Slide Show: 2014 ASCO Gastrointestinal Cancers Symposium

Slide 1: Antiangiogenesis Antibody Plus Chemotherapy Combination Improves Survival of Advanced Gastric Cancer PatientsResults from the large 665-patient second-line metastatic gastric cancer trial showed that adding ramucirumab, the monoclonal antibody against vascular endothelial growth factor receptor 2 (VEGFR2), to paclitaxel increases the overall survival of patients by 2.27 months (9.63 months for combination vs 7.36 months with paclitaxel monotherapy). Six- and 12-month survival was 72% and 40% vs 57% and 30% in the combination and monotherapy arms, respectively. Progression-free survival and quality of life were also improved in the combination arm.Source: Wilke H, Van Cutsem E, Cheul Oh S, et al. RAINBOW: A global, phase III, randomized, double-blind study of ramucirumab plus paclitaxel versus placebo plus paclitaxel in the treatment of metastatic gastroesophageal junction (GEJ) and gastric adenocarcinoma following disease progression on first-line platinum- and fluoropyrimidine-containing combination therapy. ASCO GI 2014; Abstract LBA7.Slide 2: Vaccine Combination Doubles Probability of Survival in Previously Treated Metastatic Pancreatic Cancer PatientsThe combination of two vaccines-the GVAX pancreas vaccine and CRS-207 immunotherapy-improved overall survival in a phase II 90-patient randomized clinical trial. Overall survival increased from 3.9 months in the GVAX-alone arm to 6.1 months in the combination therapy arm (hazard ratio = 0.5930; P = .0172) after a median 7.8-month follow-up.The combination of the vaccines doubled the probability of survival at 12 months from 12% in the GVAX-alone arm to 24% in the combination arm.The trial was stopped due to efficacy at the scheduled interim analysis, and patients in the GVAX-alone arm were crossed over to the combination therapy arm.Source: Le DT, Wang-Gillam A, Picozzi V Jr, et al. A phase II, randomized trial of GVAX pancreas and CRS-207 immunotherapy versus GVAX alone in patients with metastatic pancreatic adenocarcinoma: Updated results. ASCO GI 2014; Abstract 177.Slide 3: Status of RAS Mutation in Metastatic Colorectal Cancer Predicts Panitumumab ResponseAn analysis of KRAS and NRAS mutations in a phase III trial that combined panitumumab with second-line FOLFIRI chemotherapy in colorectal cancer patients shows that analysis of RAS mutations needs to go beyond just KRAS mutations in exon 2 to cover additional KRAS and NRAS mutations. KRAS mutations in exon 2 are known to predict resistance to panitumumab. The new analysis finds that KRAS and NRAS mutations in exons 2 and 3 also predict a lack of response to the EGFR inhibitor.Source: Peeters M, Oliner KS, Price TJ, et al. Analysis of KRAS/NRAS mutations in phase 3 study 20050181 of panitumumab (pmab) plus FOLFIRI versus FOLFIRI for second-line treatment (tx) of metastatic colorectal cancer (mCRC). ASCO GI 2014; Abstract LBA387.Slide 4: Oral Neoadjuvant Chemo Noninferior to Infusional Therapy in Rectal CancerThe National Surgical Adjuvant Breast and Bowel Project R-04 trial of 1,600 patients with previously untreated stage II or stage III rectal cancer showed that patients who received oral capecitabine did just as well as those treated with the standard 5-fluorouracil given by IV infusion. The recurrence rate and 3-year rate of locoregional events were not significantly different between the two treatment arms. The 5-year outcomes showed no significant differences in overall survival and disease-free survival.Source: Allegra CJ, Yothers G, O’Connell MJ, et al. Neoadjuvant therapy for rectal cancer: Mature results from NSABP protocol R-04. ASCO GI 2014; Abstract 390.Slide 5: Chemotherapy Combination Effective for Treatment-Resistant Neuroendocrine TumorsThe combination of capecitabine and temozolomide resulted in a greater than 90% objective response rate or stable disease in patients with difficult-to-treat and chemorefractory neuroendocrine tumors. Among 28 patients, the median progression-free survival was 22.2 months, and was more than 40 months in the subgroup of patients who had pituitary tumors.The most common grade 3/4 toxicities were lymphopenia (35%), hyperglycemia (6%), thrombocytopenia (3%), and diarrhea (3%).Source: Fine RL, Gulati AP, Tsushima D, et al. Prospective phase II study of capecitabine and temozolomide (CAPTEM) for progressive, moderately, and well-differentiated metastatic neuroendocrine tumors. ASCO GI 2014; Abstract 179.