ASCO 2018 Recap :: June 2018 Webinar

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 Richard Goldberg, MD
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WEBINAR TECH

RESOURCE
S
TABOO-TY PODCAST MINI MAGAZINES YOUR GUIDE IN THE FIGHT

FIGHTCOLORECTALCANCER
DISCLAIMER
The information and services provided
by Fight Colorectal Cancer are for
general informational purposes only.
The information and services are not
intended to be substitutes for
professional medical advice,
diagnoses or treatment.
If you are ill, or suspect that you are
ill, see a doctor immediately. In an
emergency, call 911 or go to the
nearest emergency room.
Fight Colorectal Cancer never
recommends or endorses any specific
physicians, products or treatments for
any condition.

RichardGoldberg,MD
Richard M Goldberg, MD, is West Virginia University Cancer Institute’s (WVUCI) Director,
and Director of the WVU Cancer Signature Program. He serves as a member of WVU
health sciences Vice President and Executive Dean, Clay Marsh’s leadership team. As
WVUCI’s Director, he oversees the clinical, research, and teaching missions of the cancer
institute and its component organizations that include satellite clinical and clinical
research locations that are dispersed throughout West Virginia.
Considered an international leader in gastrointestinal cancer treatment and research as
well as in leadership of cancer programs in academic medicine, Dr. Goldberg has been
principal investigator, co-PI, co-investigator and mentor on multiple research and training
grants funded through the National Cancer Institute (NCI). He has published more than
335 papers in peer-reviewed journals. His clinical interests are in management of patients
with malignancies in the gastrointestinal tract, particularly colorectal and neuroendocrine
cancers. His research focuses on defining new treatments, elucidating inherited cancer
susceptibility, and identification of predictive and prognostic factors in GI cancers. He
helps to lead the Alliance for Clinical Trials in Oncology as the Associate Group Chair of
this NCI funded organization that is a member of the National Clinical Trials Network. The
Alliance conducts clinical trials and does translational research across the US and Canada.
He is a sought after lecturer at academic centers and scientific conferences across the
nation and the world. He has mentored many MD, MD/PhD, and PhD doctoral students,
post-doctoral researchers and junior faculty over his 34 years as a medical oncologist in
academic settings.
Dr. Goldberg serves on several national scientific advisory committees and on the
scientific advisory committee for a number of pharmaceutical companies at the corporate
level. He is a Fellow in the American College of Physicians and the American Society of
Clinical Oncology. He is married to Lynda Goldberg MBA, MPH and has two adult children.

ColoRectal Cancer ASCO
Update 6/2018
Richard M. Goldberg MD
Director, WVU Cancer Institute

Rectal Cancer:
Important Issues
• Two types of recurrent disease
• Local (more of an issue in rectal than colon cancer)
• Distant
• Strategies to reduce the odds of recurrence
• Surgery: Does everyone need it?
• Radiation: Does everyone need it?
• Chemotherapy: Does adding more drugs improve
outcomes?
• How do you best integrate the 3 techniques?

Surgery
Standard of care for all rectal cancers
• Open vs robot or laparoscopy assisted
• The skill of the surgeon matters: how do you judge?
• Multidisciplinary consultation in every case
• Colorectal surgery fellowship
• High number of cases/year
• Best Doctor or other national rating group endorsement
• Recommendations by other specialists
• Goals of surgery: complete total mesorectal
resection, > 12 nodes, sphincter preservation
• No new studies presented to change surgery’s role

Radiation
• Skilled radiation oncologist and physicist
• The technical specifications of the machine matter
• IMRT: Intensity modulated radiation therapy
• RT before surgery has advantages
• May induce a complete disappearance of the primary
• May permit less surgery
• The radiated bowel is removed, may improve rectal
function postoperatively

Medical Therapy
• Standardly 5-FU or capecitabine (Xeloda) are used
to sensitize cancer cells to RT
• Does adding extra drugs matter?
• Negative prior data on bevacizumab and cetuximab
• Oxaliplatin?
• Does postoperative chemotherapy after radiation +
+ 5-FU followed by surgery help?

What’s New From ASCO?
• FORWARC
• 5-FU + RT + 5-FU vs FOLFOX +/- RT + FOLFOX as
preoperative therapy
• PETACC 6
• Does oxaliplatin add to capecitabine before and after
surgery?
• ADORE
• After 5-FU + RT + surgery is 5-FU or FOLFOX better?

