ASCO Highlights Major Cancer Advances of 2008

December 29, 2008 — Twelve major cancer advances and a further 19 notable advances made during 2008 have been highlighted in a report issued by the American Society of Clinical Oncology (ASCO). Compiled by a group of leading oncologists, the report selects studies that have significantly altered the way a cancer is understood or studies that had important impact on patient care.

"This report show that we are making important progress in preventing, detecting, and treating cancer," said Richard Schilsky, MD, president of ASCO. "Each of the studies highlighted in the report represents new hope for people with cancer and those who care for them."

To make their selection, the panel of experts reviewed scientific journals and presentations made at major scientific meetings between October 2007 and September 2008. Many of these studies have already been reported in some detail by Medscape Oncology, at the time when the research was presented or published.

The 12 major advances are listed as follows (not in rank order):

Improvement in survival in advanced non–small-cell lung cancer with cetuximab (Erbitux, IMClone/Bristol-Myers Squibb), when added to chemotherapy in patients with tumors expressing epidermal growth factor receptor (EGFR). (FLEX study. Pirker R et al. ASCO 44th Annual Meeting, 2008.)
Improvement in survival in early-stage resected pancreatic cancer with gemcitabine (Gemzar, Lilly). (CONKO-001 study. Neuhaus P et al. ASCO 44th Annual Meeting, 2008.)
FDA approval of bevacizumab (Avastin, Genentech) for use in women with advanced breast cancer that does not express human epidermal growth factor receptor 2 (HER2) (the majority of breast cancers), based on 2 studies. (Miller K et al. N Eng J Med. 2007;357:2666-2676. Miles D et al. ASCO 44th Annual Meeting, 2008.)
FDA approval of bendamustine (Treanda, Cephalon) for chronic lymphocytic leukemia (CLL). The drug had already been used in Europe for 30 years, but a new international trial showed bendamustine eliminated cancer completely in 30% of patients with CLL compared with only 2% treated with a standard treatment, chlorambucil. (Knauf WU et al. American Society of Hematology [ASH] 49th Annual Meeting and Exposition, 2007.)
Reduction in the recurrence of early-stage breast cancer with additional years of hormonal therapy (either aromatase inhibitors or tamoxifen) after the standard 5 years of tamoxifen. (Several studies.)
Reduction in the recurrence of early breast cancer with use of the osteoporosis bisphosphonate drug zoledronic acid (Zometa, Novartis). (Gnant M et al. ASCO 44th Annual Meeting, 2008.)
Reduction in melanoma recurrence with pegylated interferon. (Eggermont AM et al. Lancet. 2008;372:117-126.)
Prediction of response to cetuximab in colorectal cancer by KRAS mutations, with benefit from therapy seen only in patients who have normal (wild-type) KRAS and no benefit seen in those with KRAS mutations (CRYSTAL study. Van Cutsem E et al. ASCO 44th Annual Meeting, 2008.)
Reduction of the risk of ovarian cancer from use of oral contraceptives, with estimates that these drugs may have prevented some 200,000 cases of ovarian cancer and 100,000 deaths to date worldwide. (Beral V et al. Lancet. 2008;371:303-314.)
Increase in the incidence of human papilloma virus (HPV)–related head and neck oral cancers, perhaps due to an increase in oral sex, which in turn suggests a potential new use for the HPV vaccine. (Chaturvedi AK et al. J Clin Oncol. 2008;26:612-619.)
Increase in number of cancer patients — expected to grow by 55% by the year 2020, significantly outpacing the availability of oncologists, leading to a shortage of some 2550 to 4080 oncologists in the United States by 2020. (Warren JL et al. J Clin Oncol. 2008;26:3242-3247.)
Increase in risk of heart disease in childhood cancer survivors (about 5- to 10-fold increase compared with healthy siblings), emphasizing the need for life-long monitoring. (Childhood Cancer Survivor Study. Mulrooney D et al. ASCO 44th Annual Meeting, 2008.)

The report also highlighted a further 19 advances that the experts considered to be "notable," and these are listed as follows (again, not in rank order):

