EORTC at ESMO 2024
In 2024 EORTC made significant contributions at the European Society for Medical Oncology (ESMO) Congress, which took place in Barcelona, Spain, between September 13th-17th, attracting over 30,000 participants from 149 countries. EORTC presented seven research abstracts, including one featured in the prestigious Presidential Symposium, and took part in four educational sessions focused on advancing oncology knowledge.
Important new results and an update on an EORTC trial in progress were reported at the Congress underlining EORTC’s commitment to innovative cancer research.
Prostate cancer: Professor Silke Gillessen presented the results of the EORTC PEACE III trial which tested a new combination treatment for patients with metastatic prostate cancer that no longer respond to hormone therapy (metastatic castration-resistant prostate cancer, or mCRPC). Importantly, side effects were mild, although patients should receive bone-protecting agents to avoid fractures. This combination therapy has been proven to be an effective treatment option for patients with mCRPC, bone disease and disease progression already on androgen deprivation therapy.
Melanoma: Results from the EORTC MINITUB trial presented by Professor Alexander C.J. van Akkooi, indicated that some melanoma patients can avoid drug treatments or extensive surgery with minor impact on risk of developing metastatic disease or losing the battle to melanoma. In the past, patients with a melanoma that had spread to the sentinel node – the first lymph node/groups of nodes to which the cancer usually spreads – underwent a complete lymph node dissection in addition to surgery. Lymph node dissection carries significant toxicity and can have a lifelong impact on the patient’s quality of life. The objective of the EORTC MINITUB study was to assess the outcomes of patients with a minimal amount of cancer in the body, who did not undergo complete lymph node surgical removal.
Key findings of the MINITUB study: The study showed that patients with minimal cancer in the body who chose to be observed rather than have their lymph node removed, had a relatively low risk of cancer spread or death due to melanoma. These results provide strong evidence that assessing the state of the sentinel node tumour is helpful in establishing cure and survival chances of each patient and can show whether the benefits of melanoma treatments outweigh the risk of toxicities, especially for patients with a relatively low risk of developing metastatic disease.
Another presentation of relevance to melanoma featured follow-up data from the EORTC KEYNOTE study of the immunotherapy treatment pembrolizumab. Presented by Professor Alexander Eggermont, the data shows the longer-term clinical treatment benefits to patients following full removal of cancerous tissue. The trial found that after five years of follow-up, survival was improved, whilst risk of progression was significantly reduced in the patients who had received treatment rather than placebo.
Head and neck cancer: The EORTC HNCG (Head and Neck Cancer Group) trial, conducted in partnership with the International Rare Cancer Initiative (IRCI), was presented by Dr Laura Locati. It is the first-ever study conducted in salivary gland cancers (SGCs) with androgen receptors (ARs). SGCs are rare and make up less than 5% of all head and neck cancers. In cases of cancer recurrence or spread, platinum-based chemotherapy is the usual treatment for SGCs.
Despite some positive responses, the study failed show that androgen deprivation therapy (ADT) was better than chemotherapy for patients with AR. The researchers believe that combining ADT with chemotherapy and/or HER2 inhibitors-drugs which slow down or stop the growth of cells in some breast cancers, might be the way forward as a future treatment strategy in recurrent and/or metastatic SGCs and will now be investigating this further.
Lung cancer: Malignant pleural mesothelioma (MPM) is a rare form of lung cancer with a poor chance of cure or survival, for which treatment options are limited. In MPM, tumours form in the lining of the lungs (pleura) caused by the inhalation of asbestos fibres. The goal of the EORTC NEMO trial, results from which were presented by Dr Omar Abdel-Rahmann, was to evaluate the role of drugs which block formation of new blood vessels aiding cancer growth, using oral medication (nintedanib) as a new therapy in patients with MPM. In this trial, patients without progressive disease were enrolled after completing initial platinum-based chemotherapy.
Key findings of the NEMO Study: The study showed that active treatment had a negative effect on overall and progression-free survival in another LUME-Meso trial, which led to the early termination of recruitment into the NEMO trial. Due to an imbalance in immunotherapy, the effect of nintedanib was harmful to patients, as opposed to placebo. Researchers confirm that these results are consistent with those from the LUME-Meso trial.
Rare cancers: Rare cancers include more than 300 different types of cancer and may affect all organs. They represent about 20% of all adult cancer cases, but their mortality rate is 30%. Because they are very rare, patients may have limited access to molecular profiling and clinical trials, and this can lead to inaccurate diagnosis and limited treatment options. Identifying targets for therapy is therefore a priority.
Dr Marie Morfouace, presented updated results from the ARCAGEN collaborative study carried out within EORTC-SPECTA a molecular and biological research platform. The goal of ARCAGEN is the detection of genetic alterations in rare cancers. The presentation focused on specific alterations of chromosomes called rearrangements, which were identified in the tumours of 18% of the patients in the study. They were clinically significant in 11% and actionable (potentially responsive to therapy) for 3.1% of them. The researchers concluded that rearrangements in rare cancers have a similar occurrence rate to that seen in common cancers. However, despite the identification of these alterations, treatment access remains limited.
Breast cancer
From left to right: Orsolya Birta, Medical Advisor at BIG; Ana Joaquim, Clinical Research Physician at EORTC; Jose Casas, Translational Research Scientist at EORTC; Michail Ignatiadis, Chair of the EORTC Breast Cancer Group, Director of the Breast Medical Oncology Clinic & Program at the Jules Bordet Institute, Associate Professor at the Université Libre de Bruxelles, and Study Coordinator of the TREAT ctDNA trial; and Carmela Caballero, Medical Advisor at BIG.
Details of the EORTC-TREAT ctDNA breast cancer trial, currently recruiting patients, were presented by Dr Michail Ignatiadis. The international trial is investigating the effect of elacestrant, a new type of endocrine therapy, in early breast cancer patients who are identified as high risk of circulating tumour DNA (ctDNA) recurrence.
Throughout the trial’s two phases, patients are first screened for ctDNA every six months after which, those positive for ctDNA are invited to proceed to phase two where intensive follow-up is used to detect occurrence as early as possible. Patients are split into two groups-one continuing to receive existing hormone therapy, and the other switching from their current endocrine therapy to elacestrant. The investigators hope that the trial will help to prevent or delay cancer recurrence in patients with ctDNA.
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