As in years past, the trip home from the Annual Meeting of the American Society of Clinical Oncology in Chicago gives me a moment to reflect on what I have heard and hopefully learned over the past five days.
This meeting is a whirlwind of activity and information, far too much for any one person to absorb and process. You can be focused on one topic, you can be general, and you can hear new cutting edge research or be educated on topics of general interest in cancer. You can go to the exhibit hall and be overwhelmed by the booths and displays (I tend not to go there, but obviously many others do). I suspect you get the idea.
Ultimately for me it is the take away messages about trends in cancer research and cancer care that matter the most personally. And this year the trends appear to be somewhat similar to past years, with perhaps some new wrinkles. What is undeniable is that if immunotherapy is the queen at the ball, then "panomics" (I really like that word) holds the keys to the kingdom.
As I started with last week, the cost of drugs is on the minds of many. With new drugs seeking approval from the Food and Drug Administration and a pipeline filled with new opportunities, there is no question that we are going to have to find ways to make this system sustainable for patients, physicians, researchers and pharmaceutical companies. But the costs are going to go up, of which there is little doubt. And considerable uncertainty exists as to how we are going to deal with that.
Social media also had a coming out party of sorts at this year's meeting. Twitter and blogs have always been part of the "scene", but ASCO 2014 featured scientific presentations on how social media is fitting in to cancer care. Much of the work is anecdotal, but there is a developing body of research. The general consensus is that apps and other technologies have so far not made as much of an impact in cancer as they have in other diseases. One interesting observation by Robert S. Miller (https://twitter.com/rsm2800) is that patients are actually helping to sway other patients into or out of clinical trials using social communication (an example of which was one patient messaging another that they obviously got the placebo and not the new drug since their pill didn't taste bitter). If that movement takes hold, it could actually impact the results of new drug trials.
As always, there was the media buzz on a select number of trials presented at the meeting. In no small part, that buzz is directed by the conference organizers who preselect papers for special media attention, and offer news conferences and expert commentary to the assembled reporters from around the world. This year much of that buzz was directed to a variety of approaches relying on immunotherapy.
There is little question that we have entered an exciting new era when it comes to cancer treatment. As was the case last year, immunotherapy led the way. Updates on prior studies, presentations on new studies, and an expansion of the application to other disease states--especially lung cancer--garnered a lot of attention. The results of clinical trials using "checkpoint" drugs in melanoma continue to impress many experts. The response rates are reasonable--including patients who received prior treatments--and they are meaningful, which means they make a significant difference in survival for patients where those patients previously had little hope. The side effects for the newer drugs are modest, especially when compared to some of the other drugs we use to treat the disease. And in one brief exchange following a presentation on Tuesday there were unedited, unanticipated comments that even patients with advanced ocular melanoma--a disease where little hope existed for patients whose cancer spread beyond the eye--are responding to some of these new immunomodulating agents.
What really stood out to me was the fact that these immunotherapy drugs are now showing benefit even in cancers where there has been little to offer until now. Kidney cancer, pancreatic cancer, lung cancer, esophagogastric, and head and neck cancers among others are showing responses in early phase trials. Some of these are surprising to many doctors and researchers since those cancers weren't thought to be "immune responsive." But the heck with predictions: if they work, they work. Let's find out more as quickly as we can.
One immunotherapy trial that got media attention was the use of adoptive immunotherapy--namely using the body's stimulated or focused immune white blood cells--to attack cervical cancer where heretofor there was almost no hope for those with very advanced disease. Incredible responses in two patients with cervical cancer became big news. Somewhat lost in the messaging was how complex and difficult this treatment can be. It requires significant focus of researchers, doctors and money to make this work. It is fascinating, it has been successful, but it is a long way from being generally available at a hospital near you.
Genomics was not far behind in the research and information race. Presentation after presentation confirmed that we are headed far beyond understanding the cancer gene. Now we have "panomics", meaning it's not just the gene but the way that gene translates the cancer cell into its environment. Genomics, proteomics, metabolomics, whatever. There is a lot to learn about how all of this works together to influence the behavior of cancer. And clearly it is no longer 100 or 200 cancers, but many different variants. As one researcher said, every cancer in the future will be a rare cancer with its own distinguishing characteristics.
Then there is always the little bit of humor you find if you look for it, like the sign that once again told doctors from Vermont they couldn't have the free coffee. The best new thing I could find this trip was a sign guiding attendees to convention center restaurants "right and outside" showing the way to the Kosher Express--which was right next to Robinson's Ribs. That made me wonder whether the kosher kitchen was serving Robinson's Ribs, which I guess is not beyond possibility if they were kosher beef ribs--but I suspect not. I also wondered whether this was a bit of ecumenicism or a statement of political principle ("to the right) or if these two restaurants were being banished to some remote location. But to my dismay, unfortunately there wasn't much else to provide unintended humor at this year's meeting. (Unfortunately, because of technical problems with the blog I am not able to show you the picture but I have provided a link to it on Twitter.)
Ultimately, there is no way to summarize all the sights, sounds, information and trends from this meeting. Others are better equipped than I to do that. But what I always reflect on is the fact that today's marvel may be tomorrow's unfulfilled dream. Maybe I am just that way, maybe I have seen it too often. The new immunotherapy drugs appear to be the real deal, and we all hope and pray that is the case. But then you hear a researcher comment about the fact that one of the new immunomodulating drugs designed to reawaken the body's immune fighting cells actually destroyed them--literally. That may be the only comment of real concern that I heard, but that doesn't mean something else could not be in store in the future as we gain more experience with this formidable cancer treatment. Let's hope that is not the case.
So we pack our bags, get on the planes, and head to home wherever that may be in the world. We will reassemble again next year for another round of presentations and media events. In the meantime, we digest what we have heard, reformulate some of our approaches as to how we approach this terrible disease we call cancer, and ask for blessings on the work of those who make all of these advances possible giving hope to so many.