ASCO announced the results of 4 key studies on melanoma, prostate cancer, kidney cancer and multiple myeloma at the first press conference held for the 51st ASCO Annual Meeting. These results have eliminated thousands of The anxiety and complications of newly diagnosed cancer patients offer the possibility and the potential to extend the survival time of the most difficult children and adult cancer patients.

150518 At 12 noon local time on May 13, the American Society of Clinical Oncology (ASCO) announced at the first press conference for the 51st ASCO Annual Meeting (May 29 to June 2, Chicago) The results of 4 key researches are presented. The results of these four studies respectively confirmed that the use of easily available vitamin preparations can reduce the risk of non-melanoma skin cancer; early chemotherapy can prolong the survival time of patients with advanced prostate cancer; and new treatments can improve rare children with kidney cancer and recurrent multiple myeloma Outcome of adult patients. ASCO Chairman Dr. Peter Paul Yu said in an interview with a reporter from China Medical Tribune that the selection of the press conference research is based on the interests and concerns of many participants in the annual conference, and more new treatment models and clinical research on new drugs , Is still the focus of this ASCO annual meeting.

At the same time, the ASCO website (abstracts.asco.org) will publish about 5000 abstracts from the first round of the 51st ASCO Annual Meeting today. As in previous years, many major studies, including the Plenary session study, will be published as the latest abstract (LBA) at the McCormick Convention Center in Chicago. ASCO expects that about 25,000 oncology professionals will attend the conference. The conference will focus on enlightenment and innovation topics. The theme of this annual conference is "Illumination and Innovation, transforming data into learning".

In response to the four studies announced at the first press conference, Dr. Peter Paul Yu said: “Such clinical studies are the driving force behind the progress of cancer diagnosis and treatment in patients of all ages. In these four studies, we have seen the elimination of thousands of Consider the possibility of anxiety and complications of newly diagnosed cancer patients, as well as the potential to extend the survival time of the most difficult children and adult cancer patients. At the ASCO annual meeting, we will continue to see the transformation of investment in cancer research and treatment Power.” ASCO Cancer Communications Committee Chairman Dr. Gregory A. Masters (FACP, FASCO) said: “We have entered the era of cutting-edge precision medicine, but we can still achieve meaningful progress from traditional treatments. Because of cancer biology With a deeper understanding of science, we have obtained potential new targeted therapies for multiple myeloma, and can provide better individualized treatment for children with Wilms tumor. At the same time, easy-to-use vitamin tablets and long-term available Chemotherapy will play a role in improving the lifespan of patients in different ways."

Study 1: Simple oral vitamins can reduce the risk of common non-melanoma skin cancer

"Cancer prevention is welcome news at all times. Through this research, we have obtained a very simple and inexpensive method that can help people avoid some of the most common skin cancers. Using only daily vitamin tablets , As well as sun protection and routine skin cancer screening, provide high-risk groups with a good skin cancer prevention plan that is easy to follow."

——ASCO Chairman Dr. Peter Paul Yu, FACP, FASCO

Australia’s ONTRAC trial showed that a vitamin B3 called niacinamide can significantly reduce the incidence of new skin cancers in high-risk groups. When taken twice a day, niacinamide can reduce the incidence of new non-melanoma skin cancers by 23%.

The main cause of non-melanoma skin cancer is sun exposure. Despite the vigorous promotion of sun protection, the incidence of skin cancer continues to increase worldwide. In the United States, about 5 million people receive treatment for non-melanoma skin cancer each year; in Australia, more than half of the population may suffer from non-melanoma skin cancer once in their lifetime. Nicotinamide is a safe, inexpensive and available over-the-counter drug in most countries. Therefore, the research results have the potential to reduce the burden of skin cancer health care and economic costs-on a global scale.

The lead researcher, Dr. Diona Daminan, Professor of Dermatology at the University of Sydney, said: “This is the first clear evidence that we can reduce the risk of skin cancer through a combination of vitamins alone and avoid sun exposure. We hope that the above results can be quickly translated into clinical practice. People at high risk of skin cancer still need regular medical examinations."

In the ASCO annual meeting study announced today, the researchers included 386 patients (high-risk patients) who had at least two non-melanoma skin cancers in the past 5 years, and were randomly assigned to receive daily nicotinamide or niacinamide for 12 months. Placebo treatment. The study population represents a comprehensive group of patients who usually visit skin cancer clinics: the average age is 66 years, and two-thirds of the patients are men (skin cancer is more common in men). Many patients have persistent health problems such as heart disease, arthritis, high blood pressure and chronic lung disease. Compared with the placebo group, the new diagnosis rate of non-melanoma skin cancer in the niacinamide group was reduced by 23%. The number of cases of photokeratosis (thick scaly patches of skin that may be cancerous) in the nicotinamide group was reduced by 11% at 3 months of treatment, and 20% at 9 months.

