June 07, 2017 7:00 AM

Annual ASCO Meeting Suggests an Optimistic Future for Cancer Care

Michigan Medicine oncologists highlight some of the top findings that came from the field’s largest professional meeting.

About 39,300 cancer professionals from around the world met June 2-6 in Chicago for the American Society of Clinical Oncology Annual Meeting.

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“The meeting highlighted the newest science in clinical oncology and included practice-changing developments in several areas. As the largest cancer meeting in the world, it also offers the opportunity to meet with colleagues around the country and the world who care for cancer patients,” says David C. Smith, M.D., professor of hematology/oncology and urology at Michigan Medicine.

Smith served as the chair of the scientific program committee for the meeting. Daniel F. Hayes, M.D., co-director of the Breast Oncology Program at the University of Michigan Comprehensive Cancer Center, presided over the meeting as ASCO president.

“I’m incredibly optimistic about the future of oncology,” Hayes said during his presidential address. The meeting highlighted many exciting findings in immunotherapy and genetic sequencing, as well as ways to improve the way cancer care is delivered.

“We are making progress against cancer,” Hayes says. “We are curing many patients, but not enough. Too many people still die from this disease. We can do better.”

Here are a few of the meeting’s top stories:

Technology to help patients report side effects improves survival

A digital platform that allowed patients to self-report symptoms and side effects from chemotherapy helped improve survival among cancer patients.

In the study, 766 patients with a variety of cancer types were randomized to use the web-based self-reporting platform or to receive usual care. Patients in the web-based group lived a median of five months longer than those receiving standard of care. The findings were presented by Ethan Basch, M.D., from the University of North Carolina Lineberger Comprehensive Cancer Center.

“This study showed an actual benefit to overall survival for these patients. We find there are patients who quit taking their chemotherapy because of side effects. This suggests that if we can intervene earlier and get them through their full regimen, we could improve outcomes,” says Michael Sabel, M.D., division chief of surgical oncology at Michigan Medicine. Sabel was not involved in the study.

During clinic visits, patients can be hesitant to tell their doctor about complications for fear of bothering the doctor or appearing to complain, Sabel says.

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“Technology lets us take communication to the next level. This study is the most convincing evidence that this is something we need to pursue. But there are still a lot of questions,” he says.

One question that will need further study is how these kinds of tools can be incorporated in all practices, from large university settings to small community practices, says Jennifer Griggs, M.D., MPH, professor of hematology/oncology at Michigan Medicine. Griggs, who was not involved in the research, was a discussion panelist at a session at ASCO.

“How can we generalize these applications, and how does it then roll out to all patients and practices? Just like in a drug trial, we need to consider the toxicities or unexpected outcomes of these kinds of interventions, including consideration that approximately 25 percent of the email responses from patient participants were not acted upon by nurses,” Griggs says.

Sabel has developed two apps, one for patients with breast cancer and another for those with melanoma. Both are designed to provide patient education and allow for self-reporting and self-monitoring of symptoms. When patients indicate a side effect, they’re directed to information that explains how to self-manage at home and when to call their doctor.

“There are a lot of subtleties for app design, especially for an older population. It’s not as simple as saying let’s put out an app,” Sabel says. “But this finding suggests it’s a goal worth pursuing. I think this is just the beginning of our use of mobile platforms to improve patient-physician communication.”

Immunotherapy expands beyond melanoma

Two studies highlighted how immunotherapy treatments are expanding their impact to challenging rare cancers.

In one study, involving a CAR T-cell therapy for relapsed multiple myeloma, researchers in China reported that every patient responded to the therapy and all but one had a complete response without relapse for six months. The study included only 19 patients and must be seen as preliminary.

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A second study from researchers in France looked at a PD-1 inhibitor as a second- or third-line treatment for relapsed mesothelioma. At 12 weeks, cancer had either shrank or held steady in 44 percent of patients who received the immunotherapy drug nivolumab and in 50 percent of those who received nivolumab with ipilimumab. Patients in both groups had better survival than is typical for this disease.

“Immunotherapy is expanding beyond melanoma to other cancers that are difficult to treat and often resistant to our usual chemotherapies,” says Sabel, who was not involved in the research. “We’ve been studying immunotherapy for decades. It’s taken a long time to get to this point. But now that we have a better basic science understanding of how T-cells operate, it’s leading to improvements in patient outcomes.”

In addition, U-M Cancer Center oncologists shared data on clinical trials testing immunotherapy treatments in urothelial and lung cancer.

Smith presented preliminary data using two types of immunotherapy drugs in combination for urothelial cancer.

“A significant number of patients had dramatic responses with dramatic reduction in tumors. The combination of epacadostat and pembrolizumab is active in urothelial cancer, and our findings support developing a phase 3 trial,” Smith says.

Shirish Gadgeel, MBBS, clinical professor of hematology/oncology at Michigan Medicine, shared findings of a trial testing pembrolizumab as a maintenance therapy in small cell lung cancer. While the trial did not improve survival, a subset of patients had benefit.

“We need to define biomarkers to identify that subset of patients who might respond,” Gadgeel says.

Smith also chaired a symposium called “‘Check’ This Out: The Step Beyond PD-1 Blockade,” which featured three additional immunotherapy abstracts.

Mastectomy rate decreases with adoption of breast tumor margin guidelines

Determining when a patient with breast cancer needs to have additional surgery is a major concern for ensuring good outcomes. But the fear of additional surgery can also lead many women to opt for mastectomy instead of breast-conserving lumpectomy.

In 2014, two major oncology societies published guidelines to help define and limit the negative margin — a portion of tissue with no cancerous cells. Since then, rates of additional surgery after initial lumpectomy have decreased, leading to an increase in the lumpectomy rate and a decrease in mastectomy rates, a new study finds.

The research was presented at ASCO by Monica Morrow, M.D., at Memorial Sloan Kettering Cancer Center, and was published in JAMA Oncology.

“The results of our study underscore a sea change in clinician culture, increasingly committed to harnessing precision medicine to reduce the burden of cancer treatment,” says co-senior study author Steven J. Katz, M.D., MPH, professor of medicine and of health management and policy at Michigan Medicine.

Researchers found the rate of lumpectomy as the definitive surgical procedure rose by 13 percent. Rates of single mastectomy decreased from 27 percent before the guidelines to 18 percent after. And rates of bilateral mastectomy also fell, from 21 percent before the guidelines to 16 percent after. Overall, the rate of patients requiring additional surgery after lumpectomy declined by 16 percent.

The study illustrates that guidelines can be an effective, low-cost approach to addressing clinical controversies.

“These consensus guidelines sought to reduce overtreatment of breast cancer by making it clear when to avoid additional surgery after an attempt at breast conservation,” says co-senior study author Reshma Jagsi, M.D., D.Phil., deputy chair and professor of radiation oncology at Michigan Medicine.

“Our study found decreasing rates of additional surgery and mastectomy after the guideline was published, demonstrating the tremendous power that clinical practice guidelines can have in changing outcomes for patients."