So here we are again ― it's late May, and once again we are caught up in the buildup to the American Society of Clinical Oncology (ASCO) annual meeting

Chicago is hosting the meeting for the sixth year in a row, and more than 25,000 oncology professionals from around the world are expected to descend in the city for what ASCO president Peter Paul Yu, MD, describes as "the premier scientific meeting for clinical and translational oncology."

This year's theme is Innovation and Illumination ― Transforming Data Into Learning.

This is key, Dr Yu told journalists in a premeeting presscast. Noting the progress that has already been achieved with decades of clinical data, resulting in hard-won knowledge that can improve the treatment and care of our patients, he said, "The key to even greater, more rapid progress lies within these data and our ability to transform it into knowledge."

"By sharing data, we can accelerate learning and make faster strides against cancer," he said.

The annual meeting is a great place to exchanging ideas and learning, but it takes place just once a year. "Just imagine if this wealth of data could be transformed into learning in real time throughout the year," Dr Yu said. "This is where we are heading in oncology...."

Many Abstracts Already Released

The media buildup to the meeting is already intense. Most of the 5000 abstracts to be presented at the meeting have already been released online, and there has been an avalanche of press releases and notes from investors eyeing up new therapies in pharmaceutical R&D pipelines.

However, key abstracts from plenary and other sessions will not be released until the meeting is under way. The meeting takes place from May 29 to June 2.

There continues to be a buzz about immunotherapy, and particularly the programmed death (PD) inhibitors, such as nivolumab (Opdivo, Bristol-Myers Squibb Company) and pembrolizumab (Keytruda, Merck & Co, Inc). Both these drugs have already been launched, but there are similar drugs coming through the pipeline, including MPDL3280A (Genentech/Roche), MEDI4736 and MED10680 (Medimmune Inc), avelumab (Merck Serono), pidilizumab (CureTech), and others.

Although the first evidence of clinical benefit of these agents was seen in melanoma, many other tumor types have now been shown to also respond to this immunotherapy approach. Among the data that will be released on Friday, May 29, are results from early clinical trials in advanced liver disease with nivolumab (abstract LBA100) and in head and neck cancer with pembrolizumab (abstract LBA6008).

In addition, details from a phase 3 trial of nivolumab in non–small cell lung cancer (abstract LBA109) will be released on May 29. There will be a lot of interest in these clinical data, because they have already had a huge impact. The manufacturer released the topline result in January 2015, announcing that the immunotherapy produced a significant improvement in overall survival when it was compared with chemotherapy as a second-line therapy, and these results led to the FDA approval of the first immunotherapy for lung cancer in March 2015 (3 months ahead of schedule).

The approval was warmly welcomed by lung cancer experts ― David Carbone, MD, PhD, director of the James Thoracic Center at the Ohio State University, in Columbus, said, "Immunotherapy is a quantum leap for lung cancer treatments," and Julie Brahmer, MD, thoracic cancer director at the Johns Hopkins Kimmel Cancer Center and associate professor of oncology at Johns Hopkins, in Baltimore, Maryland, said, "Immunotherapy is transforming the lung cancer treatment paradigm, providing the most promising option yet in the second-line treatment for squamous cell lung cancer patients."

Saturday Presentations

Also highly anticipated are results from a phase 3 trial in breast cancer with palbociclib (Ibrance, Pfizer Inc), which was granted accelerated approval in February 2015 on the basis of phase 2 data showing a significant improvement in progression-free survival. But the crucial question is whether or not this drug improves overall survival. Data from a phase 3 study with palbociclib, which the manufacturer has already announced is positive, will be presented at the meeting (abstract LBA502).

Another drug used for breast cancer, eribulin (Halaven, Eisai Inc), has shown promise in the treatment of sarcomas. The manufacturer announced in February 2015 that the drug had demonstrated a survival benefit and that it intends to apply for approval for certain sarcomas as an additional indication. Data from a phase 3 trial of erubulin in patients with leiomyosarcoma and adipocytic sarcoma, both of which are rare and hard-to-treat cancers, will be released (abstract LBA10502).

Up-front chemotherapy in prostate cancer is a controversial topic. The current paradigm is to treat with hormonal therapy first, with radiotherapy added in appropriate cases, and to then move on to chemotherapy only after the disease has become castration resistant. But two new studies have suggested that adding chemotherapy at a much earlier stage in the disease course has a survival advantage. One of these studies (CHAARTED) was presented at the ASCO annual meeting last year and led to calls for a paradigm change.

Another positive study (STAMPEDE), which also shows a survival benefit from earlier use of chemotherapy, was highlighted in a premeeting presscast and will be presented (abstract 5001) at the meeting on Saturday, May 31. Also to be released on that day are data from another study of the early use of chemotherapy in prostate cancer, administered at the same time as hormonal treatments and radiotherapy (abstract LBA5002).

One recurring theme with new cancer treatments is concern about how much it is all costing, particularly because prices of new drugs are increasing astronomically. Perhaps that will be a key issue discussed at a special session at 3:00 pm on Saturday entitled, Global Perspective on Value. That session will be presided over by ASCO president Dr Yu together with his counterpart from the European Society of Medical Oncology, Rolf Stahel, MD, from Zurich University Hospital, Switzerland. Also presenting at this session will be our regular Medscape contributor John Marshall, MD, professor of medicine, chief of hematology-oncology, and director of clinical research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.

Plenary Sessions on Sunday

Sunday is always the big day at the ASCO meeting. This is when the studies that are considered to have the highest scientific merit and the greatest potential impact on patient care are presented at the plenary session. This year, the plenary presentations (on May 31) include the following:

  • A major phase 3 trial of elective vs therapeutic neck lymph node surgery for early-stage oral cancers (abstract LBA3)

  • Results from a definitive, randomized phase 3 trial comparing radiosurgery alone with radiosurgery followed by whole-brain irradiation in patients with limited brain metastases (abstract LBA4)

  • An analysis of survival outcomes from decades of effort to reduce life-threatening, long-term side effects of childhood cancer treatments (abstract LBA2)

  • Initial results from a phase 3 study of first-line treatment with the PD-1-targeted drugs nivolumab and ipilimumab, alone and in combination, in patients with advanced melanoma (abstract LBA1)

This melanoma study is expected to attract a lot of attention, and experts will be poring over the details of how the responses with the individual agents compare with those seen with the combination. The combination of nivolumab and ipilimumab, both immune checkpoint inhibitors but with different mechanisms of action, has already shown some "eye-opening" results in an earlier phase 2 study, but using the two drugs together increases toxicity and is hugely expensive. So there will be scrutiny of the results to see how patients fare on each of the therapies used alone in comparison with the "double whammy" approach.

The Medscape Oncology team will be in Chicago to report the news as it breaks, so make sure to check back regularly for updates. Also, visit the ASCO Live Blog for comments from oncologists on what is happening as it happens. We will also have a Medscape booth in the exhibition hall (booth 21107), so please come by and see the news being posted.


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