POST-ASCO 2019 GI Cancer. Halfdan Sorbye Professor, MD Haukeland Univ Hospital Bergen, Norway

Transkript

1 POST-ASCO 2019 GI Cancer Halfdan Sorbye Professor, MD Haukeland Univ Hospital Bergen, Norway

2 DISCLOSURES Consultant: Novartis, Pfizer, Keocyt, AstraZeneca. Honoraria: Ipsen, Novartis, Roche, Amgen, Merck, Shire, Celgene. Research funding: Novartis, Ipsen, Amgen. 2

3 Flere abstrakt på øvre GI 140 vs 110 på CRC Plenary øvre GI 3

4 Metastatic pancreatic cancer Presented By Hedy Kindler at 2019 ASCO Annual Meeting

5

6 Study design Presented By Hedy Kindler at 2019 ASCO Annual Meeting

7 Objective response* in patients with measurable disease <br />by blinded independent central review<br /> Presented By Hedy Kindler at 2019 ASCO Annual Meeting

8 Primary endpoint: PFS by blinded<br />independent central review* Presented By Hedy Kindler at 2019 ASCO Annual Meeting

9 OS: interim analysis, 46% maturity* Presented By Hedy Kindler at 2019 ASCO Annual Meeting

10 Gjennombrudd? Endelig en biomarkør for pancreas cancer NCCN i USA rutine BRAC testing på pancreas ca. Få pasienter (4%) aktuelle stort apperat. Unge? Skuffende gevinst PFS 3m, ingen OS. Men lang varighet av respons. Subopitimal kontroll arm vanligvis lengre behandling med FOLFIRINOX Kan bli en viktig del av en kombinasjonsbehandling 10

11 Abstract 4000 Presented By Margaret Tempero at 2019 ASCO Annual Meeting

12

13 Optimizing Chemotherapy for Frail and Elderly Patients with Advanced Gastroesophageal Cancer: Presented By Peter Hall at 2019 ASCO Annual Meeting

14 Slide 5 Arm A tilsvarer omtrent capecitabine 1000mg/2 x 2 dag Presented By Peter Hall at 2019 ASCO Annual Meeting

15 Patients Presented By Peter Hall at 2019 ASCO Annual Meeting

16 Slide 12 Presented By Peter Hall at 2019 ASCO Annual Meeting

17 Slide 23 Pasient som vurderes til å ikke kunne tåle full dose- gå ned til 60% dose. Kan alle gis 60% dose? OS lavere enn i studier 7.6 vs 13.3 m (EJC 2012) Presented By Peter Hall at 2019 ASCO Annual Meeting

18 Slide 11

19 Pembrolizumab With or Without Chemotherapy Versus Chemotherapy in Advanced G/GEJ Adenocarcinoma: The Phase 3, KEYNOTE-062 Study Presented By Josep Tabernero at 2019 ASCO Annual Meeting

20 KEYNOTE-062 Study Design (NCT ) Presented By Josep Tabernero at 2019 ASCO Annual Meeting

21 21

22 Overall Survival: P+C vs C (CPS 1) Presented By Josep Tabernero at 2019 ASCO Annual Meeting

23 Overall Survival: P vs C (CPS 1) Presented By Josep Tabernero at 2019 ASCO Annual Meeting

24 USA Pembro standard 3-linje Pembro 1-linje til pasienter som ikke tåler kjemo CPS>10: pembro 1-linje en mulighet 24

25 Slide 13 Presented By Osama Rahma at 2019 ASCO Annual Meeting

26 Slide 15 Presented By Osama Rahma at 2019 ASCO Annual Meeting

27 Hva sier vi til våre metastatiske esofagus/ventrikkel pasienter om immunterapi? Skal de informeres aktivt eller kun når de spør? ca 10% ser ut til å ha en markant nytte. Foreløpig ikke tilbud i det offentlige helsevesen. Om de vil ha videre behandling- nok det beste. Selv med effekt privat- offentlige overtar ikke pga likhetsprinsippet. 27

28 Immunterapi og HCC Monoterapi ser ikke ut til å ha særlig effekt Overall Survival (OS)

29 Slide 18

30 Slide 20

31 Results: DFS Comparison by Regimen Presented By Timothy Iveson at 2019 ASCO Annual Meeting

32

33 Primary outcome results: 2-year efficacy

34 So what did we learn from FOxTROT? Neocol studien (NCT ) som er en fase III studie 250 pasienter med lokalavansert kolonkreft : 3 CAPOX før operasjon og postopr kjemo om indikasjon vs Standard 8 CAPOX etter operasjon

35 in metastatic colorectal cancer Should we escalate 1st-line therapy to FOLFOXIRI?

36 Slide 11

37

38 Slide 26

39 39

40 Slide 3 Dobbel immunblokkering (PD-L1 og CTLA-4) Presented By Joleen Hubbard at 2019 ASCO Annual Meeting

41 TMB predictive for OS: Presented By Joleen Hubbard at 2019 ASCO Annual Meeting

42 Phase 1 Study Evaluating the Safety, Tolerability, Pharmacokinetics (PK) and Efficacy of AMG 510, a Novel Small Molecule KRASG12C Inhibitor, in Advanced Solid Tumors

43 CRC and Other Solid Tumors: Best Tumor Response* (n=19)

44 CRC: Individual Patient Radiologic Response and Biomarkers

45 Studien som ikke rakk ASCO med 3 dager: Press : 22 MAY 2019 The phase III BEACON study BRAF V600E-mutant mcrc 2/3 line. BRAF-inh + MEK-inh + cetuximab vs irinotecan-combo + cetux. Significant improvement in RR and OS Triplet lowered the risk of death by 48% and mos 9 m. 45

46 REGONIVO: Safety and Activity