Although the 2015 ASCO conference has come to an end, the major studies at the conference have brought a lasting and profound impact on our clinical practice. This article summarizes the top 10 clinical decision-making changes brought about by ASCO 2015.

2015 ASCO Conference 1. Recommend Ipilimumab combined with Nivolumab as the first-line treatment of metastatic melanoma

Jedd D. Wolchok of the Memorial Sloan-Kettering Cancer Center in the United States reported on ASCO that the efficacy of Ipilimumab combined with Nivoluma in the first-line treatment of metastatic melanoma is better than that of Nivoluma or Ipilimumab alone. The combination therapy group and the Nivoluma group have disease progression-free survival Time (PFS) and objective response rate (ORR) were better than those of the Ipilimumab group. The PFS and ORR of the combined treatment group were 11.5 months and 57.6%, respectively. The Nivoluma single-agent group had PFS and ORR of 6.9 months and 43.7%, respectively. The PFS and ORR of Ipilimumab as a single agent were 2.9 months and 19.0%, respectively. The combined treatment group had more grade 3-4 adverse reactions than the single-agent group. Based on the above studies, Ipilimumab combined with Nivolumab can be recommended clinically as the first-line treatment of metastatic melanoma, but its cost is very expensive.

2. Recommend Nivolumab for refractory advanced non-squamous non-small cell lung cancer

Paz-Ares et al. reported on ASCO that a global multi-center phase III clinical study found that patients with advanced non-squamous non-small cell lung cancer (NSCLC) who received a platinum-based two-drug regimen were randomly divided into the Nivolumab group or more The overall survival time (OS) and objective response rate (ORR) of patients receiving Nivolumab in the sitoxel group were better than those of docetaxel. The OS and ORR of the Nivolumab group were 12.4 months and 19.2%, respectively. The OS and ORR of the competition group were 9.4 months and 12.4%. The incidence of 3-5 degree adverse reactions in the docetaxel group was higher than that in the Nivolumab group (53.7% vs 10.5%). Therefore, Nivolumab is recommended for advanced non-small cell lung cancer that has undergone platinum-based two-drug regimen, but the cost is more expensive. Sitaxel is expensive. Currently, Nivolumab is waiting for FDA approval for its use in platinum-resistant advanced non-squamous non-small Cell lung cancer.

3. It is recommended to add docetaxel to the standard treatment of advanced prostate cancer that has not previously received androgen castration therapy

Nicholas and others from the United Kingdom reported the results of the STAMPEDE study on ASCO. More than 1700 high-risk locally advanced or metastatic prostate cancer patients were divided into 4 treatment groups according to 2:1:1:1: Standard treatment (≥ 3 years of androgen castration) Treatment ± local radiotherapy), standard treatment + docetaxel (6 cycles), standard treatment + zoledronic acid (2 years), standard treatment + docetaxel + zoledronic acid, compared with standard treatment, docetaxel The overall survival period of metabolite combined with standard treatment was extended by 10 months (67 months vs. 77 months). Standard treatment plus docetaxel chemotherapy can significantly improve the survival of patients with metastatic prostate cancer who have not received androgen castration treatment. There is no significant difference in survival between the standard treatment plus zoledronic acid group and standard treatment. Standard treatment plus docetaxel The survival benefit of zoledronic acid and zoledronic acid is similar to that of standard treatment plus docetaxel. The addition of docetaxel can significantly extend the survival period, while the addition of zoledronic acid has no survival benefit.

4. It is recommended to use Anastrozole as an alternative to tamoxifen to prevent the recurrence of ductal carcinoma in situ of the breast before menopause

This year ASCO's Professor of Oncology Surgery from McGill University Jewish General Hospital in Canada, Richard G. Margolese, reported the results of the NRG Oncology/NSABP B-35 study, which compared anastrozole and tamoxifen to prevent postoperative radiotherapy and chemotherapy The effect of tumor recurrence in patients with premenopausal ductal carcinoma in situ (DCIS). The average follow-up time was 8.6 years. During the follow-up period, 114 cases of breast cancer occurred in the tamoxifen group (including recurrence of DCIS and new DCIS or invasive breast cancer on the ipsilateral or contralateral breast) and 84 cases in the anastrozole group. The difference was statistically significant. Compared with tamoxifen, the anastrozole group can reduce tumor recurrence by 4.3%, and the effect is better for people younger than 60 years old. Therefore, both tamoxifen and anastrozole can be used to prevent the recurrence of ductal carcinoma in situ before menopause after postoperative radiotherapy and chemotherapy.

