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YOUR MOST TRUSTED SOURCE OF HEALTHCARE INFORMATION IN ASIA PHILIPPINES JULY/AUGUST 2020
ASCO20 NEWS
Paradigm shifts Camrelizumab
for maintenance therapy outwits chemo
in advanced bladder cancer for oesophageal SCC
What drives COVID-19
mortality in cancer?
EMPOWERING HEALTHCARE COMMUNITIES
YOUR MOST TRUSTED SOURCE OF HEALTHCARE INFORMATION IN ASIA
CONTENTS Managing Editor
Elvira Manzano
Contributing Editors
Roshini Claire Anthony, Pearl Toh,
Cover Story Stephen Padilla, Jairia dela Cruz,
Elaine Soliven, Audrey Abella,
Christina Lau, Dr Margaret Shi,
4 What drives COVID-19 mortality in cancer? Natalia Reoutova
Designer
Conference Coverage Peggy Tio
Production
Agnes Chieng
European Society for Medical Oncology (ESMO) Breast Cancer Virtual
Production & Advertising Coordinator
Meeting 2020, May 23-24 Raymond Choo
8 Ipatasertib-paclitaxel displays potential as first-line treatment for inoperable Circulation Executive
advanced TNBC Christine Chok
Finance Manager
Jessie Seow
9 Veliparib-carboplatin-paclitaxel combo improves PFS in HR+ or TNBC
CEO
Yasunobu Sakai
Conference Coverage
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ONCOLOGY
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CONTENTS Editorial Advisory Board:
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(National University Cancer Institute Singapore)
Prof. Pierce Chow
32 Tenofovir delivers better protection against HCC than entecavir in HBV patients (Duke-NUS Graduate Medical School)
Asst. Prof. Jeffrey Low
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ONCOLOGY
COVER STORY JULY | AUGUST 2020
What drives
COVID-19
mortality
in cancer?
4
ONCOLOGY
JULY | AUGUST 2020 COVER STORY
ROSHINI CLAIRE ANTHONY in those aged ≥75 years or with ECOG
A
PS of ≥2.
mong patients with cancer who
develop COVID-19, progressive Factors predicting all-cause mor-
disease and a higher ECOG* tality at 30 days included age (partially
performance status (PS) are tied to an adjusted** odds ratio [padjOR], 1.84 for
increased risk of mortality, according every decade increase, 95 percent con-
to early results ascertained from the fidence interval [CI], 1.53–2.21), male
COVID-19 and Cancer Consortium sex (padjOR, 1.63, 95 percent CI, 1.07–
(CCC19) registry. 2.48 vs female), former smoking (pad-
jOR, 1.60, 95 percent CI, 1.03–2.47 vs
“Older age, poor performance never smokers), and number of comor-
status, and progressing cancer were bidities (padjOR, 4.50, 95 percent CI,
strongly associated with increased 1.33–15.28 for 2 vs 0). [ASCO20, ab-
mortality, especially in subsets admitted stract LBA110; Lancet 2020;395:1907-
to the intensive care unit (ICU) and/or 1918]
intubated,” said lead author Associate
Professor Jeremy L. Warner from Van- Cancer-related factors predicting
derbilt University Medical Center, Nash- mortality included ECOG PS (2 vs 0/1:
ville, Tennessee, US, who presented the padjOR, 3.89, 95 percent CI, 2.11–
findings at ASCO20. 7.18) and active malignancy vs remis-
sion/no disease (stable or responding
The study cohort comprised 928 disease: padjOR, 1.79, 95 percent CI,
adults (median age 66 years [30 per- 1.09–2.95; progressing disease: pad-
cent aged ≥75 years], 50 percent male) jOR, 5.20, 95 percent CI, 2.77–9.77).
with prior or active haematologic or in-
vasive solid malignancies from 106 par- Patients who received the combined
ticipating institutions (primarily in North therapy of azithromycin and hydroxy-
America) in the first 30 days of the regis- chloroquine were also at an increased
try initiation (March 17–April 16, 2020). mortality risk compared with use of nei-
The most common malignancies were ther drug (padjOR, 2.93, 95 percent CI,
breast and prostate cancer (21 and 16 1.79–4.79), though use of either drug
percent, respectively). Forty-three per- alone had no bearing on mortality.
cent of patients had active cancer, 39
percent were on treatment, and 45 per- In a post hoc analysis of patients
cent in remission. who received azithromycin and hy-
droxychloroquine as combined or
After a median 21 days of follow-up, individual treatments, factors that in-
121 patients had died (13 percent). creased their risk of mortality at 30
Fifty percent of patients (n=466) re- days were ECOG PS 1 (univariate OR,
quired hospitalization upon diagnosis of 4.1), Rhesus-positive blood type (OR,
COVID-19, 23 percent of whom died. 3.2), non-Hispanic ethnicity (OR, 3.1),
Fourteen percent of patients required receipt of cancer treatment
COVER STORY JULY | AUGUST 2020
tioned Warner. The drug combination “The main lesson that we might de-
may not have led to increased mortality, duce … is that standard oncological
but rather, been prescribed to patients care should be offered if feasible, in-
with more severe COVID-19 illness, the cluding chemotherapy administration,”
authors noted. said Professor Philip Poortmans from
Iridium Kankernetwerk, Wilrijk-Antwerp,
Conversely, tumour type (haemato- Belgium, Associate Professor Valentina
logic vs solid tumour; padjOR, 1.40), Guarneri from the University of Padova,
obesity (padjOR, 0.99), and type of Italy, and Dr Maria-João Cardoso from
active cancer therapy (cytotoxic che- the Champalimaud Clinical Centre, Lis-
motherapy vs none: padjOR, 1.47; bon, Portugal, in a commentary. [Lan-
non-cytotoxic therapy*** vs none in the cet 2020;395:1884-1885]
4 weeks pre-COVID diagnosis: padjOR,
1.04) were not significantly associated “Will COVID-19 negatively affect
with an increased risk of 30-day mor- active oncological treatments or, on the
tality, nor were race/ethnicity or recent contrary, might anticancer therapy be
surgery. protective against the cytokine storm
caused by SARS-CoV-2? Are disease
“[This] suggests that curative surgi- stage and status important for these
cal resections, adjuvant chemotherapy, interactions?” they questioned.
and maintenance chemotherapy could
continue during the SARS-CoV-2 pan- The next step?
