News in brief: SERD benefit in patients with advanced breast cancer; Immunotherapy role in nonmetastatic gastroesophageal cancer; Overdiagnosis of skin cancers likely from screening

Thursday, 19 May 2022

SERD benefit in patients with advanced breast cancer

A new oral endocrine therapy option may be of benefit in patients with previously treated metastatic hormone receptor–positive/HER2-negative advanced breast cancer.

A study involving 238 patients treated with elacestrant, an oral a selective estrogen receptor degrader (SERD), showed a significant PFS improvement versus a control group who received standard of care endocrine monotherapy.

The benefits were seen both in the overall population who had received prior endocrine and CDK4/6 inhibitor therapy, and in patients with ESR1 mutations, according to results, published in Journal of Clinical Oncology.

Interim overall survival analysis demonstrated HRs of 0.59 in the ESR1 mutation population and 0.75 in the overall population.

The most common adverse event was nausea, which occurred in 35% of patients receiving elacestrant and 19% of patients receiving standard of care endocrine monotherapy.

Immunotherapy role in nonmetastatic gastroesophageal cancer

Immunotherapy may have a role in the treatment of non-metastatic oesophageal and gastric cancers when patients’ tumours exhibit a high expression of PD-L1, according to US clinicians.

Their study evaluated outcomes for  29 patients with gastroesophageal junction adenocarcinoma (cT1-3NanyM0) who received neoadjuvant pembrolizumab-containing chemoradiation (CROSS regimen) followed by surgical resection and adjuvant pembrolizumab.

While only 23% achieved pathologic complete response pCR, patients with high baseline expression of PD-L1 had a significantly higher pCR rate than those with low expression (50 vs 14%). Patients with high PD-L1 expression also experienced longer PFS and OS than propensity-score-matched patients, said study investigator Dr Harry Yoon a medical oncologist at Mayo Clinic Cancer Center.

“If these results can be confirmed in a larger, separate clinical trial, the combination of immunotherapy with standard-of-care chemoradiation and surgery could become the new standard of care for patients with nonmetastatic gastroesophageal cancer,” he said.

The research is published in Clinical Cancer Research.


Overdiagnosis of skin cancers likely from screening

New findings from the Queensland QSkin Study show that people undergoing physician-based screening for skin cancer have melanoma detection rates at least 29% higher than those not undergoing screening.

However the researchers, from the QIMR Berghofer Medical Research Institute, Brisbane, are questioning whether those mostly in situ lesions would represent overdetection.

Their study, published in the British Journal of Dermatology, comprised 38,682 Queenslanders 40-69 years with no prior history of melanoma. Almost three-quarters (73%) of the cohort reported a skin examination by a doctor in the three years before enrolment.

During follow-up, 967 participants were newly diagnosed with at least one melanoma (316 with invasive melanoma only, 586 with in situ melanoma only, 65 with both).

The age-standardised incidence of melanoma among those who reported a prior skin examination was 2.2-fold higher than in those with no prior skin examination. The age-standardised rate of biopsies was four-fold higher among those who had a prior skin examination than those who did not.

After propensity score weighting for observed risk factors, the study found significantly higher rates of melanoma (aHR 1.29, 95% CI 1.02 – 1.63) and subsequent biopsies (aHR 1.85, 95% CI 1.69 – 2.04) among those who had undergone physician skin examination prior to enrolment.

In separate analyses of invasive and in situ melanoma, the higher risk associated with skin examination was evident only for in situ melanoma (adjusted HR in situ 1.45; adjusted HR invasive 1.05). This equated to a number-needed-to-screen to detect one excess melanoma of about 206, the authors said.

Led by medical epidemiologist Professor David Whiteman, the researchers said the higher rates of biopsies and melanoma among screened patients suggested overdiagnosis.

The findings were also consistent with reports in the literature of rapidly rising incidence of in situ and very thin invasive melanomas, they said.

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