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ASCO 2019 news: targeted treatment takeover, drugging the ‘undruggable’, obesity and blood tests

by Nick Peel | Analysis

31 May 2019

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prostate cancer cells
Prostate cancer cells.

The world’s cancer specialists once again descended on Chicago to meet, discuss and share the latest in cancer prevention, diagnosis and treatment. Close to 40,000 doctors and experts gathered for the American Society of Clinical Oncology (ASCO) Annual Meeting, the largest cancer conference in the world.

The research on show makes headlines. Lots of them. And this media coverage comes with several notes of caution. 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 sometimes be missed, confusingly presented or the scale and stage of a study not always made clear.

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 also there to catch the latest news in cancer research. Here are the highlights.

Day 1 – Friday 31 May

Blood test next steps

Each year there are column inches dedicated to discussing whether now is the time that a ‘simple blood test’ for cancer has appeared on the scientific horizon. Day one of ASCO 2019 proved that this year is no exception. And, much like last year, the conclusion remains that there’s still a long way to go.

One company that many have their eye on, called GRAIL, released a glimpse of new, unpublished data ahead of a few of its conference presentations that was picked up by the media. Their goal is to develop a blood test for 12 types of cancer that can also say where in the body the cancer is growing. And there are 2 main takeaways from the latest data, which come from pilot studies of the test in 1,422 people known to have cancer and 879 who have not been diagnosed:

  1. So far, the experimental test can detect cancers with varying degrees of success across the 12 types – and the sensitivity ranged from detecting 34% of stage 1 cancers to 84% of stage 3, which could prove important if this is to become a test to detect cancers early.
  2. Of the cancers the test detected, it also correctly flagged where in the body the cancer had originally started growing in 9 in 10 cases.

GRAIL says these latest results show how they’re reaching a point where a balance can be struck between the test being sensitive enough to detect most cancers while minimising the chance that it suggests someone has cancer when they don’t. Trials with large numbers of people will be needed before it’s clear if that’s the case, and the company is already planning those. But there is a long way to go.

STAT News had an in-depth piece on the results if you have a subscription, as did Fierce Biotech.

Day 2 – Saturday 1 June

Precision drug ‘first’ for younger women with aggressive breast cancer

Combining a targeted drug with hormone therapy extended the lives of pre-menopausal women with advanced breast cancer in a clinical trial.

After three and a half years follow up, 70 in 100 women who received the combination of ribociclib (Kisqali) and hormone therapy were still alive. This was compared with 46 in 100 of those who took the standard hormone treatment with a dummy drug (placebo).

Experts said the striking survival improvements were a first for this precision medicine approach in these patients. And with less impressive results for other similar drugs in different trials, as Forbes discussed, it raises the question of which combinations will prove best for patients.

Here’s our report on the results: Precision drug combo boosts survival in younger women with advanced breast cancer

And for more on the Nobel Prize-winning science behind ribociclib, read this blog post: Understanding how cells divide – the story of a Nobel prize

UK media goes big on obesity

If you follow the UK’s media you’d be forgiven for thinking that this year’s ASCO was putting obesity at the top of the agenda. This may not strictly be true, but some new stats splashed across various headlines should help raise the challenge to a wider audience – and it’s critically important that happens, with being overweight or obese the second biggest preventable cause of cancer.

The latest numbers we’ve crunched project that over the next 15 years, overweight and obesity is set to cause almost 540,000 UK cancer cases. This tallied with NHS figures that various headlines ran with, suggesting that the obesity epidemic is on its way to becoming ‘the new smoking’.

Professor Linda Bauld, Cancer Research UK’s prevention expert, said: “These are extremely worrying numbers that paint a bleak picture, and should be a wakeup call to the Government.”

Hints that immunotherapy may benefit some with advanced stomach cancers

Immunotherapy, chemotherapy or both? New, unpublished trial results painted a mixed picture for some advanced stomach cancer patients.

On one side, the immunotherapy drug pembrolizumab (Keytruda) could prove just as effective as chemotherapy in prolonging the lives of patients with advanced cancers of the stomach or food pipe.

And for some, the immune-boosting treatment offered improved survival in the trial compared to standard treatment.

But there’s a twist: this was only seen when the immunotherapy drug was used alone. When combined with chemotherapy, it added no extra survival benefits to patients.

Our news report has the details: Immunotherapy comparable to chemo for some advanced stomach cancers

Day 3 – Sunday 2 June

The much-anticipated plenary talks took place today – they’re essentially the headliners of the conference, selected by the organisers as being likely to have a big impact. As a result, a few made headlines.

A ‘new era’ for pancreatic cancer treatment?

By targeting genetic weaknesses inside cancer cells, a precision drug held some advanced pancreatic cancers at bay for a short time after chemo, according to new clinical trial results.

