1. DiGiulio, Sarah

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The American Society of Clinical Oncology's new President, Sandra M. Swain, MD, said the words "energy" and "excitement" described this year's Chicago meeting-the depth and quantity of research speak to the progress that has been made, but also set the tone for the changing oncology care landscape.

ASCO 201213 Presiden... - Click to enlarge in new windowASCO 2012-13 President SANDRA M. SWAIN, MD, Professor of Medicine at Georgetown University and Adjunct Professor of Medicine at Uniformed Services Health Science Center; and Medical Director of George Washington University GW Cancer Institute

"ASCO's annual meeting is really the premier scientific oncology event in the world-and this year was no exception," she said in a telephone interview about two weeks after the end of the meeting. "There was a lot of energy about this time in oncology, the era of precision medicine."


Some of the most exciting advances, she said, were in targeted therapies for melanoma, non-small cell lung, breast, and renal cancers; in finding genetic biomarkers; and in quality-of-care research. Overall, about 10 percent more abstracts were submitted this year compared with last year-5,260 in total.


"The increase in the volume of the abstracts suggests that our investment in research is paying off," she said. "When I started in oncology more than 20 years ago, we had just a few drugs, which were very non-specific. But now, it's really blossoming-understanding all of these mutations and identifying new precisely targeted approaches to combat the cancer-it's very exciting."


Swain said she considered the following abstracts reported at the meeting to be the most noteworthy from her point of view.


In Targeted Therapies[horizontal ellipsis]


* Phase III trial results presented during the plenary session found a significant improvement in progression-free survival for HER2-positive metastatic breast cancer patients treated with trastuzumab emtansine (T-DM1)-an antibody conjugate that binds to HER2 on the cancer cell and delivers chemotherapy only to that cell-versus patients treated with capecitabine and lapatinib (Abstract LBA1;see news article on p. 26). "This is basically a 'super-Herceptin,'" she said. "It is not only really effective in treating the cancer cell-it has very limited side effects."


* In melanoma, phase I/II trials showed the combination of the oral BRAF inhibitor dabrafenib and the oral MEK 1/2 inhibitor trametinib (proven effective for BRAF-mutant cancer cells in preclinical trials) caused fewer MEKi-related rash and BRAFi-induced hyperproliferative skin lesions compared with single agents (Abstract 8510). "Those two together are very exciting," Swain said. "The combination was very effective in melanoma, and actually decreased the bad side effects of the BRAF inhibitors."


* Results from clinical trials of anti-PD1 (BMS-936558, MDX-1106) in advanced non-small-cell lung cancer patients showed the targeted immune therapy blocks the PD1 pathway, a receptor on the t-cells, breaking the immune response to the cancer and reactivating the immune system, she explained (Abstract 7509). "There was efficacy in non-small cell lung cancer-which is really significant because you rarely get that response rate with standard chemotherapy."


In Tumor Biology[horizontal ellipsis]


* A multicenter study in Germany analyzed more than 2,000 non-small cell lung cancer samples, and in 40 percent of the patients found genetic mutations that could be targeted with available therapies. The authors concluded that high-quality molecular diagnostics and identification of patients for targeted treatment approaches are feasible and effective for NSCLC (Abstract CRA10529). "This is another indication that the molecular techniques are going to give us more actionable therapies," Swain said.


In Quality-of-Care Research and Other Treatment Standard Recommendations[horizontal ellipsis]


* Olanzapine was significantly more effective in treating breakthrough CINV for patients receiving highly emetogenic chemotherapy (Abstract 9064; OT 6/25/12 issue).


* Phase III trial results (presented during the plenary session) found progression-free survival benefits and improved tolerability of bendamustine plus rituximab versus CHOP plus rituximab in first-line treatment in patients with indolent and mantle cell lymphomas (Abstract 3)-significant because bendamustine is associated with fewer side effects (like neuropathy, hair loss, and infection) than with CHOP, she said.


* The fourth of the four plenary studies reported continuous androgen-deprivation therapy showed survival advantages for hormone-sensitive metastatic prostate cancer patients with minimal disease over intermittent treatment, and for more extensive disease, there is no preferred treatment (Abstract 4).


Summing up, Swain said the volume of research, along with the specificity of the research in targeted therapies, genetics, and genomics, and precision medicine shows the excitement right now permeating the oncology community. "But, we do have a long way to go so we can really get an understanding of more and more targeted approaches to care-for example in breast cancer, we have great treatments, but we don't necessarily cure patients who have metastatic disease," she said. "So, we definitely need to continue to invest in research."


The Ongoing Agenda

She has chosen "building bridges to conquer cancer" as the theme for her presidential term. "At ASCO, we really bridge the gap in patient care and physician training so that all patients can receive high-quality cancer care," she said.


More specifically she explained that the gaps to bridge result from having an international membership, treating every subspecialty of cancer, and treating patients in all settings (including rural, inner city, developing nations, and academic research institutions). Working together globally is another part of the bridge-"so we can learn from each other," she said.


Other goals during her tenure, she said, are that ASCO:


* increase efforts in mentoring the next generation of oncologists to help avoid a predicted shortage of oncologists;


* address health disparities, both global and national;


* develop collaborative oncology care models to inform current changes in health care reform.



"We need to prepare the oncology work force for the future. It's going to be very different-we do face a rising tide of cancer cases-we have a growing population, an aging population, and there are more survivors [an estimated 13.7 million now in the U.S.]. We trying to learn, be nimble, and change ourselves."