What Can Change my Practice After Evaluate Progress that I Heard at the Meeting of the ASCO 2017?

Advances in personalized medicine for the management of numerous tumors and confirmation immunotherapy as a weapon fundamental in the treatment of cancer has starred Congress of the American Society of Clinical Oncology (ASCO), which was carried out in the city of Chicago, between June, 2-6 past.


Breast cancer
In metastatic breast cancer highlighted the results of the study phase III Monarch2, which increased significantly progression-free survival with the combination of the inhibitor cdk4 /6 abemaciclib and fulvestrant.
In her 2+, the combination in adjuvant chemotherapy, trastuzumab and pertuzumab was slightly higher than chemotherapy with trastuzumab and placebo.
Also, improved the progression-free survival in metastatic breast cancer her2 negative mutation brca in a study phase III olimpiad with olaparib.
It is clear, which now, we can customize the treatment based on the genetic changes of the tumor and factors inherent determining its development.
In a study phase II in patients with mutations brca1 and brca2 and metastatic disease, inhibitor PARP talazoparib was able answers in 21 percent of patients who had previously treated with platinum and not had progressed.
In the other arm of the study, the patients received three or more lines chemotherapy in the context advanced and managed to a response 37 percent of cases. Featured these two studies is that the development of these drugs has been linked to the knowledge of biology genetics of tumors. Now, alterations germ of the patients become also on a therapeutic option. Therefore, opens a new way in patients of breast cancer, with the ability to receive treatment personalized and to help prevent later cancer in other family. This genetic alteration you can determine also in family healthy, a real progress.
On the other hand, an analysis of long-term monitoring, with data from a retrospective study multicenter case controls, confirmed that the pregnancy after breast cancer can be considered safe, regardless of the status of the oncogene her. The results confirm that can be allowed to patients to stay pregnant when ask about the safety of pregnancy.
And strengthen the premise of the study ibcsg-big-nabcg positive, investigating the safety of the temporary disruption of therapy endocrine to allow pregnancy [1,2].

Advances in Prostate Cancer
One of the results highlights was obtained in prostate cancer advanced sensitive hormones studies latitude and stampede tested to add acetate abiteranona more prednisolone improved de survival 18 months and was well tolerated.
The combination of both drugs should be the standard therapy in patients starting therapy deprivation androgen long-term.
Regarding the liver cancer, lenvatinib has been the first systemic therapy in show non-inferior with sorafenib, the standard current treatment in hepatocellular carcinoma irresecable in the study phase III reflect.
Also managed to improvements progression-free survival, time to progression and response rate objective. In the field of "medicine precision" a new technique genome sequencing-denominada MSKimpact-detected DNA circulating in 89% of 124 patients who participated in the study, with breast cancers advanced, lung and prostate.
Another study, made in France in 1.944 patients (the largest done so far), has shown that the evidence genomic routine are feasible, but should be noted that only a percentage of patients get clinical benefit.
Also, in personalized medicine, an analysis in 12.800 patients has proven chemotherapy with folfox or capox for three months is almost as effective as the six months in patients with colon cancer after surgery lymph nodes positive (stage III).

Skin Cancer
Carcinoma merckel a study with avelumab front treatment in carcinoma Merkel metastatic, a cancer rare, and that have been previously treated with chemotherapy, which is the standard treatment, has positive. Preliminary data are promising, with an answers objective around 60%.

Targeted Therapies
Other result remarkable in targeted therapies was that of latotrectinib, with answers in 76 percent of patients 17 different types of advanced cancer. The drug is a selective inhibitor of proteins Fusion kinase receptor tropomiosina (trk) and has achieved, in addition, 79 percent of responses to remain twelve months after treatment initiation.

Immunotherapy
In immunotherapy, a study in which have participated Institute researchers oncology Valley Hebron (vhio) has proven antibody bioespecífico ro6958688 directed against antigen CEA could be very useful in colon cancer.
Treatment joins simultaneously to this protein (present in 95% of these tumors) and to lymphocytes T. in studies phase AI and Ibid has been administered the drug alone and in combination with atezolizumab.
In the field of immunotherapy, are also presented favorable results regarding the duration of the response pembrolizumab in numerous trials in solid tumors. In addition, the drug has shown improved survival in advanced melanoma compared to placebo and chemotherapy as second line treatment for patients with carcinoma urotelial advanced after progression to platinum.
Finally, presented studies with referrals durable with car-T in patients with multiple myeloma refractory/in relapse and on the effectiveness of dacomitinib versus gefitinib and alectinib versus crizotinib in lung cancer in lung cancer non-small cell.