demic with extreme caution,” the au- “This is early and evolving data, and
thors said, highlighting that this is not a more time and analysis will be needed
recommendation. to confirm and expand on these find-
ings,” said Warner. “Right now, we’re
Real world implications working to quickly get information
“[P]atients with cancer appear to be about why some patients with cancer
at increased risk of mortality and severe become infected with the SARS-CoV-2
illness due to SARS-CoV-2 infection, virus and identify the factors that affect
regardless of whether they have active disease severity and death. We’re also
cancer, are on anticancer treatment, or interested in the effects of treatments
both, [and several] important subgroups that are being used to treat patients
[such as ECOG PS ≥2 and active can- with cancer who have COVID-19,” he
cer] … appear to be at increased risk said.
for adverse outcomes,” noted Warner
and co-authors. In addition, ASCO President How-
ard A. Burris III who was not affiliat-
“These findings have implications ed with the study, welcomed the use
for patients and healthcare providers of registries to assess the impact of
who will be confronted with difficult COVID-19 in patients with cancer.
decisions during the SARS-CoV-2 pan-
demic, such as whether to withhold or “The cancer care community ur-
continue anticancer treatments, and gently needs data on the effects of
whether to accelerate end-of-life plan- COVID-19, specifically in patients with
ning under some circumstances,” said cancer. How we improve the care we
Warner and co-authors. provide these patients and reduce the
number of deaths and severe conse-
“[In addition,] these findings have quences associated with this disease
important policy implications includ- are among the top questions. The
ing, but not limited to, the need for CCC19 registry is a great example of
increased surveillance and testing for the community quickly coming togeth-
SARS-CoV-2 [and] minimizing health- er to identify and collect the data we
care system exposure.” need on a large scale,” he said.
6
ONCOLOGYJULY | AUGUST 2020 COVER STORY
COVID-19 mortality risk 1.09–2.63; p=0.018 vs 65 years as a con- “Therapy administered to treat
increased risk of COVID-19 mortality. tributing factor. COVID-19 is not significantly associat-
ed with outcome,” said Horn, noting the
“[B]aseline risk factors for [COVID-19] Updated analysis comparable proportions of patients who
mortality [in patients with thoracic can- The present findings are the result died or recovered after receiving each
cers] included age, PS, and the presence of analysis of the first 400 patients (me- type of drug (eg, 24 percent vs 23 per-
of comorbidities,” said study lead author dian age 67–70 years; BMI 24–25 kg/ cent for anticoagulants, 14 percent vs 12
Associate Professor Leora Horn, direc- m2), conducted after a median 33 days percent for antivirals).
tor of the Thoracic Oncology Program since COVID-19 diagnosis and including
at Vanderbilt University Medical Center, a more international population. Patients In terms of cancer-specific treat-
Nashville, Tennessee, US. were mostly male and were current/for- ment, receipt of chemotherapy (with or
mer smokers. At this analysis, 169 pa- without other treatments) was tied to an
In contrast, gender, body mass index tients have recovered, 141 patients have increased COVID-19 mortality risk vs
(BMI), smoking status, and cancer type died, and 118 patients have ongoing in- no treatment (HR, 1.71, 95 percent CI,
or stage had no effect on mortality risk, fection. 1.12–2.63) or vs immunotherapy or tar-
she added. geted therapy (HR, 1.64, 95 percent CI,
The deaths were primarily due to 0.77–3.48; p=0.025 for both).
The TERAVOLT registry was set up COVID-19 (79.4 percent), while 10.6 per-
to identify the factors – including can- cent were due to cancer. About 78 per- “Prior administration of chemothera-
cer characteristics and treatments – that cent of patients were hospitalized (me- py, as a unique modality or in combina-
predispose patients with thoracic malig- dian duration 10 days) and 8.3 percent tion with immune checkpoint inhibitors, is
nancies to elevated COVID-19 hospital- were admitted to the ICU. Five percent associated with increased risk of death,
ization and mortality risk. It also aimed required mechanical ventilation. while immunotherapy and tyrosine ki-
to identify the clinical course of patients nase inhibitors are not,” noted Horn.
with thoracic cancer infected by SARS- Patients who recovered were more
CoV-2 and assess long-term outcomes likely to have no comorbidities (18.3 per- “A number of factors – pre-existing
of treatment adjustments and delays in cent), while about 31 percent of patients lung damage, smoking status, advanced
this population, said Horn. Patients in- who died had ≥1 comorbidity. The most age, and comorbidities – make patients
cluded had thoracic cancer plus RT-PCR common comorbidities were hyperten- with thoracic cancers especially vulnera-
confirmed or radiologically/clinically sus- sion, chronic obstructive pulmonary dis- ble to COVID-19,” said Burris III. “These
pected COVID-19. ease, vascular disease, diabetes, and findings give us some insights into out-
renal insufficiency. comes for patients with cancer who de-
Initial analysis of the first 200 patients velop COVID-19,” he said.
(median age 68 years, primarily from Eu- Among patients who died, 46.8 per-
rope) after a median 15-day follow-up cent were on chemotherapy, 22 percent
showed a 33.3 percent COVID-19 mor- on immunotherapy, 12.8 percent on tar-
tality rate among patients with thoracic geted therapy, and 9.2 percent on radio-
*ECOG: Eastern Cooperative Oncology Group
cancers, while 76 percent were hospital- therapy. **adjusted for age, sex, obesity, and smoking status
ized, and 9 percent admitted to the ICU. ***including immunotherapy, endocrine therapy, tar-
geted therapy, radiation
[American Academy of Cancer Research Multivariate analysis showed that #
TERAVOLT: Thoracic cancERs international coVid 19
(AACR) 2020, session VCTPL09; Lan- age >65 years was associated with an cOLlaboraTion
non-small-cell lung cancer (NSCLC), small-cell lung
cet Oncol 2020;doi:10.1016/S1470- increased risk of COVID-19 mortality
##
cancer, mesothelioma, thymic epithelial tumours, and
2045(20)30314-4] (hazard ratio [HR], 1.70, 95 percent CI, other pulmonary neuroendocrine neoplasms
7
ONCOLOGYCONFERENCE COVERAGE JULY | AUGUST 2020
European Society for Medical Oncology (ESMO) Breast Cancer Virtual Meeting 2020 • May 23-24
Ipatasertib-paclitaxel displays 1.33 [without alterations]; median OS
25.8 vs 22.1 months; HRunstratified, 1.13, 95
potential as first-line treatment percent CI, 0.52–2.47 [with alterations]).
for inoperable advanced TNBC Median OS favoured the ipatasert-
ib-paclitaxel combination in all biomark-
er-defined subgroups, though small
sample sizes and TNBC heterogene-
ity limit interpretation of these results,
noted study author Professor Rebecca
Dent from the National Cancer Centre
Singapore, who presented the results at
ESMO Breast Cancer 2020.
