aiom post-asco gi 2018 highlights esophagus and...

Mario Scartozzi

Oncologia Medica

Università degli Studi

Azienda Ospedaliero-Universitaria

Cagliari

AIOM POST-ASCO GI 2018

HIGHLIGHTS

ESOPHAGUS AND STOMACH CANCER

(WE CAN’T GET NO) SATISFACTION

LET THEM BE

OOPS!....THEY DID IT AGAIN

STUDY No Pts CHT GOJ SURGERY Peri-OP

MAGIC 503 ECF 11% 5-yr OS 23% 5-yr OS 36%

Dist Met 37%

Dist Met 24%

R0 70% R0 79%

ACCORD 224 5FU/Cis 64% 5-yr OS 24% 5-yr OS 38%

Dist Met 38%

Dist Met 30%

R0 73% R0 84%

Peri-Operative Trials: Main Results

Cunningham D et Al, NEJM 2006

Ychou M et Al, JCO 2011

Cunningham D, Lancet Oncology 2017

ST03 (MAGIC-B)-Trial Peri-operative

Bevacizumab

UK MRC OE05: Duration & Combination

Alderson D, Lancet Oncology 2017

Peri-operative: FLOT VS. ECX/ECF

Al Batran SE et Al, ASCO/ESMO 2017


MAGIC 36%

ACCCORD 38%


Slide Courtesy of Ferdinando De Vita, AIOM 2017

NEW STANDARD OF CARE

IMPROVED OS/PFS

IMPROVED R0/Resection Rate

NO Difference in Surgery

Morbidity/Mortality

Presented By David Ilson at 2018 Gastrointestinal Cancers Symposium

Esophageal (GOJ) Cancer:

Neoadjuvant Therapy

Higher R0? Higher pCR? Higher pN0?

Lower local recurrence rate?

STUDY Regimen Eso/GOJ R0

UK MRC OE 05 ECX x 4 451 66%

CF x 2 446 59%

STO3 (Magic-B) ECX/Bev 680 69%

FLOT ECX 201 77%

FLOT 200 84%

POET CF 59 70%

CF—EP/RT 60 72%

CROSS Surgery 141 69%

Carbo/P/RT 134 92%

Ilson D et Al, Gastrointestinal Cancers Symposium 2018

STUDY Regimen Eso/GOJ R0 pCR

UK MRC OE 05 ECX x 4 451 66% 7%

CF x 2 446 59% 1%

STO3 (Magic-B) ECX/Bev 680 69% 9%

FLOT ECX 201 77% 6%

FLOT 200 84% 16%

POET CF 59 70% 2%

CF—EP/RT 60 72% 16%

CROSS Surgery 141 69% 0%

Carbo/P/RT 134 92% 23%



Al Batran SE et Al, Lancet Oncol 2016

Fields BJC 104:1840,2011; Davies J Clin Oncol 27:2983:2014;

Becker Ann Surg 253:934;2011; Lorenzin Ann Oncol 23:2068;2013

Do we need pathological response?

Smyth et Al, JCO 2016

STUDY Regimen Eso/GOJ R0 pCR pN0

UK MRC OE 05 ECX x 4 451 66% 7% 30%

CF x 2 446 59% 1% 39%

STO3 (Magic-B) ECX/Bev 680 69% 9% NR

FLOT ECX 201 77% 6% 41%

FLOT 200 84% 16% 49%

POET CF 59 70% 2% 37%

CF—EP/RT 60 72% 16% 68%

CROSS Surgery 141 69% 0% 24%

Carbo/P/RT 134 92% 23% 64%


STUDY Regimen Eso/GO

J

R0 pCR pN0 LF

UK MRC OE 05 ECX x 4 451 66% 7% 30% 10%

CF x 2 446 59% 1% 39% 13%

STO3 (Magic-B) ECX/Bev 680 69% 9% NR NR

FLOT ECX 201 77% 6% 41% NR

FLOT 200 84% 16% 49% NR

POET CF 59 70% 2% 37% 41%

CF—

EP/RT

60 72% 16% 68% 23%

CROSS Surgery 141 69% 0% 24% 34%

Carbo/P/R

T

134 92% 23% 64% 14%


Shapiro T et Al, Lancet Oncology 2015

Presented By Michael Stahl at 2016 ASCO Annual Meeting

The POET Trial

Updated OS results

Presented By David Ilson at 2018 Gastrointestinal Cancers Symposium

Ongoing Randomized Trials of Preop

Chemo/RT

LET THEM BE

Slide Courtesy of Marcello D’Erraco

Presented By Florian Lordick at 2018 Gastrointestinal Cancers Symposium

Istotipo, Integrine, VEGF e CARCINOSI

Scartozzi M et Al, Ann Oncol 2010 & PlosOne 2013

Presented By Charles Fuchs at 2018 Gastrointestinal Cancers Symposium

The RAINFALL Trial DESIGN

Primary: PFS

Secondary: OS, ORR, Safety, QoL, Pharmakinetic


The RAINFALL Trial: PFS


The RAINFALL Trial: OS ITT


The RAINFALL Trial Subgroup Analysis

PFS OS


The RAINFALL Trial: Adverse Events of

Special Interest

Lack of benefit for eastern patients!

Second-line therapy in metastatic gastric cancer

Puzzoni M et Al, Transl Cancer Res 2016


The RAINFALL Trial: Impact of PDT

Presented By Stephen Leong at 2018 Gastrointestinal Cancers Symposium

RAMUCIRUMAB in GASTRIC CANCER

Lambrechts et Al, JCO 2013

Angiogenesis is an ongoing process

(WE CAN’T GET NO) SATISFACTION

LET THEM BE


BACK UP SLIDES


The RAINFALL trial: geographic variability


The RAINFALL Trial: Impact of

Subsequent Treatment

Thuss-Patience et Al, Lancet Oncol 2017

Tabernero et Al, ESMO 2017

Trastuzumab/Chemotherapy/Pertuzumab vs.

Trastuzumab/Chemotherapy/Placebo (JACOB Trial)



MAGIC 36%

ACCCORD 38%

Slide Courtesy of Ferdinando De Vita, AIOM 2017

NEW STANDARD OF CARE

IMPROVED OS/PFS

IMPROVED R0/Resection Rate

NO Difference in Surgery

Morbidity/Mortality

Peri-operative: a matter of strategy?

Glatz et Al EJSO 2015

Slide Courtesy of Maria Di Bartolomeo

PRACTICE-CHANGING SOON

PRACTICE-CHANGING MISSED

PRACTICE-CHANGING STRAIGHT AWAY

Peri-operative: a matter of strategy?

Glatz et Al EJSO 2015

Slide Courtesy of Maria Di Bartolomeo

aiom post-asco gi 2018 highlights esophagus and...

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