2019 ASCO Annual Meeting Research Round Up: Soft-Tissue Sarcoma and Melanoma

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The 2019 ASCO Annual Meeting, held May 31 to June 4, brought together physicians, researchers, patient advocates, and other health care professionals from around the world to present and discuss the latest research in cancer treatment and patient care. In the annual Research Round Up podcast series, Cancer.Net Associate Editors share their thoughts on the most exciting scientific research to come out of this year’s ASCO Annual Meeting and what it means for patients.

First, Dr. Vicki Keedy will discuss 2 different studies in soft-tissue sarcoma, and explain how the results of these studies have lead to important conversations in the field of sarcoma.

Dr. Keedy is an Assistant Professor of Medicine in the Division of Hematology/Oncology and the Clinical Director of the Sarcoma Program at the Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center. She is also the Cancer.Net Associate Editor for Sarcoma.

Dr. Keedy: Hello. My name is Vicky Keedy, and I am a medical oncologist who specializes in the treatment of sarcomas at Vanderbilt University Medical Center. Today, I'm going to talk about 2 important studies discussed at the 2019 ASCO Annual Meeting.

The first study I would like to discuss is called the ANNOUNCE trial. This study looked at whether adding a targeted therapy called olaratumab to the standard treatment, doxorubicin, was better than doxorubicin alone for patients with adult soft tissue sarcomas. In 2016, this combination was approved by the U.S. Food and Drug Administration, or the FDA, based on the results of a smaller phase II trial. This was approved in what is called an Accelerated Approval Program, which requires a larger study to confirm the findings.

The final results presented unfortunately showed the larger phase III trial did not confirm that the combination of olaratumab and doxorubicin was better than doxorubicin alone, meaning there is no benefit to adding olaratumab to doxorubicin. The reasons for the different outcomes between the 2 studies are not completely known and is likely due to a combination of factors. An important finding, however, was that survival in patients with adult sarcomas continues to improve over time. And for patients receiving doxorubicin alone, overall survival was an average of approximately 20 months, showing that doxorubicin is an effective treatment for patients with adult soft tissue sarcomas.

Based on these results, olaratumab will be withdrawn, and no new patients should start on this treatment. For patients already receiving olaratumab for the treatment of their sarcoma, they should have an open discussion with their oncologist about stopping the drug. For patients who their doctors feel they are receiving benefit from olaratumab, there is a program to allow continued access to this drug.

What I think is most important about this trial is the focus it has drawn to clinical research and sarcoma. Because sarcoma is made up of a large number of very different and very rare cancers, advancements in treatments has been relatively slow. The results of this study have led to a larger discussion about how we think about and design trials for patients with sarcomas. It also highlights how important it is for patients to be seen at centers that have trials for their specific type of sarcoma.

Several trials reported at the meeting exemplify how the sarcoma community can successfully complete trials in rare sarcoma and make potentially substantial advancements. One example is the phase II trial of tazemetostat in patients with epithelioid sarcoma. Epithelioid sarcoma is a rare sarcoma sub-type with disappointing results from standard sarcoma treatments. One of the hallmarks of epithelioid sarcoma is the loss of a tumor-suppressor gene called INI1. When INI1 function is lost in a cell, a tumor-enhancer molecule called EZH2 becomes too active. Tazemetostat blocks the action of EZH2. The trial included patients with several types of cancer that have lost some INI1. This trial reported the results of the cohort of patients with epithelioid sarcoma. The results showed 15% of patients had a partial response, meaning their tumors d...