The OS improvement with ipatasertib
vs placebo was also more pronounced
among patients aged 2 years represents
cycles. [normal PTEN]; median 23.1 vs 15.8 a meaningful outcome in metastatic
months; HRunstratified, 0.83, 95 percent CI, TNBC,” she continued, noting that the
Primary analysis findings demon- 0.42–1.64 [low* PTEN]), and in those findings warrant confirmation in phase
strated improved progression-free sur- without vs with PIK3CA/AKT1/PTEN al- III trials.
vival (PFS) with ipatasertib-paclitaxel vs terations (median 23.1 vs 16.2 months;
paclitaxel-placebo (median 6.2 vs 4.9 HRunstratified, 0.72, 95 percent CI, 0.39– *IHC 0 in ≥50 percent of tumour cells
8
ONCOLOGYJULY | AUGUST 2020 CONFERENCE COVERAGE
European Society for Medical Oncology (ESMO) Breast Cancer Virtual Meeting 2020 • May 23-24
Veliparib-carboplatin-paclitaxel combo
improves PFS in HR+ or TNBC
disease [or] TNBC,” said Dr Jean-Pierre
Ayoub from the Centre Hospitalier de
l’Université de Montréal, Quebec, Cana-
da, at ESMO Breast Cancer 2020.
“In both subgroups, benefit of velipa-
rib was durable with an increased prob-
ability of remaining progression free at 2
and 3 years compared with placebo,” he
said.
Serious adverse events (AEs) were
reported in 33.9 and 29.7 percent of
veliparib and placebo recipients, respec-
tively, in the HR+ group, and 34.6 and
ROSHINI CLAIRE ANTHONY [HR], 0.705; p=0.002). [ESMO 2019, ab- 27.5 percent, respectively, in the TNBC
A
stract LBA9] group. The most frequent grade ≥3 AEs
dding veliparib to a carbopla- in all groups were neutropenia, anae-
tin-paclitaxel combination im- This improvement was consistent mia, thrombocytopenia, and leukopenia.
proved progression-free survival in the subgroup analysis of patients Study drug discontinuation unrelated to
(PFS) in patients with BRCA1/2 hormone with HR+ disease (median 13.0 vs 12.5 disease progression occurred in 8.0 and
receptor-positive (HR+) or triple-negative months [veliparib vs placebo]; HR, 0.69, 3.3 percent of veliparib and placebo re-
breast cancer (TNBC), subgroup anal- 95 percent confidence interval [CI], 0.52– cipients, respectively, in the HR+ group,
ysis of the phase III BROCADE3* trial 0.93; p=0.013; 2-year PFS: 27.5 percent and 10.5 and 7.5 percent, respectively, in
showed. vs 15.3 percent, 3-year PFS: 17.5 per- the TNBC group.
cent vs 8.6 percent) and TNBC (median
The overall study population com- 16.6 vs 14.1 months; HR, 0.72, 95 per- “The overall toxicity profile was not
prised 513 patients with locally advanced/ cent CI, 0.52–1.00; p=0.051; 2-year PFS: substantially different between treatment
metastatic HER2-negative and BRCA1/2 40.4 percent vs 25.0 percent, 3-year PFS: arms and was generally comparable in
breast cancer who had received ≤2 prior 35.3 percent vs 13.0 percent). [ESMO the subgroups of patients with HR+ dis-
lines of cytotoxic therapy for metastatic Breast Cancer 2020, abstract 140O] ease and with TNBC,” said Ayoub.
disease and had no progression within
12 months of ≤1 platinum therapy. They Overall survival did not significantly According to discussant Associate
were randomized 2:1 to receive carbo- differ with veliparib vs placebo in the HR+ Professor Suzette Delaloge from the In-
platin (AUC 6 on day 1) plus paclitaxel (80 (median 32.4 vs 27.1 months; HR, 0.96; stitute Gustave Roussy, Paris, France,
mg/m2 on days 1, 8, and 15) with either p=0.829) or TNBC cohorts (median 35.0 BROCADE3 suggests a 1.5–2-month
veliparib (120 mg BID on days -2 to 5) or vs 30.0 months; HR, 0.92; p=0.683). PFS benefit with veliparib in both HR+
placebo** for 21-day cycles. and TNBC patients. “Although not
Forty-seven and 28 placebo recipi- demonstrating it, BROCADE3 suggests
Fifty-two percent (n=174 and 92 in ents in the HR+ and TNBC cohorts, re- that maintenance approaches could be
the veliparib and placebo groups, re- spectively, crossed over to receive veli- of interest in BRCA-related metastatic
spectively) of the population had HR+ tu- parib monotherapy. breast cancer,” she noted.
mours, while 48 percent (n=163 and 80,
respectively) had TNBC. “[T]he addition of veliparib to carbo- *BROCADE3: A phase 3 randomized, placebo-con-
trolled trial of carboplatin and paclitaxel with or with-
platin plus paclitaxel with continuation of out veliparib (ABT-888) in HER2-negative metastatic
Overall results, presented at ESMO veliparib monotherapy at intensified dose or locally advanced unresectable BRCA-associated
breast cancer
2019, demonstrated improved PFS with and schedule if chemotherapy was with- **Veliparib or placebo doses increased to 300/400
the addition of veliparib vs placebo (me- drawn prior to disease progression led mg BID if carboplatin/paclitaxel were discontinued
pre-progression.
dian 14.5 vs 12.6 months; hazard ratio to improved PFS in patients with HR+
9
ONCOLOGYCONFERENCE COVERAGE JULY | AUGUST 2020
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
Pembrolizumab + axitinib risk disease, and a known excellent OS,”
said lead investigator Dr Elizabeth Pli-
benefit sustained at 24 mack from the Fox Chase Center in Phil-
adelphia, Pennsylvania, US.
months for advanced RCC Superior OS, PFS, and ORR with
pembrolizumab + axitinib was main-
tained in intermediate/poor-risk patients
compared with sunitinib alone at 24
months (69.0 percent vs 56.0 percent;
HR, 0.63 for OS, 34.0 percent vs 23.0
percent; HR, 0.69 for PFS, and 55.8 per-
cent vs 35.2 percent for ORR).
