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Oncology Times:
doi: 10.1097/01.COT.0000450336.09703.1a
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ASCO14 Sneak Peek: ‘Relating the Science of Oncology to Society’

DiGiulio, Sarah

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“Science does not operate in a vacuum—it operates in service to society,” Clifford Hudis, MD, FACP, President of the American Society of Clinical Oncology, said in an interview. And that is the reason he said he chose “Science & Society” as the theme of the organization's 2014 Annual Meeting.

Science is facing challenges in the public arena on the macro level in terms of cuts to funding for science, lessening support for research, debate about the value of progress made, and loss of faith in the ability of science to deliver solutions, said Hudis, Chief of the Breast Cancer Medicine Service and attending physician at Memorial Sloan Kettering Cancer Center (MSKCC), and Professor of Medicine at Weill Cornell Medical College.

“We're going to acknowledge the societal burden that results from scientific advances. We're going to discuss value—which ‘practice-changing’ advances are practice-changing because they're dramatically better and we can afford it, and which ones are slightly better and may not be so worthwhile.”

Discussing value and the value of science in society, Hudis emphasized, is the first step to making those connections. “We have the responsibility, and we uniquely have the knowledge and insight to tackle this.”

“We” refers to Hudis and the 25,000-plus oncology professionals expected to attend this year's meeting (May 30-June 3 in Chicago at McCormick Place convention center), which will mark the 50th year the meeting has been held. More than 5,000 abstracts will be published as part of the meeting, and 2,872 have been selected for presentation (the comparable numbers for last year's meeting were 4,754 and 2,720, respectively).

“We're part of the whole fabric of society when we do cancer care. I want to acknowledge our role and I want the public to understand it,” he added. “If we don't start to address this with the knowledge that only the cancer care community has, then it's possible that other people will impose limits on us that will be less than optimal.”

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Focus on Value

In a separate interview, ASCO President-Elect Peter P. Yu, MD, FASCO, Director of Cancer Research and a medical oncologist and hematologist at Palo Alto Medical Foundation, said to expect many interesting and exciting findings presented this year—“but we want to go beyond the science. We want to ask: what is the impact on our patients? What is the impact on society as a whole?”

When it is relevant to studies being presented, sessions will also feature a discussant to talk specifically about what value the research brings overall to patients—in terms of the clinical benefit, toxicity of therapy, and cost of care to society, as well as to the individual patient, he said. For example, one study being presented provides a cost analysis of the recent recommendation for low-dose CT scan screening for lung cancer for current or past cigarette smokers.

Another study compares the frequency of the use of zoledronic acid in patients with metastatic breast cancer: “There are side effects, as well as costs to the patient—so looking at the right amount of medicine necessary to do the job is an important question,” Yu said. “We are trying to put the research into a framework to ask if this is something that really benefits patients, and at what costs?”

ASCO President CLIFFORD HUDIS, MD, FACP
ASCO President CLIFFORD HUDIS, MD, FACP
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The Science

Many of the meeting's top studies and discussions assess how the latest science can improve value—in terms of quality of life and costs, Scientific Program Committee Chair Jedd Wolchok, MD, PhD, the Lloyd J. Old/Ludwig Chair in Clinical Investigation and Chief of the Melanoma and Immunotherapeutics Service at MSKCC, said via email. “Our goal was to produce a scientific program that reflects the wide variety of places where we as a scientific community interact and engage with society at large.”

There will still be, he added, the usual exciting clinical updates. “The result is a more complete picture of where we stand in terms of progress against cancer.”

In targeted therapies, data will be reported on:

  • A Phase II trial comparing the efficacy of PARP inhibitors used in combination with anti-angiogenic agents versus using PARP inhibitors alone;
  • The Phase III REVEL trial of ramucirumab in non-small cell lung cancer patients;
  • The Phase III RESONATE trial of patients with chronic lymphocytic leukemia comparing ibrutinib versus ofatumumab in patients with relapsed or refractory disease; and
  • The Phase III SELECT trial evaluating lenvatinib in patients with radioactive iodine-refractory differentiated thyroid cancer.

There will also be studies in immunotherapies—in particular in melanoma, as well as on an adoptive T-cell therapy for patients with cervical cancer.

Although at the time of the interview, Wolchok could not share specific data, he did note: “As evidenced by this year's scientific program, we're becoming more and more adept at identifying which patients can receive less therapy with the same results—to provide better care and improve quality of life.”

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Education Agenda

Expect the value discussion to continue through the Education Sessions, too, said Cancer Education Committee Chair Gini F. Fleming, MD, Professor of Medicine and Director of both the Medical Oncology Breast and Gynecologic Oncology Programs at the University of Chicago Medicine.

“We have emphasized to all the educational speakers that as they discuss standards of care and where the standard of care is going, value needs to be addressed—both in terms of side effects for patients and in terms of costs for society.”

