Highlights from 11th Breast Gynecological International immune-Oncology Cancer Conference (BGICC) 17–18 January, 2019, Egypt: One World Against Cancer
Hesham El-Ghazaly1,3, Nermean Bahie-eldin,1,3, Adel Aref 1,2
1- Breast &Gynaecological International Cancer Society (BGICS), Cairo, Egypt.
2- University of Adelaide Medical School, Adelaide, South Australia.
3- Clinical Oncology department, Ain Shams University, Cairo, Egypt.
The Breast and Gynecological Immunological International Cancer Conference BGIICC Annual Meeting was held on 17th -18th January 2019 in Cairo, Egypt was the platform for the release of thousands of scientific information -- highly anticipated cancer research news for health care professionals. This meeting was a global, multidisciplinary conference with representatives from 80 nations and every continent. Bringing together stakeholders from around the world who are committed to providing optimal cancer care to patients. Attendance at the 11th BGIICC was increased by 15% and. Abstracts submission was increased by 30 % over the 10th Conference with participation of new countries in Africa and Russia. The abstracts represented cutting edge research and delineated the most current treatment strategies. We welcomed 3000 participants who travelled from 80 countries to network and to discuss the latest development in cancer research and cancer care,300 industry related participants regionally and internationally and 80 members from the press 11th BGIICC had been accredited by European accreditation of Continuous medical education (EACCME) by 13 European CME credits.
We had been partnered with leading societies of oncology and well recognized cancer foundations worldwide as American society of clinical oncology(ASCO)European school of oncology (ESO)European society of surgical oncology (ESSO)Society of geriatric oncology (SIOG)African palliative care association (APCA) European society of radiotherapy (ESTRO)European society of gynecology (ESGO)European society of oncology imaging (ESOI) Russian association of oncomamoplastic (RAOM) Faculty of Medicine Ain shams Research institute (MASRI) Breast Gynecological international cancer society (BGICS) Breast surgery international (BSI)Society for immunotherapy of cancer (SITC)Biobank and cohort building network (BCNET) and (nature research).
Educational and interactive courses :
The Scientific Program covered the spectrum of oncology from basic science to palliative care on the treatment of breast and gynecological cancer, consideration of pathology, Surgery, radiology, radiotherapy, neo-adjuvant, adjuvant and metastatic systemic therapy, Nursing, Clinical Pharmacy, Palliative care, Scientific Research as well as genetics, molecular biology of breast cancer and industry sponsored symposia. Clinical research was most cited by the participants as their primary topic of interest. In view of personalized medicine There was an intensive course about Molecular Biology followed by post conference three days Hands on workshop in collaboration with thermofisher and Fudan university about the first Next Generation Sequencing (NGS).
Highlight from the 11th BGIICC
Metastatic Breast Cancer (MBC)
Professor Debu Tripathy showed Ribociclib plus endocrine therapy improved progression-free survival compared with placebo plus endocrine therapy, and had a manageable safety profile in patients with premenopausal, Hormonal positive, HER2-negative, advanced breast cancer. The combination could represent a new first-line treatment option for those patients median progression-free survival was 23·8 months (95% CI 19·2–not reached) in the ribociclib group compared with 13·0 months (11·0–16·4) in the placebo group (hazard ratio 0·55, 95% CI 0·44–0·69; p<0·0001 (1).
Prof. Hope Hugo discussed sequence of hormonal treatment in MBC postmenopausal Hormonal positive breast cancer and how to obtain the maximum benefit for them. Results of the PALOMA-2 study which explored the efficacy of combing palbociclib plus letrozole versus placebo plus letrozole (2) showed that the palbociclib extended the PFS from 14 to 28 months. Professor Rugo discussed the subset analysis, which showed that palbociclib was efficient across all the subgroups of the study cohort, however there was trend of more benefit in luminalA and B subgroups. The quality of life was maintained in palbociclib arm. In addition, she highlights the toxicity profile of the combination, which should be considered in patient selection. Neutropenia was the most frequently reported adverse reaction in PALOMA-2 (80%) and PALOMA-3 (83%). In PALOMA-2, Grade 3 (56%) or 4 (10%) decreased neutrophil counts were reported in patients receiving IBRANCE plus letrozole. In PALOMA-3, Grade 3 (55%) or Grade 4 (11%) decreased neutrophil counts were reported in patients receiving IBRANCE plus fulvestrant. Febrile neutropenia has been reported in 1.8% of patients exposed to IBRANCE across PALOMA-2 and PALOMA-3(2).
