Trial Results: ECOG-ACRIN research round-up – Summer 2022

Below are the highlights of ECOG-ACRIN Cancer Research Group (ECOG-ACRIN) research presentations at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago and online in early June. The National Cancer Institute, part of the National Institutes of Health, funded these studies.

• Breast Cancer—New research shows why some breast cancer survivors stop taking hormonal therapy early

For women with hormone receptor-positive (HR+) early breast cancer who are through menopause, 5-10 years of hormonal therapy with an aromatase inhibitor is standard following initial treatment (surgery, radiation if recommended, and chemotherapy). Hormone therapy helps prevent breast cancer from coming back. However, many women stop taking these medicines because they can cause severe joint pain. New data (E1Z11) show that patient reports of moderate to high treatment bother BEFORE beginning hormone therapy were associated with a higher risk of stopping early, except in Asian patients. Lingering symptoms from initial treatment appear to be part of the reason some women stop taking hormonal therapy early. Zhao F. ASCO 2022 Annual Meeting. June 2022

• Care Delivery—The reproductive health needs of women with a new cancer diagnosis are not adequately addressed by cancer care providers

The EROS (E1Q11) trial shows the effectiveness of a reproductive health program to help align women's reproductive goals and needs with cancer treatment. Uncertainties regarding future fertility, pregnancy, and cancer survival are intricate and challenging for patients and cancer care teams. The objectives of reproductive health care may sometimes conflict with the goals of cancer treatment. However, these conflicts can be resolved with appropriate counseling and preventive measures. EROS is the first clinical trial of its kind. Work from the EROS trial should inform hospitals and cancer centers to improve guidelines and include a reproductive health assessment for all young women with cancer. Patel A. ASCO 2022 Annual Meeting. June 2022

• HPV-Associated Head and Neck Cancer—Outcomes did not appear to be influenced by smoking status

E3311 is a randomized phase II study that showed that low-dose radiation at 50 Gy without chemotherapy following transoral surgery led to very high survival and outstanding quality of life in patients with human papillomavirus-positive (HPV+) throat cancer and at medium risk for recurrence. A planned analysis of patient outcomes by tobacco history found no differences in progression-free survival or overall survival outcomes at 3 years between patients with less than or greater than ten pack-year smoking history as well as current versus former smokers. This discovery may impact how doctors suggest treatment options for their patients with a smoking history. Mehra R. ASCO 2022 Annual Meeting. June 2022 

• Melanoma—The DREAMseq trial shows a 20% survival improvement for patients with advanced melanoma skin cancer

Until recently, little prospective data existed to guide the choice of initial therapy or sequence in patients with BRAF V600 mutant metastatic melanoma. The practice-changing result of the randomized phase III trial DREAMseq (EA6134) showed that the best approach, if there was disease progression, was to start treatment with immunotherapy (nivolumab and ipilimumab) followed by targeted therapy (dabrafenib and trametinib). In the study, this led to a clinically meaningful 20% improvement in estimated 2-year overall survival from the start of treatment compared to the opposite treatment sequence (72% vs. 52%, respectively). Atkins MB. ASCO 2022 Annual Meeting. June 2022

• Pancreatic Neuroendocrine Tumors—A chemotherapy drug combination shows promise

Patients with advanced progressive pancreatic neuroendocrine tumors have few treatment options. The E2211 randomized phase II trial shows the most prolonged progression-free survival reported for patients with these tumors. The group of patients who received chemotherapy with capecitabine and temozolomide had a significantly longer median progression-free survival (22.7 months) than the group who received only temozolomide (14.4 months). Kunz PL. ASCO 2022 Annual Meeting. June 2022

• Prostate Cancer—Early chemotherapy with ADT produces excellent long-term outcomes

After eight years of follow-up, the CHAARTED (E3805) randomized phase III trial continues to demonstrate that early docetaxel chemotherapy with androgen deprivation therapy (ADT) significantly improves overall survival in men with metastatic hormone-sensitive prostate cancer compared to ADT alone. Median overall survival was 60.4 months with ADT plus docetaxel vs. 47.2 months with ADT alone. The main finding related to patient care is the benefit of early docetaxel was most pronounced and maintained in patients with high volume disease. Tripathi A. ASCO Annual Meeting. June 2022