ASCO 2014 update in GI cancer treatment Kanwal Pratap Singh Raghav, MD

1. ASCO 2014: UPDATES IN
GASTROINTESTINAL
ONCOLOGY
Annual Updates on Breakthroughs in Hematology & Oncology (AUBHO) 2014
Kanwal Pratap Singh Raghav, MD
The University of Texas M.D. Anderson Cancer Center, Houston, TX
30th August 2014

2. ARCHIVES: 1964-65

3. CALGB/SWOG 80405
Alan P. Venook et al.
Abstract: LBA3

4. CALGB/SWOG 80405
Alan P. Venook et al.
Abstract: LBA3
✤ In patients with KRAS-WT metastatic CRC where we have option
of using two biologics in first line (anti-EGFR and anti-VEGF),
does the choice really matter?

5. CALGB/SWOG 80405:
OVERVIEW
Phase III trial of irinotecan/5-FU/leucovorin (FOLFIRI) or
oxaliplatin/5-FU/leucovorin (mFOLFOX6) with bevacizumab
(BV) or cetuximab (CET) for patients (pts) with KRAS wild-type
(wt) untreated metastatic adenocarcinoma of the colon or rectum
(MCRC).
FOLFOX (73%)
✤ Primary Endpoint:
OS
✤ Ho = 22 v. 27.5 m
✤ N = 1137

6. CALGB/SWOG 80405:
RESULTS
Similar PFS, Different AE/QoL (Resected disease: Median OS ~
5.5 yr)

7. CALGB/SWOG 80405: PAST &
PRESENT
GERCOR: FOLFIRI v. FOLFOX: Median OS (21.5 v. 20.6 m) (P=0.99)
NO 16966: FOLFOX/
XELOX ± B: Median
OS (21.3 v. 19.9m)
(P=0.07)
CRYSTAL: FOLFIRI
± Cetux: Median OS
(23.5 v. 20m)
(P<0.01)
PRIME: FOLFOX ±
Pan: Median OS (26
v. 20m) (P=0.04)
FOLFOX
FOLFIRI
C + FOLFIRI
FOLFIRI
B + FOLFOX/XELOX
FOLFOX/XELOX
P + FOLFOX
FOLFOX
Saltz et al. JCO 2008; Tournigard et al. JCO 2004; Van Custem et al. JCO 2011; Douillard et al. NEJM 2013

8. CALGB/SWOG 80405: PAST &
PRESENT
GERCOR: FOLFIRI v. FOLFOX: Median OS (21.5 v. 20.6 m) (P=0.99)
NO 16966: FOLFOX/
XELOX ± B: Median
OS (21.3 v. 19.9m)
(P=0.07)
CRYSTAL: FOLFIRI
± Cetux: Median OS
(23.5 v. 20m)
(P<0.01)
PRIME: FOLFOX ±
Pan: Median OS (26
v. 20m) (P=0.04)
FOLFOX
FOLFIRI
C + FOLFIRI
FOLFIRI
B + FOLFOX/XELOX
FOLFOX/XELOX
P + FOLFOX
FOLFOX
Saltz et al. JCO 2008; Tournigard et al. JCO 2004; Van Custem et al. JCO 2011; Douillard et al. NEJM 2013

9. CALGB/SWOG 80405: PAST &
PRESENT
GERCOR: FOLFIRI v. FOLFOX: Median OS (21.5 v. 20.6 m) (P=0.99)
NO 16966: FOLFOX/
XELOX ± B: Median
OS (21.3 v. 19.9m)
(P=0.07)
CRYSTAL: FOLFIRI
± Cetux: Median OS
(23.5 v. 20m)
(P<0.01)
PRIME: FOLFOX ±
Pan: Median OS (26
v. 20m) (P=0.04)
FOLFOX
FOLFIRI
C + FOLFIRI
FOLFIRI
B + FOLFOX/XELOX
FOLFOX/XELOX
P + FOLFOX
FOLFOX
Saltz et al. JCO 2008; Tournigard et al. JCO 2004; Van Custem et al. JCO 2011; Douillard et al. NEJM 2013

