The Annual Meeting of the American Society of Clinical Oncology (ASCO) drew almost 30,000 attendees to Chicago earlier this week and showcased the latest advances in cancer clinical care and research on an international stage.
The theme for this year’s 50th anniversary conference, Science and Society, reflects the growing need for stakeholders in oncology (physicians, researchers, the pharmaceutical industry, patients, etc.) to confront the challenges of maximizing benefit to patients while providing value in a rapidly changing health care environment.
Like previous meetings, however, the star of the show was the groundbreaking science presented by some of the preeminent cancer researchers in the world.
And as in the past, University of Chicago Medicine Comprehensive Cancer Center members made a significant impact on the proceedings – chairing scientific sessions, giving seminal oral presentations, or presenting their work in the popular poster sessions.
Here are my top three Hot Topics from the meeting, and specific examples of how our faculty are shaping the dialogue, and ultimately, progress in these areas.
1) THE VALUE OF CANCER CARE
The economics of cancer care, particularly in the face of health care reform, has never been a hotter topic. As discussed in a preview to the ASCO Annual Meeting on the UChicago Cancer Conversations Blog, the conference promised to tackle the complex issues around the rising costs of cancer treatment, detection and prevention. And it certainly delivered.
There were multiple sessions dedicated to cancer economics, and our faculty were featured as thought-leaders.
In an Education Session on “Preparing for an Epidemic: Cancer Care in an Aging Population,” Ya-Chen Tina Shih, PhD, associate professor of medicine, discussed how to maintain accessible and affordable health care for elders amid the rising costs.
This session focused on the recently released report from the Institute of Medicine’s (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population, calling for research and funding for clinical studies in older patients, improving geriatric assessment tools, addressing financial toxicity, and promoting full disclosure of costs and benefits of all treatment options.
Jonas de Souza, MD, assistant professor of medicine, presented a value framework for head and neck cancer treatment in an Education Session on “Value Assessment of Therapeutic Options in Head and Neck Cancer Care.”
In his talk, he argued that in our attempts to personalize medicine, the “person” can be neglected, including the patient’s preferences and functional outcomes, all of which dictate care value.
In a debate-formatted Education Session on “The Value of Cancer Care and the Professional and Ethical Obligations of the Practicing Oncologist,” Daniel Sulmasy, MD, PhD, Killbride-Clinton Professor of Medicine and Ethics, advocated for the oncologist’s priority being the individual patient’s good, rather than their duty to society.
In a lively discussion (and likely one of the only presentations at ASCO not utilizing slides), Sulmasy argued that although population medicine cannot be practiced at the bedside, physicians should strive for “therapeutic parsimony and diagnostic elegance” in clinical decision-making to help control costs.
Rena Conti, PhD, assistant professor of pediatrics, and Blase Polite, MD, assistant professor of medicine, gave talks in an Education Session on “Health Care in America in 2014: Current and Future Implications of the Patient Protection and Affordable Care Act.”
Conti discussed the impact of health care policy on drug development, and Polite addressed the key features of health care reform that impact cancer patients, including Medicaid expansion, health insurance exchanges, essential health benefits and preventive services, premium and cost sharing subsidies, and clinical trial provisions.
Polite is directly addressing many of these issues in his role as chair of the ASCO Government Relations Committee.
A poster presented by Conti described a collaborative project with an investigator from Emory University that verified a statistically significant increase in the launch prices of anticancer drugs over time and addressed the contributors to cancer drug pricing trends.
2) THE PROMISE OF IMMUNOTHERAPY
It is no surprise that the Science Magazine “Breakthrough of 2013” garnered considerable attention at the ASCO Annual Meeting.
Cancer immunotherapy, designed to target tumors by suppressing or enhancing a patient’s immune response, has made remarkable strides in recent years and is apparently not slowing down any time soon.
The immunotherapy sessions were among the most well attended at the conference, and several of our investigators have played critical roles in translating basic immunology research into the clinic.
In a Clinical Science Symposium on Immunobiology and Immunotherapy, Tanguy Seiwert, MD, assistant professor of medicine, described promising early data from a multicenter phase Ib trial of pembrolizumab (formerly known as MK-3475) in head and neck squamous cell carcinoma (HNSCC).
This anti-PD-1 antibody was well tolerated and 51% of patients with both human papillomavirus (HPV)-positive and -negative HNSCC had decreased tumor burden upon treatment.
In another study in which Seiwert was senior author, also presented in a Clinical Science Symposium, a T cell-inflamed phenotype was characterized in one-third to one-half of all head and neck cancers.
