ASCO: Breakthroughs in Cancer Care Will Drive Change

Two breakthroughs in particular have the power to change survival rates.

The American Society of Clinical Oncology (ASCO)'s recent annual meeting has set the stage for pharma players, as studies and posters across multiple therapies were presented and analyzed by the oncology community. As projections were made on the effect of the study results, from big pharma to small biotech, the overall buzz ranged from great innovation to equity in cancer care.

Innovation in Breast Cancer

News that resonated throughout the week included the groundbreaking data from the DESTINY-Breast04 study of Enhertu, which, according to Shanu Modi, MD, medical oncologist at Memorial Sloan Kettering Cancer Center, could impact survival for about half of patients currently diagnosed with metastatic breast cancer. These results, released early this year, are dramatic enough to change the way HER2-low metastatic breast cancer is treated and classified. For the first time, the HER2-directed therapy categorized the patient population of HER2-low, including disease that's hormone receptor-positive and -negative.

"This is the first randomized clinical trial to show that targeting metastatic breast cancer that expresses low levels of HER2 with trastuzumab deruxtecan, which is a HER2-antibody drug conjugate, is a more effective or superior approach versus using standard chemotherapy," Modi says in an ASCO video. "Up until now, our currently available HER2-targeted therapies have really not shown benefit in patients with HER2-low-expressing breast cancers."

In addition, the drug created a statistically significant benefit in median progression free survival (PFS) among all treated patients, increasing the median from approximately five months to approximately 10 months.

Modi further reported that patients treated with trastuzumab deruxtecan experienced an approximate 50% reduction in the risk of disease progression and an almost 40% reduction in the risk of death in comparison to standard chemotherapy. The patient's metastatic disease was under control for twice as long with trastuzumab deruxtecan therapy, and they had longer survival.

CAR-T Advancements

Five years ago, Gilead saw similar ground-breaking when Yescarta became the first CAR-T cell-based gene therapy approved for the treatment of certain blood cancers. This year at ASCO, Gilead presented new data on the use of Yescarta for second-line treatment of large B-cell lymphoma along with real-world outcomes by race and ethnicity for Yescarta. While the results are laudable, as the CAR-T field evolves, the competition for Yescarta gets stronger.

For example, small-cap biotech Arcellx reported a 100% overall response rate and a 70% complete response rate in a small phase 1 clinical trial for multiple myeloma at ASCO, putting the pressure on Legend Biotech/Johnson & Johnson's Carvykti, Bristol Myers Squibb's Abecma, and GlaxoSmithKline's Blenrep.

These remarkable results stemmed from a study that included many difficult-to-treat patients who had already received three or more prior therapies. These 21 patients were described as having poor prognostic factors, including extramedullary disease, which means myeloma cells had formed tumors outside the bone marrow in the soft tissues or organs of the body.

Legend Biotech showcased 28-month follow-up data for Carvykti, already on the market for two years. Its overall response rates remained at 98%, according to ASCO data. Fewer than 10% of patients had severe neurotoxic effects—a prior concern—from Legend's or Arcellx's treatments, which puts their products equal to Abecma in terms of side effects, but above in terms of response rates.

As the theme for this year's 2022 ASCO was Advancing Equitable Cancer Care Through Innovation, these breakthroughs bring to light just two of the many new developments that will change cancer care.