COMMENTARY

ESMO and ASCO® Presidents Issue Challenge to Oncologists

David J. Kerr, MD

Disclosures

May 27, 2011

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Hello. This is David Kerr, Professor of Cancer Medicine from University of Oxford. I'm President of the European Society of Medical Oncology (ESMO). Apologies -- I have a mild cold just now and hence my rather husky voice. I wanted to take the opportunity to discuss a little bit about the forthcoming American Society of Clinical Oncology (ASCO) meeting and some of the potential highlights. In "real life," I'm a gastrointestinal oncologist, so I wanted to talk a little about some of the interesting work that's going on in that field.

Nothing New in Colorectal Cancer

First of all, let's discuss colorectal cancer. It's a bit disappointing. There is really not much going on there that would set the heather alight. I think it reemphasizes the fact that, in colorectal cancer, we need a big, new therapeutic idea. So most of the presentations on show are reheats and retreads of old trials -- important updates, but nothing that's very significantly new, nothing that really sets the pulse racing. There are some new molecular data on subsets of K-Ras mutations, which may carry prognostic information. These data may help us further to discriminate the therapeutic value of epidermal growth factor receptor (EGFR) antibodies, but really this is something that requires validation in larger datasets.

Gastric/Esophageal Cancer

If we look at noncolorectal cancer, things do pick up significantly there. Charlie Fuchs and his colleagues[1] have a very nice study which they will be presenting on esophageal adenocarcinoma, in which they looked at a fairly complicated chemoradiotherapy regime. It compared a bolus of 5-fluorouracil (5-FU) leucovorin with a rather more complicated infusion of 5-FU epirubicin and cisplatin. They show that a good ol' bolus of 5-FU leucovorin seems to be as efficacious as the more complex infusional regime. But it does look to me that the infusional chemotherapy is better tolerated, certainly in the reduction in number of chemotherapy-associated deaths. Nevertheless, it is an important presentation.

Similarly, sticking with advanced gastric cancer, Park and colleagues[2] from Korea present probably the largest study to date looking at second-line chemotherapy in patients with advanced gastric cancer. In a study of about 200 patients, all of whom were heavily pretreated, they randomly assigned these patients to best supportive care or to best supportive care plus single-agent chemotherapy; it was the investigator's choice as to whether this was single-agent docetaxel or irinotecan. It did look as though the chemotherapy regime was associated with a significant survival benefit. This was an important and interesting study.

Pancreatic Cancer

What else is going on in pancreatic cancer? There is a very nicely designed study of more than 800 patients with advanced disease in which a comparison was done between gemcitabine and S1 (an oral fluorinated pyrimidine which is widely used in Japan) and a combination of the two. It looks as though one could conclude that S1 is as good as gemcitabine, but even with a large, well-designed study, it wasn't possible to demonstrate that the combination of S1 and gemcitabine was superior to either single agent alone.

Liver Cancer

As an update from the Intergroup on their earlier studies on anal cancer and chemoradiation therapy, and because of the quality of their trial and the length of follow-up, they have shown definitively that chemoradiotherapy with 5-FU and mitomycin C is superior to infusion of 5-FU plus cisplatin in terms of 5-year disease-free overall survival. These are the benefits of well-conducted trials with decent and mature follow-up. In liver cancer, there is another large, well-designed study with slightly more than 1000 patients in which [sunitinib] and sorafenib were compared, and it looked as though sorafenib was superior to [sunitinib]. There may be some subset analysis to do with hepatitis B-associated disease, but nevertheless the message was that sorafenib seems to be superior to [sunitinib] in treatment of hepatocellular carcinoma.

Cancer Around the World

Also at the ASCO meeting, on behalf of George Sledge, the ASCO President, and myself, we'd love to welcome you to the joint symposium that we're hosting between ESMO and ASCO, in which we explore cancer control in the developing world. We'll give examples of the epidemiologic burden of disease that we'll follow in the developing world. We'll look at management of liver cancer and cervical cancer, which is the most common cancer of women in the developing world. And to show how indefatigable our brothers and sisters in the developing world are in terms of their battle to overcome cancer with the meager resources that they have, George and I will issue a challenge to you all intellectually and from the heart to see how you can join us and how you can support ESMO and ASCO, working in partnership and in unity, to see what we can do to support cancer control, raising cancer awareness, cancer treatment, and cancer care in the developing world.

I look forward to seeing you at ASCO. I look forward to an exciting meeting. I hope to see you there. Thank you.

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