memo - Magazine of European Medical Oncology

Ladenstein, Ruth

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0172-0

Zielinski, Christoph; Brodowicz, Thomas; Just, Dagmar

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0170-2

Rothschild, Sacha; Gautschi, O.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0160-4

From May 29 to June 2, the American Society of Clinical Oncology (ASCO) held its annual meeting in Orlando, Florida (USA). The meeting was themed “personalizing cancer care”. The lung cancer track included several abstracts and discussions relevant to this theme. Furthermore, a number of promising new drugs were presented, and the timing of perioperative chemotherapy in patients with early stage non-small cell lung cancer (NSCLC) was debated. This short review summarizes some (but not all) of the emerging data, which may impact on the clinical care of patients with NSCLC today or in the near future.

Wöll, Ewald

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0161-3

Individualized tumour therapy was the leading theme of this year's ASCO. In this context Her2Neu testing could detect a subgroup of patients suffering from advanced gastric cancer who showed substantial benefit from the addition of trastuzumab to standard chemotherapy. This first phase III trial with a biological agent is the beginning of individualized tumour therapy in gastric cancer. These data will be discussed together with other abstracts from ASCO 2009 and set into context with current therapeutic strategies.

Bechter, Oliver

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0164-0

The systemic treatment of patients with soft tissue sarcomas is an area of controversies where small progress has been made over the past years. The rarity of the disease in addition to the huge diversity of subtypes is probably to be responsible for the sometimes conflicting data obtained in clinical trials. Data presented on this year’s ASCO meeting dealt with the benefit from adjuvant treatment and with the concept of highdose consolidation therapy after complete surgical resection of a metastatic disease. The results of these trials lend support to the notion that systemic adjuvant treatment requires a rigorous patient selection and that dose escalation does not confer to a survival benefit in a situation of minimal residual disease. The more detailed understanding of pathognomonic alterations in sarcomas initiated early clinical trials with molecular directed therapies, which will probably invigorate our therapeutical possibilities.

Pall, Georg

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0159-x

The publication of practice changing clinical data is a rare event in the field of pancreatic cancer. In line with this general statement, oncologists attending or following the ASCO Annual Meeting 2009 were not surprised by being confronted with the study results mainly confirming the already existing evidence. The following conference report will therefore in its first part cover the results of the most important clinical phase III-trials presented. The ESPAC 3(v2)-study established 5-Fluorouracil (5-FU) as an equally effective but more toxic alternative to gemcitabine in the adjuvant treatment of patients with resected pancreatic cancer. Concerning the palliative treatment of advanced disease the Italian GIP-1-study provided us with another set of data comparing gemcitabine with a gemcitabine/platinum-duplet, once again failing to document a survival benefit. The CONKO-004-study investigated the prophylactic application of a low-molecular-weight heparin (enoxaparin) in patients treated with chemotherapy for advanced pancreatic cancer. As one would expect, the rate of symptomatic venous thromboembolic events with this intervention was reduced. Whether this will translate into a survival benefit remains to be established, as the final analysis of this trial is still pending. Due to the paucity of presentations with further immediate practical relevance the second part of this short review will touch on two exciting abstracts dealing with the search for new therapeutic concepts, drugs and targets.

Lordick, Florian

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0165-z

Colorectal cancer is a curable disease in stage II and stage III with higher cure rates if adjuvant chemotherapy is administered and that in most cases is treated with palliative intention in stage IV. Addition of bevacizumab, a vascular endothelial growth factor (VEGF) antibody, prolongs progression-free survival in stage IV when added to chemotherapy. Results of the NSABP study C-08 show that bevacizumab does not improve outcome when added to adjuvant chemotherapy in stage II and stage III colon cancer. Oxaliplatin led to a prolongation of progression-free survival and to improved response rates when added to 5-FU in stage IV colorectal cancer. In contrast, addition of oxaliplatin to 5-FU-based radiotherapy in neoadjuvant treated locally advanced rectal cancer did not improve the response rate. Survival results with adjuvant oxaliplatin in rectal cancer need to be awaited. The addition of oxaliplatin to 5-FU-based adjuvant chemotherapy in stage II (high risk) and stage III colon cancer became a standard of care after results of two randomized studies had been published. Current results suggest that the benefit of adding oxaliplatin in patients >70 years is vanishing and 5-FU/folonic acid alone should be considered the standard of care in the adjuvant treatment of elderly patients. Cetuximab and panitumumab are two epidermal growth factor receptor (EGFR) directed monoclonal antibodies with proven activity in stage IV colorectal cancer. K-Ras mutations indicate resistance to anti-EGFR-directed antibodies. New molecular markers like the expression of the EGFR ligands epiregulin and amphiregulin, the expression of insulin-like growth factor-1 (IGF-1) and mutations of b-RAF and n-RAS may complement the panel of markers for the selection of patients who benefit from anti-EGFR treatment.

