11th World Congress on Gastrointestinal Cancer of the European Society for Medical Oncology (ESMO).

The 11th World Gastrointestinal Cancer Congress of the European Society for Medical Oncology (ESMO-GI) was held in Barcelona from 24 to 27 June, 2009. Over 400 abstracts were presented, making it the world's largest GI cancer conference. Themes this year included progression-free survival and personalised treatment approaches. In this report, some highlights of the meeting will be presented.

Sunitinib doubles progression-free survival in pancreatic islet cell tumours

Perhaps the most ground-breaking news of the conference was the use of sunitinib in the treatment of progressive pancreatic islet cell tumours. In fact, the international Phase III trial, designed to enrol 340 patients, had to be stopped early because of the benefit seen.

One hundred and sixty-nine patients with progressive pancreatic islet cell tumours who had progressed in the last 12 months were recruited and randomised to receive either sunitinib (n=75) (37.5 mg/day, continuous daily dosing) or placebo (n=79).

Progression-free survival increased from 5.5 months in the placebo group to 11.1 months in the sunitinib group (hazard ratio 0.397; P<0.001). Overall survival analysis is ongoing.

Pancreatic islet cell tumours are very rare neuroendocrine tumours which are less aggressive and slower growing than the more common pancreatic adenocarcinomas. They occur in about 2-4 people per million. Previously the only treatment option was streptozotocin, an outdated naturally occurring toxin that gained FDA approval for the treatment of pancreatic islet cell cancer in 1982.

The side effects of sunitinib in this study were comparable to those in other studies. The most common side effects reported were neutropenia, hypertension, abdominal pain and diarrhoea. There were five deaths in the sunitinib group and 15 in the placebo group.

'This is a once-in-a-lifetime finding,' said Eric Raymond, Professor of Medical Oncology at the University Hospital in Bichat-Beaujon, Clichy, France.

Sunitinib significantly increases progression-free survival in progressive pancreatic islet cell tumours and is a new treatment option in this select group.

Cetuximab improves resectability and response rates in colorectal liver metastases

The Cetuximab in Neoadjuvant Treatment of Non-Resectable Colorectal Liver Metastases, or CELIM, study compared treatment with cetuximab in addition to each of two standard types of chemotherapy, FOLFIRI (folinic acid, fluorouracil and irinotecan) and FOLFOX6 (folinic acid, fluorouracil and oxaliplatin).

In this multicentre Phase II study, 111 patients with a median age of 63 years were randomised to receive cetuximab then FOLFIRI or FOLFOX6 for eight cycles (4 months) preoperatively.

The primary outcome measure was tumour response as defined by the Response Evaluation Criteria in Solid Tumours (RECIST) criteria. Secondary outcomes included rate of R0 liver resection, progression-free survival, disease-free survival and overall survival.

Of the 111 patients, 55% were technically unresectable whilst 45% had more then five liver metastases, making them unresectable.

The confirmed response rate, presented at ESMO-GI, was 62% overall. The FOLFOX6 regimen showed an increased response rate of 68% when compared with the FOLFIRI regimen (57%). The resection rate was 32% in the technically unresectable group and 40% in the >5 liver metastases group.

Retrospective review of the pre- and post-treatment scans for 75 patients showed that 32% had converted from non-resectable to resectable, and 6% from resectable to non-resectable in the 4-month period. The status of 61% of the patients remained unchanged.

The most common side effects were skin toxicity (33%), neutropenia (23%), diarrhoea (14%) and neuropathy (10%). There were two preoperative and three postoperative deaths in the study group.

The study concluded that the addition of cetuximab to standard chemotherapy increases response rates and improves resectability rates.

Conclusion

The annual ESMO-GI conference was a well attended conference which provided an excellent opportunity to receive updated news on rapidly evolving subjects in cancer management.

References

(1.) Raymond E, Raoul J, Niccoli P et al. Phase III, randomized, double-blind trial of sunitinib versus placebo in patients with progressive, well-differentiated pancreatic islet cell tumours. Abstr. 0013.

(2.) Kohne C-H et al. Results from the CELIM study: cetuximab plus FOLFOX6 or cetuximab plus FOLFIRI as neoadjuvant treatment for nonresectable colorectal cancer liver metastases. Abstr. 22.

Correspondence to: Vanessa Brown

(email: [e-mail])

Vanessa Brown [1] and Sascha Dua [2]

[1] London Deanery, London, UK, [2] Royal Free Hospital, London, UK