ESGO: Preview of the 17th International European Society of Gynaecological Oncology Meeting

The European Society of Gynaecological Oncology (ESGO) biennial meeting is taking place in Milan, Italy, and will run from September 11–14, 2011. ESGO is Europe’s leading not-for-profit gynecological oncology society whose goal is to improve cancer care, provide education, and provide a platform for experts to present the latest treatment, care, and translational research.

There is much activity in the field of gynecological cancer research with respect to optimizing current treatments; identifying novel agents; characterizing tumor types in order to identify subpopulations that will be more likely to respond to a treatment; and identifying markers that can serve as a read-out of a response to treatment; here we provide an overview of what will take place at the meeting; next week we will be providing live coverage of the event.

ESGO topic overview

The key topics of discussion covered during the four-day meeting will include:

• Options and limits of predictive markers in gynecological oncology and mechanisms of chemotherapy resistance;

• Lowering the morbidity of surgical treatments of gynecological cancers;

• The way immunotherapy is viewed in the field, as either an established tool or a still-promising modality. Dr. Hans Nijman of the University Medical Center Groningen at the University of Groningen in the Netherlands will present the current landscape of both viral and non-viral tumor targets for immunotherapy related to this topic.

• Molecular biomarkers and therapeutic targets in ovarian cancer (implementation of biomarkers in ovarian cancer has been slower than other tumor types)

• A debate session on how surgery should be used in advanced ovarian cancer in terms of optimal timing for as frontline treatment or following chemotherapy from a surgeon’s and gynecological oncologist’s perspective;

• A workshop for patients on innovations in treatment, patient education best practices;

• An update on international collaborative clinical trials.

Key presentations and abstracts

Dr. Douglas A. Levine of Memorial Sloan Kettering Cancer Center will present an update of his research on the identification of biomarkers and therapeutic targets in endometrial cancer. The goal of the work is to find new markers that will readily predict whether a patient will respond to a certain treatment. Dr. Levine’s research focuses on profiling uterine and ovarian cancers using microarray techniques to molecularly categorize these cancers.

Abstract #423 "Establishing a molecular taxonomy for epithelial ovarian cancer (EOC) from 363 formalin fixed paraffin embedded (FFPE) specimens."
A microarray analysis of EOC samples in order to identify novel molecular subgroups to better characterize EOC which, despite histological heterogeneity and phenotypic diversity, is still largely treated as a single disease. Using microarray expression data, the authors aimed to identify novel molecular subgroups with a view to personalized therapy. Six subgroups were identified that were mostly related to histology and survival. Among the serous cancer clusters, the up-regulation of multiple angiogenesis genes were identified, which the authors suggest may be the reason for the recently reported efficacy of bevacizumab in the large-scale late-stage GOG218 and ICON7 trials.

Additionally, the data from the phase II olaparib in platinum-sensitive relapse serous ovarian cancer trial; the phase III Abagovomab as maintenance therapy in advanced ovarian cancer trial; and the OCEANS phase III trial of chemotherapy combined with bevacizumab in platinum-sensitive recurrent epithelial ovarian cancers, all of which were previously presented at other meetings, including this year’s American Society of Clinical Oncology (ASCO) meeting, will be reported on at ESGO.

Abstract #488“HE4 As Prognostic Marker In Endometrial Cancer”
The HE4 (human epididymis protein4) has been shown to have the potential to differentiate between benign endometrial disease and endometrial cancer. The data presented will provide evidence that the HE4 serum levels are an independent prognostic markers for endometrial cancer patients.

Abstract #1803"Endometrial Cancer: How should we individualize surgical treatment?"
The presentation will focus on the standard primary treatment for endometrial cancer as well as surgical treatment, including a comparison of traditional surgical techniques vs laparoscopic techniques.

