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Read below for a recap of ASCO Day #2 highlights by Dr. Chandler Park, Doximity's Hematology/Oncology Ambassador. Dr. Park kicked off Day #2 with an interview of Dr. Jame Abraham, Co-Director of the Comprehensive Breast Cancer Program at Cleveland Clinic.
ASCO Day #2 Recap:
Dr. Chandler Park [Beginning of Day Update]
Breast Cancer update with Dr. Jame Abraham
Dr. Park: Today we have Dr. Jame Abraham. A thought leader of ASCO and the Director of the Breast Oncology program at Cleveland Clinic. It is very nice to see you again.
Dr. Jame Abraham: Chandler good to see you again as well.
Dr. Park: For the medical oncologists that can't make it to ASCO this year and following daily at home on Doximity. What are the key breast trials that you are watching closely at ASCO this year?
Dr. Jame Abraham: The key studies that I am watching are the following.
- Olympiad trial: olaparib in Patients with BRCA mutated metastatic breast cancer
- MONARCH 2: abemaciclib in ER positive metastatic breast cancer
- APHINITY in adjuvant her-2 positive breast cancer
- PALOMA trial survival data
Dr. Park: Of those studies we have had only one study released so far. The MONARCH 2 trial. I was very impressed with the data released by Dr. George Sledge with Abemaciclib and Fulvestrant. Now we have 3 similar but different CDK 4/6 inhibitors. Dr. Abraham in your practice how do you separate these CDK 4/6 inhibitors?
Dr. Jame Abraham: We have 2 very active CD k 4/6 inhibitors, palbociclib and ribociclib FDA approved for the same indication. Similar efficacy. That is really good news for our patients. We can delay chemotherapy even in patients with ER positive visceral disease for close to a year. That is a huge benefit. We are very comfortable in managing the neutropenia from CD k 4/6 inhibitors such as palbociclib. But monitoring LFTs and QT interval could potentially posses additional challenges for patients and providers.
Abemaciclib has similar efficacy. We have mature data in second line setting with faslodex improvement in PFS by 9 months. Continuous dosing.
The side effect profile is different from other CD k 4/6 inhibitors: more GI side effects such as diarrhea. But it is a very active drug even in heavily pre treated patients.
More options for our patients and availability of these agents will continue to revolutionize the treatment of ER positive breast cancer. Ongoing and planned adjuvant and Neo adjuvant trials will give us more information in the future.
This is all excellent news for our patients!
Dr. Park: Thank you Dr. Abraham. We look forward to your expert commentary after the other key studies are released.
Dr. Chandler Park [5:30pm]
Olaparib for BRCA positive HER2 negative Breast Cancer Patients
Significance: OLYMPIAD trial is the first Phase 3 clinical trial that showed that a PARP inhibitor demonstrated a superior clinical benefit in a head to head study vs chemotherapy for metastatic HER2(-) breast cancer patients.
Data: The OLYMPIAD showed the median progression-free survival (PFS) was 7 months in the olaparib arm versus 4.2 months with standard chemotherapy (HR, 0.58; 95% CI, 0.43-0.80; P = .0009). Objective response rate (ORR) was 59.9% with olaparib versus 28.8% with chemotherapy.
This study validates Olaparib as a treatment option for patients with BRCA mutations and metastatic HER2-negative breast cancer. This includes patients that are triple negative patients. One thing to keep in mind is that patients in this study was a heterogenous group. 71 percent had received prior chemotherapy in the metastatic setting, and 28% had received prior platinum-based therapy in the neoadjuvant, adjuvant, or metastatic setting.
The median PFS was 7 months in the olaparib arm versus 4.2 months with standard chemotherapy (HR, 0.58; 95% CI, 0.43-0.80; P = .0009). Olaparib also demonstrated an improvement in PFS2, defined as the time until second progression or death (HR, 0.57; 95% CI, 0.40
Clinical Implications: This study validates Olaparib as a treatment option for patients with BRCA mutations and metastatic HER2-negative breast cancer. Chemotherapy arms were physicians choice of Capecitabine, Vinorelbine, and Eribulin. Also published study information did not include single Paclitaxel as a treatment option for physicians choice.
Patient consideration: Olaparib appears better tolerated than chemotherapy. Main adverse events were fatigue, nausea, and anemia. Less than 4.9% of patients discontinued treatment due to side effect toxicity, compared with 7.7% in the chemotherapy arm.
Notably, in the olaparib arm versus the chemotherapy arm, there were fewer grade ≥3 AEs and fewer AE-related discontinuations (36.6% vs 50.5%, respectively). The PARP inhibitor also had less of a negative impact on white blood cells compared with chemotherapy.
Bottom line: Very promising data since this is the first Phase 3 clinical trial that showed superior benefit for germline BRCA mutated metastatic breast cancer patients vs chemotherapy. One thing to consider is that patients In the triple negative subgroup as a comparison arm did not include Paclitaxel. With that said the patients in the Olaparib had a greater preservation of quality of life with less adverse side effects. This is a very important consideration for patients that have weathered multiple lines of chemotherapy.
Editor's Note: Which studies did you find most interesting or impactful at ASCO Day #1? Share your opinions on and experiences at ASCO 2017 and your comments will be shared with all Hem/Onc physicians to discuss.