What Did We Learn?
• Higher pathologic complete regression rate with
FOLFOX + RT
• No difference in disease free or overall survival
• Caveat: this is a small study and not definitive

547 patients in each arm

What Did We Learn?
• No differences
• Local recurrence rate
• Distant recurrence rate
• DFS: Disease free survival
• OS: Overall survival
• Oxaliplatin does not add value compared to
capecitabine alone when given with RT and after
surgery

Long-term results of the ADORE trial: ADjuvant Oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX) versus 5-fluorouracil and leucovorin (FL) after preoperative
chemoradiotherapy and surgery for locally advanced REctal cancer

Study design and Rationale
160 patients per arm

Disease-free survival, ITT population

What Did We Learn?
• An initial DFS advantage favoring postoperative FOLFOX
did not translate into better overall survival at 6 years
• What is the standard of care?
• Multidisciplinary teamwork
• Preoperative chemotherapy with 5-FU or capecitabine
• Radiation by an excellent radiation oncologist and physicist on
a modern machine
• TME by an excellent colorectal surgeon
• Postoperative chemotherapy with FOLFOX or CapeOx or 5-FU
or capecitabine

How can we tell who will benefit from
chemotherapy after surgery?
• Prognostic markers: who will do well and who will
relapse?
• Example: Staging
• Predictive markers: Who will benefit from therapy?
• RAS mutations predict resistance to Cetuximab and
Panitumumab
• Today’s Focus: Circulating tumor DNA as a
predictive marker

Abstract 3516: Serial circulating tumor DNA (ctDNA) analysis as a prognostic marker and a real-time indicator of adjuvant chemotherapy (CT) efficacy in stage III colon cancer (CC).

Adjuvant Chemotherapy for Stage III Colon Cancer

Metastatic Disease
• Peritoneal Disease:
• PRODIGE 7 trial of surgery +/- HIPEC with oxaliplatin
• HIPEC= heated intraperitoneal chemotherapy
• First Line
• FIRE-3 update: FOLFIRI + Cetuximab or Bevacizumab
• VOLPI: Folfoxiri+/- panitumumab
• MSI-H CRC
• Checkmate 142: Nivolumab +/- ipilumimab
• Keynote 16: Pembrolizumab
• Later Lines
• Reverece: Cetuximab then Regorafinib or the reverse
sequence
• EGFR inhibition and Ras mutation evolution
• ECOG 7208: Cetuximab + irinotecan +/- Ramicirumab

A UNICANCER phase III trial of Hyperthermic Intra-peritoneal Chemotherapy (HIPEC) for Colorectal Peritoneal Carcinomatosis. Prodige 7 - ACCORD 15 trial.
NCT00769405, N° EudraCT : 2006-006175-20

Unicancer Prodige 7 trial design

HIPEC Arm (open or closed technique)

What did we learn?
• The addition of oxaliplatin did not improve
outcomes over HIPEC alone
• Oxaliplatin has no single agent activity
• HIPEC increases the complication rate
• For earlier stage disease chemotherapy may be more
effective
• Outcomes with cytoreductive surgery are good
compared to historical studies
• The hardest thing is to discern who to operate on.

CALGB 81001
A Phase III Rectal Cancer Study
Deb Schrag Len Saltz Marty Weiser
Harvey Mamon Karyn Goodman, David Solit
Larissa Temple Ethan Basch
Donna Niedzwiecki

Stage II-III Rectal Cancer Candidates for LAR
5FU/XRT
Complete
Restaging TME Surgery
FOLFOX
x6
No progression
Any progression

81001 Protocol POST-OP Schema:
Stage II-III Rectal Cancer Candidates for LAR
5FU/XRT
FOLFOX
x6
R0 TME?
YES
NO
FOLFOX
X 2
Observe

What did we learn?
• For RAS wild type left sided lesions the addition of
an EGFR targeted monoclonal antibody improves
outcomes in first line therapy

Presented By Neil Segal at 2018 ASCO Annual Meeting

Nivolumab in Patients With DNA Mismatch
Repair-Deficient/Microsatellite Instability-High Metastatic
Colorectal Cancer: Long-Term Survival According to Prior Line
of Treatment From
CheckMate-142
Michael J. Overman,1 Francesca Bergamo,2 Ray McDermott,3 Massimo Aglietta,4
Franklin Chen,5 Fabio Gelsomino,6 Ka Yeung Mark Wong,7 Michael Morse,8 Eric Van Cutsem,9
Alain Hendlisz,10 Bart Neyns,11 Rebecca A. Moss,12 Huanyu Zhao,12 Z. Alexander Cao,12
Shital Kamble,12 Scott Kopetz,1 Thierry André13
Presented by: Dr. Michael J. Overman