However, the incidence of grade 3–5
treatment-related adverse events was
slightly higher with pembrolizumab + ax-
itinib vs sunitinib alone (66.9 percent vs
62.4 percent). Four and six deaths were
reported due to toxicity in the pembroli-
zumab + axitinib and the sunitinib alone
ELAINE SOLIVEN percent vs 66.0 percent; hazard ratio arms, respectively.
T
[HR], 0.68; pJULY | AUGUST 2020 CONFERENCE COVERAGE
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
Relugolix delivers therapeutic of ADT, … or those who may want to
discontinue treatment to recover from a
potential for prostate cancer serious and debilitating complication,”
they explained.
Favourable CV safety
Of note was the lower overall inci-
dence of MACE with relugolix vs leupro-
lide (2.9 percent vs 6.2 percent; hazard
ratio, 0.46), which was similarly observed
in a subgroup of men with a history of
MACE (3.6 percent vs 17.8 percent).
AUDREY ABELLA “[The subgroup results] indicate that the
T
odds of having an event were 4.8 times
he phase III HERO trial presented as high with leuprolide as with relugolix,”
at ASCO20 demonstrated the su- explained the researchers.
periority of the GnRH* antagonist
relugolix over the LHRH** agonist leupro- These findings are remarkable, con-
lide for treating advanced prostate can- sidering the increased cardiovascular
cer (PCa). (CV) event rates tied to leuprolide, they
said. About a third of men with PCa
LHRH agonists are the mainstay for have established CV disease, and more
medical castration in PCa treatment; have other risk factors###. CV events are
however, these require injections, have a This effect was sustained through- the leading cause of death in men with
delayed effect, and cause an initial testos- out the treatment period, with 96.7 per- PCa, accounting for about 34 percent of
terone surge that might trigger symptom cent of relugolix recipients achieving and deaths. [Eur Urol 2017;72:920-928; Eur
flares***. [Urology 2010;75:642-647] Use maintaining serum testosterone suppres- Heart J 2019;40:3889-3897]
of degarelix, the only commercially avail- sion below castrate levels (CONFERENCE COVERAGE JULY | AUGUST 2020
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
Vitamin D may
help prevent
advanced
cancer in older
adults
PEARL TOH Participants who received vitamin D D3 (cholecalciferol; 2,000 IU/day) sup-
V
supplementation had 17 percent lower plementation or placebo; and then each
itamin D supplementation can risk of developing advanced (metastatic arm was rerandomized 1:1 to 1 g daily
reduce the incidence of ad- and fatal) cancer of any type than those supplements of marine omega-3 fatty
vanced cancer among older on placebo (hazard ratio [HR], 0.83, 95 acids or placebo for a median duration
adults, in particular those with a normal percent confidence interval [CI], 0.69– of 5.3 years. Participants were 25,871
BMI but not those who are overweight 0.99; p=0.036). [ASCO20, abstract healthy men (≥50 years) and women
or obese, suggests the large VITAL* 1510] (≥55 years) who were free of cardiovas-
randomized study presented during cular disease and cancer at baseline. A
ASCO20. When the analysis was stratified total of 1,617 patients developed inva-
based on BMI, the reduction in advanced sive cancer during follow-up.
“Our results suggest a cost-effec- cancer risk was particularly profound in
tive, safe, and accessible vitamin as a participants with a normal BMI (BMI There was no significant difference in
potential new prevention strategy forJULY | AUGUST 2020 CONFERENCE COVERAGE
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
ADAURA: placebo (median not reached vs 28.1
months; HR, 0.21, 95 percent CI, 0.16–
Adjuvant osimertinib improves 0.28; pCONFERENCE COVERAGE JULY | AUGUST 2020
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
Longer imatinib use confers “[This suggests] that adjuvant imatinib
may not markedly impair the efficacy of
survival benefit for GI subsequent TKI treatments,” they said.
However, this should be interpreted with
stromal tumours caution owing to potential confounders.
[Lancet 2013;381:295-302]
While evidence suggests that imatinib
is cardiotoxic, [Nat Med 2006;12:908-
916] both arms had a similarly low inci-
dence of cardiac events at 1 year (6 per-
cent) and 3 years (5 percent). Secondary
cancers were detected in 12 percent and
17 percent of patients in the respective
1- and 3-year arms, the most common
being prostate cancer. No new safety
signals were reported.
Too short, too low?
Despite the long follow up, the re-
AUDREY ABELLA intra-abdominal metastases (on top of searchers noted that this appears “too
T
the primary tumour) removed at lap- short” to fully assess imatinib in the ad-
hree years of adjuvant imatinib arotomy (n=15 and 24, respectively). juvant setting. Another limitation is the
treatment is superior in efficacy vs [JAMA Oncol 2020;doi:10.1001/jamao- dose, which may have been “too low” for
1-year use in patients with gastro- ncol.2020.2091] patients with KIT exon 9 mutation. [Eur
intestinal stromal tumours (GIST) at high J Cancer 2006;42:1093-1103] “[More-
risk of recurrence post-surgery, accord- In the ITT cohort, recurrence-free over,] the longitudinal imaging [used]
ing to the secondary analysis of the SS- survival (RFS) rates were higher with the may have resulted in early detection of
GXVIII/AIO* trial. 3- vs the 1-year regimen, both at 5 (71 recurrences, potentially leading to a lead
percent vs 53 percent) and 10 years (52 time bias and slow emergence of gene
“Imatinib remains the only approved percent vs 42 percent; hazard ratio [HR], mutations that confer drug resistance,”
tyrosine kinase inhibitor (TKI) for adju- 0.66; p=0.003). they added.
vant treatment of GIST, [which has un-
favourable prognostic features],” said The longer regimen still outdid the The initial*** SSGXVIII/AIO results
the researchers. However, despite the shorter in terms of overall survival (OS), have influenced guideline recommen-
improved survival outcomes, the medi- be it at 5 (92 percent vs 86 percent) or dations of the US NCCN# and ESMO##
an survival time is only 2–3 years. [J Clin 10 years (79 percent vs 65 percent; HR, favouring a 3-year imatinib regimen for
Oncol 2018;36:136-143] 0.55; p=0.004). “[This implies that about] high-risk GIST. [JAMA 2012;307:1265-
50 percent of deaths may be avoided 1272; J Clin Oncol 2016;34:244-250;
“[Our findings suggest that adjuvant during the first [decade] of follow up after J Clin Oncol 2015;33:4276-4283; Ann
imatinib in patients with] a high risk of re- surgery with longer adjuvant imatinib Oncol 2018;29:iv267] Studies on 5 or
currence despite macroscopically com- treatment,” explained the researchers. 6 years of adjuvant imatinib treatment
plete surgery is an attractive strategy for are in progress to ascertain the efficacy
improving survival,” they stressed. Evaluation of the efficacy cohort re- of longer adjuvant imatinib treatment in
flected similar benefits with the 3- vs the this setting.
