Update from 2008 ASCO Meeting in Chicago
Some thoughts from Kate Murphy. . .
A very full day at ASCO. I began with by stopping for juice and a muffin in the Advocates’ Lounge, which is a special service provided by ASCO through their programs for people living with cancer via Cancer.Net. Advocate participation in the ASCO Annual Meeting is encouraged with scholarships, the Advocates’ Lounge, and special booth in the Exhibit Hall.
A somber but very meaningful first session on The Path to Self-Healing: Delivering Bad News designed to help oncologists learn how to help their patients find meaning in difficult diagnoses at the end of life included a wonderful documentary by Ruth Yorkin Drazen featured the life of Dr. Peter Morgan, a young oncologist with sarcoma.
“My spirits are soaring,” Dr. Morgan wrote in his diary the day that he returned to caring for patients on crutches and with a cap covering his mostly bald head.
The film reminded me that helping people with cancer isn’t all about providing technical details but helping them move from suffering to healing, even when healing doesn’t mean the cancer is going away.
A bus ride through Chicago for a meeting about how to encourage patients to enroll in clinical trials gave me time to reflect on the Drazen film, rest in a comfortable seat, and think about how Chicago’s skyscrapers are the tall, strong bones of the city. There is strength here at ASCO, as well as excitement.
The afternoon focused on lots of technical details! Much focus in colorectal cancer this meeting is on the biomarkers that predict whether or not patients will benefit from certain treatments. Rather than seeing broad new treatments this year, we’ll learning that colorectal cancers differ from each other.
A drug that can be spectacular in preventing recurrence or extending life in one person may do nothing at all for another tumor. For years, the only way to know this was by trial and error, but new techniques are letting us measure expression of genes such as K-RAS to predict patients who will get no benefit from certain treatments. We can then avoid wasting precious time with them, along with their side effects and expense.
The day ended with a very long, but important, session highlighting key colorectal cancer research. I’ll be sending you more specific information about these studies. Briefly, information included:
- After five years of follow-up fewer recurrences continue when oxaliplatin is added to 5FU for stage II and III colon cancer. There is a trend toward better overall survival. This study (NSABP C-07) uses bolus 5FU rather than the continuous infusion method in the MOSAIC clinical trial.
- Adding Avastin (bevacizumab) to FOLFOX for stage II and III colon cancer treatment appears to be safe (NSABP C-08) with no significant increases in serious side effects including GI perforations, bleeding, arterial blood clots, or death. Safety follow-up is continuing, and information about whether the new treatment is more effective will be available in about two years.
- Improvements in survival time after a recurrence is detected have weakened the link between 3 year disease-free survival and 5 year overall survival. We may need to be following up longer to find that statistical improvement.
- Patients whose tumors are the result of deficient mismatch repair genes don’t benefit from 5FU based treatment for stage II and III colon cancer. In some cases it may actually reduce survival. Testing for mismatch repair status before starting treatment is important for decision-making.
- Intravenous calcium and magnesium protects against peripheral neuropathy from oxaliplatin treatment and doesn’t reduce treatment effectiveness.
- Adding Erbitux (cetuximab) to FOLFOX and Avastin (bevacizumab) for first-line colorectal cancer treatment did not improve outcomes and, in some situations, actually decreased effectiveness. (CAIRO 2 study).
- In the CONcePT trial, giving oxaliplatin intermittently increased the time that patients remained on treatment resulting in a trend toward better progression-free survival. Calcium and magnesium infusions reduced neurotoxicity and the number of patients who had to stop treatment because of neuropathy. No reduction in effectiveness was associated with calcium and magnesium.
- Initial safety information from a randomized study of radiofrequency ablation and chemotherapy found no safety problems using the two treatments together.
- Adding irinotecan to infused 5FU after surgery for liver metastases did not appear to have an overall advantage.
Watch the C3 Research and Treatment News for more specific information about each of these ASCO presentations in the coming week.
Very tired, footsore, but excited and encouraged, I got back on the bus for my hotel and a comfy bed to prepare another day at ASCO.