ASCO President-Elect PETER P. YU, MD, FASCO
ASCO President-Elect PETER P. YU, MD, FASCO
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As usual, this year's education program includes review-type sessions planned by the individual tumor type committees. But, new this year, she said, is that each major cancer type will have a 50-year anniversary talk about the progress that has been made in that cancer during the last 50 years, which will also cover the direction people expect the field to be headed.

The education program will also include specific sessions that focus on value debates. For example, one will cover the ethical obligations of the practicing oncologists—i.e., the “creative tension” between a physician's obligation to an individual patient as the patient's advocate versus an obligation to society to keep costs controlled (chaired by Beverly Moy, MD, MPH; with debaters Daniel Sulmasy, MD, PhD, and Reshma Jagsi, MD, DPhil; Sat. 5/31, 1:15–2:30 pm).

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Emphasis on Genomics

Also notable on the Education Program this year is an emphasis on several genomics-oriented sessions. The topic was emphasized last year, and the review after the meeting showed continued high interest, Fleming said. “We have an explosion of information about tumor biology and the ability to use next-generation sequencing for tumor samples. Patients walk into the physician's office with their own tumor genomic profiling, expecting the doctor to be able to use that information to improve their therapy. That's what practicing physicians are facing every day.”

Scientific Program Committee Chair JEDD WOLCHOK, MD, PHD
Scientific Program Committee Chair JEDD WOLCHOK, MD, PHD
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The goal of the genomic-oriented sessions is to provide information on what is known, when it would be cost-effective to order such assays, and how they might be helpful in research, Fleming noted. The program also includes general genomic-oriented sessions that cover topics such as “How to Talk with Your Pathologist about Molecular Testing” (Sun. 6/1) and “Pharmacogenomics in the Era of Next-Generation Sequencing” (Mon. 6/2) (see full list at am.asco.org/genomics-oriented-sessions).

This year's meeting will also include the following session types:

  • Core Sessions—which debuted at the 2012 meeting—serve as an update in each disease track for practicing and general oncologists to cover an overview of the latest information in streamlined sessions. “They offer the practicing oncologist updates they will be able to use the next day in their practice,” Fleming said.
  • International Sessions are intended for all attendees, and cover topics of interest to the global oncology community. One of these is a joint ASCO/European CanCer Organisation session on value and cancer care (Mon. 6/2, 9:45 am), and another covers sustainable cancer care from a global perspective (“What We Can Learn from International Health Care Systems,” Sun. 6/1, 11:30 am).
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MOC Options

As of January 2014, the American Board of Internal Medicine now requires all physicians to more frequently engage in Maintenance of Certification (MOC) activities—100 points every five years and at least some activity every two years. ASCO is offering the following MOC options at this year's Annual Meeting:

  • Earn MOC points: To help oncologists meet the new requirements, meeting attendees have the opportunity to earn MOC points by participating in a specially designed MOC self-assessment activity. Participants take a pre-test before attending the meeting to highlight personal areas of educational need, and based on those results receive a customized list of Core Sessions (from the meeting's Education Program) to attend, which are intended to fill those knowledge gaps. Participants must complete and pass a follow-up exam after the meeting to earn their MOC points. Pre-registration is required, and more information is available online at am.asco.org/maintenance-certification.
  • Learn about the MOC changes: To better understand the changes to the ABIM's MOC requirements and other ways to earn those credits, ASCO is hosting two sessions: “MOC Open Forum: Understanding the Changes” (Sat. 5/31, 2:30 pm), and “MOC 101: Orientation to MOC Requirements” (Mon. 6/2, 4:45 pm).
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ASCO's First Book Club!

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New for this year is the ASCO Book Club session. Meeting-goers are encouraged to read the book Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World by Pulitzer Prize-winner Tracy Kidder, and join the interactive discussion about global cancer care.

Lawrence Shulman, MD, Senior Vice President for Medical Affairs, Director of Regional Strategy Development, and Director of the Center for Global Medicine at the Dana Farber Cancer Institute, will co-moderate the session with Teresa Gilewski, MD, an oncologist at MSKCC, who has led several innovative sessions at ASCO meetings over the years.

Education Committee Chair GINI F. FLEMING, MD
Education Committee Chair GINI F. FLEMING, MD
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The idea for the Book Club session (Mon., 6/2, 1:15 pm), Shulman explained in an interview, is to have an informal dialogue without a lecture or script, so there can be a true exchange of ideas. The book, published in 2003, tells the story of Paul Farmer, MD, PhD, creator of the international non-profit Partners in Health (OT 8/10/13 issue), which brought cancer care services first to Haiti and has since expanded to other underserved countries.