5. It is recommended to combine palbociclib with fulvestrant to treat HR-positive advanced breast cancer that has failed endocrine therapy

Nicholas C. Turner from the Institute of Cancer Research in London gave an oral report on the latest results of the Phase III study PALOMA-3. The study showed that for advanced breast cancer patients with hormone receptor positive and human epidermal growth factor receptor-2 negative (HR+/HER2-) that have progressed through endocrine therapy, add to the standard hormone therapy regimen (fulvestrant) The targeted drug palbociclib can significantly prolong disease progression-free survival time (9.2 months VS 3.8 months), and the objective disease response rate is significantly increased (44% VS 25%), but it is necessary to pay attention to the occurrence of neutropenia in combination The rate is higher than that of Fulvestrant alone.

6. It is recommended that bevacizumab combined with PC regimen treat pleural mesothelioma

Zalcman and others from France reported the results of the MAPS study. The study randomly divided 448 patients with pleural mesothelioma into 2 groups, pemetrexed combined with cisplatin (PC) and bevacizumab and pemetrexed combined The progression-free survival (PFS) and overall survival (OS) of the cisplatin group (Bev+PC) and the combination treatment group were 9.6 months and 18.8 months, respectively, while the PFS and OS of the PC group were 7.5 months and At 16.1 months, there were more hypertension (23%VS0.0), proteinuria (3.1%VS0.0) and thrombotic events (2.7%VS0.0) in the combined treatment group. Bevacizumab combined with PC regimen in the treatment of pleural mesothelioma can significantly prolong survival, and the toxicity is acceptable. Therefore, it is recommended that bevacizumab combined with PC regimen treat pleural mesothelioma.

7. It is recommended that zoledronic acid be changed from once a month to once every three months

This year, ASCO Himelstein from the United States reported the results of CALGB 70604. The study randomly divided 1822 cases of breast cancer, prostate cancer, melanoma and other patients with bone metastasis into zoledronic acid (once every 3 months) and zoledronic acid. Phosphonic acid (once a month) two groups, continued observation for 24 months, found that the incidence of bone-related events of zoledronic acid every 3 months is similar to that of monthly dosing (28.6% vs 29.5%) Therefore, it is recommended that zoledronic acid be changed from once a month to once every three months.

8. Encourage chemotherapy patients to exercise to improve cognitive dysfunction

Mustian from Europe reported the results of URCC NCORP. The study divided 479 patients with non-brain metastasis cancer patients undergoing chemotherapy into 2 groups randomly. One group received chemotherapy only, the other received chemotherapy and 6-week exercise intervention for cancer patients (EXCAP ), the results found that the cognitive impairment of the patients who received exercise was lower, and the biological indicators (IL-6, IL-10, sTNFra) were also improved. Therefore, it is recommended that cancer patients who are undergoing chemotherapy exercise.

9. It is recommended that TTF combined with temozolomide treat malignant glioma

Stupp and others from Canada reported the results of TTF (a microcurrent device) combined with temozolomide in the treatment of malignant glioma. The PFS and OS of the combined treatment group were 7.1 months and 19.4 months, respectively, while the PFS and OS of the temozolomide group were respectively At 4.2 months and 16.6 months, combined therapy can prolong PFS and OS by 3 months compared with chemotherapy alone. The 2-year survival rate of combined therapy was 43%, while that of chemotherapy group was only 29%. The side effects of combined therapy group were mainly It is skin irritation, so it is recommended to combine TTF with temozolomide in the treatment of malignant glioma, and other malignant tumors are also worthy of further research.

10. It is recommended to continue taking AI after the 5th year of endocrine therapy for HR-positive high-risk early breast cancer after menopause

At present, most HR-positive patients receive endocrine therapy within 5 years, and most high-risk early breast cancers relapse after 5 years. Whether continuing endocrine therapy after 5 years can reduce the recurrence rate of breast cancer is still unclear. This year ASCO’s Zdenkowski from Australia reported the results of LATER. The 360 postmenopausal HR-positive high-risk early breast cancer patients enrolled in the study had received at least 4 years of initial adjuvant endocrine therapy and the treatment interval before the study was at least 1 year. Researchers randomized patients to receive letrozole 2.5 mg at 1:1 or observed for 5 years. The mid-term results found that after at least 4 years of adjuvant endocrine therapy for hormone receptor-positive early breast cancer postmenopausal women, letrozole was performed 1 year later. Azole treatment can significantly reduce the 3-year incidence of invasive breast cancer (1.1% VS 8.8%). Although the study is not over yet, based on the interim analysis data, it is still recommended to continue taking AI after the 5th year of endocrine therapy for HR-positive high-risk early breast cancer after menopause.