Each year in late May, all eyes within the global oncology community start looking toward Chicago, Illinois, as the annual meeting of the American Society of Clinical Oncology (ASCO) unfolds. With nearly 40,000 attendees, this is billed as the largest cancer meeting is the world, and some of the clinical results presented are immediately practice changing.

Indeed, some presentations "will change practice overnight," commented Richard Schilsky, MD, chief medical officer at ASCO and former chief of the Section of Hematology-Oncology at the University of Chicago, speaking to Medscape Medical News ahead of the meeting.  

He highlighted the results from the British BILCAP study (abstract 4006), which show that adjuvant capecitabine (Xeloda, Hoffman-LaRoche) used for 6 months after surgery for biliary tract cancer improved median overall survival by 15 months compared with observation after surgery (51 months vs 36 months).

"Capecitabine is already available and is widely used, and clinicians are comfortable using this drug, and so I expect that these new results will lead to an overnight change in practice," Dr Schilsky commented.

Other results likely to change practice, Dr Schilsky suggested, are those from studies that will be presented during the plenary session on Sunday, June 4. These results are still protected by embargo, but the titles of the talks are posted.

The plenary presentations include the following:

  • The IDEA (International Duration Evaluation of Adjuvant chemotherapy) study comparing 3 and 6 months of oxaliplatin in stage III colorectal cancer (abstract LBA1);

  • The LATITUDE trial in high-risk metastatic hormone-naive prostate cancer, which explores use of abiraterone (Zytiga, Janssen) earlier than is currently used, (ie, first line with androgen deprivation therapy) (abstract LBA3); and

  • The OlympiAD trial of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor olaparib (Lynparza, AstraZeneca) vs chemotherapy for patients with human epidermal growth factor 2–negative metastatic breast cancer and a germline BRCA mutation (abstract LBA4).

Dr Schilsky also highlighted a set of three randomized clinical trials that assess psychological interventions in patients at various stages on their cancer journey:

  • The Conquer Fear study, which tackles clinical levels of fear of cancer recurrence (abstract LBA10000);

  • The CALM (Managing Cancer And Living Meaningfully) study (abstract LBA10001); and

  • A web-based stress management for patients with newly diagnosed cancer (STREAM) (abstract LBA10002).

All of the abstracts can be seen at abstracts.asco.org.

Oncology experts who contribute regularly to Medscape Oncology have also been through the program and have highlighted abstracts that they found interesting for their specialties, including prostate cancer,  melanoma, colorectal cancer, breast cancer,   gynecologic cancers, and lung cancer.

There will also be news on new treatment approaches to mesothelioma, usually resulting from long-term asbestos exposure; this cancer is notoriously difficult to treat and has a very poor prognosis. Results will be reported with two different treatment approaches: immunotherapy with nivolumab and ipilimumab (abstract LBA8507) and nintedanib plus standard chemotherapy with the combination of pemetrexed and cisplatin (abstract 8506).

Surprisingly, that mesothelioma study is one of the only abstracts on immunotherapy in the whole program that has been highlighted by experts.

This is surprising because over the past few years, the ASCO meeting has been dominated by immunotherapy news, with excited researchers reporting results they have never seen before — responses showing tumors "melting away" and survival for many years after one course of therapy in the lucky minority of patients who respond to immunotherapy.

First seen in melanoma, these dramatic responses have now been seen in several other tumor types, including lung, kidney, and bladder cancer. Indeed, ASCO has highlighted immunotherapy as the "clinical cancer advance of the year" for 2 years running in its annual reports for 2016 and 2015.

International Flavor

Although it is the annual meeting of a US organization, the ASCO meeting always has an international flavor to it. That can be explained by a quick look at the registration numbers for last year's meeting. In 2016, the annual meeting had 38,800 registrations, with just over half (52%) from the United States. The top countries represented in the other half of international registrations included Germany, Japan, France, and the United Kingdom, each with more than 1000 delegates, followed by China, Canada, Brazil, Spain, and Switzerland, each with more than 500 delegates.

In addition, there are sessions that shine a light on what is happening elsewhere in the world, such as the ASCO Film Club session "Cancer Is Attacking Africa" and the educational session "Diagnosis and Treatment of Prostate Cancer: What Americans Can Learn From International Oncologists" on Monday, June 5.

Other educational sessions cover a wide range of issues, including the ASCO Town Hall session, "Practice Realities in a Shifting Policy Landscape" and a session titled "Oncologist Resiliency: Cultivating Wellness Skills to Combat Burnout in Oncology."

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