I’ve just been to ASCO in Chicago, along with 34,000 other people, and it’s the usual marketplace.
A lot of good data this year but what people mostly use ASCO for is networking, getting jobs, audit committees, clinical trials planning committees and so on and that was happening all the time all over the place.
So the take-home top-liners from ASCO are three or four in number. Richard Schilsky, the Chief Medical Officer of ASCO, put a randomised trial of multiple myeloma up in top place and he was underlining daratumumab plus bortezomib and dexamethasone.
The partial response rate was 29% going up to 59% with the addition of daratumumab and the complete remission rate, this is in multiple myeloma, went from 9% to 19%. So, that’s impressive and that was his choice for the take-home message.
Then there was breast cancer, and it looks as if the story of Tamoxifen over five years versus Tamoxifen over ten years in oestrogen receptor positive breast cancer has been repeated now with letrozole.
So, letrozole for ten years is better than letrozole for five years.
Duration of treatment was also highlighted in radiation therapy for prostate cancer; it looks as if taking the standard course of eight weeks radiotherapy and contracting that into four weeks is just as good and, in fact, might even be better.
Then we saw a supplementary study for brain cancer; on temozolomide added to radiation therapy for anaplastic glioblastomas.
We’ve known for a while that temozolomide (although it wasn’t designed as such) is a radiosensitizing drug and adjuvant temozolomide after radiation therapy does seem to improve the long-term outcome from 44% up to 56% at five years, so that’s all good news.
We should also cover pancreatic cancer, for which there’s often so little to do.
A randomised study of gemcitabine plus capecitabine versus gemcitabine for advanced pancreatic cancer showed five year survival as 29% for the combination and 16% for the single agent.
Now, a couple of interesting studies on antibody drug complexes or ADCs; in small cell lung cancer there was really impressive performance by rovalpituzumab tesirine (Rova-T).
This, of course, is a dreadfully difficult disease to manage after the usual quick disappearance of cancer and the equally quick reappearance.
The interesting thing about this, apart from the ADC, was that there was a good marker called DLL3.
I spent a long time in the Netherlands between 1979 and 1989 working on intraperitoneal chemotherapy for minimal residual disease and adjuvant treatment of ovarian cancer.
It’s notoriously difficult to produce cures in that disease and intraperitoneal chemotherapy was really quite cumbersome and quite toxic.
However, we had complete remissions in patients who had progressed on the same drug given IV; mostly cisplatin.
Now it seems that some of the problems have been resolved with the use of carboplatin instead of cisplatin and a randomised trial of carbo IV and IP seems to be superior to just IV carboplatin.
It was also reported that increasing the number of stem cell transplants in neuroblastoma gave a clear improvement over neuroblastoma patients who are only treated with one stem cell transplant.
Personalised medicine, precision medicine - whatever you want to call it - has been tested in a lot of places and some of the results have been really quite disappointing.
We start with a whole batch of cancers with difficult to find mutations and then find the mutations don’t fit the drugs.
However, this time there was a really nice paper on a study of 129 patients with 12 different cancers and in 29 of them there was clinical response to trial drugs which have not yet been approved by the FDA.
So I thought that was giving some hope that we might be going down the right road.
Not the same huge harvest of PD-L1 and PD-L2 drugs, the immuno-oncology drugs, as with last year but there was a new tumour type shown to be responding: atezolizumab for bladder cancer.
We also saw a couple of interesting reports about doing away with repetitive tissue biopsies.
A huge study of 50 cancers and 15,000 patients was presented where liquid biopsy was compared to tissue biopsy.
Interestingly there was a good match - almost 90% - with the mutations in the liquid biopsy samples and the tissue biopsy which is good news for testing new drugs to quickly find out whether they’re targeting properly or not.
Then there was an interesting observation which a lot of surgeons are kicking themselves about: Patients who have got cancer of the colon on the right side do much worse than patients who have got cancer of the colon on the left hand side.
No more to say about that, just be aware of it.
Then lastly I thought a really nice bit of new technology, namely an app for patients who have got non-small cell lung cancer to report their symptoms, post-treatment symptoms, side effects, etc.
Just using this app alone in a randomised trial showed that the survival of these non-small cell lung cancer patients went up from 12 months median survival to 19 months; by being able to use the app to alert the caring doctor and nurse and supportive team of problems meant that early intervention prolonged life by 7 months.
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