The best-scored abstracts in gastrointestinal tumors show a range of promising new findings. Thus, initial data on first-line therapy of advanced hepatocellular carcinoma could be presented as well as real-life data from the pancreas platform. Similarly, we investigated whether weight loss during perioperative chemotherapy for esophagogastric tumors has prognostic significance.
The therapeutic management of hepatocellular carcinoma (HCC) after sorafenib has been effectively expanded in recent years by multikinase inhibitors and anti-PD-1 antibodies, among others. For advanced stages, it has now been investigated whether there is a synergistic effect of the two treatment approaches [1]. For this, patients with advanced HCC who had not previously received systemic therapy received regorafenib (REG) plus pembrolizumab (PEMBRO) in a phase 1b trial. In the first cohort, patients received REG 120 mg/day daily for 3 weeks (followed by a 1-week break) plus PEMBRO 200 mg IV. In later cohorts, REG dose could be increased (160 mg) or decreased (80 mg) based on the modified toxicity probability interval design; PEMBRO dose is fixed. The primary goal was safety and tolerability. Secondary objectives were to define the maximum tolerated dose (MTD) and the recommended phase 2 dose and to assess antitumor activity. The experts reported that the combination of REG plus PEMBRO for first-line treatment of advanced HCC showed no unexpected safety signals and encouraging antitumor activity.
Quality of life in pancreatic cancer in focus
Patients with metastatic pancreatic cancer (mPC) are usually treated with gemcitabine and nab-placitaxel. However, no data have yet been collected regarding quality of life under this treatment regimen. This gap has now been filled by a prospective, non-interventional, multicenter study [2]. The data collected in it went into a permanent registry that takes into account all types of treatment. Quality of life was prospectively measured by EORTC-C30 questionnaire. Therapeutic and efficacy parameters were also prospectively determined. The primary endpoint was the rate of patients with no deterioration in QoL/Global Health Score (QoL/GHS) at 3 months. The mean GHS/QoL score at baseline was low in the 600 patients enrolled and was 46.2. The median progression-free survival was 5.85 months and the median overall survival was 8.91 months. KM analysis showed that 61% and 41% of patients had maintained QoL/GHS at 3 and 6 months, respectively. The median time to QoL/GHS deterioration was 4.68 months. In QoL response analysis, 34.6%, 37.4%, and 28% had improved, stable, and worse QoL/GHS, respectively. The median overall survival (mOS) in ECOG 0 was 11.18 months was significantly better than in ECOG 1 with 8.52 months and also significantly better than in ECOG 2 with 4.80 months. The lowest mOS were observed in ECOG 3 (2.94 months). The results show that the time to deterioration is short. The evaluation of mOS supports the current recommendation to offer combination therapy only to selected patients with an ECOG of 2.
Weight loss correlates with poorer prognosis
Perioperative chemotherapy is a standard treatment for operable esophageal cancer. The aim of a study was now to find out whether an associated weight loss has an impact on the prognosis of patients [3]. For this purpose, data from 128 patients were retrospectively analyzed. Weight or weight loss during the different steps of perioperative therapy were analyzed. In addition, histopathologic, demographic, and other prognostically relevant information was collected. Subsequently, the effect on overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) was evaluated. It was found that patients with weight loss ≥5% during neoadjuvant chemotherapy had significantly worse OS (23.6 months vs. 63.5 months), DFS (12.5 months vs. 63.5 months), and CSS (35 months vs. not reached) compared with patients with weight loss <5% or weight gain. Patients with weight loss ≥14% also had significantly worse OS (43.7 months vs. not reached) and DFS (34.3 months, vs. not reached), but not significantly worse CSS, compared with patients with weight loss <14% during the same period. The experts concluded that weight loss during neoadjuvant chemotherapy, but not weight loss throughout treatment, appears to be mainly tumor-associated and correlates with worse CSS.
Source: DGHO 2020 virtual
Literature:
- Waldschmidt D, El-Khoueir AB, Kim RD, et al: Phase 1b study of regorafenib (REG) plus pembrolizumab (PEMBRO) for first-line treatment of advanced hepatocellular carcinoma (HCC) / Phase 1b study of regorafenib (REG) plus pembrolizumab (PEMBRO). DGHO 2020; Abstract 153
- Götze TO, Hofheinz RD Reichart A, et al: Real-life data from the prospective QoliXane trial of the platform for outcome, quality of life, and translational research on pancreatic cancer (PARAGON) registry. DGHO 2020; Abstract 273
- Lorusso A, Högner A, Bichev D, et al: Prognostic significance of weight loss during perioperative chemotherapy for locally advanced operable esophagogastric tumors: a retrospective analysis. DGHO 2020; Abstract 655
InFo ONCOLOGY & HEMATOLOGY 2020; 8(5): 29 (published 10/20/20, ahead of print).
