Top Abstracts from ASCO 2020

The American Society of Clinical Oncology’s annual meeting is an excellent opportunity to learn about and assess the latest developments in the field. The staff of Cleveland Clinic Cancer Center finds these abstracts the most compelling, clinically relevant and potentially transformative to the practice.

1. Late-Breaking Abstract 1

Maintenance avelumab + best supportive care (BSC) versus BSC alone after platinum-based first-line (1L) chemotherapy in advanced urothelial carcinoma (UC): JAVELIN Bladder 100 phase III interim analysis

In this randomized phase 3 trial, patients with advanced urothelial carcinoma whose cancer did not progress following four to six cycles of platinum-based chemotherapy were randomized to maintenance avelumab versus best supportive care. Patients treated with avelumab improved overall.

2. Late-Breaking Abstract 2

A randomized phase III trial of systemic therapy plus early local therapy versus systemic therapy alone in women with de novo stage IV breast cancer: A trial of the ECOG-ACRIN Research Group (E2108)

This study found no survival benefit to early local therapy for those with stage IV breast cancer at diagnosis, excluding patients with oligometastatic disease and those with progressing breast tumors during initial systemic treatment. Researchers postulated that for patients with triple-negative breast cancer, interrupting chemotherapy for surgery was associated with worse survival outcomes.

3. Late-Breaking Abstract 3

Carfilzomib, lenalidomide, and dexamethasone (KRd) versus bortezomib, lenalidomide, and dexamethasone (VRd) for initial therapy of newly diagnosed multiple myeloma (NDMM): Results of ENDURANCE (E1A11) phase III trial

In a randomized phase 3 trial, carfilzomib, lenalidomide and dexamethasone (KRd) was compared with bortezomib, lenalidomide and dexamethasone in patients with newly diagnosed multiple myeloma. There was no difference in the primary endpoint of progression-free survival between the two treatment arms. Furthermore, the three-year overall survival was also comparable. There was a significantly higher rate of cardiopulmonary and renal toxicity with KRd, while neuropathy rates were higher with VRd. VRd remains the standard triplet induction regimen in standard- and intermediate-risk newly diagnosed multiple myeloma.

4. Late-Breaking Abstract 4

Pembrolizumab versus chemotherapy for microsatellite instability-high/mismatch repair deficient metastatic colorectal cancer: The phase 3 KEYNOTE-177 study

This paper identifies a new standard of care for patients with newly diagnosed metastatic colorectal cancer with deficient mismatch repair, demonstrating that a single-agent immunotherapy drug, pembrolizumab, is superior to standard chemotherapy in this setting.

5. Late-Breaking Abstract 5

Osimertinib as adjuvant therapy in patients (pts) with stage IB–IIIA EGFR-mutation positive (EGFRm) NSCLC after complete tumor resection: ADAURA

The ADAURA trial was a phase 3 randomized trial of up to three years of adjuvant osimertinib (osi) or placebo in patients with resected stage IB-III EGFRm NSCLC. The trial was unblinded at an interim analysis for having already met its primary endpoint of improved disease-free survival (DFS) in patients with stage II/III disease, with a HR of 0.17 in favor of osimertinib (P < 0.0001), and a two-year DFS of 90% in the osi group compared with 44% in the placebo arm. While this is a very early look and no mature overall survival data is yet available, these results are likely significant enough to immediately change practice for patients with resected stage II or III NSCLC with mutations in EGFR.

6. Abstract 501

Three-year follow-up of neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2-blockade for HER2-positive breast cancer (TRAIN-2): A randomized phase III trial

Previously this study demonstrated no improvement in pathologic complete response with the inclusion of anthracycline in the setting of taxane- and carboplatin-based chemotherapy plus dual HER2 targeting with trastuzumab and pertuzumab, in neoadjuvant therapy for early stage HER2+ breast cancer. This analysis demonstrated that there is also no improvement in event-free or overall survival and that participants receiving anthracyclines experienced more toxicity including increased cardiotoxicity and acute leukemia.

