ASCO always represents the pinnacle of intellectual engagement within the oncology community, and this year’s conference should be no exception. We will be able to see, scrutinize, discuss, and decode the latest developments in cancer diagnosis and treatment, with the impacts changing the trajectory of lives around the world. As a scientist, I am always fascinated and amazed by the efforts and rigor required to translate laboratory hypotheses and findings into late-stage and approved therapeutics that address fundamental mechanisms of cancer biology. While the field is becoming more and more complex everyday with many new options, algorithms, and precision medicine approaches, the upside is that community oncologists will have more and more tools to attack cancer, with a greater runway of therapies that can preserve quality life for as long as possible.
Two particular approaches are of great interest but are seemingly at the opposite ends of the intellectual spectrum—chemotherapy, the old tried and true “blunt object” approach to killing cancer cells, and immuno-oncology (I-O), the intelligent, “holy grail” of cancer treatment. As disparate as these modalities appear to be, they both need to be evolved and optimized in order to broaden their reach and affect more patients who are still in dire need of better outcomes. We will no doubt see details of many of these efforts in the coming days.
In the case of I-O, various therapeutic options including anti-PD-1/PD-L1 therapy, anti-CTLA-4 therapy, CAR T-cell therapies and oncolytic viruses have become incorporated across many aspects of the oncology treatment landscape, yet sizeable gaps still remain. These approaches– largely focused on the adaptive immune system at the moment– work well for a significant number of patients, but durable efficacy is still elusive for the majority (an interesting article here). Part of this may be due to tumor heterogeneity and part may be due to the lack of immunogenicity in specific tumor types, among other causes. Regardless, there are new approaches (including combination regimens and/or innate immune system activation) required to successfully deploy I-O in these patient groups, and I’m tremendously excited to see the latest data on these approaches at ASCO. Whether it’s combinations with chemotherapy, radiation therapy, targeted therapy, or natural killer cell engagement, there is certain to be a whole new range of mechanisms that will be interrogated in the coming months and years, ultimately being available for the community oncologist to tailor appropriate treatment to the right patients. Additionally, further efforts should be aimed at optimizing the safety of I-O regimens so that an ideal duration of therapy can be achieved.
Beyond I-O, chemotherapy remains a mainstay of treatment for a broad range of patients, whether it’s in Hodgkin lymphoma, lung cancer, breast cancer, colorectal cancer, or other tumor types (interesting article here). As we all know, the collateral damage from these treatments can be severe, but optimizing antitumor activity while mitigating this damage offers great potential to change outlooks and outcomes for patients in dire need. For instance, approaches to minimize damage to hematopoietic stem cells and allow the blood lineages to repopulate appropriately are rapidly being optimized. And new combinations with biologics or small molecules can reduce the level of chemo required for tumor shrinkage and perhaps allow for specific toxic components to be eliminated. A vast number of lives have been saved or extended through the judicious use of chemotherapy over the decades, so the idea that chemotherapy will be made obsolete with new approaches is a bit naïve. Rather, giving patients the benefits of cancer-cell elimination without inducing short or long-term toxicity represents a whole separate but equally important effort. In this way, innovative science in oncology is not limited simply to the most novel mechanisms, biomarkers, or personalized therapies—rather, there can be great value in innovating on what is already effective and making it less burdensome for a broader population.
The result will be far-reaching impact for oncologists who are bravely confronting the most difficult challenges in patient care every single day.
Stay tuned for more 2019 ASCO content! Check out Rita Glaze’s perspective on offering the highest quality of care at the most effective cost.
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