COMMENTARY

ESMO Preview: Precision Medicine and Picasso

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci

Disclosures

September 22, 2014

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Hello. I am David Kerr, Professor of Cancer Medicine at University of Oxford in the United Kingdom and past President of the European Society for Medical Oncology (ESMO). I mention that because it is that time of year again, and I am particularly delighted, on behalf of ESMO and myself, to welcome the 15,000 or so oncologists from around the world who will be attending the ESMO meeting in Madrid next week. Our current President, Rolf A. Stahel, MD, ably supported by Scientific Chair Johann de Bono, MBChB, PhD, MSc, from London, has put together a great program. I believe this program will be full of knowledge and wisdom, and I hope it will also include elements that change practice. I look forward to what is usually a packed program in a wonderful setting, Madrid.

Madrid is a great setting for two reasons. I have always been a strong advocate and admirer of the quality of Spanish oncology, and Madrid is a wonderful city to visit, a proud city with a fantastic history of art, with the classical paintings of El Greco and Velázquez; and, for those who are interested in modern art, Picasso's famous painting, Guernica, is worth seeing in the wonderful setting of their museum of modern art (Museo Nacional Centro de Arte Reina Sofía), which provides a wonderful fusion of space and the painting itself.

Quest to Improve Progression-Free Survival

Likewise, there will be much to look at from the gastrointestinal point of view. On Saturday morning, there is an excellent session on colorectal cancer; with the first three important studies[1,2,3] quite beautifully related to each other. The programmers have done a really good job of bringing together studies that look at maintenance treatment for advanced colorectal cancer. We have the French and Spanish,[1] coming together to give us an idea about the importance of maintenance treatment with bevacizumab and erlotinib; the German study[2] that looked at bevacizumab following induction chemotherapy with fluoropyrimidine and oxaliplatin; and a large, randomized, phase 2 study[3] that examined the benefits (or lack of benefits) of cetuximab in a maintenance setting.

We look forward to the results of those trials, with the idea that we may be able to continue, prolong, and improve progression-free survival and the quality of the patient's life by omitting or reducing the intensity of the cytotoxic chemotherapy while maintaining treatment in the interim with biological agents.

We will present the QUASAR 2 study,[4] in which we looked at capecitabine plus or minus bevacizumab in the adjuvant setting in 2000 patients. This study is in the adjuvant setting with a very strong translational science element. In fact, one of the threads that is woven throughout the whole meeting is that of personalized medicine and the use of biomarkers to segment, select, and enrich populations of patients who may benefit.

East-West Fusion

Axel Grothey, MD, another great friend and someone who has made a huge contribution to gastrointestinal oncology, will be acting as rapporteur of this session, which ends with two other interesting studies—a sort of East-West fusion, if you will. Eric Van Cutsem, MD, PhD, and colleagues[5] will present results of a European trial in which they used the synthetic fluoropyrimidine TAS-102. This is a drug that was rather successfully developed in Japan as a third-line option for patients who had progressed with conventional 5-fluorouracil and capecitabine. We will see how well that crosses over from East to West.

Finally, a group from the Far East will present the results of regorafenib monotherapy.[6] We know that regorafenib is beneficial in western populations when used as third-line therapy in patients who have progressed through conventional chemotherapy with biologics. Here we have a trial that has taken a concept from the West to the East. We will see if regorafenib fares equally as well in an Asian population.

There will be lots to look out for. It will be a great meeting that, as always, will meld science, translational medicine, and—we hope—clinical practice-changing outcomes. I hope you will join me. If you see me, it would be lovely to say hello, to be able to meet as we pass each other in the concourse at the meeting.

I look forward to seeing you there. As always, Medscapers, ahoy. Take care. Thank you.

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