The beginning of June marks the calendars of many clinical oncologists, cancer researchers and pharma companies as one of the biggest cancer-focused events take place. It is the American Society of Clinical Oncology Annual Meeting in Chicago. This year’s theme of ASCO, held June 1st to 5th at McCormick Place, was “Delivering Discoveries: Expanding the Reach of Precision Medicine”.
For five days Ardigen’s Lead Scientist in Immunology, Giovanni Mazzocco, and Immunology Director, Piotr Stępniak attended presentations, talked to speakers, poster presenters and exhibitors.
Many sessions were dedicated to cancer immunotherapy, presenting the results of the newest clinical trials and giving further directions for the investigation of treatment combinations, bringing hope for new indications, but also for the treatment of progressing diseases. The results of BASKET and UMBRELLA trials, driving treatments based on shared molecular targets rather than primary tumor location, proved the validity of such approach. However the limitations of using single biomarkers for patient selection have also been underlined, pointing at the importance of companion diagnostics (CDx).
Even though immunohistochemistry (IHC) – based diagnostics is not going to be rapidly replaced, next generation sequencing (NGS) – based diagnostics approaches were widely discussed. The Foundation Medicine’s FoundationOne CDx test approved by the FDA last year, fueled discussions highlighting an undoubted change of the direction towards a broader adoption of sequencing-based cancer diagnostics. A trend that was very visible also in the exhibition arena. The presented advancement of liquid biopsy analytical techniques for the detection of cell free (cf) and circulating tumor ctDNA, as well as Circulating Tumour Cells, promotes the hope of non-invasive diagnostics for cancer detection and monitoring. The combination of IHC, computer vision and sequencing analysis might be a powerful approach for diagnostics. Nonetheless the integration and analysis of these orthogonal cancer datasets remains a true challenge. During the ASCO concluding session a case was made how powerful modeling algorithms such as Deep Learning can represent a good match for these multidimensional data problems.
Constructive criticism was directed towards current standards of immuno-therapy selection based on tumor mutational burden (TMB), microsatellite instability (MSI) and immune checkpoint staining. Speakers discussed the limitations of using surrogate measures for immunogenicity such as TMB and MSI encouraging more insightful analysis for patient stratification. Survival data pointed out how the clinical outcomes are more likely to be associated with the quality of somatic mutations than their average number. Tumor specific epitopes, their binding to HLA (including peptide orientation), the stability of pHLA complex, the recognition of pHLA by TCR and tumor clonality are all crucial for the activation of adaptive immune responses. Comprehensive overviews of these subjects were delivered by Dr Timothy Chan of Memorial Sloan-Kettering Cancer Center, and by Dr Heather L. McArthur, of Cedars-Sinai Medical Center.
The address of ASCO President, prof. Bruce E. Johnson, was on point about the progress clinical oncology has made for the last 15 year, for example increasing the range of lung cancer patients eligible for targeted treatment to 47%. And half of that exemplar progress was achieved recently just by identifying a 25% group of lung cancer patients who could benefit from anti-PD-1/PD-L1 therapy. Prof. Johnson’s reflection on the process of cancer diagnosis and treatment, after personal encounter with the disease, emphasized how much there is to be done on the speed and accuracy of the diagnostics. Acknowledging the need to tend to psychological aspects of patients coping with diagnosis and treatment resonated with the room full of hundreds of professionals and hopefully will resonate throughout the world.
Among poster presentations, we couldn’t miss those discussing microbiome influence on immunotherapy outcomes, or cancer vaccines initial trials results.
There is a clear reason why ASCO attracts thousands of attendees each year. The quality and significance of knowledge delivered during this event shapes cancer research, drug discovery, diagnostics development on top of the clinical trials and practice. ASCO happens over just 5 days but its impact is there for the whole year.