ASCO 20018

GASTROINTESTINAL (NO COLORECTAL) Critical review

Stefano Cascinu

Modena Cancer Center Modena, Italy

Stefano Cascinu

Conflict of interest disclosure:

• Consultant or Advisory Board: Celgene; Baxalta; Bayer; Amgen

• Research grant: Merck; Bayer; Celgene

• Honoraria: Celgene; Bayer; Amgen

Something new?

Pancreatic Cancer

– Adjuvant chemotherapy: GI PRODIGE 24/CCTG PA.6

– Preoperative chemoradiotherapy: PREOPANC-1

– Metastatic disease: PRODIGE 35-PANOPTIMOX;

Gastric/Esophageal cancer

– Adjuvant: S-1/docetaxel;

– Advanced: S-1/CDDP vs S-1/CDDP/Docetaxel

– 2° line:

• Trastuzumab and paclitaxel

• Pembrolizumab vs paclitaxel

Biliary tract cancer

– Advanced: S-1/GEM vs S-1/CDDP

Neuroendocrine tumours

– Temozolamide vs TEM/cape

Modified after 30 patients: Irinotecan 150 mg (diarrhea ¾)

Non noto il numero di pazienti valutati/inseriti (12 settimane per iniziare)

Follow up mediano 33.6 mesi: N° eventi 314 (>90%)

GEM: eccezionale risultato

N° eventi <50%

Differenza a 3 aa: 15%

1° domanda: RT per una malattia sistemica (30% dei pazienti

già metastatici)?

2° domanda: forse però evita chirurgie inutili e aumenta R0?

E il ruolo

dell’irinotecan nel

FOLFIRINOX?

PFS2: ?

Neurotossicità =

Dose cumulativa

Braccio A: 1.020

Braccio B: 680

Effetto della

reintroduzione?

27 su 52 a 6 mesi

Something new?

Pancreatic Cancer

– Adjuvant chemotherapy: GI PRODIGE 24/CCTG PA.6

– Preoperative chemoradiotherapy: PREOPANC-1

– Metastatic disease: PRODIGE 35-PANOPTIMOX;

Gastric/Esophageal cancer

– Adjuvant: S-1/docetaxel;

– Advanced: S-1/CDDP vs S-1/CDDP/Docetaxel

– 2° line:

• Trastuzumab and paclitaxel

• Pembrolizumab vs paclitaxel

Primary

endpoint:

3-year RFS

?

CLASSIC Trial ACTS_GC trial, Sasako JCO 2012

Trial Agent N° pat RR (%) PFS (median) OS (median)

TYTAN Lapatinib 130 27 5.5 11

Paclitaxel 131 9 4.4 8.9

Gatsby TDM-1 224 21 2.9 8.6

Placebo 117 20 2.7 7.9

Combined positive

score: number of

PDL-1 positive

cells ( tumor,

lymphocytes and

macrophages) in

relation to total

tumor cells

MSI; EBV?

KEYNOTE-059: Response according to MSI

Fuchs CS et al. ASCO 2017

JAVELIN Gastric 300: Avelumab as Third Line Treatment for Gastric or GEJ Adenocarcinoma

JAVELIN Gastric 300, a pivotal phase III open-label,

multicenter trial of avelumab vs physician’s choice

(paclitaxel/irinotecan) as a third-line treatment of

unresectable, recurrent, or metastatic gastric

adenocarcinoma.

371 patients (147 sites)

It did not meet its primary endpoint of

demonstrating superior overall survival (OS)