ASCO 2016 Roundup

Prof Gordon McVie - ecancer Editor in Chief

I’ve just been to ASCO in Chicago, along with 34,000 other people, and it’s the usual marketplace. A lot of good data this year but what people mostly use ASCO for is networking and getting jobs and doing audit committees and clinical trials planning committees and so on and that was happening all the time all over the place.

So the take-home top-liners from ASCO are three or four in number. Rick Schilsky, the Chief Medical Officer of ASCO, put a randomised trial of multiple myeloma up in top place and he was underlining daratumumab plus bortezomib and dexamethasone over the last couple. The partial response rate was 29% going up to 50% with the addition of daratumumab and the complete remission rate, this is in multiple myeloma, went from 9% to 19%. So that’s impressive and that was his choice for the take-home message, the practice changing ones if you like.

Then there was breast cancer and it looks as if the story of Tamoxifen five years versus Tamoxifen ten years in oestrogen receptor positive breast cancer has been repeated now with letrozole. So letrozole ten years is better than letrozole five years.  Duration of treatment also in radiation therapy for prostate cancer, it looks as if taking eight weeks of prostate cancer and contracting that into four weeks is just as good and, in fact, might even be better.

Then brain cancer, a supplementary study but a good one, on temozolomide in anaplastic glioblastomas added to radiation therapy. We’ve known for a while that temozolomide although wasn’t designed to be a radiosensitizing drug is that and adjuvant temozolomide after radiation therapy does seem to improve the long-term outcome something like 40% up to 55% at five years. So that’s all good news.

I suppose we should add in pancreas cancer for which there’s so little to do. Advanced pancreas cancer, and this was a randomised study of gemcitabine plus capecitabine versus gemcitabine and the five year survival is 29% for the combination and 16% for the single agent.

Now, a couple of interesting studies on antibody drug complexes or ADCs, difficult to get the names of the drugs out but in small cell lung cancer there was really impressive performance by rovalpituzumab, that was the antibody, the drug was tesirine. This, of course, is a dreadfully difficult disease to manage after the usual quick disappearance of cancer and the equally quick reappearance. The interesting thing about this, apart from the ADC, was that there was a good marker called DLL3. There was clear advantage and good remission rates now with that combination. Then the other ADC study was in triple negative breast cancer and this time the drugs were first the antibody sacituzumab and the drug was govitecan. So the triple negative patients also responded very well and, once again, out of the study came a biomarker, Trop-2.  So that’s interesting ways forward for the antibody-drug complex but also for the discovery of two new biomarkers, DLL3 for small cell lung cancer and Trop-2 for triple negative breast cancer.

I spent a long time in the Netherlands between 1979 and 1989 working on intraperitoneal chemotherapy for minimal residual disease and adjuvant treatment of ovarian cancer. Notoriously difficult to produce cures in that disease and intraperitoneal chemotherapy was really quite cumbersome and quite toxic. However, we had complete remissions in patients who had progressed on the same drug given IV, the drug mostly was cisplatin. Now it seems that some of the problems have been resolved with the use of carboplatin instead of cisplatin and a randomised trial of carbo IV and IP seems to be superior to just IV carboplatin. Also increasing the number of stem cell transplants in neuroblastoma, a clear improvement on neuroblastoma patients who are only treated with one stem cell transplant.

Personalised medicine, precision medicine, whatever you want to call it, stratified medicine, has been tested in a lot of places and some of the results have been really quite disappointing. Given a whole batch of cancers with difficult to find mutations and then we find the mutations you haven’t got the drug which fits the mutations. This time there was a really nice paper on a study of 129 patients with 12 different cancers and in 29 of them there was clinical response to trial drugs which have not yet been approved by the FDA. So I thought that was giving some hope that we might be going down the right road.

Not the same huge harvest of PD-L1 and PD-L2 drugs, the immuno-oncology drugs, at this meeting but there was a new tumour type shown to be responding and that was bladder cancer. The drug was atezolizumab.

A couple of interesting things about doing away with repetitive tissue biopsies. A big, big study of 15,000 patients where liquid biopsy was compared to tissue biopsy and this was fifty cancers, it was a huge, huge study. Interestingly there was a good match, almost a 90% match, with the mutations in the liquid biopsy samples and the tissue biopsy and that’s actually good news for testing out new drugs and finding quickly whether they’re targeting properly or not.

Then there was an interesting observation which a lot of surgeons are kicking themselves about and that is that patients who have got cancer of the colon on the right side do much worse than patients who have got cancer of the colon on the left had side. No more to say about that, just be aware of it.

Then lastly I thought a really nice bit of new technology, namely an app for patients who have got non-small cell lung cancer to report their symptoms, their post-treatment symptoms, their side effects. Just using this app alone in a randomised trial showed that the survival of these non-small cell lung cancer patients went up from 12 months median survival to 19 months just by being able to use the app to alert the caring doctor and nurse and supportive team that there were some problems and early intervention prolonged life by 7 months. Good news for next year’s ASCO 2017, again in Chicago. Thanks.