CheckMate-142 Monotherapy Cohort
Study Design
63
Primary analysis (N = 74): efficacy per BICR and safety; median follow-up, 21 months (range, 17–40)c
Subset analysis:
• Group A (n = 53): received ≥ 3 prior chemotherapies, including a fluoropyrimidine, oxaliplatin,
and irinotecan
• Group B (n = 21): did not receive prior treatment with all 3 of these chemotherapies (fluoropyrimidine,
oxaliplatin, and irinotecan
Nivolumab 3 mg/kg Q2W
• Histologically
confirmed metastatic
or recurrent CRC
• dMMR/MSI-H per
local laboratory
• ≥ 1 prior line of
therapy
Monotherapy
cohorta
Primary endpoint:
• ORR per investigator assessment
Other key endpoints:
• ORR per BICR, DCR,b DOR, PFS,
OS, and safety

Prior Therapies
64Presented by: Dr. Michael J. Overman
All patients
N = 74
Prior lines of therapy, n (%)
0
1
2
≥ 3
1 (1)
11 (15)
22 (30)
40 (54)
Prior therapies received, n (%)
Fluoropyrimidines (5-FU/capecitabine)
Oxaliplatin
Irinotecan
VEGF inhibitorsd
EGFR inhibitorse
Regorafenib
Other
73 (99)
71 (96)
55 (74)
57 (77)
31 (42)
12 (16)
11 (15)
Group Aa
n = 53
Group Bb
n = 21
0
1 (2)
15 (28)
37 (70)
1 (5)c
10 (48)
7 (33)
3 (14)
53 (100)
53 (100)
53 (100)
45 (85)
27 (51)
12 (23)
9 (17)
20 (95)
18 (86)
2 (10)
12 (57)
4 (19)
0 (0)
2 (10)
5-FU = fluorouracil; EGFR = epidermal growth factor receptor; VEGF = vascular endothelial growth factor
aGroup A patients received ≥ 3 prior chemotherapies, including a fluoropyrimidine, oxaliplatin, and irinotecan. bGroup B patients did not receive prior treatment with all 3 of these chemotherapies (fluoropyrimidine, oxaliplatin, and
irinotecan). cOne patient refused all treatment. dIncluded bevacizumab, aflibercept, and ramucirumab. eIncluded cetuximab and panitumumab.

Group Aa,b
n = 53
Group Ba,c
n = 21
14 (26)
[15.3, 40.3]
11 (52)
[29.8, 74.3]
4 (8)
10 (19)
16 (30)
19 (36)
4 (8)
3 (14)
8 (38)
7 (33)
3 (14)
0
29 (55)
[40.4, 68.4]
17 (81)
[58.1, 94.6]
NR (4.6+ to 27.2+) NR (1.4+ to 31.6+)
8.5 (4.1, NE) 5.3 (2.6, NE)
Response, Disease Control,
and Durability
• Median time to response was approximately 2.8 months across all groups
• Clinical benefit was observed across all groups
All patientsa
N = 74
ORR, n (%)
[95% CI]
25 (34)
[23.2, 45.7]
Best overall response, n (%)
CR
PR
SD
PD
Unable to determine
7 (9)
18 (24)
23 (31)
22 (30)
4 (5)
Disease control, n (%)d
[95% CI]
46 (62)
[50.1, 73.2]
Median DOR (range), months NR (1.4+ to 31.6+)
Median duration of SD (range), months 8.3 (4.2, NE)
NE = not estimable; NR = not reached.
aBICR data with a median follow-up of 21 months (range, 17-40). bGroup A patients received ≥ 3 prior chemotherapies including a fluoropyrimidine, oxaliplatin, and irinotecan. cGroup B patients did not receive prior
treatment with all 3 of these chemotherapies (fluoropyrimidine, oxaliplatin and irinotecan). dPatients with a CR, PR, or SD for ≥ 12 weeks.

