Practice Update | Onology

ASCO 2017 15

been reached in this latter group of 49 patients, but 18-month survival is 50%. As expected grade3/4 toxicity exceeded 10% in the combination arm (mainly diarrhea). These agents are not yet approved for this disease, but often can be obtained for com- passionate use, and I anticipate approval within the next year. 6. I will suggest to my patients receiv- ing taxanes, especially docetaxel, to apply a polyphenol-rich nail balm to pre- vent onycholysis. Thomas et al presented a poster (abstract 10103) with the results of the UK PolyBalm study, a randomized trial of 60 patients receiving taxanes. 8 There was a very highly significant improvement in nail health and quality of life in the 30 patients who treated their nails with the “balm” three times daily, as opposed to the control group, who used a petroleum balm. Polybalmwill be available online in the near future. Kim et al presented data in a poster at the same session (abstract 10108). 9 In a randomized Korean study of 103 patients receiving neoadjuvant docetaxel, those patients who used a hydrating nail solu- tion had a statistically significant decrease in onycholysis. This is another option and may be more readily available. 7. I will continue to use checkpoint inhib- itors in melanoma patients, even if they present with asymptomatic brain metastases and not refer for radiation treatment as initial therapy. Tawbi et al presented the results of CheckMate 204 (abstract 9507). 10 Patients were treated with the standard metastatic melanoma regi- men of nivolumab/ipilimumab followed by nivolumab maintenance. The first 75 patients in the trial had an intracranial 56% response rate, including 19% complete

the treatments as compassionate use. BONUS: I will test selective patients with refractory malignancies for TRK fusion gene in addition to MSI. Hyman et al pre- sented a much-anticipated report of 55 patients treated with the pan-TRK inhibi- tor larotrectinib (abstract LBA2501). 16 Over 17 cancer types were represented in both pediatric and adult patients. Confirmed response rate is 76%, with 12% stable dis- ease (and may be even higher after review of 5 additional patients)! Responses are durable, and toxicity is minimal. The drug is available for compassionate use. Patients who progress often respond to another inhibitor, which is being studied (LOXO- 195). Although this mutation affects only approximately 1% of cancer patients, when combined with MSI testing, very effective treatment may be found in up to 5% of patients, regardless of tumor type. Com- mercial laboratories are now testing for both; I will definitely discuss sequencing with my patients. I anticipate the discovery of additional targeted agents as we enter the age of personalized medicine! References 1. Shi Q, Sobrero AF, Shields AF, et al. Paper presented at ASCO 2017. Abstract LBA1. 2. Fizazi K, Tran N, Fein LE, et al. Paper presented at ASCO 2017. Abstract LBA3. 3. Adams S, Schmid P, Rugo HS, et al. Paper presented at ASCO 2017. Abstract 1008. 4. Adams S, Loi S, Toppmeyer D, et al. Paper presented at ASCO 2017. Abstract 1088. 5. Von Minckwitz G, Procter MJ, De Azambuja E, et al. Paper presented at ASCO 2017. Abstract LBA500. 6. Fuchs CS, Doi T, Jang RW-J, et al. Paper presented at ASCO 2017. Abstract 4003. 7. Janjigian YY, Ott PA, Calvo E, et al. Paper presented at ASCO 2017. Abstract 4014. 8. Thomas RJ, Williams MMA, Mutilib M, et al. Paper presented at ASCO 2017. Abstract 10103. 9. Kim J-Y, Ok O-N, Seo JJ, et al. Paper presented at ASCO 2017. Abstract 10108. 10. Tawbi HA-H, Forsyth PAJ, Patrick A, et al. Paper presented at ASCO 2017. Abstract 9507. 11. Long GV, Atkinson V, Menzies AM, et al. Paper presented at ASCO 2017. Abstract 9508. 12. Hoskin P, Misra V, Hopkins K, et al. Paper presented at ASCO 2017. Abstract LBA10004. 13. Raut CP, Espat NJ, Maki RG, et al. Paper presented at ASCO 2017. Abstract 11009. 14. D’Angelo SP, Mahoney MR, Van Tine BA, et al. Paper presented at ASCO 2017. Abstract 11007. 15. Burgess MA, Bolejack V, Van Tine BA, et al. Paper presented at ASCO 2017. Abstract 11008. 16. Hyman DM, Laetsch TW, Kummar S, et al. Paper presented at ASCO 2017. Abstract LBA2501.

response, without any unexpected toxic- ity. Similar results were reported by Long et al in an Australian study (abstract 9508) of 66 patients.11 There were three cohorts of patients; the group receiving the aforemen- tioned combination had a 44% intracranial response rate, with a 50% 6-month PFS. 8. I will ask our radiation oncologists to consider single-dose radiation for spi- nal cord compression in patients with a poor prognosis. As presented by Hoskin et al (abstract LBA10004), the SCORAD trial in the UK and Australia randomized 688 patients to receive a single dose of 8 Gy versus 20 Gy in 5 fractions in a noninferior- ity trial. 12 The primary endpoint, ambulatory status at 8 weeks, was similar, as was over- all survival and other secondary endpoints. Toxicity was slightly better with the single dose, as was cost. As expected, overall survival was poor in both groups, but main- taining ambulation contributes highly to quality of life. 9. I will extend adjuvant treatment with imatinib to at least 5 years in high- risk GIST patients. Raut et al reported the results of the PERSIST-5 phase III trial of 91 high-risk patients with resected GIST (abstract 11009) .13 The overall survival rate at 8 years was 95%. Only 1 patient recurred while receiving treatment. Disease recurred in 6 additional patients after discontinu- ing the drug. There were no unexpected toxicities, but nearly half the patients dis- continued the drug early. The presenter and discussant really encouraged high- er-risk patients to maintain treatment. 10. I will offer selected patients with metastatic sarcoma immune check- point inhibitors. There were two abstracts in the Sarcoma Oral Presentations that demonstrated clinically meaningful activity. Deangelo et al reported the results of ALLI- ANCE in abstract 11007. 14 The combination of nivolumab and ipilimumab was relatively active, with 54% survival at 1 year. Another multi-institutional study was reported in abstract 11008. 15 Pembrolizumab had activ- ity in UPS, LPS, and bone chondrosarcoma, meriting further study. These drugs are not yet FDA-approved, but there are clinical tri- als in progress and opportunities to obtain

Upfront PD-1 inhibitor treatment for NSCLC: a new paradigm Watch an interview with Dr Kirshner, where he discusses some of the more impressive and

practice-changing advances in non-small cell lung cancer in the past year.

VOL. 1 • NO. 2 • 2017

© ASCO 2017/Alyssa Schukar