Mark G. Kris, MD


May 24, 2012

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Hello. This is Mark Kris from Memorial Sloan-Kettering Cancer Center in New York. I would like to spend the next few minutes talking about what to expect at this year's American Society of Clinical Oncology (ASCO®) meeting.

Many of the themes that we have seen over the last several ASCO meetings are going to be played out again. However, we are going to hear additional information about some very important issues and some new developments in the field. The big story, once again, will be the emergence of targeted therapies. There is going to be a presentation of the phase 3 trial[1] comparing afatinib with the best available chemotherapy combination in advanced adenocarcinoma of the lung, which is pemetrexed and cisplatin. That is an eagerly awaited study and one that hopefully will lead to the approval of afatinib as first-line therapy.

Agents that block the epidermal growth factor receptor (EGFR) tyrosine kinase will be used first-line, and afatinib, hopefully, will soon be added to the armamentarium of drugs that we have for those patients. As we treat more and more patients in first-line and have good results, we are faced with more issues of acquired resistance to EGFR tyrosine kinase inhibitors (TKIs). You will find this year at the ASCO meeting that different approaches to treating patients with acquired resistance will be discussed. Those approaches vary, from continuation of the TKI in spite of resistance documented progression, to adding chemotherapy agents to a TKI, and stopping the TKI for a time and then reinstituting TKI therapy. In patients who have a single symptomatic site of metastatic disease, an approach is treatment of that single metastatic site. At the ASCO meeting this year, you will hear all of these topics discussed. We will hear some good information about how to take care of this scenario that we are increasingly faced with.

As all of these developments have taken place with adenocarcinoma, we have been very anxious to find out if we could take similar approaches with small cell carcinoma. Two presentations this year will directly address that question. One will report results of the cancer genome atlas.[2] Squamous cell carcinoma is one of the key targets in the first iteration of that program. We will hear genomic data from stored surgical specimens. I am particularly excited (and forgive the parochial nature of this) about the presentation by my colleague Dr. Paul Paik.[3] Paul has made upfront testing part of the care of patients with squamous cancer, looking for the common mutations and referring patients for specific trials on the basis of these mutations, just as we would do in adenocarcinoma. He is going to show data from patients in whom that program has been initiated and that strategy has been pursued. In addition to doing the standard tests, immunohistochemistry tests and mutation tests by Sequenom® MassARRAY (San Diego, California), as well as fluorescence in situ hybridization assays for amplification, they used next-generation sequencing. You will hear in that presentation about the upfront testing of patients with squamous cancer, finding targets, and how next-generation sequencing is going to fit into the equation.

With all of the excitement about TKIs, we know that eventually all patients progress, and we need to look at other strategies. What we will hear about again this year are immune strategies. Many people are looking at immune therapies as being the next step, complementary to a targeted therapy such as a TKI, and we will see information about the drug PD1[4] that has shown early promise in lung cancer patients. Trials of ipilimumab are ongoing as well, but the PD1 data are going to be important.

One last thing that all medical oncologists who treat lung cancer patients should look at is an abstract by Rudy Navari[5] in the supportive care section. He has shown that the available agent olanzapine is helpful in treating the nausea and vomiting that can follow anticancer therapies, despite the use of our best agents. We all have patients for whom we just aren't doing a good enough job. Rudy has done a nice randomized trial showing that olanzapine can be a useful adjunct. That abstract is already available online and will be presented at the ASCO meeting this year.

I invite you all to come to ASCO. There will be a lot to learn. We are going to find that a lot of our questions will be answered. We are going to leave that meeting better able to care for our patients with lung cancers. Thank you.


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