ASCO 2013 Report — Gastrointestinal Cancer

Abstract

At this year's annual meeting of the American Society of Clinical Oncology (ASCO 2013), held May 31 through June 5 in Chicago, specialists discussed the latest findings in cancer research. The editors of NEJM Journal Watch Oncology and Hematology were in attendance to report highlights of the conference. Here, David Ilson, MD, reviews key presentations on new gastrointestinal cancer treatments. A New Standard Therapy Option for Pancreatic Cancer Von Hoff and colleagues reported results from the phase III, randomized IMPACT trial (Abstract 4005), which compared conventional gemcitabine therapy with nanoparticle albumin-bound (nab)-paclitaxel plus gemcitabine in 861 patients with advanced pancreatic cancer. Patients received either gemcitabine (1000 mg/m2) weekly for 7 weeks with 1 week off and then on days 1, 8, and 15 every 4 weeks or gemcitabine (1000 mg/m2) plus nab-paclitaxel (125 mg/m2) on days 1, 8, and 15 every 4 weeks. Most patients (93%) had Karnofsky performance status of 80 to 100, and 84% had metastatic disease to the liver. Combination therapy with gemcitabine and nab-paclitaxel was superior to gemcitabine in all endpoints, including overall survival (OS; 8.5 vs. 6.7 months; hazard ratio, 0.72; P =0.000015), progression-free survival (PFS; 5.5 vs. 3.7 months; HR, 0.69; P =0.000024), and response (23% vs. 7%; P =1.1 x 10-10). Grade 3 or 4 toxicities that were higher with nab-paclitaxel included neutropenia (38% vs. 27%), neuropathy (17% vs. 1%), fatigue (17% vs. 7%), and diarrhea (6% vs. 1%). Gemcitabine plus nab-paclitaxel represents a new standard-therapy option for advanced pancreatic cancer. Although superior to gemcitabine alone, this regimen did not achieve the survival benefit reported for FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, and fluorouracil) versus gemcitabine (NEJM JW Oncol Hematol May 11 2011). Lipid-Conjugated Gemcitabine Not Superior for Pancreatic Cancer Poplin and colleagues reported data from the phase II, randomized, …