Belinda Lee, MBBS, on Early-Stage Pancreatic Cancer: New Data on Guiding Adjuvant Chemotherapy
2024 ASCO Annual Meeting
Belinda Lee, MBBS, of Peter MacCallum Cancer Centre, Northern Health, Walter & Eliza Hall Institute, Melbourne, discusses findings from the AGITG DYNAMIC-Pancreas trial on the potential role of serial circulating tumor DNA testing after upfront surgery to guide adjuvant chemotherapy for early-stage disease (Abstract 107).
Transcript
Disclaimer: This video transcript has not been proofread or edited and may contain errors.
I'm here today to talk to you about the DYNAMIC-Pancreas clinical trial. This was a non-randomized phase 2 study looking at the potential role of circulating tumor DNA testing after upfront surgery to guide adjuvant chemotherapy for early-stage pancreatic cancer patients. In this study, we explored the feasibility and clinical utility of tumor-informed ctDNA testing for patients after surgery to see if we could guide their treatment. This study confirmed that the prognostic significance of ctDNA as a biomarker after surgery in early-stage pancreatic cancer. Even when ctDNA is not detected after surgery, there is still a high risk of recurrence that remains. We enrolled 102 patients from 26 Australian cancer centers exploring the feasibility and clinical utility of circulating tumor DNA. We looked to ask questions like, can the use of ctDNA inform us about the risk of recurrence in our patients, and can we use ctDNA to guide the use of adjuvant chemotherapy comparing three versus six months duration of chemotherapy, as well as comparing the use of different intensities of chemotherapy looking at triplet versus doublet chemotherapy in our patients?
What we found was that ctDNA does indeed provide prognostic significance in early-stage pancreatic cancer. However, even in the negative ctDNA cohort, the risk of relapse remains. We would still advise that you give six months of adjuvant chemotherapy treatment. While ctDNA-negative indicates as low risk of recurrence, patients should still undergo their adjuvant chemotherapy treatment, and future studies should incorporate the use of ctDNA after treatments from surgery, as well as after adjuvant chemotherapy. Changes in ctDNA may be used to track the changes in the patient's tumor burden throughout their treatment. We could also use ctDNA to integrate ctDNA into new studies looking at novel agents as well.
The ASCO Post Staff
Peter Riedell, MD, of The University of Chicago, discusses phase III findings on the regimen of brentuximab vedotin in combination with lenalidomide and rituximab for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). This therapy demonstrated a survival advantage in the third-line setting, but as this is an interim analysis, questions remain regarding long-term safety and duration of response, according to Dr. Riedell (Abstract LBA7005).
The ASCO Post Staff
Reshma Jagsi, MD, DPhil, of Emory University Winship Cancer Institute, and Christian F. Singer, MD, MPH, of the Medical University of Vienna, discuss the MUC-1 vaccine tecemotide. When added to standard neoadjuvant systemic therapy for patients with early-stage breast cancer, this vaccine improved distant relapse–free and overall survival rates. Despite the exploratory nature of this observation, says Dr. Singer, this is the first long-term survival benefit of an anticancer vaccine in breast disease reported to date (Abstract 587).
The ASCO Post Staff
Peter Riedell, MD, of The University of Chicago, discusses phase III results on the use of tucidinostat plus R-CHOP in patients with previously untreated diffuse large B-cell lymphoma (DLBCL) with double expression of MYC and BCL2. The regimen appeared to improve event-free survival and complete response rates vs R-CHOP in the front-line setting. As this is an interim analysis, longer-term follow-up will be needed to better understand its impact, says Dr. Riedell.
The ASCO Post Staff
Milana Bergamino Sirvén, MD, PhD, of Spain’s Institute of Cancer Research, discusses her findings on molecular profiling of patients with estrogen receptor–positive, HER2-positive early-stage breast tumors after short-term preoperative endocrine therapy. This study suggests that such profiling may help clinicians identify those patients with a favorable prognosis for adjuvant endocrine therapy and those who may require additional treatment (Abstract 560).
The ASCO Post Staff
Mazyar Shadman, MD, MPH, of Fred Hutchinson Cancer Center, discusses a network meta-analysis showing that zanubrutinib appears to be the most efficacious Bruton’s tyrosine kinase (BTK) inhibitor for patients with high-risk relapsed or refractory chronic lymphocytic leukemia. It offers delayed disease progression and favorable survival and response, compared with alternative BTK inhibitors (Abstract 7048).