Four encouraging developments in cancer treatments that extend patients’ lives

Four encouraging developments in cancer treatments that extend patients’ lives

Tens of thousands of physicians gathered during the American Society of Clinical Oncology 2024 Annual Conference to learn regarding new treatment proposals

Health.- During the American Society of Clinical Oncology 2024 Annual Conference (ASCO), tens of thousands of doctors gathered in the city of Chicago, in the United States, to learn regarding new treatment proposals and how to organize the most effective “therapeutic trajectory” for the patient, or when is the right time to use each of the available resources, from surgeries to medications.

According to doctors interviewed by BBC News Brazil, the news changes the way these diseases are treated in clinics and hospitals from now on.

The experts also emphasized palliative care and even in penile cancer: An experiment conducted in Brazil suggests a new line of treatment for this tumor surrounded by taboos and prejudices.

BBC News Brazil spoke to doctors who were at ASCO 2024 and summarises below four of the main cancer news stories discussed at the conference.

1. Lung cancer: increased survival

People diagnosed with the most common type of lung cancer, which is already at stage 3 — in which the disease has advanced but not yet spread to other parts of the body — are no longer candidates for curative-intent surgery.

In these cases, The traditional therapeutic strategy involves chemotherapy and radiotherapy sessions..

In mid-2017, a study conducted by several institutions around the world revealed that Adding immunotherapy significantly increases survival time of these individuals.

Immunotherapy is a relatively new line of treatment that does not directly attack the tumor, but rather stimulates the patient’s own immune system to identify and destroy diseased cells.

Since then, the combination of chemotherapy, radiation and immunotherapy has become the standard regimen, at least for cases where modern, more expensive drugs are available.

“However, there is a specific group of patients within this universe who do not benefit from immunotherapy, because they present results very similar to those who took placebo,” highlights oncologist Mariana Laloni, technical medical director of Oncoclínicas&Co.

The doctor is referring to those who have a mutation in the EGFR gene, which is found in the DNA of between 15 and 25% of those affected by the most common lung cancer.

A study presented at ASCO 2024 sought to find solutions precisely for this group.

Researchers tested whether AstraZeneca’s drug osimertinib might prolong the lives of patients diagnosed with grade 3 non-small cell lung cancer with a mutation in the EGFR gene.

The results obtained were considered positive: in the group that received the medication, the progression-free survival time was 39.1 months (or more than three years). For those who took a placebo, this rate was 5.6 months.

Laloni believes that the results are encouraging and bring good prospects. However, he believes that There are still questions to be answered.

“We still need to know if it is better to use this drug immediately following initial treatment. [con quimioterapia y radioterapia] or when the disease progresses,” says the specialist.

“This is important to address issues such as toxicity, side effects and costs.”

The oncologist also highlights another study on lung cancer that was mentioned at ASCO 2024.

A group of American experts decided to investigate whether teleconsultations for palliative care for patients with this advanced stage of the tumour might work as well as face-to-face meetings with healthcare professionals.

“It is study compared a group that had access to a palliative care program in person with another person who received the same care through electronic telecare tools,” he explains.

The scientists’ aim was to test whether the effects of remote consultation would be worse, the same or better.

“The results show that teleconsultations are no worse than face-to-face assessments and, in some aspects, even superior,” says the doctor.

According to Laloni, having this remote care program can be particularly welcome for those who have difficulty traveling to a clinic or hospital.

2. Esophageal cancer: the order of therapies makes the difference

Treatment of adenocarcinoma of the esophagus, one of the most common types of cancer in the tube that connects the mouth to the stomach, is a very polarizing topic.

On the one hand, a group of doctors advocated a therapeutic regimen called neoadjuvant. In short, the proposal consists of carrying out chemotherapy and radiotherapy sessions before subjecting the patient to surgery to remove the tumor.

On the other hand, some experts preferred perioperative treatment, that is, undergoing chemotherapy sessions before and following the operation.

“The data we had until then did not allow us to define which of the two strategies was better, so choosing one or the other depended on the decision of each institution,” says Dr. Paulo Hoff, president of the Oncologia D’Or center.

To dispel this uncertainty, researchers from several centres in Germany decided to compare the approaches. The results obtained indicated a significant advantage for perioperative treatment.

Patients who underwent this regimen had a median survival of 66 months. The group that underwent neoadjuvant therapy had a survival of 37 months, a difference of almost 2 and a half years between the groups.

