What to watch for at ASCO
By: Terry Murdock, MS | June 01, 2016
Looking ahead to the preeminent oncology meeting of the year.
The American Society of Clinical Oncology (ASCO) will be holding its 2016 Annual Meeting in Chicago from June 3rd-7th. The commitment by leading cancer researchers — along with innovative partnerships between pharma, academia, and the government — to share knowledge and work collaboratively, has led to significant strides in developing new technologies and treatments for this disease. The number of scientific presentations submitted this year is impressive: the Chair of the ASCO Scientific Program Committee has reported that more than 5,800 abstracts were submitted, with approximately 2,200 selected for oral presentation. This year, advances in immunotherapy and precision medicine will be of particular interest. Let’s focus on each of these in turn.
The rapidly evolving field of cancer immunotherapy has already led to approval of several new immunotherapies by the United States Food and Drug Administration (FDA), and many more are presently in clinical trials for a variety of cancers. Furthermore, cellular, small-molecule, antibody-based immunotherapies all are being rigorously tested in preclinical studies for clinical translation. Consider the example of melanoma. Cancerous cells acquire the ability to evade the body’s natural defense system against foreign bodies and diseased cells. Proteins called programmed death-1 (PD-1), programmed death ligand-1 (PD-L1), and cytotoxic T-lymphocyte antigen 4 (CTLA-4) are good targets since, together, they inhibit immune cell reactions to tumor cells. If we can teach our immune systems to recognize and neutralize melanoma cells, this is a very powerful way to combat cancer. Novel immunotherapies known as checkpoint inhibitors, including anti-PD-1, anti-PD-L1, and anti-CLTA-4, are being developed to fight advanced melanomas, and they are also be beneficial in fighting lung cancer.
Combinations of these immunotherapies may be additive or even synergistic. For example, combining anti-PD-1 and OX40 agonists in solid tumors shows synergism in preclinical tests, and clinical trials are planned. OX40 is a tumor necrosis factor receptor, and OX40 agonists enhance anti-tumor immunity.
Better combination therapies will also result from elucidation of resistance mechanisms to the currently approved checkpoint inhibitors. Treated with one checkpoint inhibitor, cancer cells can adapt to use other checkpoint pathways to avoid attack and become resistant. Combining checkpoint inhibitors may overcome or delay this resistance, providing long-term remissions or cures. Discovering more about resistance mechanisms to checkpoint inhibitors should lead to better combination therapies.
Additionally, keep an eye out at ASCO for other ways to increase the efficiency of immuno-oncology therapies. As this field continues to grow there will be increased biomarker screening tests for patients based on PD-L1 expression and other gene alterations, especially in first-line settings. Look for new data regarding the use of genomics and predictive biomarkers to determine which patients are most likely to benefit from new immuno-oncology therapies.
Let’s turn now to precision medicine. Precision medicine is an approach for disease treatment and prevention that takes in to account individual variability in genes, environment, and lifestyle for each person. Given tumor genetic heterogeneity, precision medicine is particularly pertinent in oncology. Genomic testing to determine how a given drug might help a given patient is now less expensive, and using genomics in both immunotherapy and molecular targeted therapy is rapidly becoming the new standard of care. Predicting which patients will derive a benefit from a targeted therapy based on their tumor genotype is one advantage, but it also saves other patients from unnecessary exposure to toxic drugs that will not help them.
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