Zosia Chustecka

May 23, 2014

Although it's still a week away, there is already a lot of buzz about the forthcoming 2014 Annual Meeting of the American Society of Clinical Oncology® (ASCO).

Some of it is speculation about data that have already been released in abstract form online. This early abstract release always stirs up a frenzy of media and financial analyst reports, creating a hype about the meeting long before it starts, but ASCO holds back some of the most important data and releases them only at the meeting.

Among the most anticipated data are results from major clinical trials that will be presented at the plenary session on June 1. These include conclusions from clinical trials in 2 types of breast cancer, specifically the TEXT and SOFT trials in hormone-receptor positive early breast cancer in premenopausal women (abstract LBA1) and the ALLTO trial of HER2-targeted drugs in HER2-positive early breast cancer (abstract LBA4). In addition, there will be results from phase 3 trials conducted in metastatic prostate cancer (abstract LBA2) and in metastatic colorectal cancer (abstract LBA3).

Celebrating 50 Years

This year, ASCO celebrates its fiftieth anniversary, and this meeting is a little different from previous years, in that there will be quite a bit of reflection.

"I think that's a natural instinct to look back and reflect, and we have a lot to be proud of," ASCO president Clifford Hudis, MD, commented in an interview with Medscape Medical News.

There is a vote on the ASCO Web site where members can share what they think are the most significant accomplishments of the first 50 years, and during the course of the meeting, there will be numerous sessions that take a look back at progress that has been made, discussing where the latest research fits in, but also looking ahead to the work that still needs to be done.

"But we are all appropriately humbled by the fact that there is so much still to do, and mostly this meeting looks forward," Dr. Hudis commented. "Despite the pause to reflect, we want to accelerate the progress that we have begun to make," Dr. Hudis commented.

The theme of this year's meeting is "Science and Society: The Next 50 Years."

One of the education sessions marked with the "50" logo, which takes place on June 1, will cover "Immunotherapy: Transforming Frustration to Cure in the Next 50 Years," and will be chaired by David Hafler, MD, MSc, from Yale University School of Medicine in New Haven, Connecticut.

Immunotherapy is one of the buzzwords at the meeting, and indeed has been a buzzword in oncology for the past few years, with cancer immunotherapy being hailed as the "breakthrough of the year" at the end of 2013 by the editors of Science.

"This is not the year of first reports," commented Dr. Hudis. "We already know that there is activity."

There is already a lot of reported data on clinical efficacy with immune-checkpoint inhibitor drugs — such as ipilimumab (Yervoy) approved for melanoma and investigational agents acting on the programmed death (PD) pathways — as well as activity seen with vaccines (such a Provenge, approved for prostate cancer), and also with cellular products, such as the ex vivo cellular expansion and reinfusion regimens, for example, using chimeric antigen receptor cell engineering.

"There is going to be a lot of expansion of the tools that we know are effective, and also expansion of the understanding of where it works, when it works, and when it doesn't work so well. So at the meeting we'll see a lot more detailed analysis of the more nuanced aspects of immunotherapy," Dr. Hudis commented.

"But what is clear now, unlike decades earlier when it was an idea, it is now an established fact that immunotherapy is an effective treatment for some cancers," said Dr. Hudis. "Now, we are entering a second wave of establishing the details."

A lot of interest is focused on the investigational PD inhibitors, several of which are in late stages of development, and could be available for clinical use within the next year or so. They include nivolumab (Bristol-Myers Squibb), MPDL3280A (Genentech), and MK-3475 (Merck), now known as pembrolizumab (and formerly known as lambrolizumab).

These drugs have already shown activity in several cancer types, including melanoma and lung and renal cancer, but there is intense interest in identifying which patients will respond. Also at the annual meeting, there will be new data on the clinical effects of combining this PD inhibition with ipilimumab, including some long-term survival data with this combination in melanoma (abstract LBA9003).

ASCO has already highlighted several other investigational therapies, including PLX3397 (Plexxikon), which has shown "profound activity" in the treatment of pigmented villonodular synovitis, a rare joint proliferative neoplasm that involves the synovium of joints or tendons (abstract 10503).

Also offering new hope for patients who are running out of options is AZD9291 (AstraZeneca) (abstract 8009) and the similar drug CO-1686 (Clovis), both of which have been granted breakthrough designation by the US Food and Drug Administration for use in the treatment of patients with EGFR-positive non-small cell lung cancer who have stopped responding to EGFR inhibitors and who have developed a T790M mutation. At present, there is no standard therapy for such patients, and they often receive palliative chemotherapy. These 2 new drugs, both third-generation EGFR inhibitors with activity against this T790M mutation, overcome the resistance and produce responses in about 65% of patients who were previously resistant.

How best to use the therapies that are already available is another theme running through the meeting. "We are seeing that there is huge value in improving our use of long-time staples," commented Jyoti Patel MD, chair of ASCO's Cancer Communications Committee, speaking at a premeeting presscast.

As an example, she highlighted a study (abstract 5003) showing that androgen-deprivation therapy (ADT) does not need to be instigated immediately when a man with treated prostate cancer shows signs of biochemical recurrence (i.e., rising levels of prostate-specific antigen). Delaying ADT for up to 2 years after such a finding had no effect on the long-term survival. "These findings suggest that there may be no need to rush to ADT," commented lead investigator Xabier Garcia-Albeniz, MD, from the Harvard University School of Public Health in Boston.

Value Is an Ongoing Discussion

Value is becoming an important theme in oncology, and will feature in a number of discussions throughout the meeting, Dr. Hudis commented in the interview. "We need to identify the interventions that are higher and lower value across all of cancer medicine, and start to shepherd our resources even more efficiently. I think this is an important goal, and this is not something that any one stakeholder can do in isolation. It's going to require collaboration and input from everybody."

This is not just cost of therapy, Dr. Hudis emphasized. That is too simplistic, he said. "Value is much more complex, and acknowledges that expensive therapies can be cost-saving when understood in context."

"Price and cost are not the only issue here. Value is different. It has to do with the benefits of therapy, the alternatives to the choice, the broader impact on the healthcare system, the family, and the workplace. This is something that we have to grapple with in its broadest sense," he said.

"This is new for this meeting, and it's new in oncology, at least in the United States, to be discussing value in this way," he said.

As previously reported by Medscape Medical News, ASCO is currently developing a working definition of value that is specific to oncology, and the Value in Cancer Care Task Force is working on an algorithm that will help oncologists determine the value of different cancer treatments.

Medscape for News and Views From the Meeting

The Medscape team will be providing full coverage of the ASCO meeting, in news reports and video recordings, and also, in a new feature for this year, there will be a live blog from the meeting, giving immediate updates, and also views from a practicing oncologist.

A special feature to commemorate the fiftieth anniversary of the society will be Medscape's Presidential Perspective, a video discussion with 5 past presidents of ASCO, where they will review the practice of oncology over the past half-century.

Medscape will also have a booth in the exhibition hall (booth 14153). Please stop by and take a look at the news we are reporting from the meeting as it posts.


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