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Impact of ASCO’17 on Clinical Practice

ASCO 2017 met high expectations and delivered a plethora of exciting data. The conference showcased data on promising new molecular targets, combination regimens, and delivery mechanisms in development, and provided valuable insights that will impact current use of commercially available therapies. Blue Matter Consulting is closely tracking the key trends shaping the oncology treatment landscape, and has highlighted 3 takeaways from ASCO 2017 with the most immediate impact on current oncology prescribing patterns.

 

Zytiga to be considered for advanced prostate cancer regardless of hormone status

The LATITUDE study provided convincing data in support of widespread Zytiga use in high-risk metastatic prostate cancer. The phase 3 metastatic hormone-sensitive prostate cancer study showed that Zytiga use in combination with prednisone and standard androgen deprivation therapy (ADT) lowered the risk of death by 38% compared to ADT plus placebo. Meanwhile, the STAMPEDE study further supported earlier Zytiga use in showing a 37% overall survival improvement when added to ADT in treatment-naïve patients. The data is compelling enough to cause immediate change in prescribing patterns for advanced hormone-sensitive disease, with strong future potential for earlier use as standard frontline therapy.

 

 

MSI-H / dMMR testing to become part of standard practice

Keytruda long ago proved the validity of the MSI-H biomarker to predict response in colorectal cancer (CRC) across multiple trials, and took this concept one step further to demonstrate MSI-H as a predictive biomarker of response in a range of tumor types. The ASCO abstract, published in advance of the conference, showed 26% ORR in MSI-H CRC and 43% ORR outside CRC (in 21 patients). Keytruda has since gained FDA approval for any MSI-H previously treated solid tumor, and testing for the specific genetic feature should immediately be incorporated into standard practice.

 

Growing treatment options for frontline ALK+ NSCLC

Xalkori has historically been used as the standard initial therapy for ALK+ NSCLC, but the evidence for Zykadia, and particularly Alecensa is now compelling enough to consider new frontline options. At ASCO 2017, Alecensa published a head-to-head comparison with Xalkori in newly-diagnosed ALK+ patients and showed a 53% reduction in risk of disease progression. Alecensa has consistently demonstrated superior activity in patients with brain metastases, and reported a 9% incidence of brain metastases in the trial, compared to 41% in the Xalkori arm. Xalkori and Zykadia are both category 1 first-line treatment options in the current NCCN guidelines, but Alecensa is positioned to end up as the preferred frontline therapy.