10. CALGB/SWOG 80405: PAST &
PRESENT
GERCOR: FOLFIRI v. FOLFOX: Median OS (21.5 v. 20.6 m) (P=0.99)
NO 16966: FOLFOX/
XELOX ± B: Median
OS (21.3 v. 19.9m)
(P=0.07)
CRYSTAL: FOLFIRI
± Cetux: Median OS
(23.5 v. 20m)
(P<0.01)
PRIME: FOLFOX ±
Pan: Median OS (26
v. 20m) (P=0.04)
FOLFOX
FOLFIRI
C + FOLFIRI
FOLFIRI
B + FOLFOX/XELOX
FOLFOX/XELOX
P + FOLFOX
FOLFOX
Saltz et al. JCO 2008; Tournigard et al. JCO 2004; Van Custem et al. JCO 2011; Douillard et al. NEJM 2013

11. CALGB/SWOG 80405: PAST &
PRESENT
GERCOR: FOLFIRI v. FOLFOX: Median OS (21.5 v. 20.6 m) (P=0.99)
NO 16966: FOLFOX/
XELOX ± B: Median
OS (21.3 v. 19.9m)
(P=0.07)
CRYSTAL: FOLFIRI
± Cetux: Median OS
(23.5 v. 20m)
(P<0.01)
PRIME: FOLFOX ±
Pan: Median OS (26
v. 20m) (P=0.04)
FOLFOX
FOLFIRI
C + FOLFIRI
FOLFIRI
B + FOLFOX/XELOX
FOLFOX/XELOX
P + FOLFOX
FOLFOX
Saltz et al. JCO 2008; Tournigard et al. JCO 2004; Van Custem et al. JCO 2011; Douillard et al. NEJM 2013

12. CALGB/SWOG 80405: PAST &
PRESENT
GERCOR: FOLFIRI v. FOLFOX: Median OS (21.5 v. 20.6 m) (P=0.99)
NO 16966: FOLFOX/
XELOX ± B: Median
OS (21.3 v. 19.9m)
(P=0.07)
CRYSTAL: FOLFIRI
± Cetux: Median OS
(23.5 v. 20m)
(P<0.01)
PRIME: FOLFOX ±
Pan: Median OS (26
v. 20m) (P=0.04)
FOLFOX
FOLFIRI
C + FOLFIRI
FOLFIRI
B + FOLFOX/XELOX
FOLFOX/XELOX
P + FOLFOX
FOLFOX
Saltz et al. JCO 2008; Tournigard et al. JCO 2004; Van Custem et al. JCO 2011; Douillard et al. NEJM 2013

13. CALGB/SWOG 80405: PAST &
PRESENT
GERCOR: FOLFIRI v. FOLFOX: Median OS (21.5 v. 20.6 m) (P=0.99)
NO 16966: FOLFOX/
XELOX ± B: Median
OS (21.3 v. 19.9m)
(P=0.07)
CRYSTAL: FOLFIRI
± Cetux: Median OS
(23.5 v. 20m)
(P<0.01)
PRIME: FOLFOX ±
Pan: Median OS (26
v. 20m) (P=0.04)
FOLFOX
FOLFIRI
C + FOLFIRI
FOLFIRI
B + FOLFOX/XELOX
FOLFOX/XELOX
P + FOLFOX
FOLFOX
Saltz et al. JCO 2008; Tournigard et al. JCO 2004; Van Custem et al. JCO 2011; Douillard et al. NEJM 2013

14. CALGB/SWOG 80405: PAST &
PRESENT
GERCOR: FOLFIRI v. FOLFOX: Median OS (21.5 v. 20.6 m) (P=0.99)
NO 16966: FOLFOX/
XELOX ± B: Median
OS (21.3 v. 19.9m)
(P=0.07)
CRYSTAL: FOLFIRI
± Cetux: Median OS
(23.5 v. 20m)
(P<0.01)
PRIME: FOLFOX ±
Pan: Median OS (26
v. 20m) (P=0.04)
FOLFOX
FOLFIRI
C + FOLFIRI
FOLFIRI
B + FOLFOX/XELOX
FOLFOX/XELOX
P + FOLFOX
FOLFOX
Saltz et al. JCO 2008; Tournigard et al. JCO 2004; Van Custem et al. JCO 2011; Douillard et al. NEJM 2013

15. CALGB/SWOG 80405: PAST &
PRESENT
GERCOR: FOLFIRI v. FOLFOX: Median OS (21.5 v. 20.6 m) (P=0.99)
NO 16966: FOLFOX/
XELOX ± B: Median
OS (21.3 v. 19.9m)
(P=0.07)
CRYSTAL: FOLFIRI
± Cetux: Median OS
(23.5 v. 20m)
(P<0.01)
PRIME: FOLFOX ±
Pan: Median OS (26
v. 20m) (P=0.04)
FOLFOX
FOLFIRI
C + FOLFIRI
FOLFIRI
B + FOLFOX/XELOX
FOLFOX/XELOX
P + FOLFOX
FOLFOX
Saltz et al. JCO 2008; Tournigard et al. JCO 2004; Van Custem et al. JCO 2011; Douillard et al. NEJM 2013