The intention-to-treat (ITT) cohort 1-year regimen, both in terms of 10-year
comprised 397 patients** (median age RFS (52 percent vs 44 percent; HR,
*SSGXVIII/AIO: Scandinavian Sarcoma Group XVIII/
61 years, 51 percent male) who were 0.70; p=0.02) and OS (82 percent vs 67 German
randomized 1:1 to receive imatinib 400 percent; HR, 0.50; p=0.003). **Eligible patients underwent macroscopically com-
plete surgery for a tumour histologically verified as
mg daily for either 1 or 3 years post-sur- KIT-positive GIST
gery. An efficacy subgroup was formed The survival durations appear favour- ***After median follow up durations of 54 and 90
months
to exclude patients without GIST as per able compared with a study on first-line #
NCCN: National Comprehensive Cancer Network
pathology review and those who had imatinib. [J Clin Oncol 2008;26:620-625] ##
ESMO: European Society for Medical Oncology
14
ONCOLOGYJULY | AUGUST 2020 CONFERENCE COVERAGE
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
Enzalutamide-ADT extends sion (median 37.2 vs 3.9 months; HR,
0.07; pCONFERENCE COVERAGE JULY | AUGUST 2020
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
Adjuvant dabrafenib plus trametinib prolongs
RFS in stage III melanoma
ELAINE SOLIVEN metinib arm and was 16.6 months in the “This analysis represents the longest
A
placebo arm. follow-up to date from a phase III study
djuvant treatment with dab- of a current standard of care adjuvant
rafenib plus trametinib prolongs In a subgroup analysis of patients therapy, as it is approved and used in
relapse-free survival (RFS) in stratified by disease stage based on many countries, for patients with resect-
patients with resected stage III BRAF AJCC 7** classification, the 5-year RFS ed stage III BRAF V600-mutant melano-
V600-mutant melanoma, according to a benefit with dabrafenib plus trametinib ma,” said Hauschild.
5-year analysis of the COMBI-AD* study was consistent across stages IIIA (65.0
presented at ASCO20. percent vs 58.0 percent; HR, 0.61), IIIB “Dabrafenib plus trametinib led to
(55.0 percent vs 34.0 percent; HR, 0.50), long-term RFS [of] >50 percent [at 5
This phase III, double-blind trial in- and IIIC (45.0 percent vs 29.0 percent; years] … These results suggest that
volved 870 patients agedJULY | AUGUST 2020 CONFERENCE COVERAGE
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
Savolitinib an alternative Sixty participants (23 percent fe-
male) were randomized 1:1 to receive
for MET-driven kidney cancer? oral savolitinib 600 mg QD continuous-
ly or sunitinib 50 mg QD in 6-week cy-
cles for 4 weeks then 2 weeks without
AUDREY ABELLA treatment. SAVOIR was conceived under
T
the assumption that MET-driven sta-
he investigational, highly selective tus in PRCC is a negative predictor for
MET inhibitor savolitinib demon- outcomes on sunitinib; however, it was
strated encouraging efficacy and prematurely terminated due to evidence
safety vs standard-of-care sunitinib in suggesting otherwise. [Crit Rev Clin
patients with MET-driven*, unresectable Lab Sci 2019;56:533-566; Oncotarget
and locally advanced, or metastatic 2017;8:1046-1057; Invest New Drugs
papillary renal cell carcinoma (PRCC), 2012;30:335-340] This, plus the small
according to the phase III SAVOIR trial sample size, could have precluded defin-
results presented at ASCO20. itive conclusions, noted the researchers.
Despite being the most common As the current findings underscore
type of non–clear cell RCC (nccRCC), the potential of savolitinib to improve
there is no approved specific treat- treatment for MET-driven PRCC, a new
ment for PRCC. [Adv Anat Pathol study of the same population is being
2019;26:124-132; Eur Urol Oncol considered.
2019;2:643-648] Moreover, given the
various cytologic and molecular abnor- Using MET as a biomarker remains a
malities in nccRCC vs the more dom- Overall survival also favoured savoli- challenge as tests detect different sub-
inant ccRCC subtypes, treatment out- tinib over sunitinib (median not reached sets of MET-based disease. [Cancer Res
comes in nccRCC are apparently worse vs 13.2 months; HR, 0.51; p=0.11), 2019;79(suppl 13):4897] “[T]herefore, it
if managed with ccRCC-specific regi- with early separation of the Kaplan-Mei- remains unclear which biomarker is the
mens. [Eur Urol 2015;67:740-749; Ann er curves. Twenty-seven percent of sa- best predictor for sensitivity to MET-tar-
Oncol 2013;24:1730-1740] volitinib recipients exhibited a partial re- geted therapies,” said the researchers.
sponse as opposed to only 7 percent of
“[As such,] there remains an urgent sunitinib recipients. It is also unclear which population
unmet need for effective therapies [for would best benefit from MET-targeted
PRCC] … As a subset of PRCC cases Grade ≥3 adverse events were less therapy, they added. Narrowing down
are MET-driven, MET inhibition may be frequent with savolitinib vs sunitinib (42 the definition of MET-driven status might
an appropriate targeted treatment ap- percent vs 81 percent). Compared with help in identifying such patients; howev-
proach,” said the researchers. sunitinib-treated patients, fewer savoli- er, it might introduce new challenges in
tinib recipients discontinued treatment trial design and recruitment, and would
Median progression-free survival (58 percent vs 67 percent), but more re- only benefit a minority of patients, they
(PFS) was greater with savolitinib vs suni- ceived subsequent therapy (36 percent said.
tinib; however, between-group difference vs 19 percent). “This is possibly owing
was not statistically significant (7 vs 5.6 to savolitinib having a better tolerability Given the growing importance of
months; hazard ratio [HR], 0.71; p=0.31). profile than sunitinib … [P]atients were combination therapies in metastatic
[JAMA Oncol 2020;doi:10.1001/jamaon- more likely to be able to tolerate further RCC, it would also be worth looking into
col.2020.2218] treatment,” they explained. the potential role of savolitinib in a com-
bination approach in this patient subset
“PFS rates were numerically higher Were the objectives MET? using MET-confirmation with next-gener-
at months 6, 9, and 12 [with savolitinib While none of the endpoints achieved ation sequencing in a larger and longer
vs] sunitinib, hence some separation statistical significance, the limited efficacy trial, they added.
