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Top ten news (except COVID) in 2020 oncology

Despite the many challenges faced in 2020, we have seen impressive progress in many areas of cancer research. Twenty-one novel oncology drugs were approved by the U.S. Food and Drug Administration (FDA). Although cancer is one of the major public health problems worldwide, cancer mortality projections for 2021 confirm the persistent declines in cancer mortality in EU and US for many specific cancers. The breast cancer treatment landscape has evolved in the past year and several new drugs approved in 2020 as antibody drugs conjugates (ADC) sacituzumab in TNBC and fam- trastuzumab deruxtecan- nxki (T-DXd) in metastatic HER2 positive BC, as well as tucatinib, a small kinase inhibitor. A few very important clinical trial /RxPONDER, ADAPT, PRIME II/ presented last year support de-escalation of adjuvant chemotherapy and radiation, sparing patients from some of the side effects that can accompany treatments. In ovarian cancer five-year follow-up data from the SOLO-1 trial continue to show progression-free survival benefit of olaparib as maintenance therapy following platinum-based chemotherapy in the frontline setting. In the final analysis of SOLO-2 trial, maintenance olaparib provided an improvement of 12.9 months in median OS vs placebo in women with relapsed BRCA- related ovarian cancer who had responded to their most recent platinum-based chemotherapy after having received at least one more line of chemotherapy.In 2020 first new treatment for hepatocellular carcinoma approved in more than ten years according to the data from phase III IMbrave 150 trial. In that study, which includes 501 patients the combination of atezolizumab and bevacizumab provides the longest survival seen in a front-line phase III study in advanced HCC, confirming atezo + bev as a standard of care for previously untreated, unresectable HCC.In the field of thoracic oncology there were some very important news in 2020, potentially practice changing. Osimertinib, next generation EGFR-TKI, standard first line therapy in metastatic EGFR- mutated advanced NSCLC was successfully used, in ADAURA study, in adjuvant setting vs placebo (planned treatment duration three years), in resected NSCLC patients, stage IB-IIIA. Patients might had adjuvant chemotherapy also, and there was no outcome differences between these two groups. Overall, there was a 79% reduction in the risk of disease recurrence or death (DFS HR was 0.21, p<0.0001). Lorlatinib is the third generation of ALKinhibitors in the treatment of advanced NSCLC. The results of CROWN study where lorlatinib was given in the first line treatment were presented at ESMO 2020. In this randomized study, comparing lorlatinib with crizotinib, lorlatinib was superior in the term of PFS, HR was 0.28, p<0.001, this superiority was particularly pronounced in intracranial disease, where the percent of intracranial response was 82% in lorlatinib arm and only 23% in crizotinib arm, and percent of complete response per CT was 71% vs 7%. Lorlatinib has been recently approved for patients with advanced ALK-positive NSCLC, irrespectively of treatment line. Also of interest were two studies that inovatively used immunologic drugs as a combination in advanced NSCLC: in Check Mate 9LA randomized study, cytotoxic chemotherapy was given in paralell with nivolumab + ipilimumab for first two cycles, and compared with four cycles of chemoherapy. Median OS was significantly better: 15.6 vs 10.9 months, HR 0.66 and a overall response rate was 38% vs 25%. CITYSCAPE study give us inovative combination of two immuno-oncology drugs, tiragolumab as TIGIT inhibitor, and standard atezolizumab. Median PFS was particularly longer in the population of patients with high PD- L1 expression (NE vs 4.11 months, HR 0.30). In gastrointestinal oncology, last year will be remembered by introducing immunotherapy in first line treatment of metastatic colorectal cancer for Lib Oncol. 2021 ; 49(Suppl 2):1–34 34 patients with MSI-H tumors. In KN177, such patients were randomized to receive pembrolizumab or standard chemotherapy+/- biologic therapy, and after second interim analysis, there was a very clear adventage for pembrolizumab in terms of mPFS (16.5 vs 8.2 months) and duraton of response (at 24 months, 83% vs 35%). The results are impressive, and it is for expected to be confirmed by OS adventage in future analyses. In urological oncology, JAVELIN Bladder 100 study demonstrated that the maintenance avelumab + best supportive care is superior over best supportive care alone after platinum-based first-line chemotherapy in advanced urothelial carcinoma. In overall population, OS was 21.4 vs 14.3 months, HR 0.69, p<0.001, and the results are even better in PD-L1 positive population, with HR 0.56. These results are very probably practice changing, since cytotoxic chemotherapy have very modest achievements in the field of urothelial cancer.

oncology news ; breast cancer ; gynecological tumors ; hepatocellular carcinoma ; non-small cell lung cancer ; MSI-H colorectal cancer ; bladder cancer

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