16. SWOG 80405: LESSONS
LEARNED!
Chemo-Bev equivalent to
Chemo-Cetux in 1st-line mCRC
Rx of KRAS-WT (12/13) tumors.
Median OS in patient with
resected mCRC ~ 5.5 yrs.
✤ ? Clinical applicability to
extended RAS Mutants.
✤ ? FIRE-3: Better OS with
FOLFIRI + C as 1st-line.
✤ ? PEAK: Better OS with
FOLFOX + P as 1st-line.
✤ ? Sequential question
unanswered (PDT rates ?).
✤ ? EPOC: Inferior PFS in
resectable group.
✤ FOLFOX is preferred first line
chemotherapy in the US.
✤ Future: Think ahead and
homogenize population using
molecular profiles.

17. ADORE TRIAL
TAE WON KIM ET AL. (ABSTRACT 3502)
In patients with rectal cancer who have received standard of care
pre-operative chemoradiotherapy followed by surgery, is post-operative
chemotherapy with FOLFOX better than 5FU alone in
pathologic stage II/III disease in delaying recurrence?
Primary Endpoint: 3-yr. DFS.
✤ Subgroup effect: Stage III & poor
neoadjuvant therapy response, LVI -ve
✤ FOLFOX: BMD, Neuropathy, Fatigue

18. CAIRO-3 TRIAL
MIRIAM KOOPMAN ET AL. (ABSTRACT 3504)
In patients with metastatic CRC, after 6 cycles of CAPOX-B does
maintenance therapy with Cape + Bev improve PFS?
Primary Endpoint: PFS2
[Re-intro: 60% (o) v. 47% (m)]

19. ARCHIVES: 1964-65

20. STORM TRIAL
Jordi Bruix et al.
Abstract: 4006

21. STORM TRIAL
Jordi Bruix et al.
Abstract: 4006
✤ In patients hepatocellular cancer who have undergone resection
or local ablation and are without residual disease, does adjuvant
sorafenib decrease recurrence?

22. STORM TRIAL: OVERVIEW
A phase III randomized, double-blind, placebo-controlled trial of
adjuvant sorafenib after resection or ablation to prevent
recurrence of hepatocellular carcinoma (HCC).
Child-Pugh A/B7 (2-3% only) & ECOG PS 0
Background: 5-yr OS 50-80% (Patient selection) & Sorafenib
active in metastatic setting
HCC
(N = 1114)
No
Residual
Disease
Sorafenib
4 years
Placebo
4 years
Surgery
or
Ablation
Primary
Endpoint: RFS
* Sorafenib 400mg BID

23. STORM TRIAL: RESULTS
No subgroup
effect
Similar OS
(HR=0.99)
TEAE
significant
(DC 25%)
(Dose Δ 80%)
Rx duration
~12.5 (v. 22
m)

24. STORM: PAST & PRESENT
Meta-analysis (2001)
N = 180 (3 PTs)
Radical resection and
IA Epi + PO Tegafur
IA Epi + IV Epi
IV Epi
Similar OS/DFS (All Patients); Poorer OS/DFS (Cirrhosis)
Surgery
Adjuvant Rx
Ono et al. Cancer 2001

25. STORM: PAST & PRESENT
Meta-analysis (2001)
N = 180 (3 PTs)
Radical resection and
IA Epi + PO Tegafur
IA Epi + IV Epi
IV Epi
Similar OS/DFS (All Patients); Poorer OS/DFS (Cirrhosis)
Surgery
Adjuvant Rx
Ono et al. Cancer 2001

26. STORM: PAST & PRESENT
Meta-analysis (2001)
N = 180 (3 PTs)
Radical resection and
IA Epi + PO Tegafur
IA Epi + IV Epi
IV Epi
Similar OS/DFS (All Patients); Poorer OS/DFS (Cirrhosis)
Surgery
Adjuvant Rx
Ono et al. Cancer 2001

