Collective Wisdom: The Future of Patient-Centered Care and Research. This was the theme of the American Society of Clinical Oncology (ASCO) Annual Meeting held in Chicago June 3-7, 2016. Collective wisdom alludes to the innovative team science that is necessary to significantly move the needle in the prevention, diagnosis, and treatment of cancer. This new era of personalized medicine and discovery requires collaboration on the local and global scale – cooperation among academic investigators from a wide array of disciplines, as well as industry, government, and non-profit partners. On the clinical side, individualized patient-centered care requires multidisciplinary teams to take care of patients’ and families’ needs along the entire continuum from diagnosis through survivorship.
At the ASCO Annual Meeting, the largest gathering of oncologists from around the globe, this theme resonated throughout all of the scientific presentations and educational and career-development sessions. It was also central to one of the highlights of the conference – an inspiring address by Vice President Joe Biden to the ASCO community on his Cancer Moonshot Initiative.
“No single oncologist or cancer researcher can find the answer on his or her own,” Biden said. “The good news is, today, oncologists and cancer researchers realize they can’t do it alone, either….What is required today extends beyond any individual discipline, and beyond medicine itself….That requires a change of mindset. It requires a lot more openness – open data, open collaboration and, above all, open minds.”
With this emphasis on open data sharing, it was particularly fitting that Biden’s visit coincided with the launch of the Genomic Data Commons (GDC), a National Cancer Institute-supported platform for access, analysis and sharing of genomics information housed at the University of Chicago. Biden toured the University’s GDC operations center before announcing the project and describing its impact in his remarks at the ASCO Annual Meeting. Although it will continue to grow, the GDC currently contains approximately 4.1 petabytes of data from more than 14,000 anonymized patient samples. These data are derived from some of the largest and most comprehensive cancer genomics datasets, including The Cancer Genome Atlas, and will be provided as open access to cancer researchers everywhere as long as they have obtained proper authorization.
A striking example of the power of big data and teamwork comes from the recipient of the 2016 ASCO Pediatric Oncology Award, Susan Cohn, MD, professor of pediatrics, chief of pediatric hematology/oncology and dean for clinical research. Recognized for her groundbreaking work in neuroblastoma, a tumor type responsible for more deaths than any other pediatric cancer, Cohn’s legacy is centered upon collaboration and analysis of large datasets. As described in the outstanding award lecture she delivered at the ASCO Annual Meeting, Cohn led efforts to foster cooperative multi-institutional trials for this rare pediatric cancer, develop biobanks to facilitate translational research and create an international consortium to create a standardized risk and treatment classification system. Cohn described recent work aimed at compiling neuroblastoma genomics data using some of the same tools, data and expertise used to build the GDC.
“By working together and sharing big data, we will be able to optimize treatment and improve outcomes for neuroblastoma,” said Cohn. She was also named as a Fellow of the American Society of Clinical Oncology (FASCO) for her exemplary volunteer service, dedication, and commitment to ASCO.
In addition to Cohn’s award, two other University of Chicago Medicine Comprehensive Cancer Center members were recognized for their outstanding accomplishments and service at the ASCO Annual Meeting. Phillip Hoffman, MD, professor of medicine, received ASCO’s Excellence in Teaching Award, which recognizes individuals who have inspired and shaped trainees’ practice of cancer medicine. Hoffman has directed medical student programs in hematology/oncology at the University of Chicago Pritzker School of Medicine for more than 35 years, and has been honored as one of the favorite faculty of graduating students an astounding 25 times. Although considered somewhat of a throwback in terms of teaching style, using a blackboard and handouts instead of PowerPoint, Hoffman is a role model to his peers for training the next generation of oncologists.
Gini Fleming, MD, professor of medicine, was also a recipient of the FASCO distinction. This distinction recognized Fleming’s extraordinary service to ASCO and the oncology community, including her commitment to national cooperative clinical trials in oncology and cancer education.
On a scientific level, tumor immunotherapy and immunobiology took center stage once again. Thomas Gajewski, MD, PhD, professor of medicine, discussed select presentations at the conference focused on rational combinations of programmed death (PD)-1/programmed death-ligand 1 (PD-L1) immunotherapies, two immune checkpoint inhibitors. Not only did he put the largely promising data into context, he also stressed that these combinations generally had acceptable toxicity profiles but it was early to truly know how effective and long-lasting they were. Studies from his own laboratory underscored the importance and progress in developing biomarkers that can help predict responsiveness to immunotherapies.
Jason Luke, MD, assistant professor of medicine, presented data from a collaborative study with Gajewski on deciphering the mechanisms of immune exclusion in some cancers, in the hopes of converting those without immune cells to being infiltrated with antitumor immune cells. The team’s findings indicate that a specific signaling pathway (i.e., the Wnt/beta-catenin network) is activated in tumors that do not have an inflamed signature, and they identified the mode of pathway activation in most tumors, including mutations in the gene encoding beta-catenin itself. A related poster on molecular characterization of immune exclusion in small-cell lung cancer from the team and including Everett Vokes, MD, John E. Ultmann Professor of Medicine and Radiation and Chair of the Department of Medicine, was presented by fellow Sope Omowale Olugbile, MD.
Luke also moderated a session on making the best treatment choices in metastatic melanoma, highlighting the tremendous progress made in this deadly disease because of advancements in immune-based and targeted therapies. He also discussed current challenges in deciding which modality should be first-line therapy in these patients. Justin Kline, MD, assistant professor of medicine, described basic principles of tumor immunology in a pre-meeting education program on integrating tumor immunotherapy into clinical practice.
In clinical research, Tanguy Seiwert, MD, associate professor of medicine, described the multicenter phase III KESTREL trial of combination immune checkpoint inhibitors compared to the standard of care in recurrent or metastatic head and neck squamous cell carcinoma. Hedy Kindler presented results from the global ph IIb DETERMINE trial of the checkpoint inhibitor tremelimumab as a second- or third-line therapy in unresectable malignant mesothelioma, which did not achieve an increase in overall survival.
Gajewski, Luke and other nationally recognized tumor immunologists and clinicians took collaboration to new heights – musical heights. These rock stars, and their band “The Checkpoints,” took their act to the House of Blues stage on Sunday June 5, raising research funds for the Society for Immunotherapy of Cancer.
Another hot topic at the ASCO Annual Meeting was the value of cancer care. In fact, the plenary session, which features the top scientific presentations, included additional perspectives about the value of the reported findings in terms of cost vs. benefit. There was a pre-meeting education program focused on the economics of cancer care in which Rena Conti, PhD, assistant professor of pediatrics, played a central role. Not only was she on the planning committee, but she was chair/moderator of a session on innovative cancer care models in practice, moderated a Medicare Access and CHIP Reauthorization Act (MACRA) panel discussion, and spoke on outpatient consolidation and its effects on prices and quality. Conti also led a poster discussion session on value in drug cost.
Other presentations from UChicago faculty in this area included Blase Polite, MD, associate professor of medicine, who discussed pathways in payment reform and the merit-based incentive payment system and alternative payment models. Fabrice Smieliauskas, PhD, assistant professor of public health sciences presented his work on state-mandated insurance benefits and off-label use of cancer drugs, and Jonas de Souza, MD, assistant professor of medicine, discussed managing patient and provider financial toxicity.
In sum, UChicago investigators and trainees had more than 50 presentations at the Annual Meeting, illustrating the outstanding leadership and scholarship they demonstrate in a broad range of fields within oncology. Here is a complete listing of these presentations.