7. Abstract 1005

Tucatinib versus placebo added to trastuzumab and capecitabine for patients with previously treated HER2+ metastatic breast cancer with brain metastases (HER2CLIMB)

This study conducted in individuals with metastatic HER2+ breast cancer included a substantial number of participants with known brain metastases. Among those patients, the addition of tucatinib to trastuzumab and capecitabine was associated with a five-month improvement in central nervous system progression-free survival and a six-month improvement in overall survival.

8. Abstract 5001

Pembrolizumab plus axitinib versus sunitinib as first-line therapy for advanced renal cell carcinoma (RCC): Updated analysis of KEYNOTE-426

KEYNOTE-426 was a randomized phase 3 trial of axitinib and pembrolizumab versus sunitinib in patients with treatment-naïve advanced renal cell carcinoma. In this updated analysis, the combination of axitinib and pembrolizumab continued to demonstrate superiority over sunitinib, further solidifying its place as a front-line treatment option for metastatic RCC patients.

9. Abstract 6500

Transoral robotic surgical resection followed by randomization to low- or standard-dose IMRT in resectable p16+ locally advanced oropharynx cancer: A trial of the ECOG-ACRIN Cancer Research Group (E3311)

This trial was the result of a remarkable effort by head and neck oncologic surgeons to standardize and investigate the technique of transoral robotic surgical resection (TORS). In patients with p16+ oropharynx cancer, low morbidity surgery allowed the identification of patients who could undergo successful treatment deintensification with either single modality TORS, or bimodality therapy with the addition of a lower dose of postoperative radiation to TORS. Despite very careful preoperative patient selection, 31% of enrolled patients had pathologic high-risk features which mandated trimodality therapy with the addition of chemotherapy to their postoperative treatment, and these patients still had an overall worse prognosis.

10. Abstract 6501

Equivalence randomized trial comparing treatment based on sentinel node biopsy versus neck dissection in operable T1-T2N0 oral and oropharyngeal cancer

This is the first randomized trial to explore the oncologic equivalence of a surgical approach to neck dissection for oral cavity cancer based on sentinel node biopsy. It demonstrated that patients randomized to undergo neck dissection only if a positive sentinel node was identified had equivalent relapse-free outcomes and better functional outcomes when compared with the control population who all underwent a planned dissection.

11. Abstract 7506

Phase II study of pevonedistat (P) + azacitidine (A) versus A in patients (pts) with higher-risk myelodysplastic syndromes (MDS)/chronic myelomonocytic leukemia (CMML), or low-blast acute myelogenous leukemia (LB AML) (NCT02610777)

This study marked the first demonstration that azacitidine-based combination therapy leads to significantly improved event-free survival for patients with higher-risk MDS.

12. Abstract 8005

KEYNOTE-204: Randomized, open-label, phase III study of pembrolizumab (pembro) versus brentuximab vedotin (BV) in relapsed or refractory classic Hodgkin lymphoma (R/R cHL).

For patients with relapsed or refractory Hodgkin lymphoma, two broad classes of novel agents are highly effective: checkpoint inhibitors (nivolumab and pembrolizumab) and the antibody drug conjugate, brentuximab vedotin. This head-to-head study of the two approaches demonstrated superiority of pembrolizumab over brentuximab vedotin in this setting. It is widely anticipated that this study will be practice-changing for management of patients with relapsed or refractory Hodgkin lymphoma.

13. Abstract 8008

Interim analysis of ZUMA-5: A phase II study of axicabtagene ciloleucel (axi-cel) in patients (pts) with relapsed/refractory indolent non-Hodgkin lymphoma (R/R iNHL).

In the interim analysis of ZUMA-5 trial, a phase 2 multi-center study of anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy (axi-cel) in patients with advanced indolent B-cell lymphomas who had failed at least two lines of prior therapy, overall response rate of 94% was seen in 87 evaluable patients (including complete response rate of 79%). Grade >/= 3 cytokine release syndrome and neurologic events occurred in 11% and 19% patients, respectively. Axi-cel demonstrated high rates of overall response in a population of patients with relapsed/refractory follicular and marginal zone lymphoma.