27. STORM: LESSONS LEARNED!
Adjuvant Sorafenib does not
improve RFS in locally resected
or ablated HCC.
✤ Another lesson in distinctive
adjuvant & metastatic setting:
✤ ? Micro v. Macro metastatic
disease & distinct biology
✤ ? Angiogenesis (Adjuvant)
✤ ? Cytostatic v. Cytocidal drug
✤ 5-yr. OS in patient with
resected or ablated HCC ~ 70%.
✤ Drug toxicity profile very
important in adjuvant settings.
✤ Future: Molecular characterization and biology oriented therapy
and risk stratification !
Ono et al. Cancer 2001

28. LAP 07 STUDY
Florence Huguet et al.
Abstract: 4001

29. LAP 07 STUDY
Florence Huguet et al.
Abstract: 4001
✤ In patients with locally advanced pancreatic adenocarcinoma, can
use of chemoradiotherapy impact local control and time without
systemic therapy?

30. LAP-07: OVERVIEW
Impact of chemoradiotherapy (CRT) on local control and time
without treatment in patients with locally advanced pancreatic
cancer (LAPC) included in international phase III LAP 07 study.
Primary Endpoint: OS
LAPC
(N = 128) R1
Gemcitabine
4 months
Gemcitabine
+ Erlotinib
No
Progression R2
Cape XRT
(N = 136)
Same ChemoRx
2 months (N = 133)
Retrospective analysis: GERCOR study: 128 patients treated with XRT or
chemotherapy after induction chemotherapy (3 months). Median PFS
10.8 v. 7.4 m (P .005) and Median OS 15.0 v. 11.7 m (P .0009).
Huguet et al. JCO 2007

31. LAP-07 TRIAL: RESULTS
Toxicity profile similar (except nausea more in CRT arm)
Progression site: All v. R2 (32 v. 39% local, 54 v. 52% distant)
Median time to CTx
reintroduction: 5.2 v. 3.2 m

32. LAP-07: PAST & PRESENT
FFCD/SFRO study: Induction CRT v. Gem followed by Gem maintenance
showed poorer OS (8.6 v. 13 m, P=0.03).
ECOG 4201: Gem RT better OS v. Gem alone (11.1 v. 9.2 m) but higher
G4/5 toxicity (41 v. 9%).
CRT Arm FFCD Study
CTx Arm FFCD Study
CTx Arm ECOG Study
CRT Arm ECOG Study
Continued CTx Arm
CRT Arm GERCOR
Chauffert et al. Annals of Oncology 2008; Loehrer et al. JCO 2011; Huguet et al. JCO 2007
Retrospective series (N
= 181): Gem-based
therapy X 3 m followed
by continuation or CRT
(concurrent inf. FU) at
investigator discretion.
CRT improved median
PFS (10.8 v. 7.4 m) &
OS (15 v. 11.7 m).

33. LAP-07: PAST & PRESENT
FFCD/SFRO study: Induction CRT v. Gem followed by Gem maintenance
showed poorer OS (8.6 v. 13 m, P=0.03).
ECOG 4201: Gem RT better OS v. Gem alone (11.1 v. 9.2 m) but higher
G4/5 toxicity (41 v. 9%).
CRT Arm FFCD Study
CTx Arm FFCD Study
CTx Arm ECOG Study
CRT Arm ECOG Study
Continued CTx Arm
CRT Arm GERCOR
Chauffert et al. Annals of Oncology 2008; Loehrer et al. JCO 2011; Huguet et al. JCO 2007
Retrospective series (N
= 181): Gem-based
therapy X 3 m followed
by continuation or CRT
(concurrent inf. FU) at
investigator discretion.
CRT improved median
PFS (10.8 v. 7.4 m) &
OS (15 v. 11.7 m).

34. LAP-07: PAST & PRESENT
FFCD/SFRO study: Induction CRT v. Gem followed by Gem maintenance
showed poorer OS (8.6 v. 13 m, P=0.03).
ECOG 4201: Gem RT better OS v. Gem alone (11.1 v. 9.2 m) but higher
G4/5 toxicity (41 v. 9%).
CRT Arm FFCD Study
CTx Arm FFCD Study
CTx Arm ECOG Study
CRT Arm ECOG Study
Continued CTx Arm
CRT Arm GERCOR
Chauffert et al. Annals of Oncology 2008; Loehrer et al. JCO 2011; Huguet et al. JCO 2007
Retrospective series (N
= 181): Gem-based
therapy X 3 m followed
by continuation or CRT
(concurrent inf. FU) at
investigator discretion.
CRT improved median
PFS (10.8 v. 7.4 m) &
OS (15 v. 11.7 m).

