ESMO's New Focus on Cancer Prevention

John Whyte, MD; Fabrice André, MD, PhD


October 04, 2022

This transcript has been edited for clarity.

John Whyte, MD: Welcome, everyone. I'm Dr John Whyte. I'm the chief medical officer at WebMD, and I'm joined today by Fabrice André. He is the chair of the scientific committee at the European Society for Medical Oncology (ESMO), where we are today in Paris, France. Bonjour, Fabrice.

So, remind our viewers: What is ESMO? What does it do? And why is it so important?

Fabrice André, MD, PhD: First ESMO, is a scientific society — a member-based organization with around 25,000 members.

Whyte: Equivalent to ASCO in the United States, correct?

André: It has members worldwide, from all over the world. And it aims at disseminating science, educating. The name is European, so it has some roots in Europe; but it is really a global organization for education, dissemination, and also more and more to generate frameworks for the standards of treatment and the common terminology for healthcare professionals to better care for patients.

Whyte: What are you most excited by at this conference in terms of the innovations that are being discussed?

André: Today we are at ESMO 2022 in Paris, with 28,000 people registered and the vast majority on site, and what has been the editorial line — the tagline — for the scientific committee is "understand the disease to better treat the patient." This is extremely important; all of the educational program is built on this tagline, meaning that we need to understand what are the mechanisms of cancer progression? What are the determinants of outcomes if we want to integrate all the wealth of innovation that is coming?

So, then, what are the new things? In the Presidential Symposium, where we usually have the very new things, we will have very important presentations on the role of pollution on cancer and the biological mechanism that induces cancer. Why is it important? First, it has impact on public health. But also, it's important because, for us, it's raising the signal that the oncology community must start to invest in this field of prevention.

Whyte: I was at your booth, by the way, the ESMO booth here, and you have two bicycles, which impressed me. Nobody was on them, I might point out, but the focus was on prevention. But let's also address how historically, the academic community, the scientific community hasn't really been focused on prevention. It's about treatment. So it's fascinating that you're talking about prevention, because usually we talk about precision medicine, right? We talk about checkpoint inhibitors; we talk about immunomodulators. And here you're saying, "Hey, John, we need to understand how we prevent cancer," which is really a misnomer in a way, because there are many different diseases. Would you agree with that?

André: I fully agree with you. But what is the premise we are trying to address here? The premise is that prevention has always been very low in the agenda of international conferences. And we think we want to give the signal that it's really time now that clinical infrastructure, hospitals, invest in this field, create teams dedicated to prevention, new structures for prevention. Why? Because we are discovering step by step that it could be that some drugs we use for patients with cancer could also be developed in the field of prevention. And for this, we need the oncologists. So, more and more, our conviction is that it is the oncology community that will transform the field of prevention, and we need to invest now. Having said that, we have two very important abstracts on this question. The other one is about early cancer detection. But of course, we have our traditional session on immunotherapeutics, precision medicine, and all the wealth of randomized trials. And so in this field, for patients with cancer, what is the new information?

Whyte: We have this whole continuum. So you talk about prevention — how much cancer is preventable? 80%? 70%? What do you estimate?

André: You know, I'm also a scientist. So as a scientist, I will say that there is no limit for this question. No, the only limit is the knowledge.

Whyte: Well, there is some inherited mutation, so we do know that.

André: We can just go to the current status — what we know now — but I don't see why we would put some limit on how much we can prevent cancer. But indeed, so far, what are the risk factors? Genetics, hereditary cancer, all habits, and we know them. It's about tobacco, alcohol, sun, some sexual behavior, etc., that indeed account. In France, we say that around 40% of cancer could be preventable.

Whyte: More and more, we learn about the issues of gout, other inflammatory diseases; it can have an association, but then we have early screening as well. So, if we're on this continuum, how excited are you by what's happening with liquid biopsies, with other testing? Because if we can get a cancer instead of at 500,000 cells at the time of imaging, at 10 or 50 cells, while there are fragments, that's revolutionary, isn't it?

André: I fully agree with you. We will have an important trial presented during ESMO that is the first prospective trial testing the device called Galleri, a tool for early cancer detection based on ctDNA [circulating tumor DNA] analysis by methylation pattern.

Whyte: General screening of the population or a more tailored population with certain indications? Because right now, most of those have focused on a limited population or are used for patients who already have a cancer, and testing that way — you think it's going to be broader?

André: What this trial is investigating is in participants who do not have cancer, 6000 participants—

Whyte: Pas de tout? No cancer at all?

André: No cancer.

Whyte: No family history?

André: They can have family history, but no detectable cancer — can ctDNA analysis detect cancer? And the answer is, indeed, there is around 1% positivity, and around 40% of them, indeed, had cancer. So why is it important? Because it's really a landmark prospective trial that is telling us that a device based on ctDNA can detect cancer at early stage. Then, how many cancers? What percentage?