Abstract #855"Oral poster presentation of the International Cancer Benchmarking Partnership study of survival of ovarian cancer patients from 1995 to 2007."
The research shows that survival trends are increasing but there remain persistent differences in ovarian cancer survival between countries. The patterns are consistent with later diagnosis or differences in treatment, particularly in Denmark and the UK, and in patients aged 65 or over.

Abstract #528“Efficacy of platinum/taxane-based chemotherapy in elderly with ovarian cancer: explorative analysis of three phase III trials from the AGO-Study-Group”
The data show that optimal chemotherapy can contribute to a prolongation of survival in patients over 70 years of age.

Abstract #1798"Personalizing therapy for ovarian cancer: BRCAness and beyond”
The presentation, by Dr. Stan Kaye at the Royal Marsden Hospital/Institute of Cancer Research, Sutton, UK will discuss the utility of PARP inhibition in BRCA-mutated ovarian cancers, including the recent studies with olaparib, an oral PARP inhibitor that has shown single-agent activity in women with both relapsed BRCA mutated and non-mutated ovarian cancer. The olaparib ovarian cancer phase II data was recently published in Lancet Oncology.

Treatment Presentations

Abstract #474“Trabectedin+PLD significantly prolongs survival in platinum sensitive + partially platinum sensitive relapsed ovarian cancer patients in comparison to PLD alone”
The OVA-301 phase III study follow-up for a median of 47.4 months shows that T + PLD shows a consistent benefit, 27.0 compared to 24.1 months overall survival for T+PLD compared to PLD alone. The therapy translated to a 35% risk reduction for partially platinum sensitive patients.

Abstract #1403 “Antitumor activity of olaparib (AZD2281) and liposomal doxorubicin in previously treated ovarian cancer patients”
This interim review of 44 patients in the phase I trial, including 21 ovarian cancer patients that were evaluated, showed that 15 patients achieved an objective response, with two and seven patients having a complete response or partial response. All patients had at least one adverse event, with the most common including stomatitis and nausea.

Abstract #1184“Weekly topotecan and cisplatin as neo-adjuvant chemotherapy for locally-advanced squamous cervical carcinoma: preliminary results of a phase II multicentric study”
While chemoradiation is the standard treatment for locally advanced cervical cancer, the use of neoadjuvant therapy is an alternative that has seen a 14% absolute improvement in survival. The presentation will highlight the ongoing results, which include a clinical response in 81% of patients and a 64% pathological response rate. The results so far show that weekly topotecan and cisplatin show an acceptable toxicity and a promising response rate.

Abstract #532“A phase II evaluation of aflibercept in the treatment of recurrent/persistent endometrial cancer: A Gynecologic Oncology Group (GOG) Study”
Aflibercept is an anti-angiogenic agent and novel fusion protein that targets the vascular endothelial growth factor A (VEGF-A), which is required for angiogenesis. The 49-patient trial showed a median PFS of 2.9 months and a 14.6 month median overall survival. However, 2 patients had treatment-related deaths of a pulmonary embolism and GI perforation, and high-grade adverse events were frequent.

Abstract #1719 “A phase II trial of AZD6244 in women with recurrent low-grade serous carcinoma of the ovary or peritoneum”
AZD6244 is a selective and potent inhibitor of the mitogen-activated protein kinase (MAPK)/ extracellular signal-regulated (ERK) kinase 1/2. 15.4% of patients showed a complete or partial response, with 63% (33 of 52 patients) having a PFS greater than 6 months. The disease rate for this trial is 81%, an encouraging statistic to continue the evaluation of MEK inhibitors in this population. The trial did not show any difference in response rates based on the mutation of the tumor (BRAF, KRAS, or NRAS mutations). The data show that AZD6244 is well tolerated and is active in low-grade serous carcinoma and does not appear, at least, in this small patient population, to be related to the RAS/RAF mutation status of the tumor. This study is being sponsored by the Gynecological Oncology Group and the NCI.

Watch the CancerNetwork for live coverage of ESGO!