By John Otrompke.
This year’s annual meeting of the American Society of Clinical Oncology (ASCO), which ended on Tuesday, provided many examples of emerging therapies that offer new hope to even those patients with metastatic disease. Improved results in progression-free survival in clinical trials suggest that many forms of cancer may soon take on a more chronic form, like that of prostate cancer or lymphoma, allowing patients to be treated for longer periods of time. Indeed, 65% of cancer patients in the U.S. already live five or more years after diagnosis, according to Dr. Melissa Hudson, the chair of ASCO’s cancer survivorship committee, citing figures from the Centers for Disease Control.
Even the most severe metastatic cancers, such as melanoma, pancreatic, lung and ovarian cancer, may take on a more chronic aspect, within the next ten to 15 years.
The relatively new science of genomics is playing an important role in these medical successes. In metastatic lung cancer patients, treatment with an EGFR blocker called Afatinib was shown to increase progression free survival [PFS] from 6.9 months to 11.1 months, according to a study presented at the conference. In patients with certain common mutations, PFS nearly doubled, from 6.9 months to 13.6 months, according to study abstract LBA 7500, meaning that even metastatic patients may survive for more than a year.
In a trial conducted in patients with metastatic and/or unresectable stromal tumor (GIST), the most common sub-type of sarcoma, the drug Regorafenib was associated with a disease control rate of over 52%, no matter how many previous therapies had failed a patient. For many years, metastatic melanoma was one of the most aggressive forms of cancer known, and patients with the metastatic form of the disease could often expect to live only a number of weeks, at best. At this year’s conference, however, the drug Dabrafenib not only extended progression-free-survival, but even evoked a response from brain metastases for 20 weeks, or 28 weeks among those who had previously tried other therapies. Among those with advanced ovarian cancer, treatment with Bevacizumab along with standard chemotherapy nearly doubled progression-free survival to 6.7 months, compared to chemotherapy alone, and regardless of age.
Ultimately, molecular-based prognostic analysis and genomic science may help doctors and scientists understand why some forms of cancer that historically have been capable of taking on a chronic form, such as leukemia and lymphoma, sometimes present with an indolent nature, but other times appear more virulent. The complexities of what triggers these profoundly idiosyncratic tumor responses must be better understood if next stage therapies are to realize their potential.
If the potential of science set the pulse of this year’s conference, collaboration — partnerships — formed the toolbox. Many sessions focused on how stakeholders in cancer treatment needed to work more closely, especially in giving all this new science a practical application. New important constituencies were identified, such as the role of pathologists in improving the scope and quality of tissue samples needed to complement the emergence of new companion diagnostics. Collaboration is also a necessity to tackle the “elephant in the room,” which reverberated throughout the proceedings: the soaring cost of cancer care, and drugs in particular. The challenge is compounded by the ethical difficulties in setting a value for cancer treatments, because so much of the cost is concentrated on end of life interventions. And while personalized medicine may help improve outcomes, there are many hidden costs, some of which are borne disproportionately by participants in the continuum of care.