Systemic therapies refine surgical treatment of cancer

  • Markham MJ & al.
  • J Clin Oncol
  • 4 Feb 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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  • The American Society of Clinical Oncology (ASCO)'s annual report on progress against cancer lists notable studies that showed systemic therapies reduced the need for surgery, improved outcomes after surgery, and increased the number of patients who can undergo resection in melanoma, renal, and pancreatic cancer.

Key highlights

  • Advanced melanoma: neoadjuvant immunotherapy treatments improved response rate after surgery:
    • NeoCombi trial (35 patients with BRAFV600 mutation): at resection, 86% of patients achieved overall response and 46% had complete responses with neoadjuvant dabrafenib+trametinib.
    • OpACIN-neo trial: 2 cycles of neoadjuvant 1 mg/kg ipilimumab and 3 mg/kg nivolumab instead of standard 4 cycles showed 57% radiologic objective response rate and 77% pathologic response rate with fewer grade 3-4 adverse events.
  • Renal cell carcinoma: targeted therapy as an alternative to upfront surgery:
    • CARMENA: sunitinib alone was not inferior to cytoreductive nephrectomy followed by sunitinib in 450 poor/intermediate-risk patients (median OS, 18.4 vs 13.9 months).
    • SURTIME: deferred surgery allowed more patients to receive sunitinib vs upfront surgery, which resulted in superior OS (median, 32.4 vs 15.0 months).
  • Pancreatic cancer: upfront treatments make surgery possible for more patients in 2 single-arm phase 2 studies:
    • Study 1: 48 patients with borderline resectable pancreatic ductal adenocarcinoma received neoadjuvant FOLFIRINOX (folinic acid+fluorouracil+irinotecan+oxaliplatin) plus radiotherapy; 31 underwent surgery, of which 67% had negative margins.
    • Study 2: 49 patients with locally advanced disease received FOLFIRINOX+losartan; complete resection rate was 61%.