ASCO Day 3: More Mutations, Fewer Drugs

ASCOSince this is UChicago Cancer Conversations we will lead off today with a very Chicago project. At 8:15 this morning, Jane Churpek, MD, assistant professor of medicine at the University of Chicago, presented surprising new data on the frequencies of mutations in cancer susceptibility genes in African Americans to a large group of cancer specialists. She then scurried the length of the McCormick Place complex just in time to give a similar talk at the daily press briefing.

She found that more than 20 percent of the African-American women with breast cancer seen in the medical center’s cancer-risk clinic—most of them from the Chicago area—had inherited mutations in at least one of the 18 known breast cancer susceptibility genes. A description of the study is posted here. News accounts can be found here, here and here.

African-Americans are an understudied, under counseled and undertreated group in the world of cancer. Of note, only one of the 75 people in the media-briefing audience appeared to be African-American.

Two other studies presented at the daily press briefing focused on refinements of current breast cancer treatments. A team from the Cleveland Clinic found that low dose paclitaxel, better known as Taxol, produced comparable treatment effects but with fewer side effects than the standard higher dose given every two weeks.

The other study looked at extending radiation therapy to the axillary area, in place of lymph-node surgery, could reduce the frequency of lymphedema by half without affecting disease-free or overall survival.

Session moderator, Andrew Seidman, MD, ASCO spokesperson and breast cancer expert, praised both studies. “These results,” he said, “will motivate many doctors, including myself, to use weekly dosing.” He also added that he would encourage the radiotherapist at his institution to consider axillary therapy.

Another study featured a novel drug type, heat shock proteins (Hsp), also known as chaperones. This class of proteins helps other newly formed proteins take on the proper shape.

Several proteins involved in lung cancer, such as EGFR and ALK, require a chaperone known as Hsp90. By adding a drug, known as ganetespib, that inhibits Hsp90 to a standard drug, docetaxel, researchers from Emory were able to extend life for patients with advanced lung adenocarcinoma by about two months. That went up to four months for patients who had been diagnosed at least six months prior to treatment.

The press briefing also showcased two surveys of the consequences of the persistent shortage of cancer drugs. Researchers from the University of Pennsylvania received survey responses from 250 oncologists, most of whom had encountered shortages.

They were concerned that lack of access to certain old-standby drugs that were now hard to get could impact care, but they had no data on the clinical effects of the shortages.

What was clear was that this shift away from the standard, less costly generic drugs to newer, more expensive branded drugs was driving up the cost of care. Richard Schilsky, MD, formerly of the University of Chicago and now CMO of ASCO, said that a comparable survey of all ASCO members had produced similar results.

He also described an ongoing shortage of patient-support medications, such as IV therapies to reduce pain or nausea. “Most doctors,” Schilsky said, “are now living with the shortage.”

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