Prof. Sandra Swain discussed how to individualize anti Her2 positive metastatic Her2 positive breast cancer patients during the patient journey(3). The role of immunetherapy in metastatic Triple negative breast mTNBC without germline mutation proved to be effective. Prof. Edith Perez discussed the data from the IMpassion130 met its co-primary Progression free survival and intention to treat and PD-L1 positive patients, with clinically meaningful overall survival (OS) benefit seen at interim OS analysis in PD-L1 positive patients. Atezoluzimab +nab-Paclitaxel was well tolerated, with a safety profile consistent with each agent. the median overall survival was 25.0 months with the combination compared to 15.5 months with standard chemotherapy alone (HR 0.62)Most side effects were due to chemotherapy and occurred at a similar rate in both treatment groups, although there was a minor increase in nausea and cough in the combination group. Side effects related to immune therapy were rare, the most common being hypothyroidism which occurred in 17.3% of patients receiving the drug combination and 4.3% receiving chemotherapy alone(4).
Shorter-Duration Trastuzumab for HER2+ Early Breast Cancer
The optimal duration of adjuvant HER2 therapy has been the subject of multiple, large randomized trials. Although there are no compelling data regarding durations of trastuzumab beyond 1 year, Professor Pierfranco Conte discussed the five randomized trials of shorter durations of trastuzumab have been conducted with results almost the equivalent to 1 year of therapy. However, four of the five shorter-duration trials failed to demonstrated noninferiority to 1 year of therapy. A randomized, noninferiority, phase III trial (PERSEPHONE) in which 4088 women in the U.K. with HER2+ early breast cancer received 6 or 12 months of trastuzumab. Patients also received concurrent chemotherapy or sequential chemotherapy, which was anthracycline-based, taxane-based, anthracycline- and taxane-based, or cyclophosphamide/ methotrexate/fluorouracil. Patients were stratified by chemotherapy type and timing, trastuzumab timing, and ER status (69% were ER+)(5).
Disease-free survival (DFS) at 4 years (the primary endpoint) was similar with 6 or 12 months of therapy (89.4% and 89.8%, respectively; P=0.01 for noninferiority), as was overall survival (OS; 93.8% and 94.8%; P=0.0006 for noninferiority). In the group receiving 12 months of trastuzumab, 8% stopped treatment because of cardiac toxicity versus 4% of those receiving 6 months of treatment.
Longer -Duration Trastuzumab for HER2+ Early Breast Cancer
The question of when to increase the burden of treatment for patients at high risk of relapse, and when to decrease treatment for patients who have a good prognosis. Prof pierfranco Conte concluded that some countries with limited resources could benefit from understanding when it is safe to stop administering trastuzumab to subgroups of patients with a low chance of relapse.
Dual blockage of anti Her2 in adjuvant setting
Professor Conte discussed also about subgroups of breast cancer patients that might benefit from alternative treatment approaches as those with node positive and hormonal positive patients might get benefit from addition of neratinib(6).
Fertility issues in premenopausal breast cancer patients
There is now clear consensus regarding fertility preservation counseling during adjuvant treatment in premenopausal breast cancer patients Professor Valentina Guarneri explained that breast cancer patients have the lowest chance of becoming pregnant when compared with other cancers, this can be due to a risk of toxicity from treatments also the age at diagnosis Prof Guarneri emphasized the importance attributed by clinicians to address fertility preservation there are now strategies for preserving fertility in breast cancer patients, including embryo cryopreservation and ovarian tissue cryopreservation preservation in premenapausal breast cancer patients(7).
Neoadjuvant treatment in Breast Cancer
Professor Hope Rugo addressed hormonal treatment in Luminal BC Rational Evidence and outcome. She discussed some of the key outcomes from neoadjuvant session including some biological markers of endocrine sensitivity one being a fall in KI67% more than 2 % that tends to show positive outcomes as well as more widespread of preoperative endocrine prognostic index PEPI score including progesterone receptor status and lymph node status in order to look at endocrine sensitivity when choosing therapeutic options While duration of endocrine treatment in clinical trials had usually been standardized at around three to four months it was clear that volume reductions continue to occur beyond that time in a large proportion of cases and routine clinical practice was often to treat to maximum response(8).
Professor Perez discussed also GeparNuevo study which enrolled 174 patients with early triple-negative breast cancer and stratified them for tumor-infiltrating lymphocyte levels: low, 0% to 10%; medium, 11% to 59%; and high ≥ 60%. Patients were randomly assigned to receive durvalumab or placebo for 2 weeks, when a core biopsy was obtained. The experimental arm continued on nanoparticle albumin-bound (nab)--paclitaxel (Abraxane) plus durvalumab for 12 weeks, whereas the control arm received nab-paclitaxel alone. Durvalumab added to chemotherapy improved pathologic complete response rates in newly diagnosed triple-negative breast cancer. The best response rates were found when durvalumab was given for a window of 2 weeks before chemotherapy, priming the immune system first (9).
