We rounded up a few research highlights from the 2021 Congress of the European Society for Medical Oncology.
COVID-19 vaccines do protect patients with cancer
A number of studies presented at ESMO Congress 2021 reported that people with cancer have appropriate immune response to COVID-19 vaccination. Vaccine efficacy and safety was in question because cancer patients, who may have weakened immune systems, were not part of the trials conducted to develop and approve the vaccines. Among the new trials, one demonstrated that treatment with chemotherapy, immunotherapy, or a combination of both led to similar levels of viral antibodies in the blood after two doses of the Moderna vaccine as in vaccinated people without cancer. Multiple studies also demonstrated that COVID-19 vaccines are safe for people with cancer. While more research is needed on whether cancer patients would benefit from booster shots, researchers suggest the extra immune stimulation likely would increase protection from severe illness and death, especially in the context of new viral variants like Delta. Read more.
Fewer doses of ipilimumab in combination therapy resulted in less toxicity, similar survival
Reducing the dose of ipilimumab within ipilimumab/nivolumab combination therapy in patients with intermediate or poor risk advanced RCC from one dose every 3 weeks to one dose every 12 weeks led to a lower rate of grade 3 or 4 adverse events and consequently a lower rate of treatment discontinuation without appearing to compromise efficacy. Ipi/nivo is a standard first-line treatment for this patient population but previous studies have shown patients sometimes have to discontinue treatment due to ipilimumab-related toxicities, especially in the first 12 weeks of treatment. In the phase II PRISM trial, reducing the ipilimumab dose to every 12 weeks resulted in a 33% rate of adverse events versus a 53% rate in patients treated per the standard 3 weeks. While comparing the modified regimen with the historical standard treatment sunitinib did not prove superiority for survival rates, there was also no meaningful difference in progression-free survival, overall response rate, duration of response, or overall survival. While the results won’t change the dosing schedule for standard care, the primary investigator Dr. Naveen Vasudev of the University of Leeds, suggested the findings should reassure clinicians who want to delay ipilimumab due to toxicities. Read more.
Planned treatment breaks can reduce side effects without significantly affecting life expectancy
The phase II/III STAR trial showed that metastatic RCC patients treated with the targeted therapies sunitinib or pazopanib, which are standard first-line therapies that often cause significant toxicities, can take at least one treatment break (median break was 87 days) after 24 weeks without detriment to overall survival or quality of life compared to the standard continuous treatment regimen. Patients and doctors could determine together when to take subsequent breaks depending on disease response or patient/clinician choice. The study included 920 people and at least 43% in the intermittent arm had at least one break and many patients took 6-9 breaks. The trial was run in the UK and treatment breaks were also associated with cost savings there. Read more.
Belzutifan + cabozantinib is promising in pre-treated clear cell RCC
A combined strategy of anti-VEGF treatment with cabozantanib plus hypoxia-inducible factor (HIF) inhibition with the novel therapy belzutifan showed promising responses in a cohort of 52 patients with pre-treated clear cell RCC. In this phase II study, the overall response rate was 28.8% (15 participants), including one complete responder. Disease control rate was above 90% and after a year, 60% of participants did not have disease progression and 81% were still alive. About 20% of patients had to discontinue treatment because of adverse events.
Belzutifan, which was developed by Merck and is sold under the brand name Welireg, was approved by the FDA in August to treat RCC associated with the rare genetic condition von Hippel-Lindau disease, as well as a few other conditions. Belzutifan is a hypoxia-inducible factor 2a (HIF-2a) inhibitor – it helps regulate the cellular proliferation, blood vessel growth, and tumor growth associated with tumors.
This HIF-2a inhibitor plus VEGF inhibitor strategy could be another effective treatment option for metastatic clear cell RCC. A phase III study of belzutifan plus either lenvatinib or cabozantinib is currently recruiting. Read more.
Cabozantinib improved survival compared to axitinib in pre-treated advanced RCC
Advanced RCC patients who were previously treated with anti-VEGF agents had longer overall survival when treated with the TKI inhibitor cabozantainib (median overall survival of 11.41 months) compared with those treated with axitinib (medial overall survival 9.6 months). Read more.
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