AIOM POST-ASCO GI 2018 HIGHLIGHTS ESOPHAGUS AND STOMACH CANCER

Transcription

1 Mario Scartozzi Oncologia Medica Università degli Studi Azienda Ospedaliero-Universitaria Cagliari AIOM POST-ASCO GI 2018 HIGHLIGHTS ESOPHAGUS AND STOMACH CANCER

2 (WE CAN T GET NO) SATISFACTION LET THEM BE OOPS!...THEY DID IT AGAIN

3 Peri-Operative Trials: Main Results 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% Ychou M et Al, JCO 2011 Cunningham D et Al, NEJM 2006

4 ST03 (MAGIC-B)-Trial Peri-operative Bevacizumab Cunningham D, Lancet Oncology 2017

5 UK MRC OE05: Duration & Combination Alderson D, Lancet Oncology 2017

6 !

7 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, ASCO/ESMO 2017

8 Peri-operative: FLOT VS. ECX/ECF MAGIC 36% ACCCORD 38% Al Batran SE et Al, ASCO/ESMO 2017

9 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, ASCO/ESMO 2017

10 NEW STANDARD OF CARE IMPROVED OS/PFS IMPROVED R0/Resection Rate NO Difference in Surgery Morbidity/Mortality Slide Courtesy of Ferdinando De Vita, AIOM 2017

11

12 Esophageal (GOJ) Cancer: Neoadjuvant Therapy Higher R0? Higher pcr? Higher pn0? Lower local recurrence rate? Presented By David Ilson at 2018 Gastrointestinal Cancers Symposium

13 STUDY Regimen Eso/GOJ R0 UK MRC OE 05 ECX x % CF x % STO3 (Magic-B) ECX/Bev % FLOT ECX % FLOT % POET CF 59 70% CF EP/RT 60 72% CROSS Surgery % Carbo/P/RT % Ilson D et Al, Gastrointestinal Cancers Symposium 2018

14 STUDY Regimen Eso/GOJ R0 pcr UK MRC OE 05 ECX x % 7% CF x % 1% STO3 (Magic-B) ECX/Bev % 9% FLOT ECX % 6% FLOT % 16% POET CF 59 70% 2% CF EP/RT 60 72% 16% CROSS Surgery % 0% Carbo/P/RT % 23% Ilson D et Al, Gastrointestinal Cancers Symposium 2018

15 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, Lancet Oncol 2016

16 Do we need pathological response? Fields BJC 104:1840,2011; Davies J Clin Oncol 27:2983:2014; Becker Ann Surg 253:934;2011; Lorenzin Ann Oncol 23:2068;2013

17 Smyth et Al, JCO 2016

18 STUDY Regimen Eso/GOJ R0 pcr pn0 UK MRC OE 05 ECX x % 7% 30% CF x % 1% 39% STO3 (Magic-B) ECX/Bev % 9% NR FLOT ECX % 6% 41% FLOT % 16% 49% POET CF 59 70% 2% 37% CF EP/RT 60 72% 16% 68% CROSS Surgery % 0% 24% Carbo/P/RT % 23% 64% Ilson D et Al, Gastrointestinal Cancers Symposium 2018

19 STUDY Regimen Eso/GO J R0 pcr pn0 LF UK MRC OE 05 ECX x % 7% 30% 10% CF x % 1% 39% 13% STO3 (Magic-B) ECX/Bev % 9% NR NR FLOT ECX % 6% 41% NR FLOT % 16% 49% NR POET CF 59 70% 2% 37% 41% CF EP/RT 60 72% 16% 68% 23% CROSS Surgery % 0% 24% 34% Carbo/P/R T % 23% 64% 14% Ilson D et Al, Gastrointestinal Cancers Symposium 2018

20 STUDY Regimen Eso/GO J R0 pcr pn0 LF UK MRC OE 05 ECX x % 7% 30% 10% CF x % 1% 39% 13% STO3 (Magic-B) ECX/Bev % 9% NR NR FLOT ECX % 6% 41% NR FLOT % 16% 49% NR POET CF 59 70% 2% 37% 41% CF EP/RT 60 72% 16% 68% 23% CROSS Surgery % 0% 24% 34% Carbo/P/R T % 23% 64% 14% Ilson D et Al, Gastrointestinal Cancers Symposium 2018