“It's a very powerful book,” said Shulman, who has collaborated with Farmer and worked with Partners in Health. “It really puts the question on the table of what our obligation is to society to bring health care—whether it's cancer care or care for other diseases—to portions and populations of the world that otherwise have no access.

“I hope that people are able to share their own thoughts—and also ask questions about what it's like, whether there's a future for them in this work, and how they can get involved.”

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Plenary Preview

The four studies chosen for this year's plenary session are all large, Phase III trials that touch on very common illnesses—making them the highest impact abstracts of the year, Hudis said.

The studies answer or inform what were until now unanswered questions:

  • Do some breast cancer patients benefit from ovarian ablation plus adjuvant aromatase inhibition?
  • Does adding initial chemotherapy to standard hormone therapy improve overall survival for men with prostate cancer?
  • Does lapatinib improve long-term outcomes when used in the adjuvant treatment of women with HER2-positive early breast cancer?
  • Should bevacizumab or cetuximab be used for patients KRAS wild-type metastatic colorectal cancer?

None of the results were anticipated precisely, but “every one of these abstracts will have an impact on how doctors practice medicine [the day after the results are announced,” he said.

Those four studies (to be presented on Sunday June 1 from 1 to 4 pm) are:

  • A joint analysis of the TEXT and SOFT Phase III clinical trials, comparing the aromatase inhibitor exemestane with tamoxifen in premenopausal women with hormone receptor-positive early breast cancer (Abstract LBA1);
  • Interim results from a randomized Phase III clinical trial evaluating the survival benefit of adding chemotherapy to initial hormone therapy for patients with metastatic prostate cancer (Abstract LBA2);
  • Findings from a Phase III study comparing chemotherapy plus two widely used targeted drugs—bevacizumab or cetuximab—in first-line treatment of metastatic colorectal cancer without KRAS mutations (Abstract LBA3); and
  • First results from ALTTO, the largest-ever Phase III randomized trial in HER2-positive breast cancer, exploring adjuvant therapy strategies for preventing recurrence in patients with HER2-positive early breast cancer, using combinations of trastuzumab, lapatinib, and chemotherapy (Abstract LBA4).

Also noteworthy, Hudis said, is that each of these abstracts has either full or partial support from the National Cancer Institute's Cooperative Groups (although he noted that the abstracts were not chosen based on that criterion). “So, they represent a real societal effort in investing in science to get answers.”

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50 Years: ‘Celebrating with Humility’

This year's meeting will be the organization's 50th Annual Meeting. And though there will be signage to note the milestone, ASCO President Hudis said there will be a sense of humility along with celebration.

“We walk a fine line in my opinion,” he told OT. “On the one hand, we have so much to be proud of—we've made so much progress. On the other hand, there are so many diseases that are still very challenging. So, it's not really time yet for the big blowout party.

“The congratulations are that we are organized, we're focused, we're determined, and we've made real contributions and progress. But at the same time, we're not done yet.”

Expect, though, he said, to hear about the founding year of 1964 in his Presidential Address (Opening Session, Sat. 5/31, 9:30 am).

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#ASCO14

Last year, the Annual Meeting's official Twitter hashtag, “#ASCO13,” was one of the top tweeted hashtags over the weekend of the meeting. And this year, meeting planners expect #ASCO14 to be even bigger.

“It's enriching,” Hudis said. “It's real-time interpretation of what the docs think they are hearing. As people tweet their responses to unfolding information, you end up with a deep discussion within the room.”

Follow ASCO President Hudis throughout the meeting, @CliffordHudis, as well as President-Elect Yu @YupOnc, and ASCO itself, @ASCO.

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The Society also created an infographic of 12 oncologists designated as 2014 ASCO Annual Meeting Tweeters (many of whom were featured in OT's Profiles in Oncology Social Media series (bit.ly/OT-OncologySocialMediaProfiles): In addition to Drs. Hudis and Yu, they are Dr. Merry Markham (@DrMarkham), Dr. Don Dizon (@drdondizon), Dr. Deanna Attai (@DrAttai), Dr. Robert Miller (@rsm2800), Dr. Michael Thompson (@mtmdphd), Dr. Michael Fisch (@fischmd), Dr. Thomas George (@TGeorgeMD), Dr. Yousuf Zafar (@ysafar), ASCO Chief Medical Officer Dr. Richard Schilsky (@rschilsky), and Dr. Matthew Katz (@subatomicdoc).

The infographic (am.asco.org/sites/am.asco.org/files/ASCO14_Tweeters.pdf) also includes a list of 16 specialty cancer type/topic hashtags.

Also featured at the meeting will be another of ASCO's annual tweetups (Sat. 5/31, 5:45 pm, South Building, Level 2.5 Food Court).

For up-to-the-minute commentary, also follow @OncologyTimes and @OncTimes_AsstEd for live mini-reports!

Wolters Kluwer Health | Lippincott Williams & Wilkins

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