Don Dizon: What I Come Away with from ASCO25
Don Dizon, Director of the Pelvic Malignancies Program at Brown University Health, posted on LinkedIn:
“What I come away with from ASCO25
Top line: PFS (Progression Free Survival) needs to be renamed. No one “survives” progression. People don’t experience “progression”. A cancer progresses at some interval, and that’s what it should be called: PFI. The only survival is whether one is alive or dead- OS (Overall Survival). We need to stop conflating them.
Gynecologic Cancers
Top Line: immune check point inhibitors have a very limited role in ovarian cancer, restricted to perhaps clear cell cancers.
For people with OVARIAN CANCER, surgery should be done if their gyn onc feels they can have all tumor resected rather than undergoing medical therapy (neo adjuvant chemo) first. That’s been the standard everywhere I’ve worked and the TRUST trial affirms this.
For people with platinum-resistant OVARIAN CANCER, a novel drug that targets the glucocorticoid receptor, called Relacorilant, in combination with nAb-paclitaxel improved OS by 5 months over nAb-paclitaxel alone; interestingly, this benefit was bigger than the PFI benefit, which was improved by only one month. It also added no additional toxicity to nAb-paclitaxel.
Breast Cancer
Hot Take For people with hormone-positive metastatic breast cancer, the only reason to switch treatment from an aromatase inhibitor to a selective estrogen receptor degrader (SERD) based on detection of an ESR mutation in a blood test (ctDNA) is if toxicity is making it hard to take the AI. Whether ctDNA will improve OS has to be proven to warrant monitoring by ctDNA. Its about lead time bias. But the best med will always be the one someone is willing to stay on.
For people with metastatic triple-positive (Hormone and HER2 positive) disease, one trial that included 77 patients reported the combination of ribociclib, trastuzumab, and letrozole resulted in a 61% overall response rate and median PFI of 30 months. Its not a randomized trial, but the results are reassuring.
For people with advanced hormone receptor positive PIK3CA mutated disease that stopped responding to anti-estrogen treatments, first-line treatment with inavolisib + palbociclib + fulvestrant (PF) improved overall survival compared to placebo + PF by 7 months, representing an almost 30% improvement. 30-month overall survival was also improved by 10%.
For people with metastatic PDL1 positive triple-negative disease, Sacituzumab govitecan plus pembrolizumab (P) improved the PFI by about 3 months over chemotherapy plus P representing a 35% improvement. Whether this is a significant finding will depend on each patient who is a candidate for it and whether it translates in to a benefit in OS.”
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