WHATS HOT AT ASCO 2009

May 27, 2009 — Personalizing cancer care is the theme of the American Society of Clinical Oncology (ASCO) 45th Annual Meeting, being held in Orlando, Florida, and many of the presentations will reflect the advances that have been made in this new field.

"It's very clear to me that this is the future of cancer medicine, and this is the direction that all of oncology is moving in," said president of ASCO Richard Schilsky, MD, professor of medicine at the University of Chicago in Illinois. Personalizing cancer care has also been the theme of his year of ASCO presidency, which is draws to a close at the meeting.

"Oncology is no longer a one-size-fits-all medicine," Dr. Schilsky noted. "We are increasingly able to tailor treatments to an individual's or to a tumor's unique biology, which ultimately helps us to improve outcomes for patients by matching the right treatment to the right patient at the right time."

"This allows patients to avoid the unnecessary costs and side effects from therapies that are not likely to benefit them," he added. Presentations at the meeting will show the progress that is being made, from using molecular assays to select therapy to designing individualized programs for cancer survivors, Dr. Schilsky told reporters listening to an ASCO presscast.

The presscast previewed several presentations from the forthcoming meeting that illustrated this concept of personalizing cancer care. One of the previewed abstracts featured a genomics test that can predict the likelihood of recurrence in stage 2 colon cancer (abstract 4000), which could be useful in deciding whether to use chemotherapy after surgery in such a patients. Another showed that patients with nonsmall-cell lung cancer who had epidermal growth-factor receptor mutations in their tumor responded better to gefitinib (Iressa) than to chemotherapy (abstract 8006).

One of the educational sessions, organized in partnership with the American Association of Cancer Research, will also take on the theme of personalized cancer care, but will focus on the development of targeted therapies and the close collaboration needed between basic scientists and clinical investigators.

Insights Into Improving Quality of Care

Other presentations at the annual meeting will look at improving the quality of care for people with cancer, which "will be a key priority for my upcoming term," said incoming ASCO president Doug Blayney, MD, professor of internal medicine at the University of Michigan Medical School in Ann Arbor. He was also speaking at the ASCO presscast.

"As oncologists, our goal is to deliver the highest quality of care for our patients, which includes everything from ensuring that they receive the best and most effective treatment to helping them to cope with side effects from these treatments," Dr. Blayney explained. As an example, one of the abstracts featured in the presscast was a study showing that ginger supplements added to standard antiemetic therapy significantly reduced nausea in patients undergoing chemotherapy (abstract 9511). Another study focusing on side effects is a phase 3 trial (STEPP) that evaluated preventive vs reactive treatment for the severe rash that commonly occurs in patients treated with panitumumab (Vectibix) for metastatic colon cancer (abstract CRA40-27).

The educational session will consider how recent advances have added complexity to the management of patients with regard to the choice of proper imaging modality and interpretation of the imaging test. This session will provide a unique opportunity to discuss these issues in an interdisciplinary format and to identify ways of using imaging technologies in optimizing patient care, according to a statement released by ASCO.

Practice-Changing Presentations

More than 4000 abstracts have already been released, but abstracts from the plenary and late-breaking sessions will only be released when the meeting is underway. Many of the presentations of new data are expected to be practice changing, Dr. Schilsky noted.

Among the several abstracts in the area of gastrointestinal cancers that were highlighted by our own oncologist blogger John Marshall, MD, from Georgetown University in Washington, DC, is a phase 3 trial (ToGA) showing positive results for trastuzumab (Herceptin) in gastric cancer (abstract LBA4509). Although he cautions that he has not yet seen the data, Dr. Marshall suggests that these results could establish trastuzumab as a new standard of care in this patient population. About 20% of patients with gastric cancer have tumors that are HER2-positive and thus would respond to this targeted therapy, which is similar to the situation already seen in breast cancer, he said.

Another new standard of care, in fact the first time that a standard of care has been suggested for biliary tract cancer, comes out of a phase 3 study (UK ABC-02 trial) that was previewed in the presscast. It showed that the combination of gemcitabine plus cisplatin prolonged survival, compared with gemcitabine alone (abstract 4503).

Several of the large studies in the lung cancer field explore maintenance treatment with targeted agents and without chemotherapy, potentially creating a new treatment strategy. One phase 3 trial (SATURN) explores the use of erlotinib (Tarceva) alone (abstract 8001), whereas another (ATLAS) shows that combined maintenance therapy with bevacizumab (Avastin) and erlotinib is better than bevacizumab alone (abstract LBA8002).

In addition, data from phase 3 trials with 2 new therapeutic vaccines will be presented. One of these products (BiovaxID) is a personalized vaccine used in patients with follicular lymphoma after their first remission (abstract 2); the other product (gp100:209-17 peptide) was tested in patients with metastatic melanoma (abstract CRA9011).