ASCO 2018 news: ‘blood tests’, breast cancer chemo, kinder treatments and immunotherapy

Around 40,000 cancer experts descended on Chicago to share a glimpse of the latest in cancer prevention, diagnosis and treatment. The American Society for Clinical Oncology (ASCO) Annual Meeting is the largest of its kind in the world. And this means the research on show makes headlines. Lots of them.

This media coverage comes with several notes of caution though. Most of the results being shared at the conference are a preliminary look at ongoing clinical trials, and in some cases those trials are at an early stage. The researchers are also tasked with delivering these updates in incredibly short talks. This, combined with the media’s hunt for a good story, means that details can be missed, confusingly presented or the scale and stage of a study not made clear to the reader.

So, to help you judge the media stories for yourself, we’ve written this 6-point cheat sheet on what to look out for.

We were in Chicago to see for ourselves what was hot. Here’s what made our daily roundup of stories.

Day 1 – Friday June 1

‘Holy grail’ blood test

The UK’s media pounced on the story of an experimental blood test that can detect different cancers in some people who have already been diagnosed with those cancers. But a key thing to spot is that the test also missed some cancers. And it has yet to be put through its paces in diagnosing cancer in people who don’t already know they have it.

The unpublished results made several front pages in the UK. And the potential output was portrayed as a simple blood test that can detect multiple types of cancer before symptoms occur. This is an exciting idea, and one researchers really are pursuing. But this doesn’t really tally with what the research shows so far.

The cancer blood test in the news is still a long way from being widely used, as our animation explains. This blog post has tips on how to judge a story for yourself: https://t.co/e2Wj1eG3JJ pic.twitter.com/BXfq02WjHD

— Cancer Research UK (@CR_UK) June 1, 2018

Do black and white men fare differently on prostate cancer treatment?

On day one, the ASCO media team turned its focus towards disparities in cancer treatment.

Two prostate cancer studies were selected as highlights to be shared with journalists. In both cases, the results suggest that black men may do as well or better on certain treatments for advanced prostate cancer than white men.

The research, along with other studies focusing on gender and geographical differences, highlights the importance of inclusive and representative clinical trial design – something that will be vital in making treatment truly personal.

Day 2 – Saturday 2 June

The hunt for the ‘holy grail’ continues with lung cancer blood test

Following yesterday’s excitable reports on a cancer blood test, a company that many have their eyes on in this area – Grail – released the latest update on its experimental blood test for lung cancer. The bottom line: the technology is getting more precise, and the results suggest that signs of early stage lung cancer can be detected in blood samples from patients already diagnosed. But there’s a long way to go before this could be widely used to detect undiagnosed cases early.

STAT News had the must-read piece covering the results: Grail’s cancer blood test shows ‘proof of principle,’ but challenges remain.

Immunotherapy for prostate cancer

In an illuminating example of how the media sometimes reports on early stage research, there was widespread excited coverage of a small trial looking at using the immunotherapy drug pembrolizumab (Keytruda) to treat men with advanced prostate cancer.

Immunotherapy is an exciting approach to treatment but it’s well-established that it doesn’t work for every patient, and this trial was no exception. A very small proportion of men – 10-15% – showed a response to the drug – and because this is a phase 2 trial, ‘response’ range from their cancer staying the same size, shrinking, up to a complete disappearance of the tumour. So the proportion of men whose cancer actually shrank is even smaller than the 10-15% who ‘responded’.

In an interesting alternative perspective on this, a reporter in a conference session on ‘covering cancer in the media’ suggested that sometimes it would be more honest to flip the stats around – and in that case, we’d be reporting that about 90% of patients on this prostate cancer trial got no benefit from the drug.

How long should patients be checked after cancer treatment?

The Daily Mail, The Sun and The Guardian jumped on research trying to put a number on how long people should be monitored after cancer treatment, and the best way to do that monitoring. This is no easy feat, with the chance of cancers coming back varying for several reasons. The data used in the study came from the US. And in the UK, these monitoring times are set by clinical guidelines.