BGIICC Consensus :
Management of advanced Cervical cancer
The BGIICC international expert panel was discussing the best management of advanced cervical cancer. The panel came with consensus about some of the hot topics in the management of advanced and recurrent cervical carcinoma. Some of the important recommendations of the panel were the “importance of Para-aortic lymph node dissection should be included in the routine staging for early cervical cancer in view of the new FIGO classification.
Radical hysterectomy via minimal access surgery should be closely monitored, and limited to tumours ≤ 2 cm diameter following a tumour board decision and appropriate patient counseling.
For bulky Ib2-Ib3 cervical cancer patients, Neo-adjuvant Chemotherapy +Radical hysterectomy is an acceptable alternative to primary concurrent chemoradiotherapy (CCRT).
Management of breast cancer in Elderly
Management of breast cancer in elderly session was endorsed by BGICS-SIOG –ESO chaired and moderated by professor Matti Aapro starting from radiological imaging and the ebst surgical procedures and the best chemotherapy protocol and predicting the risk of chemotherapy toxicity in elder patients: The Chemotherapy Risk Assessment Scale for High age patients (CRASH) score.
Management of axilla in breast cancer
The highlight of the conference was the consensus panel, in which 50 panelists reviewed and discussed specific areas of treatment with a focus on controversies in the management of axilla in breast cancer. The goal of this consensus process was to articulate important themes in management, and to provide guidance to clinicians around the world on how to think about and best surgical procedure for axilla with breast cancer in clinically negative is sentinel lymph node biopsy (SLNB) and best management to avoid axillary dissection in positive axilla is to give neoadjuvant treatment and positive axilla as well as after neo-adjuvuant treatment and the safety SLNB during pregnancy.
One World Against Cancer “ These few words could summarize the meaning of the 11th BGICC which was supported by 15 respectful international eminent societies in the field of oncology from the whole world and leaders experts of oncology from every continent to address recent advances and future directions in all aspects of women's cancer
1. Tripathy D, Im SA, Colleoni M. Ribociclib plus endocrine therapy for premenopausal women with hormone-receptor-positive, advanced breast cancer (MONALEESA-7): a randomised phase 3 trial. Lancet Oncol. 2018; 19(7):904-915.
2. Finn RS, Martin M, Rugo HS, Jones S, Im SA, Gelmon K, et al. Palbociclib and Letrozole in Advanced Breast Cancer. N Engl J Med. 2016; 375(20):1925-36.
3. Swain SM, Im YH, Im SA. Safety profile of PertuzumabwithTrastuzumab and Docetaxel in patientsfrom Asia with human epidermalgrowth factor receptor 2-positive metastatic breast cancer: results from the phase III trial CLEOPATRA. Oncologist 2014; 19: 693-701.
4. Schmid P, Cruz C, Braiteh FS, et al. Atezolizumab in metastatic TNBC: Long-term clinical outcomes and biomarker analysis. 2017 AACR Annual Meeting. Abstract 2986. Presented April 3, 2017.
5. Earl HM, Hiller L, Vallier AL, Loi S, et al. 6 versus 12 months of adjuvant trastuzumab in patients with HER2 positive early breast cancer: randomised phase 3 non-inferiority trial with definitive 4-year disease-free survival results. J Clin Oncol 36, 2018.
6. Martin M, Holmes FA, Ejlertsen B, Delaloge S, Moy B, Iwata H. Neratinib after trastuzumab-based adjuvant therapy in HER2-positive breast cancer (ExteNET): 5-year analysis of a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2017; 18(12):1688-1700.
7. Dieci MV, Ghiotto C, Barbieri C, Griguolo G, Saccardi C, Gangemi M, Pluchinotta A, Di Liso E, Giorgi CA, Giarratano T, Tasca G, Vernaci G, Faggioni G, Conte P, Guarneri V. Patterns of Fertility Preservation and Pregnancy Outcome After Breast Cancer at a Large Comprehensive Cancer Center. J Womens Health (Larchmt). 2018 Jul 2.
8. Ellis MJ. Lessons in precision oncology from neoadjuvant endocrine therapy trials in ER+ breast cancer. Breast. 2017 Aug;34 Suppl 1:S104-S107.
9. Loibl S, Untch M, Burchardi N, et al. Randomized phase II neoadjuvant study (GeparNuevo) to investigate the addition of durvalumab to a taxane-anthracycline containing chemotherapy in triple negative breast cancer. 2018 ASCO Annual Meeting. Abstract 104. Presented June 3, 2018.