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Clinical cancer advances 2009

Research updates

Issue 2, December 2009

This is the latest in a series of annual reports that the American Society of Clinical Oncology publishes to highlight and document the most significant studies that represent major advances in clinical cancer research.

The list of 51 studies published this year is the result of an independent review by the society. The report was developed under the guidance of an 18-person editorial board made of leading oncologists and other cancer specialists. Research published in peer-reviewed scientific journals and the results of research presented at major scientific meetings over the one year period between October 2008 and September 2009 were included for review. The 15 studies shortlisted below were considered by the editors as major advances that have the potential to lead to a reduction in mortality from cancer.

This report supports what the declining mortality rates for cancer patients tell us - that investment in clinical cancer research pays off. Five year survival rates for patients have gone up and patient quality of life has improved dramatically. Advances in basic research are making personalised cancer medicine a realistic and achievable goal for the future.

However the incidence of the disease is rapidly increasing and so the scale of our collective response must match the scale of the problem. Through this report, the society calls for increased investment in research and treatment and health care reforms to end inequality in health care access.

Summary of findings: Advances in personalised medicine and targeted therapies

Breast cancer

1. Standard three-drug chemotherapy is superior to single drug regimen in older women with breast cancer: A major study compared the use of capecitabine (Xeloda)  as a single-drug adjuvant therapy to the standard three-drug combination regimen. In women aged 65 and older with early stage breast cancer the combination regimen was found to be more effective and was associated with fewer side effects than single-drug therapy.

Gastrointestinal cancers

1. First targeted treatment for gastric cancer: A large clinical trial found that adding trastuzumab (Herceptin) to standard chemotherapy for advanced gastric cancer increased survival by 26 per cent for patients whose tumours expressed high levels of the HER2 protein compared to standard chemotherapy alone.
2. First standard of care for biliary tract cancer: The largest ever trial of advanced biliary tract cancer confirmed that combination treatment with gemcitabine (Gemzar) and cisplatin is the most effective treatment approach, both increasing survival and reducing disease progression by nearly one-third compared with gemcitabine alone.
3. Adjuvant treatment with bevacizumab (Avastin): Does not prevent recurrences of colon cancer in individuals who have undergone surgery for colon cancer: Data examining the addition of bevacizumab to standard adjuvant chemotherapy (a regimen known as FOLFOX) after surgery in patients with earlier-stage colon cancer did not prevent recurrences or improve disease free survival in stage II and III colon cancer.

Gynaecologic cancers

1. Ovarian cancer treatment based on rising CA125 blood levels does not improve outcomes: Data reported this year from a large randomised clinical trial showed that starting treatment for relapsed ovarian cancer based on rising CA125 levels does not improve survival, compared to delaying treatment until symptoms of ovarian relapse arise.
2. HPV vaccine effective in older women: Researchers reported that the HPV vaccine reduces the risk of HPV infection, cervical cancer and other HPV-related disease among women aged 25 to 45 who have not been previously infected with the HPV strains targeted by the vaccine.

Head and neck cancers

1. Cetuximab improves survival for advanced head and neck cancer: Addition of EGFR-targeted drug cetuximab (Erbitux) to initial chemotherapy for metastatic head and neck cancer increased overall survival by 20 per cent and increased progression free survival by 46 per cent compared to chemotherapy alone.

Lung cancer

1. Maintenance therapy with pemetrexed improves survival for advanced lung cancer: Researchers found that pemetrexed (Alimta) increased overall survival after standard chemotherapy by 50 per cent for patients with advanced nonsquamous non-small cell lung cancer, compared with patients who received placebo, and that the risk of side effects was low.
2. Benefit of gefitinib for lung cancer depends on EGFR status: A large clinical trial found that first line gefitinib treatment slows progression of non-small cell lung cancer in Asian non-smokers or light smokers whose tumours have the EGFR mutations, but not in those without mutations. Those without the mutation responded better to standard chemotherapy.

Nervous system cancers

1. First effective immunotherapy for neuroblastoma: An antibody-based immunotherapy (called chimeric anti-GD@ antibody) was found to reduce risk of relapse and improve survival by 20 per cent for high-risk neuroblastoma, a disease of the peripheral nervous system, most commonly found among young children.
2. FDA pproves Bevacizumab for Glioblastoma: Bevacizumab was approved as a single agent for previously treated glioblastoma, providing the first new drug for the disease in a decade.

Prostate cancer

1. Radiation following surgery improves survival for early-stage prostate cancer: A large prostate cancer trial that followed subjects for a median of 13 years found that administering radiation treatment after prostatectomy reduces the risk of cancer spread and improves survival by nearly 30 per cent in men with early stage prostate cancer.
2. PSA testing has minimal effect on reducing prostate cancer mortality: Initial results from two large closely watched screening trials suggests that routine PSA testing has a small, if any, effect on reducing the risk of dying from prostate cancer, and has likely led to over-diagnosis and treatment of disease that is slow growing and non-lethal.

Renal cancers

1. Everolimus approved for treating renal cell carcinoma: The FDA also approved everolimus (Afinitor) in March 2009 for patients with renal cell carcinoma whose disease had progressed despite treatment with other targeted drugs. This approval was based on results from a randomised phase III trial which showed that these patients when given everolimus experienced better progression-free survival compared to those who received a placebo.
2. Bevacizumab approved for treating metastatic renal cell carcinoma: Bevacizumab was found to improve progression free survival and overall survival in two phase II studies and was approved by FDA to treat metastatic renal cell carcinoma when combined with interferon.

For further information, the full text of this report is now available at http://www.asco.org/