As a result, Perioperative approach becomes the main option for physicians in cases of locally advanced esophageal adenocarcinoma (when the disease has already grown, but has not yet spread to other parts of the body).

3. Melanoma: Pre-surgery medications have benefits

The debate over the sequence of treatments was also a topic of discussion around melanoma, a less common type of skin cancer, but one with a high mortality rate.

Researchers from several Dutch institutions tested different treatment regimens for grade 3 melanoma, when the disease is advanced but has not spread to other parts of the body and surgery is possible.

In these cases, The procedure involves removing lymph nodes in the lymph nodeswhich are structures of the lymphatic system located in the armpits, neck or groin region that may harbor cancer cells that have “escaped” from the original tumor.

The big question of the study was: is it better to start drug treatment before or following surgery? To answer this question, the scientists divided 423 people with the disease into two groups.

The first received two cycles of ipilimumab and nivolumab (two immunotherapeutics) and then the patients underwent surgery.

Those who had a good response following this process (i.e., had less than 10% viable tumor cells) did not need to undergo any further intervention.

Those with more than 10% underwent new cycles of medication: depending on the patients’ genetic profile, they received 11 monthly cycles of nivolumab (immunotherapeutic) or 46 weekly doses of dabrafenib/trametinib (a targeted therapy drug).

The second group underwent the standard treatment: participants underwent surgery immediately and subsequently underwent 12 monthly cycles of nivolumab.

After 12 months of follow-up, The experts calculated that the event-free survival rate was 83.7% in group 1. and 57.2% in group 2.

The results reinforce that performing immunotherapy sessions before undergoing surgery is a good idea.

“The combination of other previously published studies with the data presented provides a very solid basis for using this new regimen as the primary treatment modality for this patient with stage 3 melanoma,” says oncologist Matheus Lobo of the AC Camargo Cancer Center in Sao Paulo.

Another piece of data caught our attention: almost 60% of the participants in the first group had a good response and had less than 10% viable tumor cells following the two cycles of immunotherapy and surgery.

In practice, this meant that they did not need to use any immunotherapy or targeted therapy following the initial immunotherapy sessions and surgery.

Lobo highlights that this discovery is great news, because it is possible to reduce treatment time and the costs involved in this entire process.

“It’s like you can resolve that patient’s history in just six weeks, instead of a year,” the doctor compares.

“But this is not without reason: the study showed that the toxicity profile in individuals in the first group was higher.”

The data indicate that 29.7% of people who underwent immunotherapy before surgery experienced grade 3 or 4 side effects, requiring hospitalization or even emergency interventions.

In the group that received conventional treatment (immunotherapy following surgery), this rate was 14.7%.

4. Penile cancer: testing new treatment

Every year, more than 35,000 men worldwide are diagnosed with penile cancer.

“It is a disease that is usually diagnosed at a very late stage, partly due to misinformation and prejudices,” says oncologist Fernando Maluf, founder of the Vencer al Cáncer Institute.

Poor hygiene is one of the main causes of the development of this tumor. Not receiving the vaccine once morest the human papillomavirus (HPV) is another reason, since this group of viruses is the cause of this and other types of cancer.

The doctor points out that, In many cases, treatment includes mutilating surgeries. and chemotherapy sessions, which do not significantly prolong the individual’s life. The disease usually reappears following a while.

“The treatments available for penile cancer have been used for a long time and there have been no recent advances that have modified these protocols,” adds Maluf, who also works at the Beneficência Portuguesa Hospital and the Hospital Israelita Albert Einstein, in São Paulo.

To change this scenario, the Brazilian oncologist led a study by the Latin American Cooperative Oncology Group (Lacog). The objective was to test a new therapeutic combination, consisting of chemotherapy and immunotherapy applications.

The researchers They recruited 33 men with the tumor, who were monitored through imaging tests every month and a half.

“The response rate we obtained with the new formulation was double that observed with the previous regimen,” Maluf sums up.

Data presented at ASCO 2024 reveal that the 75% of patients had some degree of tumor reduction. 39.4% of them showed a decrease considered significant.

“In addition to maintaining long-term tumor remission, treated patients had a better quality of life and tolerated the combination of chemotherapy and immunotherapy drugs well,” he added.

According to the oncologist, the research carried out in Brazil opens up new perspectives and allows for changes in medical practice in cases of penile cancer.