Proffered paper session 1: GI, upper digestive

In this video, Prof Dr Jeroen Dekervel, digestive oncologist at the University Hospitals Leuven discusses two clinical trials that were presented during a first proffered paper session on upper digestive tumours at ESMO 2024.

The randomized phase III IMbrave050 study evaluates the combination of atezolizumab and bevacizumab (atezo-bev) as adjuvant therapy for patients with a completely resected or ablated hepatocellular carcinoma (HCC) who are at a high risk of recurrence. This trial met its primary endpoint in a previously reported preliminary analysis, demonstrating a significantly better recurrence-free survival (RFS) for adjuvant atezo-bev vs. observation (HR[95%CI]: 0.72[0.53-0.98]; p= 0.012). During ESMO 2024, updated results of this trial were presented with an additional follow-up of about 18 months. Unfortunately, the benefit in RFS obtained with adjuvant atezo-bev vs. observation was not maintained in this updated analysis, with a median RFS of 33.2 and 36.0 months, respectively (HR[95%CI]: 0.90[0.72-1.12]).1 Based on these results, Prof Dekervel concludes that adjuvant atezo-bev after curative intent resection or ablation does not seem to prevent long-term disease recurrence in high risk HCC patients. Therefore, this strategy will not be adopted in clinical practice and there continues to be a pressing need for effective adjuvant strategies that can mitigate the high risk of recurrence following a resection or ablation of HCC.

The second study that was selected by Prof Dekervel consists of the phase II PRODIGE 44 – PANDAS trial. This study evaluated whether the addition of chemoradiotherapy to modified (m) FOLFIRINOX improves outcomes in patients with borderline resectable pancreatic cancer.2 Patients in the study were initially treated with 4 courses of mFOLFIRINOX after which patients without progression were randomly assigned to receive 2 additional courses of mFOLFIRINOX either alone or followed by chemoradiotherapy (28 fractions of 1.8 Gy + capecitabine). Unfortunately, the addition of chemoradiotherapy did not lead to a higher rate of R0 resection (primary endpoint), nor did it provide a benefit in overall survival (OS). With a median OS of approximately 30 months in both study arms, this study illustrates the dismal prognosis for patients with borderline resectable pancreatic cancer and once again underscores the need for more effective treatment options in this setting.