ESMO Congress 2012

ecancer Managing Editor Prof Gordon McVie chairs a roundtable discussion at ESMO 2012 with Prof Fabrice Andre (Institut Gustave Roussy, Paris, France), Dr Ramesh Ramanathan (Virginia G. Piper Cancer Center, Scottsdale, USA), Prof Peter Harper (Kings College, London, UK) and Prof Robert Leonard (Imperial College, London, UK) on personalised medicine for cancer. They look at topics such as the need to identity differences between stratified medicines versus personalised medicine and defining personalised medicine as individualising treatment for patients. There are many factors that are already considered in treatment; however, there is a need to look further into the molecular alteration and genomics of a patient for more in-depth and effective personalised treatment. The prediction of cytotoxic effects and retrospective analysis of genomic treatments, will allow for the selection of patients based on evidence from clinical trials, saving cost in the treatment and avoiding toxicity to the patient.

Dr Gunnar Folprecht talks with ecancer at the 2012 ESMO meeting about treating liver metastases in colorectal cancer. In recent years, oncologists learned that patients who are non-resective could become resective after chemotherapy, thus allowing for increased long-term survival and even cure by removing metastases through surgery. The challenges now are finding the optimal treatment for shrinking of liver metastasis and learning which patients will benefit the most from this. In addition, there is a need for multidisciplinary cooperation to implement more surgery in patients with liver metastasis.

Prof Gabriella Pravettoni talks with ecancer at the 2012 ESMO meeting in Vienna about the need in personalised medicine to concentrate on the patient receiving treatment and not only genomics. Prof Pravettoni defines personalised medicine as helping the individual immediately, for example, with tools to help with follow up, communication with doctors and understanding treatment options. She also discusses her recent reply to a Nature article that, she feels, left out the most important part of personalised medicine, P5 or the individual. Personalised medicine and patient profiles also allow for the better understanding of potential candidates for clinical trials.

Dr Georgina Long talks with ecancer at the 2012 ESMO meeting about a highly successful phase II trial that tested a BRAF and MEK inhibitor combination therapy against metastatic melanoma. The majority of patients quickly develop resistance to BRAF inhibitors so combination therapy was introduced to improve response and progression free survival. Results from the study showed 61 percent of patients, in the combination arm, to have reduction in risk, resistance and death, with prolonged response averaging 9.4 months. The most significant statistic from the study was an increase from 33 percent of patients reaching the 12-month survival mark two years ago to 79 percent of patients reaching that mark today. Side effects from the treatment, such as manageable toxicities, are explained through the biology of the treatment.

Dr Paolo Casali talks to ecancer at the 2012 ESMO meeting in Vienna about personalised medical therapy of soft tissue sarcomas. This approach involves using histology and tailoring therapy based on each tumours genomics. These complicated procedures require a lot analysis with molecular biology had increases problems in developing clinical trials. Dr Casali also talks about the announcement of the launch of Rare Cancers Europe at ESMO 2012. This multidisciplinary initiative looks at the issues of creating clinical studies for rare cancers in order to quicken the development of drugs for clincial use.

Dr Jamie Prat talks to ecancer at ESMO 2012 about how ovarian cancer develops, and breaks down each of the cancer sub-types. Dr Prat notes that 40 years ago it was thought that ovarian cancer was a singular disease, but now at least 5 different types have been identified. In the clinic, subtypes are identified morphologically and through observation of biomarkers, genetic alterations and clinical collaborations to therapies.

Dr Thomas Bachelot talks with ecancer at the 2012 ESMO meeting about the LANDSCAPE study, which assessed the potential efficacy of combination therapy with capecitabine and lapatinib. The study’s goal was to administer the combination as front line treatment in patients with HER 2+ metastatic breast cancer in order to delay radiotherapy. This treatment can also treat metastases to the brain and other systemic diseases. Of the 45 patients in the study, 38 had either stabilised or partial response. The median time was 7.9 months to delay radiotherapy. This delay is very important for patients as it potentially extends survival without toxicity.

