Image caption, Proposals aimed at modifying the so-called “therapeutic trajectory” of patients were presented at the annual ASCO meeting.Article information
- Author, André Biernath
- Role, BBC News Brazil
July 19, 2024
Amid so many technological innovations and pharmaceutical launches, it is striking that the world’s main scientific conference on cancer highlighted well-known drugs that have been marketed in recent years.
The main news of the event reinforces the fact that one of the greatest challenges for specialists lies in organizing the most effective “therapeutic pathway” for the patient, or when is the right time to use each of the available resources, from surgeries to medications.
At the 2024 annual conference of the American Society of Clinical Oncology (ASCO), tens of thousands of doctors gathered in the city of Chicago, USA, to learn about new treatment proposals.
The research presented at the event proposed different approaches to fight esophageal cancer and melanoma (a more aggressive type of skin tumor) and laid out solutions for some unmet needs of people suffering from lung cancer.
According to doctors interviewed by BBC News Brazil, this new information is changing the way these diseases are treated in clinics and hospitals.
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Experts also emphasized palliative care and even penile cancer: an experience conducted in Brazil suggests a new line of treatment for this tumor surrounded by taboos and prejudices.
BBC News Brazil spoke with doctors present at ASCO 2024 and summarizes below four of the main cancer-related news discussed at the conference.
1. Lung cancer: increased survival
People diagnosed with the most common type of lung cancer, which is already at stage 3, where the disease has progressed but has not yet spread to other parts of the body, are no longer candidates for curative surgery.
In these cases, the traditional therapeutic strategy calls for chemotherapy and radiotherapy sessions.
In mid-2017, a study conducted by several institutions worldwide revealed that adding immunotherapy significantly increases the survival time of these individuals.
Image caption, Adding immunotherapy to lung cancer treatments has proven beneficial in extending patients’ lifespans.
Immunotherapy is a relatively new treatment line that does not attack the tumor directly, but rather stimulates the patient’s immune system to identify and destroy the diseased cells.
Thanks to this work, the combination of chemotherapy, radiotherapy, and immunotherapy has become the standard treatment regimen, at least in cases where there is access to modern and more expensive drugs.
“However, there is a specific group of patients in this universe who do not benefit from immunotherapy, as they show very similar outcomes to those who took a placebo,” emphasizes oncologist Mariana Laloni, technical medical director of Oncoclínicas&Co.
The doctor refers to those with an EGFR gene mutation, which is found in the DNA of 15 to 25% of individuals affected by the most common lung cancer.
A study presented at ASCO 2024 sought to find solutions specifically for this group.
Researchers evaluated whether the drug osimertinib, from the pharmaceutical company AstraZeneca, could prolong the lives of patients diagnosed with grade 3 non-small cell lung cancer with an EGFR gene mutation.
Image caption, Teleconsultations have not proven worse than face-to-face consultations and, in some cases, they are even better.
The results obtained were considered positive: in the group receiving the drug, the progression-free survival time was 39.1 months (over three years). For those taking a placebo, this rate was 5.6 months.
Laloni believes that the results are encouraging and bring good prospects. However, he thinks there are still unanswered questions.
“We still need to know whether it’s better to use this drug immediately after the initial treatment [with chemotherapy and radiotherapy] or when the disease progresses,” the specialist specifies.
“This is important for addressing issues like toxicity, side effects, and costs.”
The oncologist also highlights another lung cancer study mentioned at ASCO 2024.
A group of American experts decided to study whether teleconsultations in palliative care for patients with this advanced tumor could work just as well as face-to-face meetings with healthcare professionals.
“This study compared one group having access to in-person palliative care to another group receiving the same care via electronic telehealth tools,” he explains.
The scientists’ goal was to check whether the effects of remote consultations would be worse, the same, or better.
“The results show that teleconsultations are no worse than in-person evaluations and, in some respects, even superior,” the doctor explains.
According to Laloni, this remote care program can be particularly welcome for those who have difficulty getting to a clinic or hospital.
2. Esophageal cancer: the order of therapies makes a difference
The treatment of esophageal adenocarcinoma, one of the most common types of cancer of the tube connecting the mouth to the stomach, is a highly polarized subject.
On one side, a group of doctors advocated for a so-called neoadjuvant treatment regimen. In summary, the proposal consists of conducting chemotherapy and radiotherapy sessions before subjecting the patient to surgery to remove the tumor.
In contrast, some experts preferred a perioperative treatment, meaning chemotherapy sessions before and after surgery.
Image caption, Receiving chemotherapy before and after surgery increases the survival of patients with esophageal tumors
“The data we had until then did not allow us to define which of the two strategies was better, so the choice of one or the other depended on the decision of each institution,” explains Dr. Paulo Hoff, president of the Oncologia D’Or center.
