SWOG's Work Shines at ASCO and Beyond

SWOG’s Dr. Neeraj Agarwal of the Huntsman Cancer Institute at the University of Utah was study chair of S1216. This trial compared androgen deprivation therapy (ADT) combined with TAK-700 to the standard treatment of ADT with bicalutamide in patients who had metastatic hormone-sensitive prostate cancer. Dr. Agarwal’s team found that adding TAK-700 to ADT lengthens median progression-free survival in these patients and improves PSA response, but it does not lengthen median overall survival.

Dr. Ken Grossmann, also of the Huntsman Cancer Institute and chair of our Melanoma Committee, will give an oral presentation of S1404 results. S1404 tested pembrolizumab against standard of care therapies—either high-dose interferon or ipilimumab—in patients with high-risk resected melanoma. Patients in the pembrolizumab arm had improved median relapse-free survival but did not see an overall survival advantage. The safety profile of pembrolizumab, as expected, was more favorable than that of either ipilimumab or high-dose interferon in this patient population.

These two abstracts, along with the others I summarize below, are available now in the ASCO meeting library.

• Dr. Sepideh Gholami of the University of California Davis reports on a secondary analysis of data from S0809, which studied patients with resected extrahepatic cholangiocarcinoma and gallbladder cancers. The study team previously reported that adjuvant capecitabine and gemcitabine followed by radiation therapy with capecitabine improves overall survival. This secondary analysis looks specifically at patients with lymph node involvement. It finds that adjuvant chemoradiation improves patient outcomes regardless of whether lymph nodes are involved and can even have additional benefit in those with lymph node involvement, perhaps by preventing local recurrence.
   
• SWOG Vice Chair for NCORP Research Dr. Dawn Hershman will deliver long-term results from S1200 which echo the promising early results reported from that trial. An analysis of 52-week outcomes from the study found that patients with breast cancer who were treated with acupuncture for aromatase inhibitor-induced joint pain had lower worst pain levels than those who received a sham acupuncture procedure and than wait-list controls. These benefits persisted over one year (!) even though the initial course of acupuncture lasted only 12 weeks.
   
• Another secondary analysis, this of data from S1505, will be presented by Dr. Davendra Sohal of the University of Cincinnati. That trial compared two neoadjuvant treatments in patients with operable pancreatic ductal adenocarcinoma. Sohal analyzed the relationship between measurements of patients’ skeletal muscle and adipose tissue and their overall survival times. The analysis found that higher visceral fat is associated with lower overall survival.
   
• Dr. Peter Black of the University of British Columbia delivers results from S1605, a phase II trial that tested atezolizumab in patients with non-muscle-invasive bladder cancer that was unresponsive to treatment with BCG. The observed response rate suggests atezolizumab could be a valuable treatment for patients who are not candidates for surgery because of their poor general health and for patients who choose to forego operations.
   
• An update on toxicity data for S1800A is one of two Lung-MAP abstracts at ASCO. S1800A was a non-match sub-study that randomized patients with stage-IV non-small cell lung cancer to either ramucirumab plus pembrolizumab or an investigator-chosen standard of care treatment. Dr. Karen Reckamp of Cedars-Sinai Medical Center will present an analysis showing that the rate of grade-3 and higher toxicities is lower in patients in the ramucirumab plus pembrolizumab arm than in patients who received standard of care treatment.
   
• Dr. Jonathan W. Riess of the University of California Davis delivers the other Lung-MAP abstract at ASCO this year, results from S1900A, a phase II study of rucaparib in patients with stage-IV non-small cell lung cancer whose tumors had at least one of two specific genetic changes (genomic loss of heterozygosity and/or a deleterious BRCA1/2 mutation). The study failed to show sufficient efficacy of rucaparib in the overall population of these patients, but an unplanned analysis observed a signal of preferential clinical activity in patients whose tumors harbored mutations in both alleles of the BRCA gene.

These ASCO presentations represent only a fraction of the group’s recent overall productivity. Manuscripts on SWOG trial results are published at a rate of more than two per week. Below are a few of those published in the last six months or so that promise outsized impact.

• Work led by Dr. Joe Unger and published in the Journal of Clinical Oncology found that even when patients with cancer receive health care in the context of a clinical trial, those living in the poorest neighborhoods in America have a 28 percent greater chance of dying from their disease than do  those living in the most affluent enclaves.
   
• Results from S1406, which was led by Dr. Scott Kopetz, were reported (with an accompanying editorial by SWOG’s Dr. Cathy Eng) in January’s Journal of Clinical Oncology. Kopetz and colleagues found that a three-drug combination of irinotecan, cetuximab, and vemurafenib prompts higher response rates than the two-drug combination of irinotecan and cetuximab in patients with metastatic colorectal cancer whose tumors carry the V600E mutation in the BRAF gene. The results are expected to change the standard of care for these patients, whose tumors rarely respond to treatment. 
   
• Drs. Davendra Sohal and Sayed Ahmad had primary results from S1505 published in JAMA Oncology. This trial tested the use of two chemotherapy regimens before surgery for pancreatic cancer. The study did not find an overall survival benefit, but the results do establish parameters for safely administering chemotherapy before surgery.
   
• Also published in the last six months have been practice-changing results from S1007 (RxPONDER) and S1500 (PAPMET). I wrote about these last week.

If it seems difficult to keep up on important SWOG findings, it’s because they appear so regularly. The group has several dozen clinical trials open at any given time, and the data and biospecimens gathered over hundreds of past SWOG trials are continually being mined for new knowledge that will improve the lives of patients. And that, after all, is why we do what we do.