Posted on 12/06/2022 at 6:00 p.m.
(credit: ANNE-CHRISTINE POUJOULAT)
After being in a virtual format for two years, the Asco Congress of the North American Clinical Oncology Association brought together more than 40,000 people in Chicago, bringing important news for the treatment of cancer. According to experts, the event, which ended on the 7th of this month, met expectations and showed that, despite the covid-19 pandemic, it was possible to move forward with research into new treatment strategies. Also noteworthy is the debate over the inequality of access to medicines, which has worsened in the global health crisis.
From the rarest to the most common tumors, over five days, researchers from around the world literally presented the results of thousands of studies, including poster sessions. According to the doctors who took part in the event, the research that had the greatest impact on the scientific community was related to colorectal and breast cancer research. Some articles on these diseases showed significant gains in patient survival.
For oncologist Cristiano Resende of Grupo Oncoclínicas, it was the 3rd phase of the Destiny research on the “girl’s eye” conference, with patients with breast cancer metastasis. “The study was presented at the plenary session, which was attended by 100% of the doctors. The cause of the uproar was a significant increase in the overall survival of people without disease (when the cancer is at rest) and the overall survival of people who have not been able to be treated with a drug that has been proven so far. very effective in the treatment of breast tumors.
It is estimated that half of all patients with breast cancer may benefit from the finding. They are people with a metastatic form of the disease, but who have low expression of a receptor in cancer cells targeted by the drug trastuzumab deruxtecan, in combination with a combination of a monoclonal antibody and a chemotherapy drug. “A few years ago, this drug changed clinical practice,” Resend warns.
However, the substance is only targeted at women with high HER2 receptor levels in diseased cells. Tests that showed a negative or questionable expression — currently classified as low HER2 — showed no indication for such treatment. Now, however, researchers have shown that this population can also be treated with trastuzumab deruxtecan and can have a significant gain. The New York Memorial Sloan Kettering Cancer Center study included 557 low-profile HER2 volunteers. Of these, 373 received the drug, and the rest were treated with regular chemotherapy.
According to the second group of women who received trastuzumab deruxteca compared to the second group, the risk of the disease growing and spreading was 49% lower. Mortality during the follow-up – 18.4 months – was 36% lower. “Our study shows that the target therapy available for the new classification of patient substances may be a new and highly effective option,” Shanu Modi, lead author of the study, said in a press release.
The drug was approved in Brazil this year for HER2-positive patients. The laboratory has already applied for admission to the National Health Care Agency (Anvisa) for those with a low HER2 profile. However, because it is a new and very expensive drug — treatment costs $ 50,000 per person — the Unified Health System (SUS) does not offer it, and users of private plans may also have difficulty getting to the country. .
An unprecedented event in the history of Congress was the presentation of a study that reported the 100% remission of a rare rectal tumor at an advanced stage. People with dMMR have a molecular change that makes it difficult to respond to standard treatment: chemotherapy and radiation. This abnormality, which occurs when the cell makes DNA copies, is found in approximately 5% to 10% of all rectal tumors, according to the study’s authors. After six months of treatment every three weeks with intravenous dostarlimab immunotherapy, all study participants were free of dMMR rectal cancer, which was confirmed by radiological and endoscopic evaluation.
The number of patients involved was small, 14, but enough to recognize the work as one of the most important in the congress. “The responses from these initial patients were significant and exceed the standard of chemotherapy plus radiation with what we expected with radiation,” says gastrointestinal oncologist Hanna K. Sanoff, who was not involved in the study. According to a doctor at the North Carolina Cancer Hospital, in the United States, because these rectal tumors do not respond well to chemotherapy and radiation, many patients need surgery. “Unfortunately, surgery can lead to significant health consequences, including nerve damage, infertility, and intestinal and sexual dysfunction.”