Best Reduction in Target Lesion:
All Patients
• 60% of patients had a reduction in tumor burden from baseline with
nivolumab monotherapy
-100
-80
-60
-40
-20
0
20
40
60
80
100
Bestreductionfrombaseline
intargetlesionsize(%)a
Group A: patients received ≥3 prior chemotherapies including a fluoropyrimidine, oxaliplatin, and irinotecan
Group B: patients did not receive prior treatment with all 3 of these chemotherapies (fluoropyrimidine, oxaliplatin and irinotecan)
*Confirmed response per BICR assessment; % Change truncated to 100%. † Patient from Group A with 0% best reduction in target lesion
Presented by: Dr. Michael J. Overman 66
†
aBICR data with a median follow-up of 21 months (range, 17-40).
-30
20

Characterization of Response:
All Patients
aBICR data with a median follow-up of 21 months (range, 17-40).
67
Weeks
0 12 24 36 48 60 72 84 96 108 120 132 144 156
Patients(n=25)a
Censored
First response
On treatment
Off treatment
Ongoing response
Responders with Nivolumab
• Nivolumab continued to provide clinically
meaningful and durable responses
– 80% of responders had ongoing
responses at data cutoff
– 64% had responses lasting ≥ 12
months

Progression-Free Survival: All Patients
• Median PFS was 4.2 months and not
reached in groups A and B,
respectivelyb
• 12- and 18-month PFS rates were 41%
(group A) and 52% (group B)b
No. at Risk
0 3 6 9 12 15 18 21 24 27 30 33 36
Months
74 44 35 31 29 27 15 14 14 12 6 1 0
Progression-freesurvival(%)a
100
90
80
70
60
50
40
30
20
10
0
All patients
N = 74
Median PFS (95% CI), months 6.6 (3.0, NE)
PFS rate (95% CI), %
12 months
18 months
44 (32.6, 55.3)
44 (32.6, 55.3)
NE, not estimable. aBICR data with a median follow-up of 21 months. bGroup A patients received ≥ 3 prior chemotherapies, including a fluoropyrimidine, oxaliplatin, and irinotecan. Group B patients did not receive prior treatment with
all 3 of these chemotherapies (fluoropyrimidine, oxaliplatin, and irinotecan).

Overall Survival: All Patients
No. at Risk
0 3 6 9 12 15 18 21 24 27 30 33 36 39
Months
74 64 59 55 51 48 32 17 17 16 12 6 1 0
Overallsurvival(%)
100
90
80
70
60
50
40
30
20
10
0
All patients
N = 74
Median OS (95% CI), months NR (19.6, NE)
OS rate (95% CI), %
12 months
18 months
72 (60.0, 80.9)
67 (54.9, 76.9)
• Median OS was not reached in
groups A or Ba
• 12-month OS rate was 68% (group
A) and 81% (group B)a
• 18-month OS rate was 66% (group
A) and 70% (group B)a
NE = not estimable; NR = not reached.
aGroup A patients received ≥ 3 prior chemotherapies, including a fluoropyrimidine, oxaliplatin, and irinotecan. Group B patients did not receive prior treatment with all 3 of these chemotherapies (fluoropyrimidine, oxaliplatin and
irinotecan).
Presented by: Dr. Michael J. Overman 69

Conclusions
• Nivolumab continued to provide durable clinical benefit with long-term follow-up (21
months) in previously treated patients with dMMR/MSI-H mCRC
• PFS and OS rates demonstrated continued stability
• CR rate increased with longer follow-up
• Median DOR and OS were not reached
• Durable clinical benefit with deepening of response was observed regardless of prior
chemotherapy with a fluoropyrimidine, oxaliplatin, and irinotecan
• No new safety signals were reported with long-term follow-up
• Results support ongoing evaluation of nivolumab-based therapy in the
first-line setting

Nivolumab + Ipilimumab Combination in Patients
With DNA Mismatch Repair-Deficient/Microsatellite
Instability-High Metastatic Colorectal Cancer:
First Report of the Full Cohort From CheckMate-142
Thierry André,1 Sara Lonardi,2 Ka Yeung Mark Wong,3 Heinz-Josef Lenz,4 Fabio Gelsomino,5
Massimo Aglietta,6 Michael Morse,7 Eric Van Cutsem,8 Ray McDermott,9 Andrew Graham Hill,10
Michael B. Sawyer,11 Alain Hendlisz,12 Bart Neyns,13 Magali Svrcek,1 Rebecca A. Moss,14
Jean-Marie Ledeine,15 Z. Alexander Cao,14 Shital Kamble,14 Scott Kopetz,16 Michael J. Overman16
Presented by: Prof Thierry André