“There’s limited evidence on the best way to follow up many types of cancer and for how long after treatment,” says Dr Richard Roope Cancer Research UK’s senior clinical adviser and GP expert. “Often it is unclear whether doing regular scans and tests is useful or whether it is better to rely on physical examination by a doctor or nurse and the self-reporting of symptoms by patients.”

Day 3 – Sunday 3 June

Conference headliners show how to make treatment kinder

Four presentations are selected each year at ASCO to feature in what’s essentially the headline slot at the conference. And three of these talks carried a theme of how to dial back on certain treatments while not compromising on results.

There was discussion across the different talks about how the results could quickly change how patients are treated.

One study showed how a gene test can help select which women with the most common type of early stage breast cancer can safely avoid chemotherapy.

Another clinical trial showed how a targeted drug is just as good on its own as it is when combined with surgery for advanced kidney cancer. The bottom line being these patients should now be able to be treated with just the drug, and avoid the surgery.

We covered both these trials:

• Breast cancer gene test could spare some women chemo
• Some people with advanced kidney cancer could avoid surgery

And the immunotherapy drug pembrolizumab (Keytruda) was shown to be better than chemotherapy as a first line treatment for advanced non-small-cell lung cancer – all with fewer side effects.

Antibiotics and cancer treatment

Another study generated some alarming headlines – with results from a trial showing that certain immunotherapy drugs called checkpoint inhibitors might not work as well in patients who are taking antibiotics. The theory is that this is because antibiotics affect the microbes in patients’ guts – microbes that play a role in the body’s immune defences and work in tandem with immune-boosting drugs.

But it’s not a simple problem to solve – people with cancer often have less immunity to infections because of other treatments they’re having, such as chemotherapy, and sometimes antibiotics are essential to prevent them from getting seriously ill. As with most conundrums in healthcare, there is a tricky balance to be struck – but it’s probably too soon for patients to be getting anxious about whether antibiotics are affecting their treatment. For most people with cancer, antibiotics can be a crucial tool to help tackle their illness, and the researchers themselves say further studies are needed to understand their results.

Day 4 – Monday 4 June

New chemotherapy options for pancreatic cancer

In a double header of promising results in pancreatic cancer, a disease where progress has been lacking for many years, combinations of chemo or timing of chemo sparked interest.

One study found a powerful cocktail of four chemotherapy drugs was better than a single drug at extending the lives of pancreatic cancer patients after surgery. A key factor in this treatment is making sure the patient is well enough for the combination. And experts say further analysis of the results will be needed to see if there’s a way to pin down who is most likely to benefit.

A second study found that pancreatic cancer patients treated with chemotherapy and radiotherapy before surgery may live longer than those who have immediate surgery.

This is a “rapidly evolving area of research,” said Dr David Chang, a pancreatic cancer surgeon from the University of Glasgow and Glasgow Royal Infirmary. And with other combinations of treatment being tested, there could be further gains to be made, which is positive news for a disease where survival remains stubbornly low.

We covered both studies if you’re looking for more detail:

• Chemo combo could help pancreatic cancer patients live longer after surgery
• Chemoradiotherapy before surgery may extend lives of pancreatic cancer patients

Over-the-counter drugs could cut cases of oesophageal cancer in those at high risk

The potential to use cheap, available drugs to prevent cancer in certain groups of people is a compelling idea. And a study hinted at how this might be possible for oesophageal cancer.

Combining aspirin and a stomach acid blocker cut cases of oesophageal cancer in people with Barrett’s oesophagus, a condition that increases the risk of the cancer. But questions remain, such as who might benefit most from these drugs, and can they specifically prevent deaths from oesophageal cancer?

Although the researchers say that limited side effects were seen on the study, they must be considered when these drugs are taken long-term, and so the decision to take them regularly is one that must be made with advice from a doctor.

We spoke to the lead researcher behind the study to find out more:

• Combining heartburn drugs and aspirin could help prevent oesophageal cancer in people at high risk

Nick Peel and Nell Barrie, from the ASCO meeting in Chicago.