21 Shapiro T et Al, Lancet Oncology 2015

22 The POET Trial Updated OS results Presented By Michael Stahl at 2016 ASCO Annual Meeting

23 Ongoing Randomized Trials of Preop Chemo/RT Presented By David Ilson at 2018 Gastrointestinal Cancers Symposium

24 LET THEM BE

25 Slide Courtesy of Marcello D Erraco

26 Presented By Florian Lordick at 2018 Gastrointestinal Cancers Symposium

27 Presented By Florian Lordick at 2018 Gastrointestinal Cancers Symposium

28 Presented By Florian Lordick at 2018 Gastrointestinal Cancers Symposium

29 Istotipo, Integrine, VEGF e CARCINOSI Scartozzi M et Al, Ann Oncol 2010 & PlosOne 2013

30 OOPS!...THEY DID IT AGAIN

31 The RAINFALL Trial DESIGN Primary: PFS Secondary: OS, ORR, Safety, QoL, Pharmakinetic Presented By Charles Fuchs at 2018 Gastrointestinal Cancers Symposium

32 The RAINFALL Trial: PFS Presented By Charles Fuchs at 2018 Gastrointestinal Cancers Symposium

33 The RAINFALL Trial: OS ITT Presented By Charles Fuchs at 2018 Gastrointestinal Cancers Symposium

34 The RAINFALL Trial Subgroup Analysis PFS OS Presented By Charles Fuchs at 2018 Gastrointestinal Cancers Symposium

35 The RAINFALL Trial: Adverse Events of Special Interest Presented By Charles Fuchs at 2018 Gastrointestinal Cancers Symposium

36 Lack of benefit for eastern patients!

37 Second-line therapy in metastatic gastric cancer Puzzoni M et Al, Transl Cancer Res 2016

38 The RAINFALL Trial: Impact of PDT Presented By Charles Fuchs at 2018 Gastrointestinal Cancers Symposium

39 RAMUCIRUMAB in GASTRIC CANCER Presented By Stephen Leong at 2018 Gastrointestinal Cancers Symposium

40 Angiogenesis is an ongoing process Lambrechts et Al, JCO 2013

41 (WE CAN T GET NO) SATISFACTION LET THEM BE OOPS!...THEY DID IT AGAIN

42

43 BACK UP SLIDES

44 The RAINFALL trial: geographic variability Presented By Stephen Leong at 2018 Gastrointestinal Cancers Symposium

45 The RAINFALL Trial: Impact of Subsequent Treatment Presented By Stephen Leong at 2018 Gastrointestinal Cancers Symposium

46 Presented By Charles Fuchs at 2018 Gastrointestinal Cancers Symposium

47 Thuss-Patience et Al, Lancet Oncol 2017

48 Trastuzumab/Chemotherapy/Pertuzumab vs. Trastuzumab/Chemotherapy/Placebo (JACOB Trial) Tabernero et Al, ESMO 2017

49 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, ASCO/ESMO 2017

50 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, ASCO/ESMO 2017

51 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, ASCO/ESMO 2017

52 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, ASCO/ESMO 2017

53 Peri-operative: FLOT VS. ECX/ECF MAGIC 36% ACCCORD 38% Al Batran SE et Al, ASCO/ESMO 2017

54 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, ASCO/ESMO 2017

55 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, ASCO/ESMO 2017

56 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, ASCO/ESMO 2017

57 Peri-operative: FLOT VS. ECX/ECF Al Batran SE et Al, ASCO/ESMO 2017

58 NEW STANDARD OF CARE IMPROVED OS/PFS IMPROVED R0/Resection Rate NO Difference in Surgery Morbidity/Mortality Slide Courtesy of Ferdinando De Vita, AIOM 2017

59 Peri-operative: a matter of strategy? Glatz et Al EJSO 2015

60 Slide Courtesy of Maria Di Bartolomeo

61 PRACTICE-CHANGING SOON PRACTICE-CHANGING MISSED PRACTICE-CHANGING STRAIGHT AWAY

62 Peri-operative: a matter of strategy? Glatz et Al EJSO 2015

63 Slide Courtesy of Maria Di Bartolomeo