CheckMate-142 Study Design
Presented by: Prof
Thierry André
72
Primary endpoint:
• ORR per investigator
assessment (RECIST v1.1)
Other key endpoints:
• ORR per BICR, DCRb,
DOR, PFS, OS, and safety
aEnrollment was staggered with additional patients being enrolled if ≥ 7 of the first 19 centrally confirmed MSI-H patients had a confirmed response (CR or PR). CheckMate-142 monotherapy and combination therapy cohorts were not
randomized or designed for a formal comparison. bPatients with a CR, PR, or SD for ≥12 weeks. cTime from first dose to data cutoff
1. Overman MJ, et al. Lancet Oncol 2017;18:1182–1191.
• Histologically
confirmed metastatic
or recurrent CRC
• dMMR/MSI-H per
local laboratory
• ≥ 1 prior line of
therapy
Nivolumab 3 mg/kg +
ipilimumab 1 mg/kg Q3W
(4 doses and then
nivolumab 3 mg/kg Q2W)
Combination
Cohorta
• Median follow-up in the combination therapy cohort (N = 119) was 13.4 months (range, 9–25)c
Nivolumab 3 mg/kg Q2W
Monotherapy
Cohorta
Phase 2 Nonrandomized Study
• Results of the monotherapy cohort (N = 74) with a similar median follow-up of 13.4 months (range, 10–32)
will also be presented1,c

3 5
12
26
31
38
51.3
31
3.4
CR
PR
SD
PD
Unknown
Patients(%)
ORR [95% CI]:
31% [20.8, 42.9]
Nivolumab1
N = 74c
Nivolumab + ipilimumab
N = 119a
ORR [95% CI]:
55% [45.2, 63.8]
20
40
60
80
100
0
• DCRb was 80% [95% CI: 71.5, 86.6] with combination therapy
Investigator-Assessed Response and Disease Control
73

Best Reduction in Target Lesions
Presented by: Prof
Thierry André
74
⃰Confirmed response per investigator assessment
aEvaluable patients per investigator assessment
• 78% of patients had a reduction in tumor burden from baseline with combination therapy
Nivolumab + ipilimumaba
Bestreductionfrombaseline
intargetlesionsize(%)
100
50
75
0
-50
-75
-25
25
-30
20
-100
********** ************ ********** ************
*
*** ************
*
**
**

Progression-Free and Overall Survival
• Combination therapy provided improved long-term clinical benefit relative to monotherapy during a similar follow-up perioda,e,f
Nivolumab 74 48 41 32 1217 11 612 3 0
Nivolumab
Months
No. at Risk
119Nivolumab + ipilimumab 95 86 78 1239 10 311 0 0
100
90
80
70
60
50
40
30
20
10
0
0 3 6 9 1512 21 2418
Progression-freesurvival(%)c
27 30
100
90
80
70
60
50
40
30
20
10
0
0 3 6 9 1512 21 2418
OverallSurvival(%)
27 30 33
Months
119 113 107 104 3378 17 1119 0 0 0
74 64 59 55 2137 17 1119 6 1 0
Nivolumab
Nivolumab +
ipilimumaba,d Nivolumab1,e,f
9-mo rate (95% CI), % 87 (80.0, 92.2) 78 [66.2, 85.7]
12-mo rate (95% CI), % 85 (77.0, 90.2) 73 [61.5, 82.1]
NE, not estimable; NR, not reached. aMedian follow-up was 13.4 (range, 9–25) months. bMedian PFS was NR [95% CI, NE]. cPFS per investigator assessment. dMedian OS was NR [95% CI, 18.0, NE].
Median follow-up was 13.4 (range, 10–32) months. fCheckMate-142 monotherapy and combination therapy cohorts were not randomized or designed for a formal comparison
1. Overman MJ, et al. Lancet Oncol 2017;18:1182–1191.
Nivolumab +
ipilimumaba,b Nivolumab1,e,f
9-mo rate (95% CI), % 76 (67.0, 82.7) 54 [41.5, 64.5]
12-mo rate (95% CI], % 71 (61.4, 78.7) 50 [38.1, 61.4]
Presented by: Prof
Thierry André
75

