The 2016 Annual Meeting of the European Society of Medical Oncology (ESMO) was characterized by an abundance of presentations of novel and potentially practice-changing clinical trial results never seen before at a European cancer conference. This clearly underlines the importance of this meeting among the plethora of other oncology congresses. Within this huge amount of data, two main trends were observed: Immunotherapy with immune checkpoint modulators is still at the very center of scientific interest with further treatment individualization being a second main emphasis.
This short review reflects the personal highlights of three experts in medical oncology in their respective fields of expertise.
Colorectal cancer is a heterogeneous disease. In contrast to the left-sided colon, which derives from the embryonic hindgut, the right-sided colon originates from the midgut.
Primary tumors arising from different regions of the colon are molecularly and clinically distinct. Left-sided tumors more frequently possess a molecular profile of an EGFR inhibitor-sensitive phenotype, which is reflected in
EGFR/ERB-B2 and epiregulin amplification; conversely, right-sided tumors show more frequently
BRAF mutations and microsatellite instability. These molecular differences manifest in different clinical behavior, with right-sided tumors harboring a worse prognosis. At this year’s ESMO conference in Copenhagen, the predictive value of colon cancer sidedness was comprehensively discussed including retrospective analyses of the anti-VEGF versus anti-EGFR head-to-head trials FIRE-3, PEAK, and CALGB80405 [
11]. In summary, in first-line therapy of patients with left-sided
RAS wild-type tumors, a combination therapy consisting of an EGFR antibody with chemotherapy is recommended. In patients with right-sided
RAS wild-type tumors, there is presently no proven benefit of an EGFR antibody compared with bevacizumab. Therefore, a bevacizumab plus chemotherapy combination is recommended.
Apart from the seminal results of the KEYNOTE-024 and CheckMate-026 lung cancer trials, the following two presentations seem to have practice-changing impact: Mirza et al. [
4] reported results from a randomized double-blind phase 3 trial of maintenance therapy with the PARP inhibitor niraparib versus placebo (2:1) in patients with platinum-sensitive recurrent ovarian cancer (ENGOT-OV16/NOVA trial). Overall, 553 patients were enrolled after response to platinum chemotherapy, 203 with a germline
BRCA mutation and 350 patients without such a mutation. Interestingly, niraparib maintenance improved outcome in terms of PFS not only in the patient cohort with
BRCA mutation (PFS, 21.0 months versus 5.5 months;
p < 0.0001) but also in the
BRCA wild-type subset (PFS, 9.3 months versus 3.9 months,
p < 0.0001). Although overall outcome was better in the mutant subset, these results seem to indicate that PARP inhibition is an effective treatment modality for ovarian cancer independent of germline
BRCA mutation status. Important results were also reported on the adjuvant treatment of stage III melanoma. Eggermont et al. [
1] showed that ipilimumab not only prolonged relapse-free survival in this setting, but also led to an improvement in terms of overall survival compared with placebo (5-year overall survival 65.4% versus 54.4%;
p = 0.001; EORTC 18071 trial).
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