The most common types of non-melanoma skin cancers are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). SCC can spread to lymph nodes and internal organs. BCC rarely spreads, but because it usually appears on the face, it can cause cosmetic problems. Niacinamide has comparable efficacy in preventing BCC and SCC.

Ultraviolet radiation in sunlight causes skin cancer through two key pathways-DNA damage and skin immunosuppression (the skin immune system helps remove abnormal cells before they become cancerous). The design of this prevention study is based on nearly a decade of preclinical and early clinical studies-studies suggest that nicotinamide can enhance the repair of skin cell DNA damage caused by sunlight, and protect the skin immune system from UV damage. DNA repair is an energy-intensive process. Ultraviolet radiation blocks energy production in skin cells. Cells convert nicotinamide into a molecule called nicotinamide adenine dinucleotide, which is necessary for cell energy production. Researchers believe that nicotinamide helps to replenish cell energy after sun exposure and provides cells with the energy needed to repair DNA damage and prevent immune suppression.

In the future, researchers will further determine whether nicotinamide can help reduce skin cancer in immunosuppressed people, such as organ transplant recipients who must take immunosuppressive drugs for life. The prevalence of skin cancer in people with suppressed immune system is 50 times higher than that in people with normal immune system.

This research was funded by the Australian Health and Medical Research Council (NHMRC).

Study 2: Increasing elotuzumab can significantly reduce the risk of recurrent multiple myeloma progression

"In the past ten years, we have made significant progress in understanding and treating multiple myeloma, the third most common blood system cancer. This research is an innovative method that will be based on the precision of immune targeted therapy and traditional myeloma. The method of combining treatments. The results of the study are extremely encouraging and bring new hope to patients with relapses."

——Dr. Julie M. Vose, Chairman-designate of ASCO, MBA, FASCO

The results of another study announced at the press conference showed that a new monoclonal antibody, elotuzumab, was added to the standard lenalidomide and dexamethasone treatment, and compared with standard treatment alone, the duration of remission was extended by an average of about 5 Months.

The lead study author, Dr. Sagar Lonial, Chief Medical Officer of the Winship Cancer Institute of Emory University in the United States, said: “For patients with relapsed multiple myeloma who have only received lenalidomide and dexamethasone treatment, the addition of this new targeted drug can make The outcome is better. What is particularly surprising is that the difference between elotuzumab and the control group seems to become larger over time, which really illustrates the effect of this type of immunotherapy."

Elotuzumab binds to a cell surface protein called SAMF7; the latter is found in myeloma cells and natural killer (NK) cells. Researchers believe that elotuzumab attacks cancer in two ways by directly attacking myeloma cells and by enhancing NK cells to kill myeloma cells. According to the information provided by the ASCO press conference, this is the largest study of monoclonal antibodies in the treatment of multiple myeloma, and is the first phase III trial that uses an immune-based targeting method to treat the disease and shows benefits.

In this study, 646 patients with recurrent multiple myeloma were randomly assigned to receive lenalidomide and dexamethasone (control group) or lenalidomide, dexamethasone, and elotuzumab. At a median follow-up of 24 months, elotuzumab reduced the risk of cancer progression and death by 30%. The progression-free survival of patients in the Elotuzumab group (average 19.4 months) was significantly longer than that of the control group (average 14.9 months). In addition, the two subgroups of patients with high-risk characteristics, del(17p) and t[4;14], achieved the same benefits as patients with average risk. Conventional treatments are not effective in such high-risk patients.

In general, elotuzemab was well tolerated and did not affect the quality of life of patients or increase the burden of symptoms. In 10% of patients in the elotuzumab group, mild infusion reactions occurred after the first few doses.

In 2014, the US FDA authorized the combination of elotuzumab, lenalidomide and dexamethasone to treat patients with recurrent multiple myeloma as a breakthrough therapy designation. This certification helps to speed up the development and review process of drugs to treat serious or fatal diseases. The ongoing clinical trials are exploring the possibility of integrating elotuzumab into the treatment of patients with newly diagnosed multiple myeloma, and evaluating various combinations of elotuzumab and existing treatments.

