Pancreatic & Hepatobiliary cancer

In this video, Prof Anne Demols, digestive oncologist at the Hôpital Erasme and the Institut Jules Bordet in Brussels, summarises the key take-aways from ASCO GI 2025 related to pancreatic and hepatobiliary cancer. While ASCO GI did not prove to be a ‘grand cru’ edition in these indications, the meeting still featured some interesting new data.

In the phase III STARTER-NET trial, adding lanreotide to everolimus significantly improved the progression-free survival (PFS) of patients with unresectable or recurrent gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) (grade 1/2) (median: 29.7 vs. 11.5 months; HR[99.91%CI]: 0.38[0.15-0.96]).¹ While these findings are promising, Prof Demols underscored that this study has some important limitations. Mainly, no placebo for lanreotide was used in the control arm and there was no central review of the imaging in the study.

ASCO GI also featured the presentation of two studies evaluating pamrevlumab, a fully human monoclonal antibody that inhibits the connective tissue growth factor, in patients with pancreatic cancer.^2,3 In the phase III LAPIS trial, adding pamrevlumab to chemotherapy did not improve the overall survival (OS) of previously-untreated, locally advanced pancreatic cancer patients.² Similarly, also the Precision-Promise study, evaluating the combination of pamrevlumab and chemotherapy (nab-paclitaxel/gemcitabine) in the first or second line treatment of patients with metastatic pancreatic cancer, failed to show an OS benefit.³

The most notable data for patients with hepatocellular carcinoma (HCC) came from the randomised phase III CheckMate 9DW study, comparing nivolumab plus ipilimumab (nivo-ipi) to lenvatinib or sorafenib as first line treatment for patients with unresectable HCC.⁴ Previously, this trial demonstrated a significantly better OS for the nivo-ipi combination. Updated results of this trial presented at ASCO GI show a statistically significant and clinically meaningful benefit in overall response rate (ORR) with nivo-ipi over lenvatinib/sorafenib. Importantly, this benefit was seen across all investigated subgroups, irrespective of age, etiology, and the Child-Pugh score or BCLC stage at baseline.⁴ As such, these data further support nivo-ipi as a first line treatment for patients with unresectable HCC.

Also in HCC, the CARES-005 study showed a significant PFS benefit with the addition of camreluzimab and apatinib to transarterial chemoembolization (TACE) in unresectable HCC patients eligible for embolization (median: 10.8 vs. 3.2 months; HR[95%CI]: 0.34[0.24-0.50]; p< 0.0001). At 6 months, more than twice as many patients in the combination arm were alive and free of progression than in the TACE-alone arm (70.8% vs. 31.5%).⁵

ASCO GI only featured one oral abstract dedicated to biliary cancer. In the randomised, phase III ACCELERATE study, 94 patients with resected (R0/R1) gallbladder cancer (≥pT2 or N+) were randomly assigned between adjuvant chemotherapy or adjuvant chemoradiation (radiation: 45 Gy in 25 fractions, over 5 weeks). Unfortunately, however, the addition of radiation therapy to the chemotherapy backbone did not result in a better recurrence-free survival in this trial. An important sidenote to these findings is that this trial faced important accrual difficulties, mainly due to the COVID pandemic. As such, a larger trial into this issue is needed before firm conclusions can be made.