Whyte: Which type of cancer?

André: And is it going to have an impact on outcome? And for all the questions, we don't have the answer here. But the answer we have here today is that with this device, done prospectively, you can detect some cancer that would not be detectable without symptoms.

Whyte: It's only going to get better, too.

André: Yeah. So then the next step is improving technology, integrating this technology with other ones we already have, in order to increase the percentage of patients in which we detect cancer at an earlier stage.

Whyte: What about pancreatic cancer, cancers we can't detect through screening? People forget that most cancers cannot be detected through screening, so we need better tools. We do know that there are inherited mutations. Those really aren't preventable in many ways; the goal is to get them early. So then we move to treatments, and you talked about precision medicine. What excites you about what's going on these days at ESMO right now.

André: We have many trials on precision medicine. We will have two randomized trials that investigate two new targets; one is gamma secretase inhibitor. So, it's a first-in-class, first time we even hear about this target at a clinical conference. And the second highly expected trial is a clinical trial in patients with metastatic lung cancer, KRAS mutated, testing sotorasib, which is a KRAS inhibitor, and showing the magnitude of improvement associated with sotorasib. The trial is positive, and it improved PFS [progression-free survival] in these patients. So these are two new targets that are validated at this conference.

Then, if we go on another topic of genomics, there is a question that is extremely important: Can we define patients who present an outlier sensitivity to immunotherapeutics? There will be one trial presented in the Presidential Symposium of immunotherapeutics in patients with colon cancer and microsatellite instability (MSI), showing that a few weeks of immunotherapeutics followed by surgery can cure patients. Why is it important? It's important because we are all facing a shortage in the healthcare workforce. We have fewer nurses, fewer doctors, and we all have issues of sustainability. So, really now is the time to think about precision medicine, how precision medicine, by identifying outlier responders, can decrease the amount of resources we need to cure a patient. And this trial on immunotherapeutics, guided by genomics, is exactly this point: 8 weeks of treatment to cure a patient.

Whyte: Do you think there's going to be a cure for cancer 10 years from now?

André: What I'm convinced of is that, in the 10 years that are coming, we are going step by step; we're going to continue to increase the life expectancy of patients with cancer.

Whyte: And quality of life too, right?

André: Quality of life is a major issue. We had today a keynote on digital medicine and how ePRO [electronic patient-reported outcomes] can help the patient to really decrease the burden of symptoms. Quality of life is, of course, extremely important because of the very high number of patients who are cured of cancer; we need to decrease the burden of symptom in patients.

Whyte: And even though cancer rates are going down in most areas of the world, we still globally have millions of deaths from cancer every year. And sometimes people forget that, because they hear about some of the innovations. But I want to end with this: Are we investing enough in cancer care? Because let's be honest — there are other diseases that we also need to spend time on. Cardiovascular disease is a global burden; infectious disease is a global burden. Are governments, are industries spending enough on cancer research and development?

André: Well, we can always claim for more, no? This is how everyone is trying to be, I think. But the reality is that we are living in a world where we have limited resources. I think what is more important for me is to be sure that any euro or dollar invested in cancer research is well used and generates an impact for patients. That is the most important, I think.

Whyte: And that's why outcomes are so important in this research.

André: My conviction is that we have the tools, meaning the knowledge, the biotechnology, to really go the next step in terms of improving outcomes for patients. And for this, we now need clinical trials and translational research, but the tools, meaning basic science, basic knowledge, biotechnology — the basement for progress is here. We need now to transform this into direct impact for the patient. But I would not like to finish by saying we need more money in the field; what we need are people who can transform one euro, one dollar into concrete and measurable advances.

Whyte: We're going to need more time on another day because I want to ask you about diversity in clinical trials, how important that is. I want to ask you about pediatric cancers; there are a whole bunch of things that I want to talk to you about. So hopefully we'll find more time when we're not at a big international conference such as ESMO. So, Dr Fabrice André, I want to thank you for taking time today.

André: Thank you and have a nice day.

Whyte: Stay tuned for a future discussion with Dr André on more about where we're going in terms of cancer research and development. Thanks for watching, everyone.


European Society for Medical Oncology

American Society of Clinical Oncology

What Is Precision Medicine?

How Immunotherapy for Cancer Works

Galleri® Multi-cancer Early Detection Test

First Positive Phase III Data for a Gamma Secretase Inhibitor in Desmoid Tumours

Sotorasib Improves PFS Versus Docetaxel in Patients With Pre-treated KRAS G12C-Mutated NSCLC

Neoadjuvant Immunotherapy in dMMR Colon Cancer -- A Paradigm Shift?

Can Telehealth Be a Genuine Replacement for Face-to-face Healthcare?

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