Trevor Christ, PharmD BCOP
Clinical Pharmacy Specialist in Adult Hematology/Oncology
UChicago Medicine
Chicago, IL

The 2017 annual meeting of the American Society of Clinical Oncology (ASCO) was held at McCormick Place in downtown Chicago, IL, June 2–6. The largest global meeting in oncology practice, this year’s meeting boasted 39,400 attendees.¹ Physicians, researchers, business representatives, nurses, and pharmacists gathered from all over the world to hear the latest updates in oncology practice.

The conference’s opening session began with an address from ASCO president Daniel Hayes. This was followed by award acceptance presentations from Carl June, MD, who received the David A. Karnofsky Memorial Award for his work with chimeric antigen receptor T-cells (CAR-T) in the treatment of acute lymphocytic leukemia, and Olufunmilayo Olopade, MD FACP, who received the Humanitarian Award for her work in global health disparities, equity, and cancer prevention. Siddhartha Mukherjee, guest speaker and Pulitzer Prize–winning author of The Emperor of All Maladies, gave an address touching on the past, present, and future of cancer care while highlighting the personalization of treatment and prevention of disease.

The opening session sets the tone for a conference, but the plenary sessions contain presentations on much of the most influential research.^2,3 Among the highlights were these:

• International Duration Evaluation of Adjuvant Chemotherapy (IDEA) trial presented by Qian Shi⁴—This trial was a pooled analysis of 6 prospective, randomized, clinical trials that showed noninferiority of 3 versus 6 months of adjuvant chemotherapy for stage 3 colon cancer. Noninferiority was met for 3 versus 6 months of the XELOX-treated arms but was not met in the FOLFOX arms. Certain stages (T1-3, N1) showed noninferiority across both the XELOX and FOLFOX arms.
• An evaluation by Ethan Basch, MD MSc, of the use of a Web-based 12-symptom report on tablet computers given by patients with metastatic solid tumors who received chemotherapy as compared to standard practice⁵—The survey included assessment of common symptoms such as pain, shortness of breath, loss of appetite, fatigue, nausea, and hot flashes on a 5-point scale. This intervention resulted in a more than 5-month increase in overall survival (31.2 months vs. 26.0 months)—even after correcting for confounders via multivariate analysis—in 766 patients with gynecologic, genitourinary, breast, and lung cancer.
• A presentation by Karim Fizazi on the upfront use of abiraterone (1,000 mg daily) plus prednisone (5 mg daily) in addition to androgen deprivation compared to placebo, prednisone, and androgen deprivation in newly diagnosed high-risk, castration-sensitive, metastatic prostate cancer patients in the LATITUDE study⁶—The major coprimary end points of overall survival (not reached vs. 34.7 months) and radiographic progression-free survival (33 months vs. 14.8 months) favored the addition of abiraterone to antiandrogen therapy at the risk of increased incidence of hypertension, hypokalemia, and transaminitis.
• Mark Robson’s presentation on the findings of the OlympiAD trial that randomized HER-2 negative patients with relapsed or refractory metastatic breast cancer with a germline BRCA mutation to olaparib tablets (300 mg twice daily) or physician’s choice of chemotherapy (capecitabine, vinorelbine, or eribulin⁷—Progression-free survival (7.0 months vs. 4.2 months) and overall response rate (59.9% vs. 28.8%) were improved with olaparib compared to the control arm. Additionally, a decrease in grade 3/4 adverse events and less discontinuation of therapy was seen with olaparib. Overall survival was not improved in the olaparib group.

Outside the plenary sessions, the expanding role of immunotherapy took the driver’s seat in many sessions, including research on biomarker analysis, expanded indications for programmed cell death-1 inhibitors, and trials combining U.S. Food and Drug Administration–approved immunotherapy drugs with chemotherapy, radiation, or additional checkpoint inhibitors. Precision medicine was also a large topic of discussion at many sessions, especially with respect to clinical decision making and navigating genomic data sets in clinical practice.

Finally, the costs of cancer care and the cost-effectiveness balance in cancer care were the subject of multiple discussions and poster sessions. This healthcare issue continues to be of importance and is one that oncology pharmacists can clearly have an impact on.

ASCO’s 2018 meeting will be held in Chicago on June 1–5; visit www.asco.org for more information.

References

1. ASCO Annual Meeting Demographics. https://am.asco.org/about/demographics. Accessed September 18, 2017.
2. Robson M, Im SA, Senkus E, et al. Olaparib for metastatic breast cancer in patients with a germline BRCA mutation. N Engl J Med. 2017;377(6):523-533. doi:10.1056/NEJMoa1706450. Epub 2017 June 4.
3. Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA. 2017;318(2):197-198. doi:10.1001/jama.2017.7156.
4. Shi Q, Soberto AF, Shields AF, et al. Prospective pooled analysis of six phase III trials investigating duration of adjuvant (adjuv) oxaliplatin-based therapy (3 vs 6 months) for patients (pts) with stage III colon cancer (CC): the IDEA (International Duration Evaluation of Adjuvant chemotherapy) collaboration. J Clin Oncol. 2017;35(suppl; abstr LBA1).
5. Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. J Clin Oncol 2017;5(suppl; abstr LBA2).
6. Fizazi K, Tran N, Fein L, et al. LATITUDE: a phase III, double-blind, randomized trial of androgen deprivation therapy with abiraterone acetate plus prednisone or placebos in newly diagnosed high-risk metastatic hormone-naive prostate cancer. J Clin Oncol. 2017;35(suppl; abstr LBA3).
7. Robson M, Im SA, Senkus E, et al. OlympiAD: phase III trial of olaparib monotherapy versus chemotherapy for patients (pts) with HER2-negative metastatic breast cancer (mBC) and a germline BRCA mutation (gBRCAm). J Clin Oncol. 2017;35(suppl; abstr LBA4).