ASCO President Talks of 'New Understanding' After Own Cancer

Zosia Chustecka

June 02, 2018

CHICAGO — Addressing a packed hall here at the American Society of Clinical Oncology (ASCO) 2018 annual meeting, the president of ASCO drew long-standing applause after he described the new understanding he now has for patients after his own brush with cancer.

The disclosure came at the end of the presidential address from Bruce Johnson, MD, who is also chief clinical researcher officer at the Dana Farber Cancer Center in Boston, Massachusetts, in which he recapped the rapid progress that has been made in his own specialty, lung cancer.

At the beginning of the new millennium, chemotherapy was the only drug treatment for lung cancer, he recalled. Then came the discovery of oncogenes such as EGFR and ALK, and targeted agents, and in this last decade, "immunotherapy has come of age."

Almost half of all patients with lung cancer can now be treated with targeted agents or immunotherapy, he said, and these new therapies have revolutionized treatment with their milder adverse effect profiles compared with chemotherapy. There is also hope that some of the responses with immunotherapy are durable long-term. "I truly believe that we will be able to cure lung cancer," he said.

To illustrate the talk, Johnson showed video footage of two of his patients with lung cancer talking about their experiences: one who was treated with a targeted agent and another who received immunotherapy.

Then he turned the talk back to himself and his own experience with cancer, which has given him new insights into the feelings of his patients.

Johnson told the audience that his father was diagnosed with prostate cancer in 2006 at age 75. The elder Johnson was treated with hormone therapy and radiation and is now cancer free, celebrating his 86th birthday this year.

With that family history, Johnson realized he was at high risk for prostate cancer, but recalled how he felt he was in a dilemma over whether to have a prostate specific antigen (PSA) test, and when. Guidance on this issue has been evolving, he pointed out.

In recent years, the recommendation about PSA screening from the US Preventative Services Task Force (USPSTF) changed several times, going from an "I" recommendation in 2008, when the task force concluded there was insufficient evidence to recommend screening, to a "D" recommendation against routine screening in 2012, and then to a "C" recommendation in 2018. The most recent guidance is that screening is an individual decision for the man to make, together with his own physicians.

PSA Test, Results, and Next Steps

Johnson said that after discussion with his internist, he decided to have a PSA test in November 2010, when he was 57 years old. The value was 2.7, which was on the upper level of normal.

However, a subsequent PSA test on March 15, 2012, showed an elevated level (9.68), and it had risen even higher when the test was repeated 2 weeks later (10.69).

This was followed by weeks of waiting for a prostate biopsy, carried out in May 2012, and then a wait of a month to hear the result.

The biopsy showed cancer in two of the six cores that were biopsied.

He decided to undergo surgery on June 28, 2012.

"Altogether, there was a 3-month period between the PSA test showing raised levels and my surgery...and during that time, it was a challenge to focus on my duties while having this uncertainty," he recalled.

Johnson told the audience how he had carried on seeing patients and writing academic papers and applying for research grants while this new knowledge that he had cancer was always at the back of his mind.

That uncertainty hasn't gone away.

His prostate cancer was stage 2, which he joked with the audience full of oncologists, "we all know is neither the best nor the worst."

"So I continue to live with uncertainty," he said. He is now 6 years postsurgery, and so far, so good.

In those last 6 years, he has seen many lifetime milestones: he saw both his son and his daughter get married and became a grandfather for the first time when his son had a son. As he was speaking, he was waiting for news about another grandchild: his daughter had gone into labor at 7 am that morning.

He was also elected to be president of ASCO, and took over the position at last year's annual meeting. "This is the greatest honor of my life, to be standing here before you," he said to tremendous applause.

As he recapped again the progress made in cancer treatments in the last few years, he emphasized the personal insights into the anxiety that comes with a cancer diagnosis: "We must go beyond selecting appropriate therapies for our patients," he told the audience of fellow oncologists and healthcare professionals. "We must look after their psychological needs as well."

American Society of Clinical Oncology (ASCO) 2018: Presidential Address. Presented June 2, 2018.

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