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ASCO Annual Meeting: Hot Topics & Research Sneak Peeks

DiGiulio, Sarah

doi: 10.1097/01.COT.0000466386.93664.82
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The theme for this year's ASCO Annual Meeting is “Illumination & Innovation: Transforming Data into Learning.” That was chosen, ASCO President Peter Paul Yu, MD, FACP, FASCO, explained, because oncologists and all health care providers need to be able to make sense of the bombardment of data that comes along with advances such as the promise of precision medicine and the digitalization of clinical health.

“It's about how we make sense of the world around us and derive insight into improving the lives of our patients,” said Yu, Director of Cancer Research at Palo Alto Medical Foundation. “Perhaps most of the data is background noise. But identifying and understanding the important pieces of data lead to models or algorithms that help us understand the behavior of cancer—or other human diseases—design intervention strategies, and improve human health.”

More than 25,000 oncology professionals from around the world will convene at Chicago's McCormick Place convention center May 29 through June 2 to go about that task of making sense of the newest research and care changes in oncology. Last year's meeting drew 28,800 cancer care professionals and had an overall attendance of 34,750. The 2015 Annual Meeting will be the organization's 51st, and approximately 5,000 abstracts will be presented as part of the meeting.

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Immunotherapy to Make Headlines

The hot topic in oncology right now is immunotherapy, Scientific Program Committee Chair Alan P. Venook, Professor of Hematology/Oncology in the Department of Medicine at Helen Diller Family Comprehensive Cancer Center, said in an interview about a month before the meeting. And the science at this year's Annual Meeting will reflect that, he added: “The abstracts highlight new data where these therapies work—in some cases where we didn't expect them to.”

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It is known now that immunotherapies are effective for the treatment of melanoma and a certain subset of non-small cell lung cancer, but the next question is: “Is this a generalizable strategy across other cancers?” Yu noted in a separate interview.

Four late-breaking Annual Meeting abstracts will be released at a press briefing on Friday, May 29, to highlight the latest evidence on the effectiveness of immunotherapies in non-melanoma cancers. Those abstracts report data on patients with lung cancer, colon cancer, hepatocellular carcinoma, and head and neck cancer.

ASCO President PAUL YU, MD, FACP, FASCO

ASCO President PAUL YU, MD, FACP, FASCO

“There are different tools of the immune system that we are now uncovering and learning how to use—and that's why we're seeing this breakthrough,” Yu said.

The immunotherapy evidence coming out is a new approach compared with earlier immunotherapy work, he explained. First there was an effort to develop vaccines against cancer, which was not scalable for all cancers. Then there was an effort to stimulate cytokines to stimulate the immune system—but those efforts came with a lot of toxicity and less efficacy outside of melanoma, he said. “This [new evidence] is a totally different approach of exploiting the control mechanisms in the immune system that the tumor has subverted—using checkpoint inhibitors—which appears to be the most powerful and effective use of the immune system.”

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More Science Program Musts

For an overview of the updates in immunotherapies across all cancers, the program features a new Clinical Science Symposium on the topic, designed for the general oncologist, Venook explained.

“Because the Annual Meeting has become very much driven by the subspecialties within oncology, we believe there has been a problem for the average clinician—the general oncologist—to be able to gather enough information on the new key topics that might be within a melanoma session or a lung cancer session. They may not be able to get to all of those sessions,” which is what the Immunotherapy Clinical Science Symposium is designed to address.”

Scientific Program Committee Chair ALAN P

Scientific Program Committee Chair ALAN P

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In addition to that Symposium (“Immunotherapy for Every Patient: Check Your Enthusiasm,” Sat. May 30, 8am), there are similarly designed symposia that will highlight the top news from the meeting in targeted therapies (“Targeted Therapies: Does the Disease Still Matter?” Sun. May 31, 9:45am) and diagnostic tests (“New Diagnostics: When Actionable is Objectionable,” Mon. June 1, 9:45am). All three symposia are focused on specific cancer treatment pathways and cut across cancer types.

“These sessions were designed for the general oncologists to get a grasp of what is pertinent to them. They emphasize what we felt were the dominant issues that the general oncologist is really confronting,” Venook said.