Activity in relapsed/refractory Hodgkin's lymphoma with the investigational agent SGN-35 (Seattle Genetics) (an antibody targeting CD30 attached to the chemotherapeutic monomethyl auristatin E). (Younes A et al. ASCO 44th Annual Meeting, 2008.)
Food and Drug Administration (FDA) approval of ixabepilone (Ixempra, Bristol-Myers Squibb) for advanced breast cancer in patients unresponsive to other types of chemotherapy. (Thomas ES et al J Clin Oncol. 2007;25:5210-5217.)
Link between vitamin-D deficiency and worse breast cancer outcome. (Goodwin P et al. ASCO 44th Annual Meeting, 2008.)
Increase in progression-free survival in glioblastoma with bevacizumab added to irinotecan (Camptosar, Pfizer). (Cloughesy TF et al. ASCO 44th Annual Meeting, 2008.)
Confirmation of deficient mismatch repair (dMMR) as a predictive marker for lack of benefit from 5-fluorouracil-based chemotherapy in stage II and III colon cancer. (Sargent DJ et al. ASCO 44th Annual Meeting, 2008.)
Activity in advanced hormone-refractory prostate cancer with abiraterone acetate (Cougar Technology) (an inhibitor of CYP17, an enzyme involved in testosterone production) (Attard G et al. ASCO 44th Annual Meeting, 2008) and also with the antisense oligonucleotide custirsen (OGX-011, OncoGenex), which increases sensitivity to chemotherapy, (Saad F et al. ASCO 44th Annual Meeting, 2008.)
Activity in thyroid cancer with sorafenib (Nexavar, Bayer Healthcare) and the investigational agents axitinib (AG-013736, Pfizer) and motesanib (AMG 706, Amgen). (Gupta-Abramson V et al. Cohen EE et al. Pfister G et al. J Clin Oncol. 2008;26:4714-4719, 4708-4713, 4701-4704. Sherman SI et al. N Eng J Med. 2008;359:31-42.)
Noninvasive method for genotyping tumor cells in blood for patients with non–small-cell lung cancer (Maheswaran S et al. N Engl J Med. 2008:359:366-377. )
Identification of gene that increases risk of neuroblastoma. (Mosse YP et al ASCO 44th Annual Meeting, 2008.)
Increased leukemia risk in childhood cancer survivors who were treated with platinum compounds and etoposide (Shankar SM et al. ASCO 44th Annual Meeting, 2008.)
Prediction of leukemia outcome with the use of minimal residual disease (MRD) (Borowitz MJ et al. ASCO 44th Annual Meeting, 2008.)
Activity in sarcoma with the investigational agent CP-751871 (Pfizer) (an anti-IGF-IR-antibody) (Olmos D et al. ASCO 44th Annual Meeting, 2008.)
Activity of sorafenib in gastrointestinal stromal tumors (GIST) that had become resistant to imatinib (Gleevec, Novartis) and sunitinib (Sutent, Pfizer). (Wiebe L et al. ASCO 44th Annual Meeting, 2008.)
Improvement of progression-free survival in melanoma with sorafenib plus dacarbazine. (McDermott DF et al. J Clin Oncol. 2008;26:2178-2185.)
Value of dermoscopy for diagnosis of cutaneous melanoma in suspicious skin lesions. (Vestergaard ME et al. Br J Dermatol. 2008;159:669-676.)
Explanation of the link that had been reported between finasteride and high-grade prostate cancer in the Prostate Cancer Prevention trial (PCPT) — new analyses found that the drug did not increase aggressive prostate cancer but decreased prostate volume and made such cancers easier to detect. (Cohen YC et al. Lucia MS et al. J Natl Cancer Inst. 2007;99:1366-1374, 1375-1383.)
Cancer screening choices may change with health-insurance changes. (Wharam JF et al. Ann Intern Med. 2008;148:647-655.)
Significant increase in cost of initial cancer treatment between 1991 and 2002 among elderly patients with breast, colon, prostate, and lung cancer. (Warren JL et al. J Natl Cancer Inst. 2008;100:888-897.)
Benefit of acupuncture in easing pain and dry mouth after head and neck surgery. (Pfister D et al. ASCO 44th Annual Meeting, 2008.)

Call for Renewed Investment in Cancer Research

"This year's report illustrates that investment in cancer research pays off," says one of the report's executive editors, Eric Winer, MD, director of the Breast Oncology Center at the Dana-Farber Cancer Institute, in Boston, Massachusetts, and chair of ASCO's Cancer Communications Committee.

"But unless we reverse the effects of flat federal funding, the great potential we currently have to advance cancer treatment will go to waste," he commented in a statement.

The United States is in the midst of the longest sustained period of flat funding for cancer research in the country's history, ASCO points out. Budgets for both the National Institutes of Health and the National Institute of Cancer have remained unchanged for years and hence are not even keeping up with inflation. In the report, ASCO calls for renewed investment into cancer research.

"Scientifically, we have never been in a better position to advance cancer treatment. But 5 years of flat federal funding for cancer research puts future success at risk," commented Dr. Schilsky. "We're seeing signs of a slowdown already. Tighter budgets mean less funding for high-risk research that could have big payoffs, the most significant clinical cancer research is increasingly being conducted overseas, and talented young physicians are seeing less opportunity in the field of oncology and are opting instead for other specialties."

The other major recommendation that ASCO makes in its report is for increased patient participation in clinical trials. At present, only 5% of all cancer patients are involved in such studies, it points out.

"Clinical trials offer patients promising new therapies and high-quality care. But without greater participation, the pace of progress will slow," commented Julie Gralow, MD, associate professor of medicine/oncology at Washington University, in St. Louis, Missouri, another executive editor of the report.

"We need to reduce unnecessary barriers so that doctors can enroll patients and patients have the information and the coverage they need to participate," she said.

The report outlines several steps that would encourage participation, including nationwide public and private insurance coverage of clinical trials and full reimbursement to oncology practices for the costs incurred in participating in such studies.

J Clin Oncol. Published online December 22, 2008. Abstract

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ASCO Highlights Major Cancer Advances of 2008

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