To resolve this doubt, researchers from several German centers decided to compare the approaches. The obtained results indicated a wide advantage for perioperative treatment.
Patients following this regimen had a median survival of 66 months. The group receiving neoadjuvant treatment had a survival of 37 months, marking a difference of nearly 2.5 years between the groups.
As a result, the perioperative approach has become the main option for doctors in cases of locally advanced esophageal adenocarcinoma (when the disease has already developed but has not yet spread to other parts of the body).
3. Melanoma: drugs before surgery have benefits
The debate on the sequence of treatments was also a topic of discussion around melanoma, a less common type of skin cancer but with a high mortality rate.
Researchers from several Dutch institutions tested different treatment regimens for grade 3 melanoma, when the disease is advanced but has not spread to other parts of the body and surgery is possible.
Image caption, Melanoma is a type of skin cancer that can spread to other parts of the body.
In these cases, the procedure involves removing lymph nodes, which are structures of the lymphatic system located in the armpits, neck, or groin that can house cancer cells that “escaped” from the original tumor.
The big question of the study was: is it better to start pharmacological treatment before or after the operation? To answer this question, scientists divided 423 people with the disease into two groups.
The first received two cycles of ipilimumab and nivolumab (two immunotherapies) before the patients were operated on.
Those who had a good response after this process (i.e., they had less than 10% viable tumor cells) did not require further intervention.
Those with more than 10% were subjected to new cycles of medications: depending on the patients’ genetic profile, they received 11 monthly cycles of nivolumab (immunotherapy) or 46 weekly doses of dabrafenib/trametinib (a targeted therapy drug).
The second group underwent standard treatment: participants were immediately operated on and then received 12 monthly cycles of nivolumab.
After 12 months of follow-up, experts calculated that the event-free survival rate was 83.7% in group 1 and 57.2% in group 2.
Image caption, The main cause of melanoma is ultraviolet light, which comes from the sun and is also used in tanning beds.
The results reinforce that performing immunotherapy sessions before undergoing surgery is a good idea.
“The sum of other previously published studies with the presented data provides a very solid basis for using this new regimen as the main treatment modality for this stage 3 melanoma patient,” evaluates oncologist Matheus Lobo from the AC Camargo Cancer Center in Sao Paulo.
Another fact that caught our attention: nearly 60% of participants in the first group had a good response and less than 10% viable tumor cells after the two cycles of immunotherapy and surgery.
In practice, this meant they did not need to undergo immunotherapy or targeted therapy after the initial sessions of immunotherapy and the surgery.
Lobo emphasizes that this finding is excellent news, as it is possible to reduce treatment time and the costs involved in the entire process.
“It’s as if you were resolving this patient’s story in just six weeks instead of a year,” compares the doctor.
“But it’s not free: the study showed that the toxicity profile in individuals from the first group was higher.”
Data indicates that 29.7% of individuals who underwent immunotherapy before surgery experienced grade 3 or 4 side effects, requiring hospitalization or even emergency interventions.
In the group that received conventional treatment (postoperative immunotherapy), this rate was 14.7%.
4. Penile cancer: Trial of a new treatment
Every year, over 35,000 men worldwide are diagnosed with penile cancer.
“It is a disease that is generally diagnosed at a very late stage, partly due to misinformation and prejudices,” explains oncologist Fernando Maluf, founder of the Beating Cancer Institute.
The lack of hygiene is one of the main causes of the development of this tumor. Not receiving the human papillomavirus (HPV) vaccine is another reason, as this group of viruses causes this cancer and others.
The doctor emphasizes that, in many cases, the treatment includes mutilating surgical interventions and chemotherapy sessions, which do not significantly prolong the individual’s life. The disease generally recurs after some time.
“The available treatments for penile cancer have been used for a long time and we have not had recent advances that changed these protocols,” adds Maluf, who also works at the Beneficência Portuguesa Hospital and the Albert Einstein Israelita Hospital in São Paulo.
To change this scenario, the Brazilian oncologist led a study of the Latin American Cooperative Oncology Group (Lacog).
The objective was to test a new therapeutic combination of chemotherapy and immunotherapy applications.
Researchers recruited 33 men with the tumor, who were monitored by imaging tests every month and a half.
“The response rate we obtained with the new formulation was double that observed with the previous system,” summarizes Maluf.
The data presented at ASCO 2024 reveals that 75% of patients showed some degree of tumor shrinkage. 39.4% of them experienced a deemed significant reduction.
“In addition to maintaining long-term tumor remission, treated patients had a better quality of life, in addition to tolerating well the combination of chemotherapy and immunotherapy drugs,” he adds.
According to the oncologist, research conducted in Brazil opens new perspectives and allows for changing medical practice in cases of penile cancer.