Dostarlimab is an immunotherapy and is due to arrive in Brazil in August with an indication for the treatment of endometrial cancer. Finally, in a study of 30 patients, all 14 participants had dMMR rectal cancer in the more advanced stages 2 and 3. “I would like to point out that most of these patients have large and large tumors. The standard of care for them would probably require three treatment modalities: chemotherapy, radiotherapy, and surgery,” said Andrea Cerce, head of the colorectal section. One of the authors of the Memorial Sloan Kettering Cancer Center and author of the article, which was also published in The New England Journal of Medicine. The data for the publication is for 12 people, but the number later increased.
“We treated a total of 14 patients, all of whom had a 100% complete clinical response to dostarlimab alone. No patients required chemotherapy, radiation, or surgery. There was no progression of tumor grade. There was no recurrence of the disease. Cercek said that a longer follow-up of these people is necessary to establish the sustainability of the treatment. So far, they have been evaluated for two years.
to ask three questions
credit: Personal archive
Fernando Maluf, oncologist and founder of the Vencer o Câncer Institute
Has the Kovid pandemic somehow interfered with oncology research?
The pandemic has disrupted cancer research and treatment worldwide, and one of the main reasons was isolation. What has happened is that the number of patients included in clinical protocols has dropped dramatically. Many of them had difficulty accessing the centers in the end. In our country, where the cancer structure was associated with non-oncological areas, the beds were directed to the covid; rooms for the application of chemotherapy for other conditions; and ZIU overcrowded. What happened was that, as a structural problem, many hospitals reduced the care of cancer patients.
There were a lot of predictions about Asco 2022, which will be the first congress since 2019. Did the submitted works match what was expected?
It was great to be able to face, once again, what we can’t do online, which is to connect with colleagues and leaders around the world and design research projects that work as a team. The works met expectations. Major breast cancer studies have been conducted that have shown a very significant progression-free survival gain such as Destiny. Another study found that only 12 patients had a complete response to immunotherapy with patients with a rectal tumor without the need for chemotherapy, radiation, or surgery. In addition, there was a significant strengthening, such as radiopharmaceuticals, in the case of prostate cancer against metastatic castration; the role of immunotherapy in increasing the survival of patients with cervical cancer; new immunotherapeutic drugs in the treatment of skin bladder cancer; and the introduction of new agents in head and neck cancers, increasing survival with radiotherapy. These studies are very important because they can benefit patients in the short term.
In addition to the results of the study, the conference addressed the difference in access to medicines. How was that discussion?
It was the subject of several tables in Congress. It is useless to have technology if it does not reach everyone. So I think from the perspective of international agencies there is also a greater concern about how we can ensure equity in the care of cancer patients within their own countries as well as among countries around the world.
Increased cases of metastasis
credit: Personal archive
The Covid pandemic did not only cause casualties among those infected with Sars-CoV-2. Patients with cancer were harmed, which led to a reduction in the diagnosis in the early stages, making it more difficult to cure. A Brazilian study presented at a poster session of the North American Clinical Oncology Association (ASCO) found a statistically significant reduction in attendance and, at the same time, increased the number of patients with metastasis.
The study was based on data from nearly 12,000 people served by the Oncoclínicas team across the country, including Brasilia. The researchers compared the number of breast cancer patients they searched for in online clinics in 2018/2019 with those seeking medical help in 2020/2021.
“The number of initial patients (who were first consulted) fell from 68% to 58%. At the same time, the number of patients with metastatic disease rose from 12% to 19%.” says oncologist Cristiano Resende, one of the authors of the study. He explained that although the study did not investigate the cause-and-effect relationship, it is very likely that the statistics show pandemics, as many people have stopped leaving their homes for routine tests that can detect the disease early.
“It’s very clear that this is related to the lack of a screening test,” Resend warned. “We are talking about a disease that is incurable when metastasis. There has been a 7% increase in patients with metastasis, in fact, there were more opportunities to prevent it in the age group, that is, women over 50 and later. Menopause. That also covid the highest risk. So we think a lot of people have stopped taking exams because of their isolation. ”