Photo by Todd Buchanan / ASCO
The biggest cancer conference in the world, an annual meeting hosted by the American Society of Clinical Oncology that attracted more than 35,000 cancer researchers, oncologists, patient advocates, politicians and other major players in pharma and biotech, just closed its doors for another year.
Immunotherapy was one of the hottest topics there, with presentations on new therapies for lung cancer, metastatic melanoma, metastatic kidney cancer and much more, including exciting results from Fred Hutchinson Cancer Research Center’s Dr. Cameron Turtle regarding his recent work with CAR T-cell therapies in leukemia and lymphoma patients.
Hundreds of new findings and insights were presented during the five-day event in Chicago, covering all things cancer from biomarkers to big data, prevention to palliative care, survivorship to social media. There was even news of a new drug that uses artificial intelligence to slow the growth of cancer.
What were some of the other big takeaways at this year’s meeting, dubbed “Collective Wisdom: The Future of Patient-Centered Care and Research”? What’s cool but perhaps not quite ready for primetime? We turned to a handful of experts – online and off – to provide a bit of perspective.
Photo by Todd Buchanan / ASCO
Headlines about “liquid biopsies” and their ability to track cancer via a simple blood test cropped up soon after the conference opened its doors, thanks to a large new study presented by researchers at the University of California Davis Comprehensive Cancer Center.
Researchers there used more than 17,000 blood samples from patients diagnosed with 50 different types of cancer to see if a liquid biopsy test from Guardant Health (which paid for the study) would flag known mutations that drive cancer. The blood test detected known mutations in 83 percent of the samples. Researchers also analyzed the DNA in tumor tissue samples from nearly 400 patients taken during a traditional surgical biopsy and compared that with the patients’ liquid biopsies. Mutations detected in the tumor DNA matched those found in the liquid biopsies in 87 percent of the cases. But in some cases, such as for mutations in genes related to treatment residence, the two types of biopsies didn’t match as well.
Biopsies will remain the gold standard for the time being, but many medical professionals lauded the potential for monitoring cancer patients without invasive tests (others predicted the public would soon start clamoring for these “blood tests to find cancer”).
Two experts at Fred Hutch agreed that liquid biopsies had great potential but stressed it was still early days for this new technology.
“We need more data but with further research this will hopefully become routine and standard in the future and further enhance our understanding of cancer biology and behavior,” said Dr. Gary Lyman, an oncologist and public health researcher with Fred Hutch.
“If it’s used for its intended purposes, to replace a biopsy, I don’t see a minus if it’s equally accurate and less invasive,” said Hutch biostatistician Dr. Ruth Etzioni, who helped create the latest set of breast cancer screening guidelines for the American Cancer Society.
“It could be very useful in a cancer setting to see if there’s been a recurrence,” she said. “But in a prevention setting, it could open a Pandora’s box of overdiagnosis and overtreatment. We have to figure out the harms and the benefits and the potential issues with unintended uses.”
Vice President Joe Biden, who’s spent the last several months touring the country and talking to researchers, oncologists, patients and others about the new Cancer Moonshot Initiative, gave a rousing speech that called for more collaboration, coordination and innovation in order to accelerate research and break down institutional barriers.
“Our ability to penetrate the mysteries of cancer depends on our willingness, and especially your willingness, to see beyond the usual and the expected,” he told the ASCO audience. “The annals of ASCO are filled with revelations that surprised and upended the expected course of treating cancer, and collectively you have saved countless lives.”
Biden repeatedly pushed for a “team science” approach, stressing the importance of data sharing and collaborations in order to break down the barriers that are keeping crucial scientific data buried away in “siloes.”
“You don't 'intend' to put up barriers but there are institutional barriers,” he said. “Most of the data is out of reach of scientists. We have to allow the data to yield the answers. We need to share not only clinical data but ALL of the data that will drive progress in the fight against cancer.”
Toward that end, Biden announced the launch of an open-access cancer database known as the Genomic Data Commons. Part of the National Cancer Institute, the Commons will house the raw genomic and clinical data for 12,000 patients (to start). Researchers will be able to check the molecular makeup of the patients’ tumors, see what treatments they received and see how well they responded. New information will be added as new records and research come in.
From this point on, Biden told the audience, all information coming from NCI-funded trials will be submitted to the database.