Ploner, Ferdinand

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0166-y

For years interest in developing new treatment strategies in SCLC has lagged behind the efforts addressing NSCLC. This trend could easily be followed during the ASCO 2009 meeting. Fifty-two abstracts relating to SCLC were exhibited, whereas 392 abstracts covered NSCLC research topics. None of the presentations dealing with SCLC showed successful phase III results no results were presented in the lung cancer oral presentation session. We are left with efforts in challenging the first-line standard regimen of etoposide/platinum (EP) with the irinotecan/platinum (IP) regimen as an alternative treatment choice with comparable results but different toxicity. Randomised phase II results with amrubicin seem to support the use of second-line treatment in an otherwise chemo-resistant and desperate disease. In various trials most of the investigated new targeting agents did not lead to a reproducible improvement in the outcome of SCLC patients. After ASCO 2009 it seems that progress in the treatment of SCLC requires not only a tailored medical approach, which is difficult to achieve, but also changes in therapeutical strategies in radiotherapy and surgery for LD-SCLC.

Eisterer, Wolfgang

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0167-x

Neoadjuvant chemoradiation therapy followed by the surgical resection of residual disease has become the most common treatment strategy for locally advanced disease despite the lack of a convincing phase III trial supporting this treatment approach. This year’s ASCO meeting saw the presentation of the first results of neoadjuvant chemoradiotherapy replacing old drugs such as Cisplatin by newer substances such as Oxaliplatin, Docetaxel and the integration of biological agents into the preoperative approach.

Eniu, Alexandru; Morar-Bolba, G.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0158-y

The 45th annual meeting of the American Society of Clinical Oncology took place on May 29–June 2 in Orlando, Florida. Important clinical and research data in the field of breast cancer presented during this prestigious meeting are reviewed in this material. The breast cancer sessions were marked by advances in prognostic and predictive markers, pharmacology, and, most notably, the treatment of metastatic breast cancer. A new class of drugs, the poly (ADP-ribose) polymerase (PARP) inhibitors, showed remarkable efficacy in the treatment of triple-negative breast tumors and BRCA1 and 2 associated tumours. New data confirmed that bevacizumab could be associated with different types of chemotherapy in the first-line treatment of metastatic breast cancer, with limited benefit in progression-free survival, but without improving overall survival. Long-term follow-up data confirmed the importance of urokinase tissue plasminogen activator/plasminogen activator inhibitor type I (uPA/PAI-1), as a prognostic factor for node-negative breast cancer patients. A large sentinel node study suggests that if a patient has a positive sentinel lymph node, axillary dissection remains the standard of care. Several studies investigated the influence of CYP2D6 inhibitors on the outcomes of patients with breast cancer receiving tamoxifen as adjuvant therapy.

Jörger, M.; Senn, H.-J.; Thürlimann, Beat

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0163-1

The 11th St. Gallen consensus meeting on the primary treatment of early breast cancer put a special emphasis on a tailored approach for patient subgroups, and by the selection of targetted treatments according to tumour biology. Sentinel node procedure was considered as the standard in invasive breast cancer with no clinical evidence of lymph node involvement. Concerning ductal carcinoma in situ (DCIS), the panellists voted for adjuvant radiotherapy to be considered standard for excised DCIS, but irradiation might be avoided in the elderly and in patients with low-grade DCIS. Accelerated whole breast radiotherapy was considered an acceptable optional after tumour excision, especially in patients above the age of 60 years. Furthermore, the panel supported validated multigene assays to be considered as an additional tool for choosing chemotherapy in endocrine-responsive disease. Concerning endocrine treatment, the panellists preferred upfront endocrine therapy with an aromatase inhibitor on the basis of the updated results of BIG 1-98, especially for cases with high risk of early recurrence. Changing the aromatase inhibitor to tamoxifen after 2 years of treatment was accepted as a treatment option. Finally, dose-dense doxorubicin/cyclophosphamide chemotherapy followed by paclitaxel, and docetaxel/cyclophosphamide were added to the group of standard adjuvant regimens.

Gastl, Günther; Geissler, D.; Geissler, K.; Lang, A.; Ludwig, H.; Müller, M.; Sitte, H.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0162-2

This position paper on the clinical use of biosimilars presents the consensus of an expert group who met on June 19, 2009 in Vienna at the initiative of the Austrian Society of Hematology and Oncology (ASHO).

Tallen, G.; Dworzak, M.; Gadner, H.; Masera, G.; Schrappe, M.; Biondi, A.; Vassal, G.; Pieters, R.; Jazbec, J.; Morland, B.; Creutzig, Ursula

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0168-9

Tallen, G.; Dworzak, M.; Gadner, H.; Masera, G.; Haupt, R.; Eggert, A.; Schrappe, M.; Biondi, A.; Vassal, G.; Creutzig, Ursula

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-009-0169-8