ECC 2015

ECC 2015 scientific highlights

Prof Peter Naredi - University of Gothenburg, Gothenburg, Sweden

We have a glittering array of abstracts here in Vienna at the meeting and you have had some role in commenting on these. I wonder if you could pick out from the many fascinating new abstracts what you think are some of the best and most important topics. Renal cell cancer is one of them, isn’t it?

Oh yes. It’s those kinds of moments you don’t think that will happen to you when not only one late breaking abstract has a result that could be clinically practice changing but we actually had two. One phase III trial comparing standard treatment with a targeted drug, a TKI, and a clear positive result for the tyrosine kinase inhibitor. Then we had another one comparing standard treatment with a checkpoint inhibitor, these new immuno-oncology drugs. Both are so positive so I cannot really see that right after this meeting this will be something, they are new treatments considered for patients with renal cell carcinoma.

So the big hope was in which stage of renal cell?

This is advanced renal cell carcinoma.

It’s been a real step forward?

Yes, we are talking not days but several months of prolonged survival, median survival. We have clear curves for progression free survival. When you see those data it’s not a statistical difference, it’s something  that I think that you, as a clinician, will say, ‘Yes, this will change how we look upon the treatments.’

You’ve had doubling of survivals, haven’t you?

Almost. Again it’s in a study form so let’s see what it will be in real life. But I really think that this will be the new standard of therapies. And it’s interesting because we are not following one track, we are not looking only at single pathway inhibitors, we are getting different tools to treat renal cell carcinoma.

What about rare tumours, neuroendocrine tumours have featured, haven’t they?

Yes, that’s the other thing. Rare tumours are so difficult to do randomised trials because they are rare by definition. Here we have studies performed globally by many different sites and we get them reported here. One is for those who are really not producing any active substance and we show a clear difference in survival with the active treatment. Then we have the carcinoids, the same thing. So again we are with the use of the inhibitors of the signalling pathways and with the checkpoint inhibitors we are changing, actually, the way of looking at these tumours.

So molecular oncology is finding its role now?

Yes, I think you really formulate that well. I wouldn’t say precision medicine yet but this is molecular oncology and when we learn even more about that, because there are several abstracts here looking at the expression of, for example, one of these checkpoints, PD-1, and whether that is of any influence. That’s what we are exploring. But just to give the drugs we are having now changes the outcomes.

Of course we have been looking into the nuances of checkpoint inhibition, haven’t we, and finding some big advances by understanding the different arms of that whole process.

Yes, but to me, what impresses me is that we don’t get it for the tumours we expect it, we get it for so many different tumours today. So these are general principles. Now we will be better to understand who should have the treatments but right now, by giving them rather broadly to a certain tumour type, we really already now see an effect. But we will, of course, learn a lot more on selecting the right treatment for the right patient.

And that applies to some of the common tumours as well, not just melanoma which is relatively common but not very.

Oh yes. It’s the diversity now, it’s like when we started using chemotherapy for most tumour types and we knew in some cases they are really efficient, in some they are not that efficient. Now we get the checkpoint inhibitors doing something with the immune system, we get the tyrosine kinase inhibitors, so we have a completely different toolbox to work with.

What do you think, then, is the take-home message for doctors coming out of these exciting abstracts here in Vienna?

We are now at the point where you cannot sit around and not read the literature and not follow what’s going on. Now you really have to follow the advances in the field where you’re working, whether it’s in kidney cancer, whether it’s the rare tumours or lung cancer, things are happening very fast now. Then of course it has to be followed up by the critical discussion – the complications, the adverse effects of getting these treatments is also very obvious and the next step is of course to give treatments that keep the quality of life as good as possible so it’s not only giving as tough treatments as possible. You must, as a practising physician, understand where you have to consider, really, the survivorship of what you are doing.

So the short take-home message, if there is one, for practising clinicians is what?

Follow the news, read it critically, listen to what people say and then start using the new treatments.

Thank you very much.