Many Sermo member physicians were at ASCO this week, The American Society of Clinical Oncology’s Annual Conference. There were more than 31,000 attendees and 5,100 abstracts. We’ve rounded up physician comments about what they saw and what they hope for cancer treatments.
Preventing Gastric Cancer
A paper presented at ASCO by David Graham, MD called for the prevention of nearly all gastric cancers. A GastroEndoNews.com report writes, “nearly all gastric cancers are caused by an H. Pylori infection which causes inflammation and progressive gastric mucosal damage. “ The bacteria damages DNA which leads to tumor growth. The researchers recommend the following treatment:
- Test for H. Pylori noninvasively (e.g. urea breath test) in adults and in children of infected parents.
- Eradicate H. pylori, confirm cure and noninvasively test for gastric atrophy (e.g., serum pepsinogen level, histology or both).
- Assess risk based on serum pepsinogen ratio.
- For pepsinogen I <70 and for pepsinogen I:II <3, perform endoscopy to look for atrophic changes.
- Assess gastric cancer risk according to the Operative Link for Gastritis Assessment (OLGA) staging system.
- For OLGA stages 0 – 2, no follow-up is required; for OLGA stages 3-4, develop a surveillance plan.
Preserving fertility for breast cancer/lymphoma patients
One physician at ASCO wrote about a talk he attended that would help preserve fertility for women undergoing cancer treatment.
“For breast cancer patients, giving goserelin injections, a GNRH agonists, during chemotherapy for pre-menopausal women has a higher chance of preserving fertility or preventing ovarian failure and more suucessful pregnancies vs placebo. I like that at least I have a pharmacologic option to discuss with my very young lymphoma patients.”
Bonuses for Following Guidelines for Cancer Treatments
One private insurer announced plans to bonus physicians $350 if they followed certain pathways for treatment. A paper released at ASCO said currently less than 50 percent of patients follow prescribed pathways.
One oncologist noted, “If only life were so simple that flowcharts could replace training, experience, and wisdom. It would be nice if real life patients fit neatly onto a pathway. In reality some do and some don’t. The diseases are very heterogeneous and so are the patients.”
New Approach for Prostate Cancer Treatment
A new study released at ASCO shifts treatment protocols for prostate cancer patients. One physician reported, “The most influential presentation was clearly the ECOG trial looking at the addition of docetaxel to standard androgen deprivation therapy for men with metastatic hormone sensitive prostate cancer. 790 men were randomized in 1:1 fashion. Docetaxel was only limited to 6 cycles. The unforeseen improvement in median overall survival from 42 to 53 months (11 months improvement) was shocking. Most of the benefit was noted for patients with high volume disease (as defined by visceral metastases and/or 4 or more bone metastases) with a 17 months improvement in median OS (49 months compared to 32 months). The median overall survival was not reached for both arms in the low volume group implicating the need for longer follow up. This will likely be the ONLY standard of care for metastatic castrate sensitive prostate cancer patients deemed fit for chemotherapy and will likely be what I will recommend for the next patient walking through my door. Despite that one should be cautious about the drawbacks. The median follow up was only 29 months, this is part is due to the premature termination of the study at the interim analysis. Another more important drawback is the fact that only 123 pts out of 395 randomized to androgen deprivation only, received docetaxel after disease progression. This potentially questions if the improvement in overall survival would have been lost if more patients received docetaxel on progression.”
Genomics and Personalized Medicine
There was a full day seminar, pre-ASCO entitled, “The Genetics and Genomics for the Practicing Clinician,” attended by one oncologist. He writes about the latest research using genomic sequencing to pinpoint cancer treatments.
“Dr. David Solit from MSKCC [Memorial Sloan-Kettering Cancer Center] addressed how genetic alterations are matched with targeted therapies. Instead of targeting just one tumor type, studies of new targeted agents are being addressed in ‘basket studies’. For example, a phase 2 clinical trial of Neratinib, a new anti-HER 2/EGFR agent involves patients who must have HER2 mutation-positive solid tumors that cannot be cured using standard therapies. These include (but are not limited to) bladder, colorectal, endometrial, gastric/esophageal, and ovarian cancers. This essentially leads to multiple parallel phase 2 studies of the drug in these tumor types. This allows us to address if patients with specific mutations respond to inhibitors and if specific mutant alleles affect response to the drug.”
Genomics was a common subject at ASCO and another physician wrote about a lecture by Dr. Lee Herod. He, “is working with systems biology a company that basically uses engineering/technology and genomics study and is doing lots of basic science research with the goal of P4 medicine, namely Predictive, Preventive, Personalize and Participatory. The presenter clearly separated it from the population-based medicine and sees this as a future of healthcare. One example was a study of 13 proteins that can help distinguish between lung cancers and benign pulmonary nodules irrespective of age, smoking status or size of nodule.”
New Approach to Melanoma
One physician attended a session he considered life-changing for patients. “The biggest news was presented when a phase 1 trial enrolled 411 patients (not a typo), including 200 pts previously treated with Ipilumumab for metastatic Melanoma in a trial of another PD-1 inhibitor, Pembrolizumab or MK-3475 or PEMBRO as it is now called. The complete + partial response rate was 34% ( 40% in the Ipi naive group, and 28% in the pts treated with prior Ipi. The one year survival rate was 70% including 65% for patients previously treated with Ipi. The median survival is not yet reached. Folks, this is HUGE in this disease, because these responses are durable unlike as with the BRAF Inhibitors. An expanded access program has now become available, and I would urge you to consider this for your pts with melanoma. I have used the same drug in an ongoing phase 3 trial in NSCLC and it is extremely well tolerated; none of the Ipi side effects. There is a small risk of pneumonitis and of course rash.”
Oncologists Hope for Better Treatments
One oncologist wrote eloquently about the drive for improved patient outcomes.
“After 19 years in Oncology, I approach every year’s meeting with some degree of anticipation, hope, yet trepidation regarding new findings presented/shared at this meeting. How much of what we hear or learn is something we can use every day in the clinic with our patients; yet how far are we from the holy grail of a cure or even less, “durable long term remissions” for our patients. Every new drug that a pharmaceutical company touts as having a two to three month survival advantage compared to current standards is a small step forward, but so very miniscule in the grand scheme. But I have hope that we are at the very least, changing and hopefully improving our practice paradigms to some degree and in that sense, benefiting our patients in giving them ‘the best quality of life for the longest time possible.’”
There are dozens of comments about ASCO this week, and physicians regularly comment about what they see at conferences. If you’re an M.D. or D.O. please join the conversation, membership is free.
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