ASCO Day 1: Large Numbers of Small Steps

ASCO at McCormick PlaceThere are rare years when progress in science and medicine is measured in leaps and bounds and far more years when it is measured in feet and inches.

The consensus this year, as determined by the revelations at the annual meeting of the American Society of Clinical Oncology, is that the cancer field has moved forward in real and significant ways, but that progress will be described as a large number of relatively short steps.

The initial press briefing, held this morning, focused on six studies involving melanoma, ovarian cancer, colorectal cancer and HPV transmission. They concentrated on advanced cancers that are resistant to traditional therapies. The presentations tend to include phrases like “extends disease-free survival by an average of 5.6 months, compared to placebo.”

Arguably, the biggest advance presented today came in uveal melanoma, a rare cancer of the eye, described as “one of the most difficult cancers to treat.”

This is orphan disease, with about 2,000 cases a year in the U.S.- but half of them progress to metastatic disease. There has been no effective systemic therapy.

The study, from Memorial Sloan-Kettering Cancer Center, but including the University of Chicago, compared two drugs that target a specific molecular pathway (MAPK) that drives this cancer.

Both helped–the first real advance for these patients. About half of the 90 patients experienced tumor shrinkage. Time to disease progression, unfortunately, was measured in weeks.

Another metastatic melanoma study, from Dana Farber, combined two immunotherapies, GMCSF and ipilimumab. Some patients got one, some got the other, and some got both.

The combination was the most effective: almost 70 percent of patients who received both drugs were still alive one year later, compared to just over 50 percent who received ipilimumab alone.

Also encouraging, patients who received the combination had fewer side effects – a rare case where adding more drugs improved both efficacy and safety.

With roughly 5,000 abstracts, hundreds of data-heavy presentations and 30,000 or so participants at the meeting, the numbers can become overwhelming.

It was a relief to hear a brief nod to the humanity underlying this massive gathering. In summing up some of the gains reported at the press session, commentator Richard Goldberg, MD, dropped in what seemed at first like a throwaway line, but what was an ultimately telling sentiment.

“Within the data,” he said, “there are many stories we have yet to understand.”

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