The European Society for Medical Oncology (ESMO) 2024 was held in Barcelona from 13 to 17 September. The five-day event welcomed nearly 33,000 attendees and 598 speakers offering the latest cutting-edge data and high-quality training sessions in the field of oncology. Daniela Marín-Hernández and Ivana Nedic share highlights from the congress.
Dr Helena Linardou (Greece), Chair of the ESMO Women for Oncology (W4O) Committee, presented updated findings from ESMO's monitoring and authorship studies on female oncologists in leadership roles and as authors in oncology journals. The data show that while women are still less likely to be invited as speakers at oncology congresses compared to men, there has been a rise from 30% in 2014 to 41% in 2022. Notably, a regional disparity was observed, with US-based congresses featuring more female speakers than those in Europe or Asia. Despite progress, women remain underrepresented as board members or presidents of oncology societies, with figures climbing from 10.4% in 2016 to 34% in 2022. The gender balance among ESMO members has seen growth, with 49.8% female members in 2022 and a further increase to 51% in 2024, with the highest proportion of female members in Europe.
Patritumab deruxtecan for HR+/HER2- advanced breast cancer: ICARUS-BREAST01
Dr Barbara Pistilli (Villejuif, Cedex, France) and colleagues presented the results of a multicentre, single-arm, phase II study (NCT04965766) evaluating activity, safety and biomarkers of response and resistance to patritumab deruxtecan (HER3-DXd) in patients with HR+/HER2-advanced breast cancer who progressed on CDK 4/6 inhibitors and one line of chemotherapy. The primary endpoint was confirmed objective response rate (cORR) as assessed by local investigator and secondary endpoints were clinical benefit rate (CBR), progression-free survival (PFS), duration of response (DOR) and safety. In addition, exploratory translational analyses of blood and tumour samples were performed. A total of 99 participants were included. With a median follow-up of 15.3 months [95% CI 13.0; 17.2], cORR was 53.5% [95% CI 43.2; 63.6], CBR 63.6% [95% CI 53.4; 73.1], mPFS 9.4 months [95% CI 8.1; 13.4] and mDOR 8.7 months [95% CI 8.1; 12.5]. Adverse events occurred in 98.0% and grade 3 or higher in 55.6% of patients, leading to dose reduction and treatment discontinuation in 20.2% and 12.1%.
Neoadjuvant endocrine therapy plus trastuzumab and pertuzumab versus de-escalated chemotherapy for HR+/HER2+ early breast cancer: WSG-TP-II trial
Dr Oleg Gluz (Mönchengladbach, Germany) and colleagues showed findings of a phase IIa, multicentre, randomized, open-label study (NCT03272477) comparing a pre-surgical combination of trastuzumab and pertuzumab with concurrent weekly paclitaxel chemotherapy or endocrine therapy given for 12 weeks in patients with operable HER2+/HR + breast cancer. 207 patients were randomized 1:1 and the primary endpoint was pathological complete response (pCR) and event-free (EFS), distant disease free and overall survival (OS) were secondary endpoints. After a median follow up of 60 months 5-year EFS rates of endocrine therapy versus chemotherapy + trastuzumab and pertuzumab were 92.0% versus 94.8% (HR = 1.29, 95% CI: 0.26–2.32, p = 0.65). 5-year OS rates were 100% versus 97.9% (not statistically significant). Only clinically node positive status was significantly associated with worse EFS by multivariable analysis. Additional chemotherapy after pCR was not associated with any significant survival impact.
Ramucirumab in combination with trifluridin/tipiracil versus trifluridin/tipiracil monotherapy in heavily pretreated metastatic colorectal cancer: RAMTAS/IKF643 trial
Dr Stefan Kasper-Virchow (Essen, Germany) and colleagues reported results of a randomized, controlled, open-label, multicentre phase IIb study evaluating overall survival, safety and tolerability of ramucirumab + trifluridin/tipiracil and trifluridin/tipiracil monotherapy in patients with advanced metastatic and inoperable, colorectal cancer who have progressed on, after or did not tolerate luoropyrimidines, oxaliplatin, irinotecan, anti-angiogenic therapies and anti-EGFR (epidermal growth factor receptor) antibodies. 428 patients were enrolled and randomized, the primary endpoint was overall survival (OS), and the secondary endpoints included disease control rate (DCR), progression-free survival (PFS) and safety. With a median OS of 7.46 months for the group with ramucirumab versus 7.06 months for the one without ramucirumab (HR 0.871; p = 0.1941), the primary study endpoint was not met. Median PFS was 2.37 in the group with ramucirumab versus 2.07 in the group without ramucirumab (HR 0.774; p = 0.011). DCR was higher in the group with ramucirumab (39.4% versus 31.6%; p = 0.0336). In the subgroup analysis OS of female patients (HR 0.712; p = 0.0371) and patients with left-sided tumour (HR 0.770; p = 0.0469) was improved with ramucirumab.
