Kathy D. Miller, MD


May 17, 2012

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Hi. It's Dr. Kathy Miller from Indiana University with a pre-ASCO® Medscape Oncology blog. I'm going to focus on the plenary session. I have been heavily involved in the scientific program committee for the last couple of years, and I can tell you that the program committee works incredibly hard on the plenary session. There are lots of discussions, lots of debate, and occasionally, heated arguments about what are the most important advances in the field -- studies that, regardless of your practice setting or your own professional focus, you need to know to be up-to-date and to take the best care of patients.

This year, we selected 4 abstracts for the plenary session. The first is the EMILIA trial[1] that I spoke about in a separate blog when we saw the press release. The EMILIA study was for patients with previously-treated HER2-positive breast cancer, looking at the standard combination of capecitabine plus lapatinib and comparing it with the novel antibody-drug conjugate trastuzumab-DM1 (T-DM1). The results could not be more striking.

The discussion of that trial will take these results beyond what they mean for the treatment of HER2-positive breast cancer and look at the potential power of antibody-drug conjugates as a therapeutic strategy and how they might be applied to other disease settings.

A fascinating study in prostate cancer, a long-awaited trial that was a decade in the making, looked at the critical balance of disease control versus toxicity of therapy and the relative impact on quality of life of both disease and therapy.[2] They asked a very simple question: For men with metastatic prostate cancer, does continuous androgen ablation or intermittent androgen ablation result in a better balance of those competing factors?

Although it is a simple question, the results were unfortunately not so simple. For that reason, there will be a special session immediately after the plenary to give those who are interested in prostate cancer -- those who are either intimately involved in research in prostate cancer or who take care of many prostate cancer patients -- a chance to come together in a smaller group for a discussion of the nuances of these results, how to best apply these results to treating patients, and the dramatic changes in the treatment of patients with prostate cancer over the last 5-6 years.

A crucial update of a trial on low-grade lymphoma was reported about 3 years ago on the bendamustine/rituximab (BR) combination. The preliminary results suggested that the BR regimen might have superior efficacy and less toxicity. However, this is a very indolent disease, and that regimen was not adopted as standard therapy in many parts of the community because they were early results. There was also concern about whether those results would hold up with further follow-up and whether there might be issues with second malignancies or crucial toxicities that would be important to know about for younger patients. Now, with 3 more years of follow-up and very mature results, we think that this will result in an important change in the treatment of patients with low-grade lymphoma.[3]

Finally, another rare disease, but one for which the abstract results showed profound changes in the treatment of patients, is a particular subtype of oligodendroglioma.[4] A study was reported in its full form a couple of years ago, looking at either radiation alone or radiation with chemotherapy. The results of all the patients together did not show a benefit from chemotherapy.

Along the way, however, we learned a lot about the biology of oligodendroglioma. Patients with a particular genetic abnormality derived a huge improvement in overall survival with the addition of chemotherapy. Differences were measured in years. It is a rare disease, but the results are crucial to know for people who take care of patients with that disease, and it is another study that highlights how understanding the detailed molecular biology and genetics of diseases can result in powerful improvements.

I look forward to seeing you all there. Please come join the plenary and stick around for the prostate cancer discussion.