What's Happening at ASCO 2019?

Zosia Chustecka

May 21, 2019

All eyes in the cancer field are now turning toward Chicago, which once again is hosting the annual meeting of the American Society of Clinical Oncology (ASCO). It's convenient going back to the same city and the same conference center year after year, as it saves time and effort in locating sessions, never mind finding coffee!

This year, the ASCO annual meeting will run from Friday, May 31, to Tuesday, June 4. More than 39,000 attendees from around the world are expected.

The meeting "provides a unique forum for global information exchange and collaboration," says current ASCO President Monica Bertagnolli, MD.

"This year's theme is Caring for Every Patient, Learning From Every Patient, and I selected this theme to help address how we can provide every patient with equal access to the highest quality of care," Bertagnolli commented during a press briefing held ahead of the meeting.

This theme will be reflected in some of the news coming out of the meeting — some of the abstracts highlighted at press briefings during the meeting will be about new approaches to overcoming limited access to care, noted Richard Schilsky, MD, chief medical officer at ASCO.

It will also be addressed in the first presentation at the plenary session on Sunday when Blythe J. S. Adamson, PhD, MPH, senior quantitative scientist from Flatiron Health in New York City, will discuss the impact of the Medicaid expansion of the Affordable Care Act on racial disparities regarding time to cancer treatment (abstract LBA1). The paper will be discussed by Yousuf Zafar, MD, from the Duke Cancer Institute, Durham, North Carolina.

It's a bit of a departure for ASCO to feature this type of topic at the plenary session, where the top abstracts usually report clinical trial results.

This is "a groundbreaking step taken by ASCO," says Bishal Gyawali, MD, PhD, assistant professor of cancer care and epidemiology, Queen's University, Kingston, Ontario, Canada. "The inclusion of this nontrial outcomes/policy research as a plenary motivates many researchers such as myself," he told Medscape Medical News.

"Until now, one would think that the only way to get to an ASCO plenary stage is by being a trialist and running a phase 3 trial. Trials are important, but policy, outcomes, disparities, and meta-research are also equally and sometimes more important varieties of cancer research that directly affect cancer outcomes," he commented.

However, the fact that the paper is specifically about an issue that is uniquely American has evoked "mixed feeling," he says, "because honestly, outside of US, very few know and understand about Affordable Care Act or Medicaid, and still fewer actually care about it."

Another plenary abstract covers a trial that had negative results. This choice by the selection committee has also been applauded by some cancer researchers on Twitter, who were pleased to see that a phase 3 trial that failed made it onto the most important podium of the meeting.

This is the ANNOUNCE trial in sarcoma (abstract LBA3) with olaratumab (Lartruvo, Lilly), a monoclonal antibody directed against platelet-derived growth factor receptor alpha. This drug was approved in 2016 for use in soft-tissue sarcoma on the basis of a small phase 2 trial that showed a survival benefit when olaratumab was added to doxorubicin, but at the time, the regulatory agencies required that a confirmatory trial be conducted. This is that trial; the topline results have already been reported and have led to the drug's being discontinued.

The other two abstracts in the plenary session are what would be expected — positive phase 3 trial results. One is the ENZAMET (ANZUP 1304) trial of enzalutamide (Xtandi, Pfizer/Astellas) for metastatic hormone-sensitive prostate cancer (abstract LBA2), and the other is the POLO trial of olaparib (Lynparza, AstraZeneca/MSD) for patients with a germline BRCA mutation and metastatic pancreatic cancer (abstract LBA4).

These late-breaking abstracts from the plenary sessions, as well as a few others, will become available only when the meeting is underway, but most of the meeting's abstracts are already available online.

Some have already been highlighted at the premeeting press briefing and were reported by Medscape Medical News.

One of these reports is on the use of lenalinomide (Revlimid, Celgene Corp) for patients with smoldering myeloma. Lenalinomide improved progression-free survival to 91% at 3 years, compared to 66% for those who were followed with observation (abstract 8001). In a blog post for the International Myeloma Foundation, Brian Durie, MD, commented, "These results are very encouraging and support other data indicating benefit with early intervention. Perhaps even more importantly, this randomized trial strongly validates the risk of progression without intervention, which is 24% and 34% at 2 and 3 years of follow-up."

Another report describes lowering of the chemotherapy dose in frail elderly patients with advanced gastroesophageal cancer. In that trial, lowering the dose reduced toxicity, and the oncology outcomes were maintained (abstract 4006). This is something that clinicians do already, but now there is evidence to support this practice, commented the lead researcher, Peter S. Hall, MB ChB, MRCP, PhD, a medical oncologist at the University of Edinburgh, United Kingdom.

Discussing Feelings, Featuring Stories

In addition to the scientific sessions, the annual meeting also features discussions of issues that are more personal to oncologists. "The Elephant in the Room: Addressing Depression and Suicide Among Oncology Providers" is the title of a session to be held at 1:15 PM on June 3. "The faculty will review causes and signs of depression in oncology professionals, and provide strategies that individuals can use to seek help and manage the symptoms of depression," according to the program notes. "The session will also cover what we can do as colleagues to support the mental health of one another."

Returning this year after a successful launch at last year's meeting is a session entitled "ASCO Voices," which will be held on June 1 at 4:45 PM. This session "features a variety of personal narratives and perspectives to expand your view of oncology, medicine, and the world — from big ideas to personal passions. These lightning talks offer a break from the science and an opportunity to reflect on personal stories and experiences."

Last year, as reported by Medscape Medical News, these talks included a moving story about a colleague who developed brain cancer. For this year, after an open call for auditions, five speakers were chosen, including Monica Morrow, MD, whose talk has the provocative title, "Surgery Is Never Elegant When Women Are in the Operating Room."

In addition, there is a session devoted to the ASCO book club, which has been running for several years now.

In 2016, the featured book was the New York Times bestseller, When Breath Becomes Air, by Paul Kalanithi, MD, a neurosurgeon at Stanford University in California, who wrote about his love for his work, what it means to be a doctor, and how he had to make the transition to patient after receiving a shock diagnosis of metastatic lung cancer when he was just 36 years old. The ASCO session featured his widow, Lucy Kalanithi, MD, clinical assistant professor at Stanford, who completed the unfinished manuscript and added an epilogue.

This year, the featured book is Cancerland: A Medical Memoir, by David Scadden, MD, a hematologist/oncologist at Harvard Medical School and Massachusetts General Hospital, in Boston, who will be talking at the session, to be held at 4:45 PM on June 1. The program promises "stories of loss and hope, and the promise of science and medicine in cancer treatment."

Hints on navigating the ASCO annual meeting have already been posted on Medscape Oncology from regular columnist David J. Kerr, CBE, MD, professor of cancer medicine, Oxford Cancer Center, United Kingdom, with more to come soon.

The Medscape team will be out in force at the ASCO annual meeting, reporting on the news as it breaks and on views as they are being formulated. We also have a booth (#3134) at the exhibition hall, so please come by and say hello.

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