David Graham, MD

Disclosures

June 29, 2015

Was the American Society of Clinical Oncology (ASCO) 2015 annual meeting practice-changing?

Reflecting on the Chicago 2015 meeting, there were a few things that I think were important to take back to my practice. Some of these are clinical, but there was also a very important procedural lesson to put into play.

Scientifically, and likely as much financially, there was tremendous interest in the various immunotherapies. As an aside, how many national medical meetings does CNBC broadcast live from? There was some of that in the genitourinary (GU) presentations as well, but that is not what I will use day to day—yet.

The first change that will be taking hold in the GU field pertains to when docetaxel will be used in the therapy for recurrent or metastatic prostate cancer. Research presented at the 2014 ASCO annual meeting demonstrated the benefit of adding docetaxel to androgen deprivation therapy in men with high-volume metastatic disease.[1]

At this year's meeting, the results of the STAMPEDE trial were presented, showing that adding docetaxel up front with androgen deprivation therapy was useful in men with metastatic disease, positive nodes, or very high-risk node-negative disease.[2] After the trials presented over the past 2 years, there is little doubt that docetaxel should have a very real role in up-front therapy for prostate cancer. We do not know that it has a role in biochemical-only recurrence at this point, however.

There were certainly two very interesting immunotherapy trials presented in urothelial cancer.[3,4] Neither of these drugs will be used anytime soon, however. The costs are very high and more robust data will probably be required prior to any approvals. What didn't get the same level of attention but will more likely be something available to use now is eribulin (Halaven®).[5] Response rates for this tubulin inhibitor were 34.7%, a figure that compared favorably to the immunotherapy reports. This is an agent that I will be much more likely to have access to now.

The procedural change that I have already taken back to my institution comes from a poster presented by Dr Natalie Cook and colleagues[6] of Princess Margaret Hospital. They looked at the use of email by cancer patients and physicians. Many of the findings were not much of a surprise. What was a surprise was that a review of the charts after email communications revealed that only 9% of those communications were documented. I have already taken these findings back to the Health Information Technology committee at my home institution/network. These findings certainly lend credence to the use of patient messaging portals present in many of the EMRs available. I know many physicians fear an onslaught of messages should these be more widely implemented. Discussions I have had with physicians at institutions where these are in place would tend to argue that this is not as likely as many would expect.

I left the meeting with a real sense of hope and optimism for what the future of cancer care holds. Along with that, however, I also came home with tools to use today. To my mind, that is the best mix of all.

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