This and other genomic databases are part of a move toward precision medicine, in this case precision oncology, which is all about creating individually tailored cancer treatments to match the specific genetics of the patient’s tumor. A person with lung cancer might take the same drug as a person with breast or prostate cancer. It all depends on the cancer’s genetic mutations.
Mutations are commonly found through some kind of biomarker – or tumor marker – test. Once identified, researchers try to create a targeted molecular treatment. According to ASCO, there are currently targeted treatments for more than 25 cancers in the U.S. Many more are under study in clinical trials.
Fred Hutch’s Lyman, who recently helped develop policies to guide the use of biomarker tests for molecularly targeted treatments – basically the key to unlocking precision medicine – was enthusiastic about the vice president’s speech and his vision.
“It was a fantastic presentation from someone dedicated and passionate about moving cancer research and patient care forward,” he said.
Lyman presented policy recommendations from his work with the Institute of Medicine at ASCO, stressing the incredible opportunities precision medicine offers cancer patients. The recommendations were summarized in a publication by Lyman and Dr. Harold Moses from Vanderbilt in the New England Journal of Medicine coinciding with the start of the ASCO meeting. Useful biomarkers and their matched targeted therapies – potentially less invasive than traditional therapies – are already being produced for many cancers, he said, including liver, head and neck, brain, breast, melanoma, lymphoma and more.
But challenges remain. Not all biomarker tests are valuable. Some targets are “undruggable.” Clinical trials need to be redesigned for this new, ever-expanding technology. Regulation and reimbursement also need to be figured out. And patient access is key.
“It’s a very challenging area, based on the human genome and its 30,000 different genes and hundreds of thousands, or even millions, of mutations,” Lyman said. “To identify the ones that are really important and find or develop the right strategy or agent that targets it is extremely complicated and costly.”
Patient power was another big theme at ASCO, both in terms of their presence and their active contributions to research.
The patient-driven Metastatic Breast Cancer Project uses social media and crowdsourcing to fast-forward research within the MBC realm. The project, just seven months old, has already registered more than 2,000 patient participants from all 50 states.
“In the United States, only a small fraction of the 150,000 women and men living with metastatic breast cancer receives care at centers that conduct research on tumor samples,” said lead study author Dr. Nikhil Wagle, a medical oncologist at Dana-Farber Cancer Institute in Boston and an associate member of the Broad Institute in Cambridge, Massachusetts. “With this new approach we hope to empower patients to directly participate in research, regardless of where they live, and contribute to the effort to improve outcomes for all people with advanced breast cancer.”
Other patient-focused research efforts include “Let’s Win,” a new online community for pancreatic cancer patients designed to help them learn about the latest scientific innovations and cutting-edge treatment.
Created by a patient and team of scientific advisors, including Dr. Allyson Ocean, associate professor of clinical medicine at Cornell University, the new digital platform is intended to help patients make better, faster, more informed treatment choices.
Photo by Robert Hood / Fred Hutch News Service
A new lung cancer app used by patients to report and track their symptoms also created buzz at the conference.
Known as MoovCare, the app seemed to improve survival outcomes in patients who used it, with 75 percent of patients in the app group still alive after a year compared to 49 percent in the non app group.
“Through personalized follow-up using this convenient and simple online application, we can detect complications and signs of relapse and offer appropriate care earlier,” said lead study author Dr. Fabrice Denis, of the Institut Inter-régional de Cancérologie Jean Bernard in Le Mans, France. “This approach introduces a new era of follow-up in which patients can give and receive continuous feedback between visits to their oncologist.”
Metastatic lung cancer patient Janet Freeman-Daily said she was excited about the symptom tracking app and the other patient-focused research featured at this year’s ASCO.
“The trial of a web-based system that allows lung cancer patients to report and track their symptoms offers a vision of how connected health could improve outcomes for cancer patients,” she said. “The app helps detect cancer progression and identifies dangerous conditions such as blood clots in the lungs, common in lung cancer patients, sooner. Now we have to ensure U.S. providers will make time to monitor the information such apps provide.”
As for the MBC Project, Freeman-Daily said it proved what could happen when patients are included in the research design and recruitment process.
“These methods could accelerate research for ALL cancers,” she said.