35. LAP-07: PAST & PRESENT
FFCD/SFRO study: Induction CRT v. Gem followed by Gem maintenance
showed poorer OS (8.6 v. 13 m, P=0.03).
ECOG 4201: Gem RT better OS v. Gem alone (11.1 v. 9.2 m) but higher
G4/5 toxicity (41 v. 9%).
CRT Arm FFCD Study
CTx Arm FFCD Study
CTx Arm ECOG Study
CRT Arm ECOG Study
Continued CTx Arm
CRT Arm GERCOR
Chauffert et al. Annals of Oncology 2008; Loehrer et al. JCO 2011; Huguet et al. JCO 2007
Retrospective series (N
= 181): Gem-based
therapy X 3 m followed
by continuation or CRT
(concurrent inf. FU) at
investigator discretion.
CRT improved median
PFS (10.8 v. 7.4 m) &
OS (15 v. 11.7 m).

36. LAP-07: PAST & PRESENT
FFCD/SFRO study: Induction CRT v. Gem followed by Gem maintenance
showed poorer OS (8.6 v. 13 m, P=0.03).
ECOG 4201: Gem RT better OS v. Gem alone (11.1 v. 9.2 m) but higher
G4/5 toxicity (41 v. 9%).
CRT Arm FFCD Study
CTx Arm FFCD Study
CTx Arm ECOG Study
CRT Arm ECOG Study
Continued CTx Arm
CRT Arm GERCOR
Chauffert et al. Annals of Oncology 2008; Loehrer et al. JCO 2011; Huguet et al. JCO 2007
Retrospective series (N
= 181): Gem-based
therapy X 3 m followed
by continuation or CRT
(concurrent inf. FU) at
investigator discretion.
CRT improved median
PFS (10.8 v. 7.4 m) &
OS (15 v. 11.7 m).

37. LAP-07: PAST & PRESENT
FFCD/SFRO study: Induction CRT v. Gem followed by Gem maintenance
showed poorer OS (8.6 v. 13 m, P=0.03).
ECOG 4201: Gem RT better OS v. Gem alone (11.1 v. 9.2 m) but higher
G4/5 toxicity (41 v. 9%).
CRT Arm FFCD Study
CTx Arm FFCD Study
CTx Arm ECOG Study
CRT Arm ECOG Study
Continued CTx Arm
CRT Arm GERCOR
Chauffert et al. Annals of Oncology 2008; Loehrer et al. JCO 2011; Huguet et al. JCO 2007
Retrospective series (N
= 181): Gem-based
therapy X 3 m followed
by continuation or CRT
(concurrent inf. FU) at
investigator discretion.
CRT improved median
PFS (10.8 v. 7.4 m) &
OS (15 v. 11.7 m).

38. LAP-07: PAST & PRESENT
FFCD/SFRO study: Induction CRT v. Gem followed by Gem maintenance
showed poorer OS (8.6 v. 13 m, P=0.03).
ECOG 4201: Gem RT better OS v. Gem alone (11.1 v. 9.2 m) but higher
G4/5 toxicity (41 v. 9%).
CRT Arm FFCD Study
CTx Arm FFCD Study
CTx Arm ECOG Study
CRT Arm ECOG Study
Continued CTx Arm
CRT Arm GERCOR
Chauffert et al. Annals of Oncology 2008; Loehrer et al. JCO 2011; Huguet et al. JCO 2007
Retrospective series (N
= 181): Gem-based
therapy X 3 m followed
by continuation or CRT
(concurrent inf. FU) at
investigator discretion.
CRT improved median
PFS (10.8 v. 7.4 m) &
OS (15 v. 11.7 m).

39. LAP-07: LESSONS LEARNED!
Consolidation CRT after
induction CTx in LAPC
increases treatment free
interval without improvement
in overall survival.
May play a role in select subset
of patients with biology
favoring local growth over
distant metastases.
✤ ? Is LAPC truly different
from metastatic disease.
✤ ? FOLFIRINOX or Gem +
Abraxane alter the role of
radiation.
✤ Is the duration of induction
chemotherapy important to
tease out biology
✤ Future: Need for effective systemic therapies and predictive
biomarkers of response to both chemotherapy & radiation!