The drug, called olaparib (Lynparza), delayed the progression of the disease by 7.4 months on average, compared with 3.8 months in those treated with a dummy drug (placebo).

Olaparib is a treatment that’s specially designed to kill cancer cells that carry a fault in the BRCA genes, which help cells repair damage to their DNA. And while longer term survival analysis is still needed to gauge the potential impact, some pancreatic cancer experts were cautiously optimistic about the trial results.

“We’re potentially on the cusp of a new age of treatment for pancreatic cancer, where for the first time we can tailor therapy based on a biomarker and where having a BRCA mutation opens up more treatment options,” said Dr Suzanne Cole in a comment from ASCO.

We have more on this in our news report: Targeted drug trial points to potential ‘new age’ for pancreatic cancer treatment

And in more PARP news, a prostate cancer trial showed early signs that olaparib might also benefit some men with faults in genes linked to DNA repair, including the BRCA genes.

It’s an impressive sign of how treatments and clinical trials are moving away from focusing on cancer types, and instead aiming to treat patients based on the unique characteristics of their cancer.

The Mail Online and Telegraph were among those who covered the early results.

Treat prostate cancer ‘early and hard’, but with which drug?

A new drug was added to the list of possible up-front treatment options for people diagnosed with prostate cancer that has spread.

The latest, based on a clinical trial presented at this year’s conference, showed that adding a hormone treatment to standard therapy extended men’s lives.

8 in 10 men (80%) who received the drug, called enzalutamide (Xtandi), were alive 3 years later, compared with just over 7 in 10 men (72%) who received standard treatment.

With similar results seen in previous trials for a chemotherapy drug – called docetaxel – and another hormone treatment called abiraterone (Zytiga), this points to the possibility of doctors and patients having 3 options for treatment in the future.

Docetaxel is the treatment offered to men on the NHS, and experts don’t see that changing any time soon – especially as it’s a cheaper option compared to the more targeted drugs.

But there was one thing for certain, according to Dr Tanya B. Dorff from City of Hope in the US, who said the results show that these prostate cancers need to be treated “early and hard”.

A(nother) blood test… this time to predict breast cancer’s return

Away from the packed plenary talks, media outlets picked up on the promise of a new cancer blood test. But instead of using blood samples to detect cancers early (which we wrote about at the beginning of the conference), this focuses on a test that could help predict if breast cancer will come back after treatment.

The experimental test hunts for chunks of cancer DNA released into the bloodstream. And researchers found that seeing certain gene faults in these blood tests might help gauge the risk of breast cancer returning or becoming resistant to treatment.

The Institute of Cancer Research, where the study was carried out, has more on their website: New blood test predicts breast cancer’s return at start of treatment

Day 4 – Monday 4 June

Experimental approach to ‘seek and destroy’ prostate cancers

An experimental treatment that’s designed to home in on prostate cancer cells, and deliver radiotherapy directly to the cancer, attracted interest from the UK’s media outlets.

Early stage trials are under way for the therapy that uses a targeting system linked to a radioactive payload to seek out a molecule found on prostate cancer cells, called prostate-specific membrane antigen (PSMA). Comments from doctors labelling it ‘the next big thing’ certainly stirred the media interest, as some new data were presented at ASCO.

We’ll have to wait for longer term results before we’ll know if the treatment adds benefit for men with advanced prostate cancer whose disease no longer responds to other therapies.

It’s fascinating science born from cancer imaging, where PSMA is targeted with molecules that light up where prostate cancer cells are on scans. By combining a radiotherapy dose that could treat the cancer, researchers are dubbing it a hybrid of therapy and diagnostics, or theranostics for short.

Small, early stage trial on an ‘undruggable’ molecule

Most clinical research on show at ASCO is at too early a stage to get excited about. But the sheer weight of scientific expectation around one very early-stage trial this year means it’s worth a mention.

For more than 30 years, scientists have tried – and largely failed – to develop experimental drugs against a molecule that fuels many cancers: K-Ras. But by focusing on a particular faulty version of the molecule, one drug company – Amgen – has been able to develop an experimental drug that it’s just getting into clinical trials.

A glimpse at unpublished data from an ongoing trial hinted that some patients’ lung cancers respond to the drug, as STAT News covered if you have a subscription.

There are important caveats here: this is a small, early stage trial with data for just 10 lung cancer patients so far. And it’s only relevant to cancers that carry this one faulty version of K-Ras. But, while it’s too early to say what will happen next, it highlights how persistent scientists can be – if this did turn out to work for even a small number of patients, it would be a “watershed moment”, according to Dr. Trever Bivona, from the University of California, San Francisco, who gave comments to STAT News.

Nick Peel, from the ASCO Annual Meeting in Chicago.