Could fewer cancer treatments be more beneficial in certain cases?

According to STAT_­+, one of the topics that came up repeatedly at ASCO was whether cancer drugs are more likely to be curative or chronic treatments that patients need to continue taking over the long term.

For example, Lecia Sequist from Massachusetts General Hospital noted that chemoradiation, the control arm of AstraZeneca's lung cancer drug, Tagrisso, was believed to be potentially curative. However, she argued that it would be fairer to patients to inform them that they may need chronic therapy to prevent the return of brain metastases.

Not all patients may need chronic treatment. In a new study that combined Bristol Myers Squibbs' Opdivo and Yerboy, patients received the treatments twice before having their tumors surgically removed. Following the treatment, 59% of patients saw their detectable disease levels decrease significantly, and they didn't require additional treatment.

Among the people who had a major response to the treatments, melanoma recurred in only 5% of the patients, though they didn't have adjuvant therapy. In comparison, melanoma recurred in 24% of patients with a partial response and in 43% of patients who didn't respond to the treatment.

Christian Blank, one of the study's authors from the Netherlands Cancer Institute, referred to the current practice of giving treatment both before and after surgery as a "sandwich treatment." However, he said that "throwing out the sandwich" would reduce the resources spent and lead to a better patient experience.

Jedd Wolchok, from Weill Cornell Medicine, who helped pioneer using immunotherapy to treat melanoma, said current efforts to reduce treatments for cancer patients were similar to efforts oncologists made in the past to treat childhood leukemias.

"Our colleagues in pediatric oncology have spent the better part of the past 40 years to understand how little of those regimens you need to use so that those children can have a healthy life span both in terms of length and quality," Wolchok said.

Research finds less intensive treatment may be better for certain cancers

At the same time, several new studies were presented at ASCO that suggested less-intensive treatments could be more effective for certain types of cancer.

Ovarian cancer

In a study funded by France's National Institute of Cancer, researchers found that it is safe to avoid removing seemingly healthy lymph nodes during surgery for advanced ovarian cancer.

For the study, researchers compared the results of 379 patients, half of whom had their lymph nodes removed and half who didn't. After nine years, researchers found that there was no difference in how long patients lived. They also found that those who didn't have their lymph nodes removed had fewer complications, such as a need for blood transfusions.

Esophageal cancer

In a study funded by the German Research Foundation, researchers found that patients who received chemotherapy and surgery for esophageal cancer lived just as long as those who received chemotherapy, surgery, and radiation.

Among 438 patients with esophageal cancer, half received chemotherapy and surgery on their esophagus, while the other half received chemotherapy, surgery, and radiation. After three years, 57% of patients who received chemotherapy and surgery were alive, compared to 51% of patients who received chemotherapy, surgery, and radiation.

Hodgkin lymphoma

In a study funded by Takeda Oncology, researchers compared two chemotherapy regimens for advanced Hodgkin lymphoma and found that the less intensive treatment was more effective and had fewer side effects.

In a trial of 1,482 patients across nine countries, researchers found that the less-intensive chemotherapy treatment was able to prevent the disease from recurring in 94% of patients, compared to 91% of patients who received the more intense treatment.

"The good news is that cancer treatment is not only becoming more effective, it's becoming easier to tolerate and associated with less short-term and long-term complications," said William Nelson, from the Johns Hopkins School of Medicine, who wasn't involved in the new research.

Advisory Board's oncology resources

For more insights on oncology, check out these Advisory Board resources:

Growth in demand and costs, as well as innovative technologies and disruptors, will change how cancer care is delivered, experienced, and paid for going forward. This resource outlines out four predictions for how the cancer care delivery landscape will evolve by 2030.

Separately, this expert insight explains three strategies organizations can use to leverage oncology pharmacists and improve cancer care. Similarly, these ready-to-use slides outline the major structural shifts impacting cancer care and the strategic decisions that oncology leaders will need to make.

You can also check out our upcoming webinar "Oncology market trends in 2024" on June 27. Here, we'll discuss major trends influencing today's oncology market and the implications they’ll have for stakeholders across the industry. (Johnson, Associated Press, 6/2; Herper et al., STAT+ [subscription required], 6/3; Herper, STAT+ [subscription required], 6/2)