NCI at ASCO: A brief overview on research in women's cancers
The 2014 annual American Society of Clinical Oncology (ASCO) meeting in Chicago in June highlighted results from a number of NCI-supported and -sponsored clinical trial results in women's cancers. Taken together, these results represent important advances in our understanding of how to treat these diseases and improve the lives of women living with them. Among the highlights were:
- Two studies showed positive results for young women with premenopausal breast cancer. One study (called SOFT/TEXT ) compared two types of antiestrogen therapy in women whose cancers were hormone receptor-positive (the tumors were responsive to hormonal treatment) and found that women who received the drug exemestane had better disease-free survival (they lived longer without their disease progressing) than women who received tamoxifen. A second study (called POEMS) showed that young women with hormone receptor-negative breast cancer (their tumors were not responsive to hormonal therapy) could receive chemotherapy treatment for their cancer without losing their fertility. These two studies make clear the importance of studying cancer in younger women. Cancers in younger age groups have been understudied and under-addressed so these studies fill in some important research gaps.
- The NCI and the Breast International Group (BIG) cosponsored the ALTTO study which was designed to determine whether chemotherapy plus the combination of of lapatinib and trastuzumab was better than chemotherapy with either agent alone. Although this trial yielded a negative finding for benefit of using a combination of the two drugs, the principle tested in ALTTO allowed researchers to get results sooner and with fewer patients overall than if the U.S. had conducted its own trial without this international collaboration. The greater than 90 percent overall survival rate at four years or more for women observed in this trial underscores the importance of NCI research (NCI-funded research contributed to the development of both lapatinib and trastuzumab) in turning an aggressive disease into a treatable one. In addition, molecular studies planned in ALTTO will potentially allow researchers to better understand the tumor characteristics of 550 of the 8,000 patients in the trial who relapsed. This may help scientists develop better drugs in the future.
- The lessons learned from ALTTO also helped NCI and BIG to more quickly launch a large international phase III trial called OlympiA (olaparib in BRCA mutation carriers in the adjuvant treatment of early stage breast cancer). OlympiA is being conducted by the NCI-supported NRG group. OlympiA will be activated in the NCIs National Clinical Trials Network in June 2014.
- In addition to the ALTTO trial, several trials presented at the ASCO annual meeting were international collaborations, including POEMS and SOFT/TEXT. Enrollment by NCI-sponsored trial groups in collaboration with other groups worldwide allowed clinicians to get important answers faster and with fewer resources. The results of the POEMS and SOFT/TEXT trials would have not been available this quickly if not for the ability to leverage global networks with U.S. cooperative groups.
- The clinical trial using a novel targeted combination of cediranib and olaparib in ovarian cancer, which showed a doubling of median survival time, is based, in part, on results from a NCI-sponsored TGCA (The Cancer Genome Atlas) Research Network study. There are plans to confirm this finding in large phase 3 trials in ovarian cancer. In addition, results from TCGA have shown that there are genetic similarities between high-grade serous ovarian cancer and BRCA-type breast cancer, which supports studies of this combination in some types of breast cancer as well.
- An NCI study done at the National Institutes of Health clinical center found that a novel immunotherapy approach for cervical cancer showed promise for other HPV-related cancers. See this page for more information on other cancers treated with this approach. In this study, a patient's own lymphocytes were collected, and those with the best antitumor activity were grown in the laboratory to produce large populations that were infused into the patient. Before this work, it had not been clear whether the human immune system could mount an effective response against the HPV proteins produced by cervical cancer cells.