Also debuting at this year's Annual Meeting is a revamped model for the poster discussions: “Those sessions will be integrated into the general poster session. There will be fewer, but the presenter will be available on the podium to answer questions and interact with the discussant. We hope this will give more opportunity for attendees to focus on the top posters and also give the poster presenters the opportunity to talk about their work.”

Cancer Education Committee Chair JOHN V

Cancer Education Committee Chair JOHN V

Another noteworthy session, he said, is the joint American Association for Cancer Research/ASCO session, “Translating Biology into Therapeutics”—which has a slate of “really, really high-level speakers [including Yu and AACR Immediate Past President Carlos L. Arteaga, MD; Andrew H. Ko, MD; Maha Hussain, MD, FACP, FASCO; and Alan Ashworth, PhD, FRS]” (Sun., May 31, 9:45am). The session will cover PARP inhibitors in BRCA-deficient cancers, “with each speaking discussing how the research will get from the ‘bench to the bedside’ successfully,” and a few recent examples of why certain preclinical models were not successful in patients.

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The Value Discussion

Alongside discussion of the latest science at the meeting there will be an emphasis on the value question—a dialogue ASCO has had a voice in for quite awhile now and that was a focus at last year's Annual Meeting as well, Yu said.

“Doctors like me were trained with the idea that you never consider cost—that's not your job. Your job is to find the best treatment. And the best treatment was defined by any incremental improvement, whether it be one month more or two months more. And the thinking was that this was how we were going to cure cancer—slow incremental improvements,” Yu explained.

“But the thinking has changed. There's too much toxicity with some of these treatments—and there are other choices. We need to tell the doctors it has changed. And we need to tell the patients, too.”

Across the scientific and education programs, speakers and session chairs, therefore, have been prompted to discuss how value relates to the sessions—value not only in terms of financial costs, but also in terms of patient experience, toxicity, and other endpoints—including during the plenary session. The plenary reports reflect advances in both putting together new combinations of therapies “with dramatic outcomes and great costs” and in other cases, “subtracting long-standing treatments after studies show them to be harmful rather than helpful”—and one of the discussants during the plenary session will be focusing on value, Venook noted.

“It's always relevant to talk about value to the patient—even if you forget about the dollars you spend—how much is the patient willing to go through? What are the quality-of-life issues for the patient? And then there's the obvious elephant in the room, which is how expensive some of these new treatments are. The practical reality is that we can't keep ratcheting up the cost of everything we do.

“Whether it's the physical or emotional cost of chemotherapy or the costs—the bankruptcies families go through—everything we do has consequences; and we need to talk about it rather than making believe it's not going on.”

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A Practical Education Program

The value discussion will continue throughout the meeting's education track. Additionally, there is an emphasis on making the education sessions as practical as possible by highlighting bottom-line boxes or bullets with key takeaway messages, said Cancer Education Committee Chair John V. Cox, DO, MBA, FACP, FASCO, Professor in the Department of Internal Medicine at the University of Texas Southwestern Medical Center.

“This new charge follows Dr. Yu's theme of ‘illumination comes through knowledge.’ We present a lot of data on new information, but we also need to transform that into the knowledge that people use in their practices.”

In particular, there are several very interesting sessions on care delivery, he said. “There is a very strong focus in the program this year on the patient-care issues we face day-in and day-out. I'm very excited about a lot of the health policy, administrative, and care delivery sessions.”

Specifically, Cox noted the following:

  • “Alternatives to ASP-Plus-Six: What are the Options?” (Sat., May 30, 8am): This session will focus on the challenges of drug costs and billing.
  • “Payment Reform in Oncology: The Way Forward” (Sat., May 30, 4:45pm): This town-hall session will include a discussion about the new Centers for Medicare and Medicaid Services innovative alternative payment methodology for oncology, as well as on ASCO's two-year project to help guide policy-makers on how oncology reimbursement should be transformed.
  • “Beyond the Concept: The Patient-Centered Medical Home in Oncology” (Sun., May 31, 11:30am): This session will look at the Medical Home Model in oncology, which has been reprised in the last couple of years—“and how it can transform oncology practice to be more patient-centered, and also more friendly to the providers who deliver care.”
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Global Oncology Symposium

Another noticeable addition to this year's Education Program is the four-and-a-half hour Global Oncology Symposium (Fri., May 29, 1pm), which will focus on global perspectives in cancer care.