40. RAINBOW TRIAL
Shuichi Hironaka et al.
Abstract: 4005

41. RAINBOW TRIAL
Shuichi Hironaka et al.
Abstract: 4005
✤ In patients with advanced gastric or gastroesophageal cancer
refractory/intolerant to 5FU and platinum based regimen in first
line does addition ramucirumab to second line therapy with
paclitaxel improve survival?

42. RAINBOW: OVERVIEW
A Global, Phase III, Randomized, Double-Blind Study of
Ramucirumab Plus Paclitaxel versus Placebo Plus Paclitaxel in the
Treatment of Metastatic Gastroesophageal Junction and Gastric
Adenocarcinoma Following Disease Progression on First-Line
Platinum- and Fluoropyrimidine-Containing Combination Therapy:
Efficacy Analysis in Japanese and Western Patients.
Background: AVAGAST study failed to
show OS benefit from bevacizumab (median
PFS & RR improved).
Japanese (0lder, better PS, doublet
1st Rx, gastric): more TEAEs !
Ohtsu et al. JCO 2011; Ciombor et al. CCR 2013

43. RAINBOW TRIAL: RESULTS
More Japanese pts
(75% v. 35%)
received PDT.
Adjusted PDT
trends same.

44. RAINBOW: PAST & PRESENT
BSC v. Salvage ChemoRx (Docetaxel or Irinotecan): 5.3 v. 3.8 m
(P = 0.007)
BSC
Salvage Chemotherapy: Docetaxel/Irinotecan
Ramucirumab
BSC II
REGARD:
BSC v. Ram.
5.2 v. 3.8 m
(P = 0.047)
New
standard of
care.
Kang et al. JCO 2012; Fuchs et al. Lancet 2014

45. RAINBOW: PAST & PRESENT
BSC v. Salvage ChemoRx (Docetaxel or Irinotecan): 5.3 v. 3.8 m
(P = 0.007)
BSC
Salvage Chemotherapy: Docetaxel/Irinotecan
Ramucirumab
BSC II
REGARD:
BSC v. Ram.
5.2 v. 3.8 m
(P = 0.047)
New
standard of
care.
Kang et al. JCO 2012; Fuchs et al. Lancet 2014

46. RAINBOW: PAST & PRESENT
BSC v. Salvage ChemoRx (Docetaxel or Irinotecan): 5.3 v. 3.8 m
(P = 0.007)
BSC
Salvage Chemotherapy: Docetaxel/Irinotecan
Ramucirumab
BSC II
REGARD:
BSC v. Ram.
5.2 v. 3.8 m
(P = 0.047)
New
standard of
care.
Kang et al. JCO 2012; Fuchs et al. Lancet 2014

47. RAINBOW: PAST & PRESENT
BSC v. Salvage ChemoRx (Docetaxel or Irinotecan): 5.3 v. 3.8 m
(P = 0.007)
BSC
Salvage Chemotherapy: Docetaxel/Irinotecan
Ramucirumab
BSC II
REGARD:
BSC v. Ram.
5.2 v. 3.8 m
(P = 0.047)
New
standard of
care.
Kang et al. JCO 2012; Fuchs et al. Lancet 2014

48. RAINBOW: PAST & PRESENT
BSC v. Salvage ChemoRx (Docetaxel or Irinotecan): 5.3 v. 3.8 m
(P = 0.007)
BSC
Salvage Chemotherapy: Docetaxel/Irinotecan
Ramucirumab
BSC II
REGARD:
BSC v. Ram.
5.2 v. 3.8 m
(P = 0.047)
New
standard of
care.
Kang et al. JCO 2012; Fuchs et al. Lancet 2014

49. RAINBOW: LESSONS
LEARNED!
Ramucirumab + Paclitaxel
improves PFS/OS in 2nd-line
mG/GEJ cancers refractory to
5FU and Platinum therapy.
✤ ? Is this similar to the story of
Bevacizumab (AVAGAST).
✤ ? Why 2nd-line & not 1st-line
efficacy.
✤ ? Chemotherapy backbone
matters.
✤ ? Validity across populations.
✤ Very heterogenous disease.
✤ Future: Biomarker analysis and
comparative angiogenic efficacy!
✤ PDT can confound OS. Choice of
control arm critical in studies
with OS endpoint.
✤ 1st-line Ramu. + FOLFOX-6:
Negative for PFS (HR 0.98).
✤ Apatinib 3rd-line study (v. BSC)
(N = 273): OS benefit (HR 0.7)
(P = 0.0149)

50. DISCUSSION