ECC 2015

ECC 2015: Editor's highlights

Prof Gordon McVie - ecancer Managing Editor

Welcome to Vienna and the European Cancer Congress and our round-up. This congress is not just about the new drugs. As I spoke to the oncologist on this little island south of England who said, ‘Yes, but I can’t afford any of these things. It will be three or four years before I can get atezolizumab for my patients. So what’s important for me is to hear the way things have changed and the way I treat my patients has changed.’ He highlighted top of his list was the dramatic change in terms of management of prostate cancer, locally aggressive prostate cancer plus or minus metastasis. There is a really super video which the ecancer team have captured with two of the most eminent urologists in Europe talking about how this is going to change the management of prostate cancer. Noel Clarke and Bertrand from Belgium have discussed how it’s going to be that they’re going to take the message that docetaxel plus or minus hormones up front are now the best treatment, the optimal treatment.

The problem for the urologist is that they have, generally speaking, been used to given hormone treatment and that didn’t require any interaction with anybody else, medical oncologist or radiation therapist or whatever. The challenge now for urology is to start up wherever they are not yet in place multidisciplinary teams. The way forward for the management of prostate cancer is multidisciplinary teams. Twenty years behind breast cancer but it’s going to happen because the data is demanding that it happens. Better patient outcomes if we come up-front with the best equipment we’ve got now which includes docetaxel and they may use other cytotoxic drugs but most of the trials have been docetaxel. There are all these interesting drugs which are coming through and have clearly got massive futures, I would predict, the really exciting drugs which have come through to be so effective in castration resistant prostate cancer, like abiraterone and enzalutamide. So a sea-change in the management of prostate cancer and that is what this oncologist said was the most important thing to take away from this exciting meeting.

There are a lot of interesting messages which are generalizable. There are a lot of oncologists who, like this man, can’t afford all these drugs, can’t afford to have the latest in radiation therapy but can afford to encourage patients to take exercise, can afford to advise on proper diet. The data is coming through now that we know an awful lot about the best management of cancer but we’re not making it available to all our patients. That’s proven by the heterogeneity of outcomes which have been shown in the EUROCARE study at this meeting on blood cancers. Unacceptable differences according to where you live in Europe. The usual league tables which were published just before the ECC meeting showing yet again, and highlighted in the UK papers, that Britain is behind a lot of the other countries in Europe in curing common cancers. So we have to find out what has worked. It’s all been presented here at the ECC, it’s not a mystery anymore, and it’s up to ecancer to publicise this across Europe to the people who didn’t come to this meeting and to emphasise it to those who did.

We are not getting the messages out so that all cancer patients, irrespective of what kind of cancer they’ve got, are actually benefitting. So, simple things that we already know about like multidisciplinary care for prostate cancer, like the influence of exercise from the diagnosis, not just in a preventive way but from diagnosis. And good diet is not just a preventive measure, it’s also a therapeutic issue.

What was new here was aspirin. We know all about aspirin being preventive for colorectal cancer, probably 30% of colorectal cancers could be avoided if people take 75mg aspirin from about the age of 50 but do we do it? No, we don’t. This paper here at the ECC showed that if aspirin is given in a randomised trial after colorectal treatment then survival is better. So there are three simple things that should be being done, aspirin, the diet and exercise, all proven to work in the preventive area but not yet coming into practice in the whole of the journey of the person who gets cancer.

There was a very important session here on the cost of care. If we’re expecting cancer rates to rise up to 2030 so that we are swamped in the cancer clinics, we are going to be completely bankrupted. So we must develop better prevention strategies, and we’ve just talked about that, and we must find some way of lowering the costs of cancer care. This requires not just doctors and not just patients but regulators and governments and insurance companies etc. These are all really important issues.

So, no point in going through the blockbuster, look at the videos on ecancer but remember the general message and that is that at ECC all the disciplines are here and they’ve got to be speaking to each other in every area of cancer and they’ve got to be raising the level in every country in Europe to the top.