Regorafenib as maintenance therapy for advanced soft-tissue sarcoma: the EREMISS trial
Dr Nicolas Penel (Lille, France) and colleagues presented results from the EREMISS trial (NCT03793361), a double-blind, placebo-controlled phase II study evaluating regorafenib as maintenance therapy in advanced soft-tissue sarcoma (ASTS) patients after first-line doxorubicin-based chemotherapy. 120 mg/d was given to enrolled patients with non-adipocytic ASTS, who had stable disease (SD) or partial tumour response (PR) after 6 cycles of doxorubicin-based chemotherapy as first line treatment. The primary endpoint was progression-free survival (PFS) assessed by blinded independent central review. A total of 126 patients (median age 58) were enrolled across 17 centres. Median PFS was 5.6 months for regorafenib versus 3.5 months for placebo (HR = 0.51; p = 0.001), while investigator-assessed PFS was 6.8 versus 3.6 months (HR = 0.56; p = 0.002). Median overall survival (OS) was 27.6 versus 21.0 months (HR = 0.82; p = 0.41), though not significant. Grade ≥3 adverse events occurred in 11% of placebo versus 66% of regorafenib patients, with 28% of regorafenib patients discontinuing treatment due to toxicity. The trial met its primary endpoint, showing regorafenib delays disease progression, though OS benefit was not significant.
Stereotactic body radiation therapy and immunotherapy for high-risk early-stage ER+/HER2- breast cancer: Neo-CheckRay trial
Dr Alex De Caluwe (Brussels, Belgium) and colleagues shared the outcomes of a randomised, prospective, phase II trial (NCT03875573), which evaluated stereotactic body radiation therapy (SBRT) combined with neo-adjuvant chemotherapy (NACT) ± durvalumab (anti-PD-L1) ± oleclumab (anti-CD73) in high-risk early-stage ER+/HER2-breast cancer patients. A total of 147 patients were randomized to one of three treatment arms: NACT + SBRT (arm 1), NACT + SBRT + durvalumab (arm 2), or NACT + SBRT + durvalumab + oleclumab (arm 3). The primary endpoint was residual cancer burden (RCB) 0–1 rates, while secondary endpoints were pathological complete response (pCR; ypT0/Tis ypN0) rate, adverse event (AE) and death. Results showed that RCB 0/1rates were 37.8% in arm 1, 51.1% in arm 2, and 51.1% in arm 3 [OR = 1.7 (0.7–4.0); p = 0.2031]. Grade 3/4 adverse events occurred more frequently in arm 2 (64.7%) and arm 3 (70.8%) compared to arm 1 (27.1%). The trial did not meet its primary endpoint but demonstrated promising activity at surgery of the novel treatment combination as the addition of durvalumab ± oleclumab increased pCR and RCB 0/1 rates compared to NACT + SBRT. Ongoing translational research aims to understand the mechanisms of response.
Multi-omic insights for refining molecular classification of neuroendocrine tumours
Dr Carlos Carretero-Puche (Madrid, Spain) and colleagues reported findings from their study aimed at developing a molecular classification of neuroendocrine tumours (NETs) using multi-omic integration models. NETs are rare, with diverse origins and few recurrent mutations, but epigenetics play a significant role. The team analysed transcriptomic and methylomic data from 194 NET samples from the gastroenteropancreatic (GEP) tract and lungs. Using Multi-Omics Factor Analysis (MOFA), they identified three neuroendocrine subtypes (NS) with distinct prognoses. NS1, associated with good prognosis, had enriched immune populations and higher expression of metabolism-related genes. NS3, linked to poor prognosis, showed aggressive clinical features, higher methylation levels, and elevated expression of neuroendocrine function and proliferation-related genes like PTPRN, BEX1, and NOVA1. NS2 had an intermediate prognosis with a mixed molecular profile. The model establishes that NETs from different organs share common molecular traits and biological characteristics. This classification unveils novel neuroendocrine subtypes across diverse NETs, potentially aiding the identification of universal biomarkers and therapeutic targets.
Ivana Nedic