Updates from ASCO 2012 Part One

Here’s the first of our updates from ASCO (American Society of Clinical Oncology) in Chicago.

So far, this has been an excellent conference with MANY updates on kidney cancer, including updates on existing therapies and several presentations on brand new therapies. We have also attended sessions on cancer prevention for cancer survivors.

To highlight some of what we’ve learned so far:

Cancer Prevention for Cancer Survivors

– 18% of new incident cancers in the U.S. are actually 2nd primary cancers (of which 2.3% are kidney cancers).

– sessions focused on the possible reasons for 2nd primaries — including the late effects of chemotherapy for some cancers (e.g., Non Hodgkins Lymphoma), radiation, use of growth factors, and of course lifestyle and environmental factors. Key facts included that continued smokers have a 2x-3X higher risk of second cancers.

– achieving a healthy weight is the Number One recommendation for cancer survivors. Recommendations are to exercise for at least 150 minutes per week including some strength training 2x per week, and to avoid inactivity. Key quote that captured our attention: “What fits your busy schedule better, exercising 1 hour a day or being dead for 24 hours a day?”

– notes on diet: high veg/fruit/whole grains with a limit of processed and red meats and refined carbs.

– notes on supplements: “playing with fire”. Indicated only if the patient is deficient in specific nutrients.

“Cancer provides a teachable moment for lifestyle change: seize the moment!”

Kidney Cancer Updates

PISCES Study: Dr. Bernard Escudier (France) presented a very interesting trial that reported on patient preferences between Sutent and Votrient in the first line setting. This trial reports a significant patient and physician preference for Votrient. However, we await the head-to-head trial results from another study (COMPARZ) which will address whether the agents are equally effective for mrcc. For more information about the PISCES study, see:

http://abstract.asco.org/AbstView_114_98799.html

TIVO-1: Dr. Robert Motzer reported on a large Phase 3 first-line study comparing tivozanib vs. sorafenib (Nexavar) in the first line. Tivozanib proved superior with a significant advantage in safety (side effect) profile requiring fewer dose adjustments. It is expected that tivozanib will become a choice in the first line setting. For more information about this study, see:

http://abstract.asco.org/AbstView_114_96560.html

 

BMS/MDX-1106:

Dr. David McDermott presented information on a new immunotherapy in early trials. Preliminary results included 296 patients of which 34 were metastatic renal cell patients. Of importance was that over 50% of these patients had had at least 3 prior treatments. The new agent proved highly tolerable (no maximum tolerated dose was identified). Anti-tumour activity was noted in rcc, melanoma and non-small cell lung cancer. Phase 3 trials for this BMS agent are expected to start globally this fall.

To be further explored: whether tumour biopsies can potentially select patients who are more likely to respond to this therapy (testing for PD-L1 expression).

For more information about this trial, please see:

http://abstract.asco.org/AbstView_114_92248.html

Hope this information is helpful. We’re off to the next session on optimal use of imaging to guide treatment decisions for kidney cancer.

More as we can. Great to see so many Canadian kidney cancer specialists here — and so much new knowledge being exchanged here in Chicago.

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2 thoughts on “Updates from ASCO 2012 Part One

  1. Hi,

    Just a comment about the PISCES study. The results showed quite a difference between the two drugs, but this was based on the study design asking patients to report how well they felt on one or the other therapy. Suprisingly with over 60% of Votrient patients getting diarrhoea, they still preferred this to Sutent. What it did not capture were events which are symptomless such as liver enzyme elevations.
    Finally, patients are treated for efficacy not just tolerance, lets wait for the true head-to-head (Comparz), otherwise we can dispose of oncologists.

    1. Hi J-P,
      Totally agree that efficacy is the number one consideration. Wish I could figure out how to attach a photo though, because the PISCES presentation did include the symptom-free side effects (such as elevated liver enzymes etc.). I had a photo of Dr. Escudier presenting that particular information. I’m sure it will be in the full manuscript when it’s written up.

      Another interesting aspect was that they measured Physician Preference as well as patient preference — and the physician preference was fairly similar (e.g., 61% vs 70% in favour of pazopanib). Physicians made their evaluations after they had seen the second set of scans (after 22 weeks in total).

      As patient advocates we questioned whether it was fair to do the imaging during the Sutent break (when you might expect a flare). We also probed whether a patient getting a tremendous result on drug #1 could stay on that drug (and the answer was yes, that of course they could leave the study).

      All very interesting, and now today in the news we have heard of a similar patient preference trial called TAURUS to evaluate patient preference between tivozanib and sunitinib. As you imply with your note, a head-to-head trial on efficacy would really help more than preference… great to have both, but personally I would prefere CHOCOLATE to any of these drugs. It’s just that chocolate doesn’t actually work (or does it??)

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