I have been attending the Chemotherapy Foundation symposium this week in Manhattan, an annual event held in honour of Dr Ezra Greenspan, who first created the idea.
and clinical research projects at major New York metropolitan medical
centers, symposia for the profession, and publishes a series of free
informative booklets for the profession and the public. Until his death
in 2004, the pioneering oncologist Ezra M. Greenspan, M.D. was Chairman
and Medical Director. Noted oncologist and investigator Franco M.
Muggia, M.D. was then appointed and fulfills this leadership role."
It's a great opportunity to catch up on snapshots of the latest data in different tumour types as well as meet and greet with pharma people and doctors alike and I try to go every year. It's a fun meeting, with one hall for presentations, lots of variety and topics organised by session type. It is also considerably less tiring than the large ASCO and ASH meetings where you constantly dash from Hall H to A to F to B and wear yourself out in the process.
On Wednesday, one of the interesting sessions was on GI cancers. Jaffer Ajani reviewed modified docetaxel-based regimens in gastric cancer, including ways to optimise therapies and improve the safety profile. Anthony El Khoueiry discussed biomarkers in colon cancer and reviewed progress to date with pathways. The most interesting news was that the ECOG trial E5202 is looking at the potential prognostic role of 18q deletions, which may turn out to be a useful approach in the future.
Tyrosine kinase inhibitors (TKI's) were discussed by Paulo Hoff, including an overview of progress with VEGF and EGFR inhibitors plus some new ones being investigated in the clinic including Src, mTOR and others. So far, the only targeted therapies with demonstrated effectiveness have been three monoclonal antibodies, which act extracellularly rather than intracellularly, i.e. Avastin, Erbitux and Vectibix, but in combination with chemotherapy, not each other.
Neal Meropol's presentation on circulating tumour cells as a predictive marker in colorectal cancer (CRC) highlighted the difference between predictive and prognostic markers but concluded that it is too early to tell whether this approach will be useful or not yet. More research on phenotyping and genotyping may make it a valid approach in the future.
Sonic hedgehog signalling was the focus of Mace Rothenberg's entertaining overview. He covered proteins, pathways, role in cancer and a quick review of the data from Genentech's compound, GDC 0449, which was licensed from Curis. It is curently being investigated in basal cell carcinoma, ovarian cancer and CRC (in combination with Avastin).
Howard Hochster covered strategies for reducing neurotoxicity in CRC. This occurs as result of the duration of oxaliplatin therapy and the cumulative dose. In trial N9741 it was shown that 63% of patients stopped the trial due to neurotoxicity rather than progressive disease. Among the strategies suggested were optimising the oxaliplatin regimen from FOLFOX4 to FOLFOX6 and 7, adding Ca or Mg to offer neuroprotection, and consider a trial with xaliproden or xenon. What was interesting though, is that he did ot mention another viable alternative – picoplatin, which in currently in clinical trials and may have equivalent efficacy but reduced neurotoxicity compared to oxaliplatin. That would reduce the need to add on extra treatments and have a simple regimen for doctors to follow without fear of excessive neurotoxicity reducing the overall survival benefit.
Overall, it was a diverse and interesting meeting, definitely well worth the trip into town.