The European Society for Medical Oncology (ESMO) congress, held under the tagline "Securing access to optimal cancer care" is about to conclude for another year. As always, a wide range of topics were covered and discussed giving a glimpse of where the field of oncology is heading to.
There were several clear winners: AZ's Lynparza scored big with SOLO-1 study in ovarian cancer, Roche's Tecentriq came up positive in front line lung cancer (NSCLC) and Pfizer/Astellas' Xtandi offered promise in prostate cancer (M0 CRPC).
However, I think two particular data sets, which were presented at ESMO by Bayer/Loxo Oncology and Roche are worth highlighting here as they build on an emerging trend and shift in the approach to cancer treatment. The companies talked about their tissue-agnostic cancer drugs: larocitinib and entrectinib.
What is tissue-agnostic approach to treatment? In simple terms, it is an approach, in which physicians base treatment decisions on a tumour genetic signature rather than tumour type i. e. lung, breast, pancreatic cancer etc. (defined based on the tumour origin).
ESMO 2018 highlights: tumor-agnostic cancer drug
Larotrectinib - Bayer/ Loxo Oncology discussed data from 100-plus patient integrated dataset, which included both adult and very young patients (ranging from just one month to 80 years) across 24 different tumour types. These included cancers of the salivary gland, thyroid, lung, colon, infantile fibrosarcoma and sarcomas. The common characteristic for all these tumours was the presence of a specific genetic mutation - TRK fusion.
In those patients, with TRK mutation, larotrectinib showed very promising results: an overall response rate of 81%, partial response was seen in 63% of patients and 17% achieved complete response.
"The larotrectinib experience provides strong clinical evidence supporting the development of singlepurpose drugs against oncogenic driver targets, and underscores the importance of tumour genomic profiling capable of identifying NTRK gene fusions alongside other activating alterations.” Ulrik Lassen, M.D., Ph.D., Department of Oncology, Rigshospitalet, Copenhagen.
Entrectinib - Roche showed data from an integrated analysis of 3 pivotal clinical trials showing that entrectinib shrank tumours in more than half of people with NTRK-fusion positive tumours - objective response rate of 57.4%. Importantly, the objective responses were seen across 10 different solid tumours with more than a quarter having a complete response.
"These data demonstrate the potential of entrectinib to treat a range of difficult-to-treat and rare cancers regardless of their site of origin," said Sandra Horning, MD, Roche's Chief Medical Officer and Head of Global Product Development. "Entrectinib has the potential to redefine personalised medicine, which can utilize tests such as next-generation sequencing, to find the right treatment for each individual patient. People with NTRK fusion-positive solid tumours need more options, and we look forward to working with health authorities to bring this potential treatment to patients as soon as possible."
A precedent for tumour-agnostic therapy was established back in May 2017 when Merck's Keytruda received a pan-tumour approval from the FDA. The accelerated approval was granted for the treatment of adult and paediatric patients with unresectable or metastatic solid tumours that have been identified as having specific genetic abnormalities (MSI-H or dMMR).
The recently released data at ESMO will likely fuel and accelerate progress of the tissue-agnostic oncology. In fact, the Bayer/Loxo Oncology drug larotrectinib is expected to get a 'green light' from the FDA later this year.