Prof David Ferry talks to ecancer at the 2012 ESMO meeting in Vienna about the first randomised phase II clinical trial in metastatic oesophageal cancer. Previously, after first line chemotherapy, which only provides an average of 10 months survival, no second line therapy could be offered. Between 1996-2011, only 55 phase II trials had been conducted for oesophageal cancer and just five trials resulting in response. Prof Ferry and his team investigated gefitinib with 450 patients, but with results not meeting the primary goal of overall survival. However, secondary goals of increased progression free survival and quality of life in patient reported outcomes were reported. Future studies from the data are already occurring in the translational setting with analysis of biopsy samples for potential biomarkers.

Prof Georgio Scagliotti talks to ecancer at the 2012 ESMO meeting in Vienna about a phase III study that looked at treating small cell lung cancer patients with MET inhibitors in the second and third line setting. In the trial, patients received erlotinib and tivantinib against MET vs erlotinib alone. The phase III study included molecular analysis, of cMET and collected tissue samples from all patients for further study. Prof Scagliotti also discsses the links between KRAS and MET.

Prof Vincenzo Valentini talks to ecancer at ESMO 2012 in Vienna about the importance of collaboration between radiologists and medical oncologists. Through a multidisciplinary approach, radiologists can look at evidence that colleagues produce in their fields and familiarise themselves with the new language of treatment and methodology. Prof Valentini stresses to radiologists that understanding new drugs and compounds will allow for reduced toxicity, hypoxias, managing resistance, and even how radiation therapy can help with immunological response.

Dr Dirk De Ruysscher talks to ecancer at ESMO 2012 in Vienna about the treatment of non-small cell lung cancer and current and previous clinical trial results. The difficulty in choosing a treatment stems from the fact that not all patients react the same to combination chemotherapy and radiation treatment. While the majority of patients react better to concurrent radiotherapy, rather than sequential, there is a minority that does not. Currently these topics are being investigated in on going trials. Previous trials, such as the RTOG trial, showed an example of this when a high dose of chemotherapy is actually less effective than smaller doses.

Dr Carmen Criscitiello talks to ecancer at ESMO 2012 in Vienna about a clinical study that showed the effects of lapatinib and trastuzumab combination therapy in breast cancer patients. Results from the study showed an increase in improved pathological complete response; however, this did not translate into a higher rate of breast conservation surgery. The study looked into what factors effect the decision for surgery and early results show that the largest factor for patients wanting to receive surgery is the preplanning of the procedure. Patients feel that this is the best treatment for them because it has already been decided, despite the effects of non-surgical treatment.

Dr Atanasio Pandiella talks to ecancer at the 2012 ESMO meeting in Vienna about the basis of personalised therapies for cancer and what the future holds for this type of treatment. In addition, Dr Paniella talks about the impact that this will have on patients through more efficient treatment with less toxicity and minimising relapse. Technologies that will help in these fields are proteomic and genomic technology that analyse the changes in alterations of the DNA in tumour cells, thus revealing potential targets. The development of these therapies and technologies faces the challenge of costs and efficiency.

Dr Angelo Dei Tos talks with ecancer about the surgical challenges and approaches to retroperitoneal sarcomas at the 2012 ESMO. Dr Dei Tos explains how factors like the anatomical location of the tumour and the aggressiveness of the surgery are key to the patients overall survival. Understanding the disease pathologically as well as surgically will determine the amount of surrounding tissue that can be removed during resection which greatly effects the patients outcome. Other topics covered include gynaecological sarcomas and systemic treatments.

Dr Alice Shaw talks to ecancer at the 2012 ESMO meeting in Vienna about a randomised phase III study comparing targeted therapy crizotinib with standard chemotherapy in cases of ALK+ lung cancer. ALK+ lung cancer is defined by a genetic abnormality and is present in about 5% of the total lung cancer population. The trial looked to increase progression free survival; results confirmed with a 7.7 month average increase with crizotinib compared to 3 months with standard chemotherapy. The total response rate with crizotinib was 65.3 percent. Side effects that occurred were visual disturbance, nausea vomiting diarrhea, liver irritation, but all were at manageable levels.