To mark the first day of the ESMO Congress 2019 (27 September – 1 October, Barcelona, Spain) we have collated key news headlines for you.
Olaparib and bevacizumab show a benefit in ovarian cancer
Data presented from the PAOLA-1/ENGOT-ov25 trial have demonstrated the benefit of a more intensive maintenance regimen, consisting of the PARP inhibitor olaparib added to bevacizumab, for ovarian cancer.
The PAOLA-1/ENGOT-ov25 trial is the first Phase III trial to examine the efficacy and safety of a PARP inhibitor with bevacizumab as first-line maintenance therapy. The study enrolled 806 participants with stage III/IV ovarian cancer who had had a partial or complete response to standard platinum-based therapy and bevacizumab.
The patients were then randomized 2:1 to receive the PARP inhibitor olaparib or a placebo in combination with bevacizumab. In this all-comers population, including women with and without a BRCA mutation, the more intensive olaparib regimen was discovered to extend progression free survival; the median in the olaparib group was 22.1 months, compared with 16.6. months in the placebo group.
Study author Isabelle Ray-Coquard (Universite Claude Bernard, Lyon, France) commented: “This study reports the greatest hazard ratio (0.59) and longest progression free survival we have ever seen,”
“Patient selection was not restricted by surgical outcome or BRCA mutation status, so participants represent the general population of women with advanced ovarian cancer. Previous studies of relapse have suggested benefits from combining anti-angiogenic agents and PARP inhibitors and today’s results appear to support this. In addition, olaparib did not increase side-effects compared to placebo.”
One in two patients survive metastatic melanoma after 5 years with combination immunotherapy
Results from the 5-year analysis of CheckMate 067 have demonstrated five-year overall survival rates of 52% for nivolumab plus ipilimumab, 44% for nivolumab, and 26% for ipilimumab. “This is a major improvement on what we have seen historically,” commented James Larkin (Royal Marsden NHS Foundation Trust, London, UK). “10 years ago, the 5-year survival for melanoma was around 5%. With ipilimumab monotherapy, which has been used for around 10 years, around 20% of patients are long-term survivors and the remainder live for just 6-9 months.”
The analysis is the longest Phase III follow-up for checkpoint inhibitor combination therapy. A total of 945 patients with previously untreated stage III or IV melanoma were randomly allocated in a 1:1:1 ratio to 1) nivolumab plus ipilimumab; 2) nivolumab plus placebo; or 3) ipilimumab plus placebo until progression or unacceptable toxicity. Each nivolumab arm was compared to ipilimumab monotherapy.
“In the past, metastatic melanoma was regarded as untreatable,” commented Larkin. He continued: “Oncologists considered melanoma different to other cancers – it couldn’t be treated once it had spread. Traditional chemotherapy never really worked well. This treatment transforms the disease to one with an approximately 50% cure rate. The priority now is to find ways to cure the remaining 50%.”
New studies question whether novel anti-cancer drugs are worth their extra cost
A research team from the University of Zurich (Switzerland) have presented a study that indicates many new cancer therapies (introduced in the last 10-15 years) have low added value scores based on the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS).
The group also compared these added value scores to drug costs in Europe and America, which on average cost less than half the price in Europe than in America. There was no relationship between the price of the new cancer drugs and ESMO-MCBS score, indicating new drugs aren’t worth the extra cost.
The group emphasize the importance of ESMO-MCBS in clinical practice and how it should inform discussion between doctors and patients concerning treatment decisions. This way, patients can receive standardised, optimal therapy wherever they live.