After attending the recent annual AACR meeting in Denver, where the weather went on a wild ride from arriving in a snowstorm dumping a foot of snow to 74F and glorious sunshine, I thought it was time to capture a few thoughts on the new trends emerging there. Normally, I would have updated this blog on the conference much earlier, but the demands of client meetings and proposals have intervened somewhat.
Image by bridgepix via Flickr
It was my first time in Denver and Colorado, so I wasn't really sure what to expect at all but after spending nearly a week there, it's definitely somewhere I would think about visiting again, mainly because every where one went, the people were exceedingly nice and polite, adding to the positive experience.
The organisers were also on Twitter (@aacr) and that helped tremendously with little things like getting the sound up in Hall A or wherever, as the acoustics was rather faint and fuzzy at times. Kudos to their marketing team for their engagement, interaction and responsiveness, they really added to the overall positive experience. More organisations can listen and learn from their approach, because it not having problems that is the issue but how you handle them. AACR handled things with ease and aplomb. Nice one guys, very professional job!
Ok, you're all wondering what about the science and oncology data?
Well, what struck me as general trends and interest was the wealth of information on mTOR, IGF-1R, PI3K/Akt, c-Met and HDACs, plus miRNA seemed to be in just about everything. Sirtuins came up a few times, but the concept is still very early before we can make any conclusions.
Of course, Novartis' mTOR inhibitor, Afinitor, was approved in renal cell carcinoma just before the meeting so there was inevitably a lot of interest in the drug class and where it might be going given that there are now two on the market. Anticipating the concomittant interest a product launch may bring is one bane of conference scheduling – the small room was full to overflowing. I stood outside the double doors and managed to capture a few notes of the session standing up, but some parts of the chicken scratch defy even my interpretation.
Suffice to say, it was clear that investigators see both mTORi and HDACi as an exciting opportunity to add either drug to standard of care and produce wither an additive effect or possibly reduce the resistance that occurs by blocking an important pathway, thereby making the regimen work more effectively for longer. Merck's HDACi, (vorinostat or Zolinza), was another drug with a similarly bright future in this respect, because while efficacy may be limited as a single agent, it could well be a good drug for multiple combinations. Many of these ideas were discussed at different sessions and checking out clinicaltrials.gov showed over 100 trials already underway or planned with the therapy. That's not bad going for a drug approved for a rare form of lymphoma so far, ie CTCL.
It was interesting that the established medical news reported on some odd things at the meeting such as a urine test to predict smokers risk of lung cancer, drug combinations in pancreatic cancer (a deadly disease) and the impact of the Stimulus Package on cancer research. There was very little on the basic scientific research and progress with biomarkers. Yet virtually every session I went to, including the poster sessions, covered biomarkers in considerable depth.
Biomarkers can be used for different things – as a marker of activity, as a marker of outcome or as a marker for patient selection amongst other things. The field is really only just getting going and will have an increasing impact on healthcare over the next few years. As more targeted agents are developed at great expense, patients, physicians and payers alike want to know which patients are most likely to respond and why? This exciting approach is great news for diagnostic companies such as Nodality, who help pharma companies identify and track critical biomarkers in clinical trials.
Predicting which patients will respond to which therapies will increase the chances of success, reduce costs and improve confidence. The idea of treating everyone with a given cancer to get 10% response rate is old hat now. Why not figure out which 10% are likely to respond to EGFR therapy and just treat those? The ongoing story of the impact of KRAS/BRAF and loss of PTEN in CRC is fascinating; we can now identify 70% of the non-responders and treat those patients more appropriately.
The role of histology is also becoming important in some cancers, especially in NSCLC. For example, it appears that patients with squamous, non-squamous and even non-smoking Asians with adenocarcinoma can each be treated differently. The discussions in the corridors and poster sessions were very much focused on this and more on this topic is expected at ASCO, when Genentech announce the full data for Avastin and Tarceva in first line NSCLC. Alimta also appears to be more effective in non-squamous NSCLC, whereas Avastin is considered for squamous patients to avoid the increased risk of GI bleeds.
All of this information and much more, such as the Erbitux front-line data in CRC will make for a fascinating ASCO later this month.