City of Hope researchers report on new findings at ASCO annual meeting

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H. Chung So
Phone: 800-888-5323
hso@coh.org
 
City of Hope researchers report on young adult cancer patients, location of cancer care, medication nonadherence and phase II drug trials of XL184 (cabozantinib) for breast cancer and ABT-888 (veliparib) for lung cancer
Findings will be presented at American Society of Clinical Oncology’s 50th annual meeting
 
DUARTE, Calif., May 16, 2014 — City of Hope researchers will be presenting numerous studies at the American Society of Clinical Oncology (ASCO) annual meeting, which takes place in Chicago from May 30 to June 3. The meeting will commemorate ASCO’s 50th anniversary and bring together more than 25,000 oncology professionals to educate one another about the latest scientific findings on cancer prevention, detection, treatment and follow-up.
 
Significant City of Hope findings at this year’s meeting include:
• Results of a phase II trial supporting use of  a combination of cabozantinib plus erlotinib for advanced lung cancer
• Results of a phase II trial supporting use of the new drug veliparib, alone and in combination with carboplatin, for BRCA-mutation associated metastatic breast cancer
• Contributors to medication nonadherence among pediatric cancer patients
• Factors that affect where cancer patients go for treatment
• Identification of poorer survival outcomes for young adults with breast cancer compared to their older counterparts
 
“Over the last 50 years, our knowledge of cancer has expanded exponentially and there have been major advances that have prolonged lives and reduced human suffering. However, a significant number of patients still succumb to cancer,” said Steven Rosen, M.D., City of Hope’s provost and chief scientific officer. “The interaction that takes place at the ASCO annual meeting will foster collaboration among researchers and clinicians, renewing our sense of urgency and ultimately furthering our collective progress to make a meaningful, tangible impact against the disease.”
 
Results of a phase II trial supporting use of cabozantinib plus erlotinib combination therapy for advanced lung cancer
Abstract #8014
“Phase II trial of XL184 (cabozantinib) plus erlotinib in patients (pts) with advanced EGFR-mutant non-small cell lung cancer (NSCLC) with progressive disease (PD) on epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy: A California Cancer Consortium phase II trial (NCI 9303).”
Tuesday, June 3, 8 to 11 a.m.
McCormick Place, Room E354b
 
Karen Reckamp, M.D., M.S., co-director of the Lung Cancer and Thoracic Oncology Program, and her colleagues studied 35 patients with advanced, EGFR-mutant nonsmall cell lung cancer whose disease progressed during therapy with a class of drugs called tyrosine kinase inhibitors (TKI). Such drugs are standard therapy for the disease, but patients often become resistant to their effects. In this study, the patients were given 40mg of the experimental drug cabozantinib in addition to 150mg of TKI drug erlotinib daily for 28 days, and were then examined to see if their tumors had responded to the combination therapy.
 
Reckamp and her team found that the cabozantinib-erlotinib combination significantly slowed tumor growth, as measured by a 30 percent or higher increase in doubling time (the amount of time it takes a tumor to double in size). Additionally, four patients showed partial remission of their cancer while on cabozantinib-erlotinib therapy. Based on these findings, the researchers noted that the cabozantinib-erlotinib regimen has potential benefits for patients with EGFR-mutant nonsmall cell lung cancer that should be further investigated.
 
Phase II trial using PARP inhibitor ABT-888 (veliparib), as a single agent and in combination with carboplatin, for BRCA-mutation associated metastatic breast cancer patients
Abstract #1021
“Phase II trial of single agent PARP inhibitor ABT-888 (veliparib [vel]) followed by postprogression therapy of vel with carboplatin (carb) in patients (pts) with stage BRCA-associated metastatic breast cancer (MBC): California Cancer Consortium trial PHII-96.”
Monday, June 2, 1:15 to 4:15 p.m.
McCormick Place, Room E354b
 
George Somlo, M.D., professor in the Department of Medical Oncology & Therapeutics Research, and Jeffrey Weitzel, M.D., director of the Division of Clinical Cancer Genetics, investigated the efficacy of an experimental PARP inhibitor veliparib, alone and in combination with the standard chemotherapy drug carboplatin, to assess whether the therapy has any benefit for patients with BRCA-associated breast cancer.

Somlo and his colleagues treated 41 patients, all with metastatic breast cancer and carrying a BRCA1 or BRCA2 gene mutation, with 400mg of veliparib twice a day. Upon detectable progression of the disease, they switched the patients to a combination regimen of 150mg veliparib twice a day plus an intravenous infusion of carboplatin.