in the Kaplan-Meier curves beyond ~6 data collectively favoured savolitinib over
months. However, … the number of pa- sunitinib, with the former showing superi-
tients at risk at these points was low,” ority over the latter in terms of safety and *MET and/or HGF amplification, chromosome 7 gain,
explained the researchers. tolerability, noted the researchers. and/or MET kinase domain mutations
17
ONCOLOGYCONFERENCE COVERAGE JULY | AUGUST 2020
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
JAVELIN: Paradigm shifts “The maintenance setting is an attrac-
tive time for using a checkpoint inhibitor.
for maintenance therapy Disease control is achieved with the initial
chemotherapy, and this provides time for
in advanced bladder cancer the immune therapy to have an effect,”
he said. “Instead of waiting for disease to
progress after chemotherapy — which it
PEARL TOH Although 65–75 percent of patients will quickly do in patients with advanced
A
with advanced bladder cancer typical- urothelial cancer [UC] — adding avelum-
dding the PD-L1 inhibitor avelum- ly achieve disease control with first-line ab significantly improves survival.”
ab to best supportive care in the chemotherapy, Powles explained that
maintenance setting yields sig- progression-free survival (PFS) and OS Avelumab has been approved for pa-
nificant survival benefit compared with are short because of chemo-resistance. tients with advanced UC who had pro-
best supportive care alone for patients “[Also,] outcomes with second-line treat- gressed on platinum-based chemother-
with advanced bladder cancer who have ment are poor, because the disease is apy. The current study represents the
stable disease following first-line plati- aggressive and grows rapidly.” first maintenance trial to demonstrate a
num-based chemotherapy, an interim survival benefit in patients with advanced
analysis of the JAVELIN Bladder 100 UC with stable disease following first-line
study shows. chemotherapy.
Overall survival (OS) was significantly
longer with the addition of avelumab in “Instead of waiting for
the overall patient population and was
especially pronounced in the patient
disease to progress after
subgroup with PD-L1-positive status, chemotherapy — which it
reported Dr Thomas Powles of the Barts will quickly do in patients
Cancer Institute in London, UK, during with advanced urothelial
ASCO20. [ASCO20, abstract LBA1]
cancer — adding
avelumab significantly
improves survival”
18
ONCOLOGYJULY | AUGUST 2020 CONFERENCE COVERAGE
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
Participants in the multinational, Similar results in favour of avelumab cent vs 0.6 percent), and back pain (1.2
open-label, phase III trial were 700 pa- were seen across key subgroups in- percent vs 2.3 percent).
tients (median age 69–70 years) with un- cluding different types of first-line che-
resectable locally advanced or metastatic motherapy, best response to first-line “There were no grade 4 or 5 im-
UC whose disease did not progress after chemotherapy, and regardless of visceral mune-related AEs [with avelumab] …
four to six cycles of standard chemother- metastases. [and] hypothyroidism was the com-
apy of gemcitabine with either carbopla- monest immune-related AE,” reported
tin or cisplatin. They were randomized 1:1 “Avelumab first-line maintenance Powles. “High-dose corticosteroids
to receive first-line maintenance therapy in patients whose disease has not pro- were given to only 9 percent of the pa-
with avelumab plus best supportive care gressed with platinum-based induction tients.”
or best supportive care alone. chemotherapy represents a new stan-
dard first-line treatment for advanced Paradigm shifts for mUC
Survival benefit across UC,” said Powles. “JAVELIN 100 ushers in two para-
the board digm shifts in metastatic UC,” highlight-
The addition of avelumab for mainte- ed Plimack. “[Firstly, the data] provide a
nance therapy significantly extended OS new framework around which to con-
by 7 months in patients with advanced “The median OS sider a treatment break vs maintenance
[of 21.4 months] for therapy post-platinum [and secondly],
avelumab … is notably they mark a shift in the selection of first-
line systemic therapy.”
the longest OS ever
documented in a phase “In the front line, … platinum-based
III metastatic UC trial chemotherapy remains the best initial
in any line of therapy therapy for these patients. It has the
highest overall response rate. There’s
and superior to best a tail on the curve, with durable treat-
supportive care alone” ment-free survival for some, and it sets
your patient up for the best chance at
OS to their subsequent checkpoint in-
hibitor,” she stated.
Furthermore, PFS based on indepen-
dent radiology review was significantly Furthermore, platinum-based che-
UC compared with best supportive care prolonged with the addition of avelumab motherapy does not require PD-L1
alone (median 21.4 vs 14.3 months; haz- (median 3.7 vs 2.0 months; HR, 0.62; testing for treatment selection, and it
ard ratio [HR], 0.69; pCONFERENCE COVERAGE JULY | AUGUST 2020
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
Smoking cessation improves The findings were also generally
consistent regardless of whether pa-
lung cancer survival tients smoked less or more than 30
pack-years (eg, adjHR, 0.84 and 0.78
for >5 years since smoking cessation in
patients with 30 pack-years, re-
spectively; p5 years
“Individuals who quit smoking 0.73–0.8; pJULY | AUGUST 2020 CONFERENCE COVERAGE
American Society of Clinical Oncology 2020 (ASCO20) Virtual Scientific Program • May 29-31
First-line pembrolizumab tance to anti–PD-1 therapy,” suggested
Overman. “Biomarkers of resistance
improves PFS vs chemo need to be identified. The MSI-ness or
level of insertion or deletion mutations
in MSI-H/dMMR mCRC should be evaluated, and results of
planned immune or genomic analyses
of KEYNOTE-177 are awaited.”
