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Christine Wilson, cancer survivor, shares her experiences from the The American Society of Clinical Oncologists (ASCO) national conference in 2013. This summer, 30,000 cancer specialists and researchers from around the world gathered to present their latest findings on the prevention, diagnosis and treatment of science. At a recent continuing medical education meeting, experts from the Abramson Cancer Center summarized some of the most important research from ASCO 2013 for a packed room of over 300 local oncologists.

Most experts would characterize this year’s meeting as one in which the progress reported was important, but largely incremental. Today, the advances that we see in cancer treatment are the result of a rapidly emerging understanding of the biology and genetics of malignant cells, and the ways in which they interact with our immune systems and neighboring tissues. That new knowledge has lead to the development of targeted therapies that are changing the ways in which many cancers are treated. This same research is also revealing the incredible complexity of thousands of diseases we call cancer. A discovery in one critical area more often than not opens new, unexpected doors, and raises new questions.

Genitourinary Tumors

David Vaughn, MD

Dr. Vaughn reported progress for three different cancer types:

• Prostate cancer
• Renal cell cancer
• Testicular cancer

Prostate Cancer

Treating Bone Metastases:

When prostate cancers spread, it is often to the bone. Bone metastases cause pain and weakness and can lead to fractures. A major clinical trial, called TRAPEZE, studied several approaches to treating prostate cancers that have spread to the bone and are not responsive to hormonal therapies, and who are receiving chemotherapy with docetaxel. The trial found that

• A radioactive substance known as Strontium-89 improves bone related progression free survival--the time until the cancer begins to grow again.
• Zolendronic acid, which is widely used to treat bone metastases, does decrease the number of bone related events
• Neither of these approaches improves overall survival--the time to death

Duration of Treatment for High Risk Prostate Cancer

For men whose prostate cancers are at high risk of recurring or spreading, standard treatment is 36 months of androgen deprivation therapy (ADT). This therapy is effective but also causes side effects including weakened bone and possible cardiovascular problems. A Canadian trial demonstrated that 19 months of ADT is as effective as 36--which means that men with high risk prostate cancer can get the full benefit of this treatment with fewer side effects.

Renal Cell Cancer (Kidney Cancer)

What is the Right Sequence for Drugs in Metastatic Renal Cell Cancer?

Today, there are a number of agents available to treat renal cell cancers that have recurred or spread. Some of these drugs target different genetic mutations or pathways that have been identified as drivers for this kind of cancer. The RECORD-3 clinical trial confirmed that sunitinib, an agent that inhibits the VEGF mutation remains the standard of care for first line therapy of metastatic renal cell carcinoma. Everolimus, which targets the mTOR pathway, can be considered for patients with poor risk disease and those who have heart problems that make it impossible for them to sunitinib and other drugs known as TKIs.

Testicular Cancer

What is the Role of Active Surveillance for Stage I Testicular Cancer?

The majority of patients diagnosed with testicular cancer have early, stage I disease. Treatments for this type of cancer are very effective with an almost 100% cure rate. After surgery, there are several options for follow up treatment, including what is known as active surveillance--regular checkups and observation. Two new Danish studies demonstrate that active surveillance is as effective as treatment for men with stage I testicular cancer, whether it is seminoma or non-seminoma.

Christine Wilson, cancer survivor, shares her experiences from the The American Society of Clinical Oncologists (ASCO) national conference in 2013. Every year in the first week of June, over 30,000 cancer specialists and researchers from around the world gather to present their latest findings on the prevention, diagnosis and treatment of science. At a recent continuing medical education meeting, experts from the Abramson Cancer Center summarized some of the most important research from ASCO 2013 for a packed room of over 300 local oncologists. 

In this blog, Chris presents information from Kevin Fox, MD, director of the Rena Rowan Breast Center at Penn Medicine

Extending Tamoxifen Therapy Beyond Five Years

Tamoxifen has proven remarkably effective in preventing recurrences of hormone dependent breast cancer, but it is also associated with some significant side effects. A major study done in Great Britain showed a slight advantage to extending tamoxifen therapy for 10 years, but also a higher incidence of pulmonary embolism and uterine cancer. The study reinforces the need for women with this type of breast cancer to talk to their doctors about their preferences.

Neoadjuvant Therapy for HER2 Positive Patients

Neoadjuvant therapy means treating people before their surgery. It is in Dr. Fox’s words, “a rich area for clinical research.” For patients with aggressive or high risk disease, it offers the prospect of attacking the cancer when it is in its earliest stage, for other women, it can provide a way of making breast conserving surgery possible. It also subjects women to additional treatment. The two major issues with neoadjuvant therapy are:

1. Which women will benefit from this approach?
2. How can the success of this treatment be measured. Most trials measure success in terms of disease free survival, progression free survival or overall survival, but these endpoints cannot be applied to neoadjuvant trials. The current outcomes measurement is called pathologic complete response, pCR, or the complete disappearance of all evidence of disease prior to surgery.

The bottom line for now is that, if the decision is made to give neoadjuvant therapy to HER2 positive patients, the regimen should trastuzumab and one additional agent. Questions remain, however, as when to use this therapy and how best to measure its success.

In another study, neoadjuvant therapy did result in changing the decision about the type of surgery from mastectomy to breast conservation in 43% of patients.

Sentinel Lymph Node Dissection

Sentinel lymph node dissection has now been established as standard for most women with breast cancer. Two studies presented at ASCO 2013 addressed issues related to this procedure.

• The first determined that although microscopic signs of cancer can be found in 25% of sentinel nodes identified as negative when they are more closely examined, this finding has little clinical significance, and in Dr. Fox’s words “is not worth doing.”
• The AMAROS trial randomized women undergoing SNL biopsy with a positive lymph node into either completion lymph node dissection or radiation therapy. The study found no difference in the axillary recurrence rate-which was very low in both groups--but did determine that women who had the additional surgery had twice the incidence of lymphedema as those who got radiation therapy.

The Natural History of Small HER2 Positive Tumors

HER2 Positive tumors are known to have a poorer prognosis, but the tendency has been not to treat very small tumors aggressively. A new analysis showed that patients with small HER2 Positive tumors do benefit from systemic adjuvant therapy.