ESMO Congress is the largest European meeting of oncology, a global stage for the exchange and debate of translational cancer science of excellence and for first announcements of potentially practice changing data. This year with 3,904 submitted abstracts and 28,571 participants from 138 countries.

Patient Advocacy Sessions

There was a tremendous effort by the ESMO Patient Advocacy Working Group to increase the quality, bringing many more stakeholders into Advocacy sessions that contributed with high level input. There were both educational and experience sharing sessions and the main topics were how to promote a patient-centred care, issues related with access to drugs in combination, what are the main hurdles with care of rare cancers as uveal melanoma (UM), challenges with immunotherapy and how far would you go in your treatment. MPNE had an important participation with talks and session moderation by their members.

Clinical trials

Two negative phase 2 clinical trials in metastatic UM were presented at ESMO Congress this year. Unfortunately, the two combination treatments (SELPAC trial: selumetinib + paclitaxel and PEMDAC trial: pembrolizumab + entinostat ) failed to increase time to disease progression or median survival stablished by other studies on this condition.

However, these two trials represent valuable efforts to find better therapeutic approaches and contribute with associated translational research which is critical to guide future trial design in metastatic UM. Another important comment is the increased acceptance in the scientific community of phase 2 trials without control arm in rare diseases, with clinical outcomes being compared with historical references instead of an ineffective control arm.

Posters

There were six abstracts for poster presentation about UM at the congress program.

One basic science research study , using cell lines from UM, aimed to understand the relative contribution of different cellular mechanisms responsible for UM tumour survival and proliferation. They tested in vitro inhibitors of intracellular mechanisms, showing that there is no single dominant pathway for UM development.

Two real-life studies measured the impact of immunotherapy in metastatic UM. One of them had the participation of Institut Curie, member of our consortium, and described the characteristics and the clinical outcomes of the group of patients treated with immunotherapy in eight French centres, either in first, second or third-line. This study reports an important benefit from this treatment mainly in the patients that responded to treatment (median overall survival not-reached), but also in those who did not respond, with 25.9 months of median survival. The seven patients who showed objective response to immunotherapy are being further investigated to identify biomarkers of response to immunotherapy. The other clinical study used the Danish Metastatic Melanoma database and compared the clinical outcomes before and after the local approval of immunotherapy for the treatment of metastatic UM. Interestingly, this study reports a 21% response rate out of 19 patients treated with ipilimumab plus nivolumab combination treatment. The median time to progression and median overall survival met the benchmarked outcomes in this disease, with a statistically significant gain of 2 months of survival with the implementation of this strategy in clinical practice.

Ultimately, there was an epidemiological study using the Surveillance Epidemiology and End Results database, with the aim of identifying the differences between the UM tumours presenting alone or in association with other tumours. This study reports different clinical behaviours within the three defined groups: single UM, UM followed by another primary tumour and UM following another primary tumour. It opens new ideas to further assess underlying common mechanisms that may be associated with the development of different tumours and therefore explain different disease trajectories.

We were not able to get any additional information from the remaining two abstracts as they were not there during the poster session.

You may find the abstract of each mentioned study through the respective hyperlink above and search for additional abstracts of the meeting here.

In summary, we still did not bring from ESMO Congress 2019 practice changing results from research studies, but there were some valuable new pieces filling in the puzzle of UM understanding.

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