BGICC conference highlights: Changing standards in breast and gynaecological cancers

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Published: 26 Jan 2018
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Dr Hesham El Ghazaly - Ain Shams University, Cairo, Egypt

Dr Ghazaly, general secretary of the 10th BGICC in Cairo, meets with ecancer to discuss key topics from the conference sessions.

He hightlights the drug discovery sessions focussing on the latest generation of tyrosine kinase inhibitors now available, ongoing trials of targetted PD-1/PD-L1 checkpoint inhibitors, and panel discussions of disease prevention.

Dr Ghazaly notes the number of young conference attendees, which has informed programme sessions in next years conference to include mentoring and training opportunities.

This year it was important to discuss the recommendation of SITC and the BGICS in immuno-oncology. Because all of us know that the immunotherapy now is the fourth pillar of treatment after chemo, radiation and hormonal treatment for cancer management so a lot of drugs have been discovered in the last years, last four or three years. So it is important to go for the areas of controversy which are the patient selection, the adverse events, what is the best strategy for going maintenance. Yesterday we went for the first SITC and BGICS recommendation in immuno-oncology and there we discussed the testing, the concept of immuno-oncology - shall we use the immunotherapy and all checkpoint inhibitors instead of each other or not? We stated that is not, every checkpoint inhibitor is different in terms of efficacy and toxicity.
Also we went for an algorithm for treatment of non-small cell lung cancer and dividing the patients into three main groups - either those with oncogenic driven tumour positive with PD-L1 positive or negative or oncogenic driven tumour negative and PD-L1 negative and consider these like the triple negative disease of breast cancer. The other is oncogenic driven tumour negative and PD-L1 positive. So we got a first line treatment for all of these and second line and how the science changes very fast and now we have a first line approval of the immunotherapy, especially pembrolizumab in the first line treatment if the PD-L1 is more than 50%. Also we showed that it is different not to use all the other checkpoint inhibitors because we have some failure of the nivolumab in the first line compared with the chemotherapy in this line.

In the second line also the panellists were agreeing that there is no need for PD-L1 assessment and we can use immunotherapy in the second line without PD-L1 assessment. We discussed the combination with chemo, combination with targeted therapy and we discussed the KEYNOTE-021, the IMpower study and also weighing against efficacy compared with the adverse events and the cost of the treatment, especially in a region like the Middle East.

We have also in this conference two very important sessions. Firstly the prevention session which will be held in collaboration with the National Cancer Control committee in Egypt and the NCN MENA and the ICC, the WHO EMRO. This is very important for the region because it is important to go for tailoring the prevention guidelines of prevention in the population in the MENA and limited resources countries. We have today morning a small panel for completing this recommendation before the voting session which will be attended by fifty of the, most of the, important KOLs in the region and the world to emphasise about this recommendation in the prevention.

Also the drug discovery is an important session we introduced this year in collaboration with the pharmaceuticals and the clinical pharmacy departments in the Faculty of Pharmacy. We have multiple new molecules starting to appear in the Egyptian market with tyrosine kinase inhibitors. There are a lot of preclinical studies and phase I studies in these tyrosine kinases, new tyrosine kinase molecules.

One of the important things also in the prevention session that we have the numbers of the cancer patients in Egypt is about 115,000 patients per year and the breast cancer constitute about 34% of this number. So with the prevention we can reduce these numbers to about 40% of this amount. So we go for the plans and the strategy for this cancer control plan.

What are your thoughts on this year's conference?

I'm very happy with this year because we are celebrating the tenth one, the tenth round of the BGICC with participants reaching about 3,200 participants from all specialities divided in ten parallel sessions, as you see in the conference. Also it is important that about 70% of the attendees are young oncologists and young doctors, some of whom are very happy to have this educational activity for them. This year also we have a collaboration with the international journal, the Tumori Journal and all the proceedings and the abstracts of the conference were published in this journal so it may be more exposed to international societies and practitioners for their work.

The good thing that me and Leisha Emens and Professor Hope Rugo discussed next year that we will go for a young oncologist activity because of this. So we will go for two activities - a masterclass for the young oncologists and also to have breakfast with experts for all of them to try to share the knowledge and ideas to improve the career of young oncologists in research and also in their physician career.