Study 3: Expanding standard treatments can increase the cure rate of high-risk Wilms tumor

"It is extremely encouraging that we are benefiting children with a rare, high-risk type of Wilms tumor. The ability to identify a small subgroup of children with poor prognosis means that these children can receive appropriate treatment , While reducing the side effects of treatment for low-risk children. This also means that cancer survival conditions are better."

——Dr. Julie M. Vose, Chairman-designate of ASCO, MBA, FASCO

Two phase III children's oncology group studies found that increasing the expansion of drugs can improve the outcome of children with high-risk types of Wilms tumor. Such children carry special chromosomal abnormalities associated with poor prognosis. In previous studies, the 4-year recurrence-free survival rate for these patients with stage I/II disease was 74.9%, and for stage III/IV disease was 65.9%. In the new study, expanded treatment increased the survival rate of children with stage I/II tumors to 83.9%, and the survival rate of children with stage III/IV tumors increased to 91.5%.

The lead investigator, Dr. David B. Dix, British Columbia Children's Hospital in Vancouver, Canada, said: “Personalized treatment that adapts to the risk of recurrence of different patients has always been the focus of pediatric oncology. For cancers with a lower risk of recurrence, we strive to reduce treatment and use Potentially toxic drug exposure is minimized. On the other hand, we hope to expand treatment for patients with a higher risk of recurrence, so that we can hope to increase the chance of cure. Our study is one of the examples of successful expansion of treatment for patients in the high-risk group. We are very happy Seeing that augmented therapy can overcome the adverse effects of biomarkers in children with Wilms tumor."

Wilms tumor is a rare type of kidney cancer that mainly affects children under 5 years of age. Approximately 500 new cases are diagnosed in North America each year. This study focused on children with so-called good histological Wilms tumor, which accounts for 75% of childhood kidney cancers. About 5 to 6% of tumors with loss of heterozygosity (LOH) on chromosomes 1p and 16q have chromosomal abnormalities. Researchers have previously found that patients with LOH 1p and 16q have an increased risk of recurrence.

In this study, 35 children with stage I/II and 52 children with stage III/IV were detected with LOH 1p and 16q. For children with stage I/II, standard treatment (vincristine/dactinomycin chemotherapy) is expanded with doxorubicin. Children with stage III/IV receive M regimen treatment: standard treatment (vincristine/dactinomycin/doxorubicin and radiotherapy) is extended with 4-cycle outpatient cyclophosphamide/etoposide.

At a median follow-up of 3.6 years, the 4-year recurrence-free survival rates of stage I/II and III/IV children were 83.9% and 91.5%, respectively. When compared with standard treatment options (75% for early disease and 66% for late disease), such studies suggest that expanded treatment can significantly improve the outcome of children with late disease. Given the small sample size of the study, the benefit of children with lower-stage disease is not clear, but it suggests an improved outcome.

Overall, the treatment was well tolerated. For children with stage I/II, there is no correlation between expansion therapy and any significant short-term increase in side effects. For children with stage III/IV, the most common serious side effect of the M regimen is bone marrow suppression, which occurs in 60% of children; however, the side effects are controllable. According to the authors, the M program can significantly reduce the number of relapsed children and prevent them from receiving extremely intensive relapse treatment. However, it is predicted that this program is associated with certain risks of reduced fertility. The author recommends a detailed discussion with the family about the pros and cons of this augmentation therapy for children at high risk of LOH.

The LOH 1p and 16q tests are available in the Biopathology Center of the Children's Oncology Group, National Children's Hospital in Columbus, Ohio, as well as several other centers in North America.

Study 4: Adding chemotherapy to the initial treatment can extend the life of men with advanced prostate cancer who have not been treated with hormones

"This is the largest trial of its kind, and its results strongly support the idea that adding chemotherapy to standard hormone therapy can extend the lifespan of men with advanced prostate cancer. The innovative design of this study is eye-catching, and we may in the future We will see similar designs in other oncology fields."

——ASCO Chairman Dr. Peter Paul Yu, FACP, FASCO

The STAMPEDE trial led by British scholars found that the addition of sitoxet chemotherapy to standard hormone therapy can significantly improve the survival of newly diagnosed men with advanced prostate cancer who have not previously been treated with hormones (hormone-naïve). Compared with men who received only standard treatment (SOC), those who received docetaxel combined with standard treatment had an average of 10 months longer survival time. In contrast, adding zoledronic acid on the basis of SOC did not affect survival, and the effectiveness of the combined increase of zoledronic acid and docetaxel was not increased compared to when only docetaxel was added.

Consultant Clinical Oncology, Coventry Warwick, Queen Elizabeth Hospital, Birmingham, UK