Chicago, May 28-June 2, 2015
As you may have heard, many cancer professionals attended a major research meeting in Chicago recently. The American Society of Clinical Oncology (ASCO) held its annual meeting in Chicago from May 28-June 2. This meeting attracts over 35,000 researchers, physicians, nurses, health care providers and advocates from around the world. It’s quite an experience to be part of this huge conference that takes over the city of Chicago.
We are grateful to ASCO’s Conquer Cancer Foundation for providing a patient advocate sponsorship for Heather Chappell, Executive Director, to attend this conference, along with Deb Maskens, our Past Chair and Co-Founder. Canada was well represented there with 272 abstracts presented in the form of posters and presentations, the 2nd highest non-US country contribution! It was wonderful to see so many Canadian kidney cancer researchers and clinicians there as well.
Here is our ‘lay’, non-medical perspective of the sessions that we thought were interesting for the kidney cancer patient community. As always, if you have questions about any of these updates and how they may apply to your care, please ask your physician.
Immuno-oncology was the topic everywhere for many types of cancers including kidney cancer. Until any immuno-oncology drug is approved for kidney cancer, patients can access through clinical trials. The first data to report will be for nivolumab (PD-1) possibly later this year. Words of wisdom we heard from many of the medical experts include:
- Patients need to investigate thoroughly: these clinical trials are not right for everyone. Some of the toxicities can be long-term (permanent) and even the most experienced nurses are still learning how to manage the side effects which are quite different from those of targeted therapies. While there has been a great deal of media attention about immuno-oncology, we still have much to learn about “which patient” will respond.
- Early indication is that some of the more aggressive kidney cancers (Fuhrman grade 4 or sarcomatoid mrcc) may respond better. It may be true that the worst-acting tumours will be the best responders, perhaps due to the high number of genetic mutations.
- Patients on clinical trials should, whenever possible, consent to a biopsy if a tumour is accessible. Rationale is that if you happen to be a responder or not, you will know why – and the results from the biopsy could help direct decision making for future treatments.
- Biomarkers for immuno-oncology treatments are being sought, but none is currently predictive of response.
For information about clinical trials for mrcc including immuno-oncology trials, please contact Kidney Cancer Canada. This information changes quite quickly. Trial sites are coming online across Canada in major centres.
One pleasant surprise was to see a new drug, lenvatinib in combination with Afinitor achieve excellent results in the 2nd line. This trial was conducted in 37 centres in 5 countries. All patients had one prior VEGF therapy. The median to progression in the 2nd line was 14.6 months, indicating that further studies with this new drug are warranted.
Several investigators noted that there could be big changes in the 2nd line after trials for cabozantinib and also nivolumab report later this year. We are eagerly awaiting the results of those trials.
NON-CLEAR CELL / PAPILLARY RCC
Often called a “basket diagnosis”, non-clear cell rcc is not one but many different diseases. Trial results from the ASPEN trial for non-clear cell mrcc included 108 patients in 3 countries with many “unclassified” histologies, papillary, and chromophobe. Results favoured sunitinib (Sutent) over everolimus (Afinitor), but neither treatment was particularly impressive in this group of mixed patients. Some genetic profiling from other studies indicates that possibly a TSC1 or TSC2 mutation may indicate likelihood of response to everolimus (Afinitor). Other studies are underway with cMET inhibitors (including in Canada) and with Avastin/Tarceva for papillary only.
Summary conclusion is that patients with non-clear cell mrcc should be referred to expert centres and enroll in clinical trials whenever possible.
For many cancer types including kidney cancer, a spread to the brain, or brain metastasis (mets), can be a treatment challenge. Surgery is sometimes difficult due to location and the blood-brain barrier can prevent systemic treatments from working. There was a group of research papers presented tackling this treatment challenge. Research focused on how to manage the side effects of the current treatment options, and highlighted ongoing research in detection and treatment options.
- Whole brain radiation (WBR) side effects may be worse than the treatment benefits for some patients. WBR can cause more thought and memory problems than stereotactic surgery alone, and may not improve survival. Patients should talk to their doctors about whether this treatment option is right for them. A great summary of this research can be found here.
- Research in managing the side effects of whole brain radiation is ongoing. Some treatment options currently under study include hippocampus-sparing procedures and pharmaceutical options to prevent cognitive decline.
- New treatment options such as targeted therapy and immuno-oncology are currently being studied.
- Future research should focus on how to prevent and detect brain mets early such as:
o Predictive markers for when brain mets will occur
o Preventing brain mets from happening at all after 1st line targeted therapies
o How to detect brain mets early when they are easier to treat
QUALITY OF LIFE AND SURVIVORSHIP
It was great to see so many sessions focussed in this area, complementing the clinical treatment sessions. Some of the focus areas at this year’s conference included financial burden of treatment, patient-centred care and survivorship (post treatment).
FINANCIAL IMPACT OF CANCER
There was a group of presentations focused on economic disparities and the financial burden of cancer treatment on patients. The term, ‘financial toxicity’ was used to describe the financial hardships due to high out-of-pocket spending for cancer treatment.
- Bankruptcy rates are higher in cancer patients in the U.S. than in the average population
- There is an association between health outcomes and financial distress
- Mortality risk was 79% higher among cancer patients who filed for bankruptcy.
- Higher co-pays for treatment, starting at $50/month, have a 70% higher likelihood of non-adherence to medication (patients may skip doses).
There was discussion around the role of physicians or other members of the healthcare team discussing financial issues with patients. While the data presented was focussed on the U.S., there are financial barriers for Canadians patients as well, especially with take home medications. You can learn more about this issue in Canada here.
Make sure to discuss with your healthcare team if you are experiencing financial distress from your cancer treatment.
It was no surprise to see research confirming that patient-centred care leads to better patient outcomes. Some key indicators of quality care include good follow-up, integrated systems that support good information sharing, and connecting patients to community resources.
SURVIVORSHIP CARE PLANS
There was a session dedicated solely to survivorship care plans. These are tailored plans that are developed for each patient with guidelines for monitoring and maintaining their health. These are typically shared with patients and their primary care physicians. Some great tips on successful implementation was shared, including how to adapt the IT platforms and how to create an efficient program for busy clinicians. Moving forward they are looking at expending the reach to include community services.
The Kidney Cancer Research Network of Canada (kcrnc.ca), supported in part by Kidney Cancer Canada, is currently conducting research in this area as well, developing survivorship care plans for early stage kidney cancer patients. Pending funding, work on survivorship care plans for advanced stage patients will follow the initial pilot project.
The overall message from ASCO 2015 is that the field of cancer treatment is changing rapidly. Words such as “practice-changing” and “breakthrough” were heard often, but there is also room from some caution while we await more information from upcoming trials.
Most of all, we heard from many, many presentations that we are ALL indebted to the many cancer patients and their families who have engaged in previous trials and who will continue to contribute to moving this research forward. Thank you!
As always, your questions, thoughts and insights are welcomed!
For more information about the whole conference, please see here.