) and bevacizumab vs mFOLFOX6 and bevacizumab in the first-line treatment of metastatic colorectal cancer. A subgroup of patients may benefit from adding nivolumab to the standard of care in this setting (Abstract 8).
Nilofer Saba Azad, MD, of Johns Hopkins Sidney Kimmel Cancer Center, assesses the findings from the phase III TOPAZ-1 trial, a study of durvalumab in combination with gemcitabine plus cisplatin in patients with advanced biliary tract cancer. Dr. Azad explains why the study sets a potential new standard of care of gemcitabine plus cisplatin and durvalumab in unselected patients.
Afsaneh Barzi, MD, PhD, of City of Hope Comprehensive Cancer Center and AccessHope, discusses results from a phase I/II study of regorafenib and pembrolizumab in refractory microsatellite-stable colorectal cancer. Although the trial did not meet its primary endpoint, the median overall survival is “provocative,” says Dr. Barzi. An analysis of biomarkers to identify patients with a longer duration of benefit is ongoing (Abstract 15).