This work was performed with Comprehensive Cancer Center colleagues Vassiliki Saloura, MD, Everett Vokes, MD, de Souza, Victoria Villaflor, MD, Justin Kline, MD, Thomas Gajewski, MD, PhD, and Mark Lingen, DDS, PhD.
The reported frequency of the T cell-inflamed phenotype is similar to melanoma, the tumor type where immunotherapy has proven quite successful, and further supports the potential benefit of head and neck cancer to analogous approaches.
Speaking of melanoma, Gajewski was also a collaborator on a phase II, multicenter study of pidilizumab in patients with metastatic melanoma.
This study presented in the Melanoma/Skin Cancer Session showed that the regimen was well tolerated and resulted in promising 12-month survival rates in heavily pretreated patients, despite low response rates overall.
An innovative study presented by MD/PhD student David Binder in the laboratory of Hans Schreiber, MD, PhD, professor of pathology, described a novel approach to eradicate tumors with heat-killed bacteria in combination with adoptive T-cell therapy using preclinical models.
3) USING PHARMACOGENOMICS TO PREDICT DRUG RESPONSES
A major challenge in oncology is the inability to predict which patients will positively respond to particular therapies or develop debilitating toxicities from their treatment.
Pharmacogenomics addresses this challenge by identifying genetic variants that influence an individual’s response to a drug. Although this area of research in oncology has gained much attention recently, there is an emerging need to ensure pharmacogenomic studies are designed and conducted properly and can be translated into cancer clinical practices.
Mark Ratain, MD, Leon O. Jacobson Professor of Medicine, presented on genetic polymorphisms and translation to individualized care for drug dosing and supportive care in an Education Session on “Genetic Predisposition to Survival and Survivorship: How Far Are We from Individualized Therapy?”
Using examples from his work, including CYP2D6 polymorphisms in codeine effectiveness and FGD4 variants in taxane-induced neurotoxicity, he emphasized the importance of appropriate study design and conduct with respect to genotyping, phenotyping, and statistical analysis.
Ratain also collaborated on a genome-wide association study of docetaxel-induced neutropenia in metastatic castration-resistant prostate cancer in the CALGB 90401 trial (Alliance) in addition to an analysis of bevacuzumab and risk of hemorrhage in the same trial, both of which were presented as posters.
In an Education Session on “Pharmacogenomics in the Era of Next-Generation Sequencing,” Peter O’Donnell, MD, assistant professor of medicine, discussed the implementation of pharmacagenomic information into clinical decision-making, particularly focusing on his experience with The 1200 Patients Project.
His work highlighted the value of pre-emptive application of pharmacogenomics data to optimize therapeutic choices, and the overwhelming interest from study physicians and patients in utilizing this type of information.
A study from the Children’s Oncology Group, of which M. Eileen Dolan, PhD, professor of medicine, is an author, was presented identifying two variants associated with increased in vitro cytarabine sensitivity and increased treatment-related mortality in pediatric acute myeloid leukemia.
Importantly, when these findings are validated in independent datasets, these variants could be used to stratify to standard and high-dose cytarabine regimens.
A poster presentation from Manish Sharma, MD, assistant professor of medicine, and Comprehensive Cancer Colleagues Hedy Kindler, MD, Daniel Catenacci, MD, Theodore Karrison, PhD, and Polite, described the tolerability of modified FOLFIRINOX in previously untreated patients with advanced gastrointestinal malignancies associated with specific polymorphisms in the UGT1A1 gene.
Their data that patients with the UGT1A1 *1/*1, *1/*28 and *28/*28 genotypes tolerated different doses of mFOLFIRINOX illustrates the power of pharmacogenomics for optimizing drug dosing.
Additional key areas in which our investigators contributed significantly to the body of work presented at the ASCO Annual Meeting include patient quality of life and survivorship, personalized medicine/targeted therapy advances, and second malignancies.
William Dale, MD, associate professor of medicine, Kenan Onel, MD, PhD, associate professor of pediatrics, Rita Nanda, MD, assistant professor of medicine, Kindler, Vokes, Sonali Smith, MD, associate professor of medicine, Tara Henderson, MD, assistant professor of medicine, Olatoyosi Odenike, MBBS, associate professor of medicine, and Andrew Artz, MD, assistant professor of medicine, were among UChicago faculty invited to give oral presentations or chair scientific sessions.
Additionally, Gini Fleming, MD, professor of medicine, served as chair of the Cancer Education Committee for this year’s Annual Meeting.