“All of us—wherever you practice in the world—are seeing the world come to your practice,” Cox noted. There is a growing interest in being more culturally aware and connected to science across the globe, he added.

And, though ASCO's international members represent the most rapidly growing segment of ASCO membership, this session was designed and should appeal to all attendees, both domestic and international members, Cox said. Topics for the symposium include: geographic differences in the underlying biology and treatment of gastric cancer, access to care, and health care delivery systems.

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Plenary Abstracts

The following plenary abstracts will be presented during the Plenary Session at this year's Annual Meeting (Sun., May 31, 1pm):

  • Abstract LBA1: “Efficacy and safety results from a phase III trial of nivolumab (NIVO) alone or combined with ipilimumab (IPI) versus IPI alone in treatement-naïve patients (pts) with advanced melanoma (MEL) (CheckMate 067)” with Discussant Michael B. Atkins, MD, of Lombardi Comprehensive Cancer Center;
  • Abstract LBA2: “Reduction in late mortality among 5-year survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CSSS)” with Discussant Michael Paul Link, MD, FASCO, of Stanford University School of Medicine;
  • Abstract LBA3: “Elective versus therapeutic neck dissection in the clinically node negative early oral cancer: A randomised control trial (RCT)” with Discussant Hisham Mohamed Mehenna, MD, PhD, of InHANSE School of Cancer Sciences at University of Birmingham; and
  • Abstract LBA4: “NCCTG N0574 (Alliance): A phase III randomized trial of whole brain radiation therapy (WBRT) in addition to radiosurgery (SRS) in patients with 1 to 3 brain metastases” with Discussant Andrew B. Lassman, MD, of the Department of Neurology and Herbert Irving Comprehensive Cancer Center at Columbia University Medical School.

Leonard Saltz, MD, of Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, will also speak at the end of the session about value across the plenary abstracts.

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Economist Michael Porter to Deliver Keynote

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Economist and Harvard Business School Professor Michael Porter, PhD, MBA, will deliver this year's Annual Meeting Keynote Address (Opening Session, Sat., May 30, 9:30am)—and is one of the sessions that ASCO President Peter Paul Yu, MD, said he is most looking forward to. Porter will speak about value-based health care delivery.

“Whether one calls it a practice-changing discovery, quality improvement, or health care reform, measurement of patient outcomes and improving the patient experience is the measure of success,” Yu said.

Porter is an expert on economic theory, and his work has brought strategy concepts to bear on many of the most challenging problems facing corporations, economies, and societies—including market competition, company strategy, economic development, the environment, and health care. He has published a framework on measuring value in breast cancer care in the New England Journal of Medicine (http://bit.ly/1AltIiP?). And in 2012, he delivered a keynote address at the American Society for Radiation Oncology Annual Meeting on how to move health care delivery into a value-based system (OT 12/25/12 issue).

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Pre-Annual Meeting Seminars

ASCO's Pre-Annual Meeting Seminar series has expanded this year to now feature five different seminars, each offering in-depth coverage of a key topic in oncology. The seminars will be held at McCormick Place on Thursday, May 28 (12:30pm-5pm) and Friday, May 29 (7am-11am).

“The seminars allow attendees to spend a whole day delving into a more detailed aspect of a topic with a lot of experts,” ASCO's Cancer Education Committee Chair for the meeting, John V. Cox, DO, MBA, FACP, FASCO, said. The topics are:

The Economics of Cancer Care;

  • Faculty Development for Medical Educators: Advancing My Career and Teaching Repertoire;
  • Hematology for the Oncologist;
  • New Drugs in Oncology; and
  • Genetics and Genomics for the Practicing Clinician.

Pre-registration for the seminars is required (am.asco.org/pre-annual-meeting-seminars).

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Before You Go...

Create a personalized schedule on the meeting's iPlanner (available online iplanner.asco.org/am2015/AM2015 and in the App Store) at home before the meeting, Scientific Program Committee Chair, Alan P. Venook, MD, recommends. The iPlanner lists session chairs, speakers, and abstract links.

“Choreograph as much as possible before you get to the meeting,” he advised. “And to maximize what you hear and learn—bring your iPad or smartphone [or other mobile device] so you have your references right there.”

The Annual Meeting will feature free Wi-Fi throughout McCormick Place (including in the session rooms).

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