ASCO 2018: Extending the Reach of Precision Medicine

CHICAGO — The 54th annual meeting of the American Society of Clinical Oncology (ASCO) will once again feature the latest news, information, and data about advances in clinical cancer, but the program content also reflects a desire to broaden the reach of those advances and ensure that the maximum number of patients derive maximum benefit.

With a working theme of “Delivering Discoveries: Expanding the Reach of Precision Medicine,” ASCO will provide the venue for more than 2,500 research abstracts that will be reported during the meeting. An additional 3,350 abstracts were accepted for publication online. Beyond conventional basic and clinical research, a substantial portion of the program will be devoted to issues such as access to care; social, economic, and clinical disparities; use of technology to broaden the reach of cancer care and make it more efficient; greater emphasis on patient-reported outcomes and shared decision-making; and caring for the growing population of cancer survivors.

“The promise of precision medicine is only as good as our ability to make these treatments available to all patients,” said ASCO President Bruce E. Johnson, MD.

Recent advances in cancer research, and their subsequent translation into clinical practice, have had a transformative effect on the way cancer is treated. In a video developed for the 2018 annual meeting, Johnson talked about how advances that began in laboratories often have evolved into life-changing experiences for patients. He said that as a lung cancer specialist, his personal favorite is the discovery that mutations in the EGFR gene drive the progression of cancer in some patients, a development that for the first time allowed many patients to be treated with a pill instead of chemotherapy.

One example of potential practice-changing clinical research at this year’s meeting has already emerged: A study showing that 6 months of adjuvant trastuzumab (Herceptin) is at least as effective as the standard-of-care 12 months for women with HER2-positive breast cancer, causes less cardiac toxicity, and costs less.

Something for Everyone

Oncology practitioners look forward to ASCO for a variety of reasons. Heading the list for many attendees are the opportunities to learn about new research, attend discussions and lectures by leaders in the field of oncology, and participate in interactive sessions to exchange information and ideas.

“I like to attend ASCO each year because it allows me to think about the new data presented and have vibrant discussions with colleagues in terms of how we can use this data to establish great practice patterns that may best benefit our cancer patients,” said Daneng Li, MD, of City of Hope in Duarte, Calif.

One study in particular caught Li’s attention: A randomized trial showing improved progression-free survival in patients with pancreatic neuroendocrine tumors treated with temozolomide and capecitabine instead of temozolomide alone.

Gynecologic oncologist Rebecca Arend, MD, of the University of Alabama at Birmingham, said she is attracted to several studies in ovarian cancer: the value of secondary debulking in platinum-resistant disease, retreating patients with bevacizumab (Avastin), and long-term survival data from a study of upfront treatment with bevacizumab. A session on developmental therapeutics in immunotherapy and another on emerging therapeutics in gynecologic cancers also hold special interest for her.

“ASCO, for me as a physician-scientist, is a meeting where the basic science is all extremely relevant to patient care and the data presented helps shape how we should treat our patients in the future,” she said. “More importantly, it provides platforms for discussions about understanding where the field is going and what we should be exploring further in order to better focus our research effectors in the lab and in clinical trials.

“In addition, clinicians have always been extremely collaborative and traditionally keep the focus on helping the patients and improving survival of the cancer survivors that we see in clinic and in our practice, which makes ASCO a very productive and important meeting for me.”

Connecting, Reconnecting, Affirming

Hossein Borghaei, DO, a lung cancer specialist at Fox Chase Cancer Center in Philadelphia, said he is looking forward to hearing the results of a late-breaking study comparing the PD-1 inhibitor pembrolizumab (Keytruda) with standard platinum-based chemotherapy as first-line treatment for patients with advanced non-small cell lung cancer and different levels of PD-L1 expression.

“This study potentially could affect what we do in the clinic, if it shows a benefit for single-agent immunotherapy,” he said. “This study will be included in the plenary session, and to be included in an ASCO plenary session is a big deal, indicating that a study is important.”

Several studies of immunotherapy-containing combinations for lung cancer will likely attract a lot of interest among lung cancer specialists, he added. Updated information on some previously reported clinical trials also will provide anticipated information that might readily apply to clinical practice, particularly mature data from studies involving targeted therapies.

“Some of these studies have the potential to change clinical practice, and others may affirm what we are already doing,” said Borghaei, who will also moderate an education session about strategies for treating patients with lung cancers that are not molecularly driven (without EGFR, ALK, or ROS1 mutations, for example).

Borghaei said that as a frequent attendee of ASCO, he has found that the meeting also affords opportunities for interactions that go beyond scientific research and clinical practice: “It’s a good way to reconnect with colleagues and friends, establish collaborations, and affirm existing connections with people you know.”

Two studies in advanced/metastatic renal cell carcinoma (RCC) head the list of new research on the radar of genitourinary cancer specialist Elizabeth Plimack, MD, also of Fox Chase Cancer Center. One study showed an “impressive response rate” with the immune checkpoint inhibitor pembrolizumab as first-line therapy for patients with advanced clear-cell RCC.

The second study provided insight into patient-reported outcomes (PROs) for treatment with the combination of a VEGF inhibitor and another immune checkpoint inhibitor for metastatic RCC.

“This trial shows better overall PROs with the combination of bevacizumab and atezolizumab [Tecentriq] versus sunitinib [Sutent],” said Plimack. “This refutes the dogma that combination therapy typically leads to higher side effects compared with monotherapy.”

The meeting continues here through Tuesday, and MedPage Today will have comprehensive coverage of the news and developments.


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