CHRISTINA LAU
P
The KEYNOTE-177 study included
embrolizumab as first-line thera- 307 patients with stage IV CRC who had
py significantly improves progres- MSI-H/dMMR tumours and an Eastern
sion-free survival (PFS) vs chemo- Cooperative Oncology Group (ECOG)
therapy in patients with microsatellite performance status of 0 or 1. The patients
instability-high (MSI-H)/mismatch-repair were randomized (1:1) to receive pem-
deficient (dMMR) metastatic colorectal brolizumab (200 mg Q3W for up to 35 cy-
cancer (mCRC), according to results of cles) or investigator-choice chemotherapy
the KEYNOTE-177 study reported at (mFOLFOX or FOLFIRI, with or without
ASCO20. bevacizumab or cetuximab). Crossover
to the pembrolizumab arm was allowed in
PFS, one of the dual primary end- patients with confirmed PD.
points, reached a median of 16.4 months
in the pembrolizumab arm vs 8.2 months “Fifty-six patients [36 percent] in the
with investigator-choice chemothera- chemotherapy arm crossed over to re-
py (hazard ratio [HR], 0.60, 95 percent ceive pembrolizumab after confirmed
confidence interval [CI], 0.45–0.80; PD. Thirty-five additional patients re-
p=0.0002). [ASCO20, abstract LBA4] ceived anti–PD-1/PD-L1 therapy outside
of the study, for an effective crossover
“PFS rate at 24 months was 48 per- rate of 59 percent in the intent-to-treat
cent in the pembrolizumab arm vs 19 population,” said Andre. “The study will
percent in the chemotherapy arm,” re- brolizumab vs chemotherapy (43.8 per- remain blinded for the other dual prima-
ported investigator Dr Thierry Andre of cent vs 33.1 percent; p=0.0275), with ry endpoint of overall survival [OS]. OS
the Sorbonne University and Saint-An- complete response rate being nearly results will be reported at final analysis.”
toine Hospital, Paris, France. three times as high with pembrolizumab
(11.1 percent vs 3.9 percent with che- In the trial, the safety profile of pem-
Improvement in PFS was consis- motherapy). brolizumab was consistent with that
tently observed with pembrolizumab observed across various tumour types.
vs chemotherapy across key prespeci- “Reduction in size of target lesions Grade ≥3 adverse events (AEs) were re-
fied subgroups, except in patients with was more frequent and deeper with ported in 22 percent of patients in the
KRAS or NRAS mutant tumours (HR, pembrolizumab. The median duration pembrolizumab arm vs 66 percent of
1.19, 95 percent CI, 0.68–2.07). of response was not reached in the those in the chemotherapy arm, while
pembrolizumab arm vs 10.6 months in grade ≥3 immune-mediated AEs and
“The potential benefit [of pembroli- the chemotherapy arm, with 83 percent infusion reactions occurred in 9 percent
zumab] in patients with RAS wild-type vs 35 percent of patients having a re- vs 2 percent of patients.
MSI-H mCRC is a new finding, which sponse duration of ≥24 months,” said
was not seen in the KEYNOTE-165 and Andre. “The clinically meaningful and sta-
CheckMate-142 trials,” commented dis- tistically significant improvement in PFS
cussant Professor Michael J. Overman “However, we also saw a higher rate with pembrolizumab vs chemotherapy,
of the University of Texas MD Anderson of progressive disease [PD] in the pem- together with the higher ORR, more
Cancer Center, Houston, Texas, US. brolizumab vs chemotherapy arm [29.4 durable responses, and improved safe-
“Validation in other data sets is needed.” percent vs 12.3 percent],” he noted. ty profile, suggest that pembrolizumab
should be the new standard of care as
Overall response rate (ORR) was “These [29.4 percent of] patients are first-line therapy in patients with MSI-H
likewise significantly improved with pem- demonstrating intrinsic or innate resis- mCRC,” concluded Andre.
21
ONCOLOGYNEWS JULY | AUGUST 2020
Excessive sleepiness at daytime may signal heart
disease, cancer, diabetes
Among sleep disorders that can result in EDS include
obstructive sleep apnoea (OSA), central sleep apnoea, and
sleep-related hypoventilation or hypoxemia syndromes.
Researchers polled 10,930 individuals by phone on two
occasions at 3 years apart. In the second interview, 3,701
were aged 65 years; 59 percent were women. Twenty-three
percent and 24 percent of those polled in the first and sec-
ond interviews, respectively, reported hypersomnolence.
Forty-one percent reported EDS as a chronic problem. [AAN
2020, abstract 4619]
“Among sleep disorders that can result
in EDS include OSA, central sleep
apnoea, and sleep-related hypoventilation
or hypoxemia syndromes”
ELVIRA MANZANO
Older adults who are excessively sleepy Greater risk among sleepy heads
at daytime are twice as likely as their non- Older adults who reported hypersomnolence in the first
sleepy counterparts to develop either heart interview had a more than twofold greater risk of develop-
disease, cancer, or diabetes, new research ing diabetes (relative risk [RR], 2.3, 95 percent confidence in-
released at the American Academy of terval [CI], 1.5–3.4) or hypertension (RR, 2.3, 95 percent CI,
1.5–3.4) 3 years later vs individuals who had not reported ex-
Neurology (AAN 2020) meeting has shown.
cessive sleepiness. They were also twice as likely to develop
E
cancer (RR, 2.0, 95 percent CI, 1.1–3.8).
xcessive daytime sleepiness (EDS), or hypersomno-
lence when wakefulness is expected, was also linked to Of adults who reported hypersomnolence in the first in-
musculoskeletal and connective tissue conditions. terview, 6.2 percent developed diabetes and 2.4 percent de-
veloped cancer vs 2.9 and 0.8 percent, respectively, in those
The study was “informative,” but it does not necessarily who did not have EDS.
indicate that hypersomnolence itself is causal for heart dis-
ease, cancer, or diabetes, commented Dr Harly Greenberg Chronic hypersomnolence was associated with a greater
from the Northwell Health Sleep Disorders Center, New York than twofold increased risk of developing heart disease (RR,
City, US, who was unaffiliated with the study. “Instead, exces- 2.5, 95 percent CI, 1.8–3.4).
sive sleepiness may be a marker of sleep disorders that can
cause sleepiness and contribute to the risk of these medical Those who reported hypersomnolence in the second in-
conditions.” terview were also 50 percent more likely to have arthritis, ten-
dinitis, and lupus, than those who did not have EDS.
Not something to be ignored
The takeaway message is that “excessive sleepiness Doctors need to pay attention
during the day should not be ignored,” said Greenberg. “Not The study supports the importance of sleep for overall
only does it impair quality of life, daytime function, and vigi- health, and this is where paying attention to sleepiness in
lance … it also increases the risk of sleepiness-related acci- older adults could help doctors predict and prevent future
dents and may be a marker for serious sleep disorders that medical conditions, said principal investigator Dr Maurice
can increase the risk for medical disorders.” Ohayon from Stanford University in Stanford, California, US.