After more than 10 months of treatment and monitoring, 10 patients remain on veliparib-only therapy — indicating their disease had not progressed — and another 10 proceeded onto veliparib and carboplatin therapy (another three patients are still too early to assess at the time of this abstract’s publication). Somlo and his team also reported that partial responses were seen in both veliparib-only and veliparib+carboplatin groups, and they concluded further trials are warranted to investigate the drug’s potential benefits against BRCA-associated breast cancer.
 
Finding out what contributes to medication nonadherence among pediatric cancer patients
Abstract #10013
“Factors associated with nonadherence to oral 6-mercaptopurine (6MP) in children with acute lymphoblastic leukemia (ALL): A report from Children’s Oncology Group (COG) study AALL03N1.”
Sunday, June 1, 10:57 to 11:09 a.m.
McCormick Place, Room S504
 
Wendy Landier, Ph.D., M.S.N., R.N., C.P.N.P., assistant professor in the Department of Population Sciences, and Smita Bhatia, M.D., M.P.H., the Ruth Ziegler Chair in Population Sciences, sought to determine the demographic and behavioral predictors of adherence to oral chemotherapy in children with acute lymphoblastic leukemia, the most common childhood cancer. Their analysis showed that numerous factors are associated with a higher likelihood of nonadherence, including belonging to African-American or Hispanic backgrounds, having a lower household income ($50,000 or less), taking the oral chemotherapy at different times of the day or with milk or dairy products, and having more than one adult responsible for administering the medication.
 
The last factor is a surprising finding, since the presence of multiple adults should theoretically increase the likelihood of the medication being administered. But the researchers speculate that having multiple adults involved may lead to a lower likelihood of adherence because each adult assumes another administered the medication.
 
With respect to the observation regarding dairy products, Landier and Bhatia noted that patients and their parents are advised against taking the medication with dairy products, which makes the medication less absorbable. Those who chose to disregard this caution may also be less likely to be stringent about adhering to the medication schedule, they said.
 
These findings are currently being used to plan and implement interventions to enhance adherence to oral chemotherapy among pediatric cancer patients.

Exploring factors that affect where cancer patients go for treatment
Abstract #6541
“Impact of care at NCI comprehensive cancer centers (NCICCC) on cancer outcome: Results from a population-based study.”
Monday, June 2, 1:15 to 5 p.m.
McCormick Place, South Hall A2
 
Julie Wolfson, M.D., M.S.H.S., assistant professor in the departments of Population Sciences and Pediatrics, and her team evaluated more than 53,000 cancer patients over 10 years (1998 to 2008) to determine which factors were tied to treatment at a National Cancer Institute-designated comprehensive cancer center, and whether treatment at such a center improved outcomes.
 
The researchers noted that for patients diagnosed with breast, lung, liver, stomach or pancreatic cancers, treatment at a comprehensive cancer center significantly improved five-year overall survival rates. However, she and her team also found that a number of factors are tied to a lower likelihood of treatment at a comprehensive cancer center. These include:
• Residing more than nine miles from the nearest comprehensive cancer center (30 to 50 percent less likely, depending on cancer type)
• Having public or no health insurance (10 to 60 percent and 40 to 90 percent less likely, respectively)
• Lower socioeconomic status (40 to 60 percent less likely)
• Having African-American or Hispanic backgrounds (30 to 60 percent less likely)

Wolfson and her colleagues are planning further studies to investigate these barriers and explore potential strategies to overcome them.
 
Young adults with breast cancer may fare worse than their older counterparts
Abstract #6591
“What is the extent of the AYA gap for young adults with cancer?”
Monday, June 2, 1:15 to 5 p.m.
McCormick Place, South Hall A2
In a study evaluating data from more than 67,000 patients, including almost 6,000 patients diagnosed between 22 and 39 years of age, Julie Wolfson, M.D., M.S.H.S, and her team found that young adults diagnosed with breast cancer have worse outcomes (20 percent increased risk of mortality) compared to older adults with the same disease, even after accounting for other clinical factors, including the cancer’s stage at diagnosis. They also found that, although young adults with lung, liver or gastric cancers have superior survival compared to older adults, their survival rate has not improved between 1998 and 2008, while those for older adult patients have.
 
Wolfson and her team concluded that the causes of this disparity need to be further studied.
 
About City of Hope
City of Hope is a leading research and treatment center for cancer, diabetes and other life-threatening diseases. Designated as a comprehensive cancer center, the highest recognition bestowed by the National Cancer Institute, City of Hope is also a founding member of the National Comprehensive Cancer Network, with research and treatment protocols that advance care throughout the nation. City of Hope’s main hospital is located in Duarte, Calif., just northeast of Los Angeles, with clinics in Antelope Valley and South Pasadena. It is ranked as one of "America's Best Hospitals" in cancer by U.S.News & World Report. Founded in 1913, City of Hope is a pioneer in the fields of bone marrow transplantation and genetics.