Around 40,000 cancer specialists and researchers descend on Chicago every year to share and present new research studies that help advance new cancer cure and prevention strategies. The American Society for Clinical Oncology (ASCO) Annual Meeting is the largest of its kind in the world and is a showcase for the latest and greatest in cancer. This month’s blog will highlight the important updates from the conference that may impact your cancer care right now
Breast Cancer: 70% Breast cancer patients do not need chemotherapy after surgery when evaluated by a ‘Genetic risk study’
The Oncotype Dx study has been used to predict which women would benefit from chemotherapy after breast cancer surgery. We had been waiting for the results of the so-called TAILOR RX study to help determine how to treat ‘Intermediate risk patients’ with Recurrence risk score of 11-25. Previously we would mostly treat them. Now this study that included over 9,000 patients with no lymph nodes involved and a score between these numbers could do without toxic chemotherapy. There are caveats to the study that your oncologist would be able to consider but this is now the standard recommendation.
Pancreatic Cancer: Increased survival with a new combination treatment
Very promising results from the Phase 3 (Human studies needed for FDA approval) called PRODIGE trial that included 493 patients who had surgery to remove tumors in their pancreas and were healthy enough after their operation to have chemotherapy did vastly better with a new cocktail of chemotherapy.
Compared to the standard chemotherapy of one drug commonly used the combination of four drugs called FOLFIRINOX cocktail had an overall survival of more than 54 months (4.5 years) as compared to slightly under 2 years (34 months). These are terrific numbers for a dismal cancer and should be discussed with patients and family members of patients who have a diagnosis of pancreatic cancer since the cure comes with significantly more toxicity.
A key factor in this treatment is making sure the patient is well enough for the combination
Lung cancer: Frontline immunotherapy becomes a treatment option for most lung cancers
For patients with advanced or metastatic stage IV lung cancer called non-small cell lung cancer (NSCLC) who have a certain marker in their cancer called PD-L1 of over 50% can be now treated with immunotherapy alone based on earlier studies in this cancer. Now data presented for patients with even less than 50% of that marker can receive immunotherapy but needs to be combined with chemotherapy to improve outcomes in lung cancer rather than using chemotherapy alone.
Kidney cancer: Many people with advanced kidney cancer may not need surgery
Findings from a study of people with metastatic (disease widespread) renal cell carcinoma, in the Phase III ‘Carmena’ clinical trial showed that many people with advanced kidney cancer can avoid surgery to remove the kidney (nephrectomy). On average the people who received only the targeted therapy with the oral drugs lived about 18.4 months, compared to 13.9 months for those who received surgery followed by the oral targeted treatment which currently is the trend. This will likely change the way stage IV kidney cancers are now approached.
Blood test to detect lung cancer
A blood test that detects circulating tumor cell DNA has shown potential for finding early lung cancer in early reports from the fascinating but ongoing, large Circulating Cell-Free Genome Atlas (CCGA) study enrolling over 12,000 patients. The tests detected cancer in the blood of 38% to 51% of people with early-stage lung cancer and was highly specific (98%). Free-floating tumor DNA is seen in higher amounts as the amount of cancer increases so early detection with these techniques will eventually find cancer even before a scan shows a tumor. That’s how early cancer diagnosis in the future with these studies will help cure cancer by nipping it in the bud. More research is still needed. There is now hope that we would be able to screen people for lung cancer using a simple blood test in the future. Currently, a low dose CT is approved by FDA/CMS to be used for lung cancer screening.
Cost of medicine
In an interesting study that shed light on the rising cost of cancer in America, we found that treatment for colon and rectal cancer costs twice as much for U.S. patients than in Canada. A study of health claims data from neighboring regions on either side of the U.S. and Canada border shows that common treatment used costs twice as much here. Despite the higher cost, the U.S. patients are not living longer than those in Canada.
Opioid overuse in breast cancer patients
In a study of 664 patients treated between 2013-2018 in NM data presented at ASCO this year by Kymera and Dr. Araujo showed that Curable breast cancer patients who continue short-term use of opioids at 3 months are much more likely to be using narcotics long-term use at one year leading to addiction and negative consequences from opioid overuse. Several factors in rural practices intensify this issue including prescribing practices. Alternative non-narcotic pain medications should be discussed and narcotic use should be attempted to taper within 3 months of breast surgery.
Q: Is lifestyle connected to cancer, If so how?
A: Although family history of cancer is important only 5–10% of all cancer cases that oncologists see are caused by genetic defects, whereas the remaining almost 95% have their roots in the environmental factors and lifestyle. If I had to do one thing and only one thing alone that had the largest effect I would recommend a stop on cigarette smoking (linked to many cancers especially lung, kidney/ bladder, oral and throat cancer), followed by diet to avoid or limit red meat (colon cancer), deep fried foods (likely carcinogenic), alcohol (liver cancer, bladder/kidney cancer, food pipe cancer), sun exposure (melanoma, skin cancer), obesity, and physical inactivity. Almost 25–30% of cancers are due to tobacco, as many as a third are linked to poor diet, about 15–20% are due to infections. Small numbers of cancers are due to radiation, lack of physical activity, pollutants (widely varies based on location).
Q: How is cancer treatment changing. Is Chemotherapy a thing of the past?
A: Two words! Immunotherapy and targeted treatments. We are now stimulating the body’s amazing capacity to fight cancer. These treatments if used right in specific situations are tolerated better and could in some cases have excellent and prolonged remissions or even cures. We are figuring out how to best select those patients that would benefit from immunotherapy based on tumor testing. Targeted treatments (targeting a specific tumor molecule) had been quite the rave a few years ago however mostly provide limited cures and are usually not a panacea.
Chemotherapy is by no means dead and will not be for a while. We are now combining immunotherapy, radiation and chemotherapy for improved benefit utilizing the concept called ‘Immunogenic cell death’ where how tumor cells are killed is important and when they die they release certain protein molecules that can be recognized by body’s immune cells activated by immunotherapy. It’s a long battle, we are making some inroads. We are by no means there yet.