22
ONCOLOGYJULY | AUGUST 2020 NEWS
Study reveals inverse association between
breast cancer, arthritis
AUDREY ABELLA
Women with rheumatoid arthritis (RA) have
a reduced risk of breast cancer; similarly,
women with breast cancer have a reduced
risk of RA, reveals a Swedish study. Moreover,
adjuvant antihormonal therapy for breast
cancer prevention does not appear to
increase the risk of RA.
“
In this large population-based study, we made a series of
important observations … [In a] cohort of patients followed
from RA diagnosis, there was a decreased risk of breast
cancer … independent of RA serostatus, [which] remained af-
ter adjusting for breast cancer risk factors*,” said the research-
ers. These associations were observed at 5 years (hazard ra-
tios [HRs], 0.80, 0.77, and 0.81 for overall, seronegative, and
seropositive, respectively). [Ann Rheum Dis 2020;79:581-586]
in patients with RA is due to the RA disease or its treatment,”
“Furthermore, the risk of future RA in women with a history explained the researchers.
of breast cancer was reduced,” they added, an effect that was
observed at index date (odds ratio [OR], 0.87). “Rather, our data suggest that RA and breast cancer share
genetic or environmental factors acting earlier in life. In this re-
Studies have shown arthralgia and inflammatory arthritis gard, it is interesting that the breast cancer ORs and HRs were
as typical side effects of antihormonal therapy. [J Rheumatol similar for seropositive and seronegative RA,” they continued.
2015;42:55-59; RMD Open 2017;3:e000523] However, the
current findings showed otherwise, given the reductions in RA Despite the large sample, long follow up, and registers with
risk in breast cancer patients on tamoxifen, aromatase inhibi- high internal validity and coverage, the team was not able to
tors (AIs), or both (ORs, 0.86, 0.97, and 0.68, respectively) vs establish the origins of the link between the two conditions.
those who have never received antihormonal treatments. The adjustments for risk factors did little to influence the find-
ings, noted the researchers. “Whether this is due to residual
Looking into the cumulative exposure however, there was confounding or a true absence of confounding is difficult to as-
a trend toward a higher RA risk among women receiving AI at certain, but we did observe that these factors were indeed risk
the beginning of treatment (24 months; OR,
0.57), suggesting that antihormonal therapy did not seem to be The lack of data on other potential confounders (menarche,
a risk factor for RA development, they said. menopause, breastfeeding, body mass index, smoking, alcohol
consumption) should also be taken into context, they added.
Shared contributing factors
A total of 15,921 women with RA (mean age at index date “[Nonetheless,] we believe that our nationwide study with
59 years) were identified and matched with 79,441 women a clearly defined population, which could account for per-
from a general cohort. At index date, 555 women with RA son-time at risk, age, and several other potential confounders,
had a history of breast cancer. At a mean follow up of 5 years, and the use of an appropriate comparator group, provides a
breast cancer was identified in 190 women with RA. reliable estimate … Our findings suggest that other factors, in-
dependent of RA, drive the inverse association between the
“[Taken together,] the relative risk of RA in women with a two diseases,” they said.
history of breast cancer was similar to the relative risk of breast
*Age, country of birth, educational level, hormone replacement therapy, oral con-
cancer in women with a history of RA … [T]his would argue traceptives, age at first birth, number of children, family history of breast cancer/
against the hypothesis that the decreased risk of breast cancer ovarian cancer, previous invasive cancer, and calendar year
23
ONCOLOGYNEWS JULY | AUGUST 2020
Children with IBD face increased subsequent
cancer risk
JAIRIA DELA CRUZ
Paediatric-onset inflammatory bowel disease
(IBD) carries a doubled risk of developing
cancer later in life, with skin, lymphoid, and
gastrointestinal tumours of a particular
concern, a study has found. The risk is higher
in males and independent of IBD subtype and
medical treatment.
“
Notably, our observation of a twofold increased risk of can-
cer in patients with paediatric-onset IBD, which may cause
unnecessary concern, corresponded to only one additional
case of cancer for every 1,000 individuals followed for a year,”
according to the researchers, adding that absolute rather than
relative risk estimates should inform management guidelines.
The analysis used data from the Danish National Patient
Registry and included 5,380 paediatric IBD patients (Crohn’s
disease, n=2,673; ulcerative colitis, n=2,707) who were fol- Cancer risk was not modified by age, year of diagnosis, and
lowed for 77,821 person-years. Each patient was matched by medical treatment.
sex and age to 10 non-IBD controls selected from the general
population. The observations are in line with a Swedish nationwide co-
hort study. A recent multicentre study of a similar population
Over a median follow-up of 12 years, 158 paediatric IBD of patients, although not exclusively population-based, also
patients and 701 controls developed cancer. The corre- described a risk increase in some but not all the 25 includ-
sponding incidence rates were 2.03 and 1.00 per 1,000 per- ed countries. [BMJ 2017;358:j3951; Aliment Pharmacol Ther
son-years. Those with paediatric-onset IBD were twice as likely 2018;48:523-537]
to develop cancer (hazard ratio [HR], 2.16, 95 percent confi-
dence interval [CI], 1.82–2.58), according to multivariable Cox “The increased risk of cancer in the present study was ex-
proportional hazards regression analyses. [Gastroenterology plained by [heightened] risk of skin, lymphoid, and gastrointes-
2020;doi:10.1053/j.gastro.2020.06.030] tinal cancer, confirming results from the Swedish cohort study,”
the researchers said.
The overall risk increase was driven by a rise in the risks of
liver (HR, 22.68, 95 percent CI, 8.51–63.15), colorectal (HR, “Chronic inflammation in IBD may promote carcinogen-
17.22, 95 percent CI, 9.05–32.75) and small bowel cancers esis due to rapid regeneration of cells, especially in patients
(HR, 4.58, 95 percent CI, 1.82–11.45), lymphoid cancer (HR, diagnosed early in life. Yet, the long-term risk of cancer in pae-
2.43, 95 percent CI, 1.28–4.62), and melanoma (HR, 2.01, 95 diatric-onset IBD, particularly in the context of immunomodu-
percent CI, 1.19–3.42) and non-melanoma skin cancers (HR, latory treatment remains debated,” they noted. [Gastroenterol-
2.21, 95 percent CI, 1.49–3.28). ogy 2017;152:1901-1914; JAMA 2014;311:2406-2413; BMJ
2017;358:j3951; Aliment Pharmacol Ther 2018;48:523-537;
Further analyses indicated that the association between Am J Gastroenterol 2013;108:1647-1653]
IBD and increased cancer risk was more pronounced among
male than female patients (HRs, 3.89 and 1.49; pYou can also read