Safety Summary
• ORR (63%) in patients (n=16) who discontinued
treatment due to a study drug-related AE was
consistent with the
overall population
• No new safety signals or treatment-related
deaths were reported
• For combination therapy relative to
monotherapy:1,b,c,d
• Any-grade TRAEs (73%; 70%) were comparable
• Grade 3–4 TRAEs (32%; 20%) were acceptable
• TRAEs leading to discontinuation (13%; 7%) were
modest
76
Patients, n (%)
N = 119
Any grade Grade 3–4
Any TRAE 87 (73) 38 (32)
Any serious TRAE 27 (23) 24 (20)
Any TRAE leading to discontinuation 15 (13)a 12 (10)
TRAEs reported in > 10% of patients
Diarrhea 26 (22) 2 (2)
Fatigue 21 (18) 2 (2)
Pruritus 20 (17) 2 (2)
Pyrexia 18 (15) 0
Increased AST 17 (14) 9 (8)
Hypothyroidism 16 (13) 1 (1)
Nausea 15 (13) 1 (1)
Increased ALT 14 (12) 8 (7)
Rash 13 (11) 2 (2)
Hyperthyroidism 13 (11) 0
TRAE, treatment-related adverse event. aAutoimmune hepatitis and acute kidney injury were the only TRAEs that led to discontinuation in > 1 patient (2% each). bCombination: median follow-up, 13.4 (range, 9–25) months.
cMonotherapy: median follow-up, 13.4 (range, 10–32) months. dCheckMate-142 monotherapy and combination therapy cohorts were not randomized or designed for a formal comparison
1. Overman MJ et al. Lancet Oncol. 2017;18:1182–1191.

Conclusions
• Nivolumab + ipilimumab provided durable clinical benefit in previously treated patients with
dMMR/MSI-H mCRC, of whom 76% had received ≥ 2 prior lines of therapy
• High ORR (55%) and durable responses (median DOR not reached)
• High rate of disease control for ≥ 12 weeks (80%)
• Encouraging survival (median PFS and OS not reached)
• Safety was manageable with a low (13%) rate of discontinuation due to TRAEs
• Meaningful improvements were observed in key patient-reported outcomes
• Indirect comparisons in this nonrandomized phase 2 study (CheckMate-142) suggest that nivolumab
+ ipilimumab provides numerically higher response rates and improved long-term clinical benefit
relative to nivolumab monotherapy with a favorable benefit-risk profile
• Nivolumab + ipilimumab represents a promising new treatment option for patients with previously
treated dMMR/MSI-H mCRC
Presented by: Prof
Thierry André
77

MSI-H tumors respond to anti–PD-1 
Presented By Neil Segal at 2018 ASCO Annual Meeting

Best Percentage Change From Baseline in Target Lesion Size (RECIST v1.1)

What did we learn?
• In MSI-H metastatic colorectal cancer PD-1
inhibitors can result in a substantial percentage of
responses, many of which are durable
• Adding additional immunomodulatory agents (nivo
+ ipi) can add activity
• All patients with CRC should have MSI testing
• For diagnosing Lynch syndrome
• For eligibility for a PD-1 inhibitor in metastatic disease
• One could argue that all patients with metastatic
cancer should have MSI testing

Late Line Therapy for
Metastatic Disease

3511 Parseghian. Anti-EGFR resistant clones decay exponentially after progression:Implications for anti-EGFR rechallenge

Effects of cetuximab re-challenge in pts progressing on CET-based therapy and a second non anti-EGFR therapy: phase II studies

What did we learn?
• EGFR inhibitor resistance as measured by RAS
mutation can change with exposure or withdrawal
of the drug
• Rechallenge with an EGFR targeted monoclonal
antibody is rational after a treatment break
• It appears the regorafenib + cetuximab is
advantageous over the reverse sequence

A Randomized Phase II Study of Irinotecan and Cetuximab (IC) with or without the Anti-Angiogenic Antibody, Ramucirumab (IMC-1121B) (mICR), in Advanced, K-ras Wild-type
Colorectal Cancer Following Progression on Bevacizumab-Containing Chemotherapy (E7208)

Ramucirumab improves PFS

What did we learn?
• Irinotecan with both an antiangiognesis and anti-
EGFR targeted agent deserves further study

Summary
• Preoperative chemotherapy + radiation remains
standard for rectal cancer
• The role for postoperative adjuvant therapy needs
more study
• Cytoreductive surgery is useful in prolonging survival
and inducing long term remission in some patients
• The roles of EGFR targeted monoclonal antibodies need
to be refined and these agents show more promise
with time
• Regorafinib and ramicurimab have activity in advanced
disease

We have miles to go
before we sleep

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ASCO 2018 Recap :: June 2018 Webinar

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