Updates from day four of the American Society of Clinical Oncology conference in Chicago:
Study results from a very small study cabozantinib were presented on Sunday. This study included only 25 patients with renal cell carcinoma (along with others of different tumour types). Interesting highlights presented:
— patients were all heavily pre-treated with other therapies (8 had at least 4 prior treatments). Despite these prior treatments, the median PFS (Progression Free Survival) was 14.7 months with confirmed partial response in 28% of those patients and stable disease in 52% of patients.
— one of the most interesting findings with this agent was with regard to bone metastasis. (Bone mets occur in up to 30% of rcc patients). Patients on this study experienced pain resolution and reduced use of narcotics. One patient demonstrated a dramatic resolution of bone mets as demonstrated in bone scans before and after.
— Toxicities (side effects) include fatigue, diarrhea, nausea. Further study in mrcc is warranted — perhaps even at lower doses to determine whether the same efficacy can be achieved at a lower dose.
For more information, see: http://abstract.asco.org/AbstView_114_95382.html
Optimal Use of Imaging to Guide Treatment Decisions for Kidney Cancer
Dr. Walter Stadler presented several known problems with rcc treatments:
– Degree of shrinkage is less than with traditional agents
– Treatment also slows progression
– Immune treatments may have a delayed response
– Therapies have toxicities.
What defines disease Progression?
Dr. Stadler stated that the RECIST PD or “Progressive Disease” criterion are completely arbitrary and that measuring tumour burden in terms of selected lesions and uni-dimensional measurements is not as effective as volumetric measurements (all dimensions). Perfusion changes (how much the tumours enhance with contrast) are also dependent on contrast administration during scans.
Discussed Technetium Bone Scans and commented that the sensitivity for detecting known bone mets is only 62%. Discussed FDG-PET scans and commented that FDG-PET can only detect 64% of small pulmonary nodules. Controversial comment was that the only reason to order a FDG-PET scan (for clear cell rcc) was “to support your radiology department”.
Net summary: that “Judicious clinical judgment and review of MULTIPLE scans OVER TIME” is the only way to fully capture clinical effect of treatment and disease progression.
Making Time for Internet Information in the Clinical Encounter
Dr. Paul R. Heft discussed the fact that internet information is pervasive and here to stay thus both patients and the medical profession need to find productive ways to manage the information and resulting questions. Of note from Dr. Heft’s discussions:
– 2/3 of patients with cancer use the internet to obtain information;
– We are seeing a shrinkage in the “digital divide” of race, age, geography, economics etc. suggesting more and more patients have and will access disease information on the internet;
– Oncologists report that internet information increases hope, confusion, anxiety and knowledge all at the same time;
– Patients worry about asking questions about their disease and about treatment options for fear of push-back from physicians and the risk of contributing to a negative perception/relationship with their physician.
Physicians clearly have to adapt their clinical encounters with patients to include time to discuss patient questions as more and more information becomes available to patients via the internet. That said, patients need to ensure they are clear and succinct with their questions and that the information they are using to form the basis of those questions is accurate and from a credible source.
Patient organizations can certainly play a strong role in assisting patients with disseminating credible and valid information prior to discussion with their physicians so as to maximize the time spent in the clinical encounter.
Looking forward to sessions today — Recent Innovations in the Management of Genitourinary Cancers (New Developments in Renal Cancers) and Optimizing Efficient and Effective Care of Cancer Survivors.
All the best from Chicago, Deb & Catherine.