Cancer Insights: What I’ll be looking for in Chicago – an ASCO 2015 preview

May 27, 2015 | by Sumanta Kumar Pal M.D.

The American Society of Clinical Oncology (ASCO) is a U.S.-based organization that ties together oncology health care professionals (doctors, nurses and pharmacists) from around the world. The organization’s annual meeting represents a key forum in which scientific breakthroughs in oncology are unveiled. Attendance is nothing short of spectacular – last year, the meeting drew 34,000 attendees with just over half coming from outside of the U.S.

ASCO 2015: What's hot ASCO 2015 preview: For a medical oncologist specializing in prostate, kidney and bladder cancer, the annual meeting of the nation's top oncologists is a learning opportunity that can't be missed. One of the most promising topics is about a clinical trial using gene therapy.

This year’s meeting begins Thursday in Chicago. After a busy clinic today, I’m going to hop on a red-eye and make my way there. As a medical oncologist focused on prostate, kidney and bladder cancer, I'll be focused on the following research in particular:

1. “Gene therapy” for bladder cancer: The BOREALIS-1 trial: For years we have longed for new therapies for advanced bladder cancer. It’s been three decades since cisplatin (a standard chemotherapy agent) was introduced for the disease, and since that time, we’ve had virtually no effective drugs developed. This appears to be changing dramatically.

My friend and colleague Przemyslaw Twardowski, M.D., was involved in an international study evaluating a novel drug called apatorsen. Apatorsen represents a sort of “gene therapy” – a short strand of DNA that enters the cancer cell and shuts down its defense mechanisms. At this meeting, we will see data suggesting that when added to chemotherapy, apatorsen led to an impressive improvement in survival.

That data is a real glimmer of hope for patients with advanced bladder cancer.{C}

2. Gene profiling in kidney cancer points to new targets for treatment: Unlike bladder cancer, the treatment of kidney cancer has made a number of important strides over the past several decades. Specifically, targeted drugs have been introduced – the drugs have specific shapes and contours that bind to the unique proteins with drive kidney cancer. One of the challenges, however, is that we’ve hit a bit of a plateau. We’re able to effectively block a handful of targets, but we suspect that there’s a multitude of targets in kidney cancer that haven’t been unearthed.

At this year’s meeting, I’ll be presenting data with colleagues from Foundation Medicine, the Dana Farber Cancer Institute and MD Anderson Cancer Center in which we present detailed genetic profiles from 443 patients with advanced kidney cancer. This rich dataset has allowed us to discover many new genetic alterations in kidney cancer, and possible targets for new drug treatments.

3. Chemotherapy for prostate cancer: The STAMPEDE trial: There has been a raging debate on when to apply chemotherapy in patients with advanced prostate cancer – traditionally, we have waited until patients develop resistance to standard hormone therapies. Last year, shock waves emerged when a U.S.-led trial (ECOG 3805) suggested that using chemotherapy earlier in the disease course (e.g., before hormone resistance develops) could lead to a profound improvement in survival. Several camps have expressed skepticism given a previous trial producing the opposite findings. The STAMPEDE trial, which will be presented this weekend, may put this debate to rest.

Like the previous studies, the trial compared chemotherapy with hormone therapy versus hormone therapy alone in patients with “hormone-sensitive” advanced prostate cancer. The results clearly favor chemotherapy, and thus, the STAMPEDE trial pushes the pendulum back in favor of chemotherapy in this setting.

These are three highlights from the meeting I’m excited about, but please feel free to follow me on Twitter over the next several days as I post live from the meeting. As it is every year, the ASCO Annual Meeting is the premier forum for revealing key discoveries in cancer treatment.

Looking forward to bringing my new knowledge with me to clinic next week!

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Sumanta Kumar Pal, M.D., is an assistant clinical professor in the Department of Medical Oncology & Therapeutics Research and co-director of the Kidney Cancer Program at City of Hope.

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