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Last week, Blue Latitude sent two of our consultants to Chicago to attend
ASCO
15, a key annual meeting for
oncology specialists that brings over 30,000 delegates together to talk about
innovations and progress in the field. David takes us through the highlights of the event and his take on the
exciting developments that came out of the conference.
Medical Developments: The
Immuno-oncology Era
Without question, this year really
was the heralding of the immuno-oncology era, both in terms of medical developments
and the great
coverage ASCO got in
the media. We’ve been working in immuno-oncology for a year and a half now,
but we were still very impressed by the data coming out of the conference. Specifically,
we thought the checkpoint inhibitors in head and neck, lung cancer and melanoma
really shone. In particular, the fact that not only are the therapies showing deep
responses, they are also providing a much longer duration of response, which
was discussed as being a hallmark of immunological agents in oncology.
Bristol-Myers-Squibb redefines Melanoma treatment standards
In terms of winners here, BMS is
likely to redefine the standard of care in Melanoma with the Opdivo/Yervoy
(ipilimumab) combination. However, the advantage BMS had over Roche and Merck
in the programmed cell death pathway space (PD-1/PD-L1) was thrown open over a biomarker
debate around activity in PD-L1 positive patients.[1] The
challenge here is: firstly, there is no clear criteria for defining PD-L1
positivity (the part of the checkpoint pathway expressed on the tumour cell);
and secondly, there is no standard assay to measure PD-L1 expression. I think
the strength of the Checkmate-057 data[2] will
ultimately give Opdivo an advantage in all patients, but I also think that how
the other PD-1/PD-L1s challenge Opdivo will depend on how the European markets
provide access to it, as well as how issues of cost versus value of the
treatment are addressed.
Personalised treatments: targeting genetic mutations to treat cancer
The second area that really
impressed me was the large National Cancer
Institute (NCI) trial[3] that
will look to treat patients with solid tumours based on their genetic mutations
and not their organ of origin. A list of targeted treatments, such as
crizotinib and TDM-1, will be used to target specific genetic abnormalities in patients’
tumours. This represents a real step forward in terms of precision medicine,
which will further link whole genomic
screening to the tailoring of an individual patient’s treatment. It will be
extremely exciting to see what comes out of this trial.
Transforming multiple myeloma treatment with monoclonal antibodies
The third area was the arrival of breakthrough
therapies in plasma cell disorders. Three monoclonal antibodies were presented
on the last day of ASCO - two in multiple myeloma and one in amyloidosis. For
years, leukaemia and lymphoma patients have benefited from power of monoclonal
antibody treatment while plasma cell malignancies showed little activity with
CD20 targeting treatment. In multiple myeloma, we saw data from two
immunotherapies showing clinical activity. In particular, daratumumab in double
refractory multiple myeloma represents a truly transformational treatment in
this area for patients who have tried all current options[4]. In an
area dominated by combination trials, daratumumab showed significant single
agent activity in this hard to treat population with tolerable safety profile.
ASCO 15: Highlighting innovation
and raising key questions
Amgen and AstraZeneca had excellent
booths that were extremely interactive with some great educational tools. The
Amgen booth had a giant mechanical puppet show that explained their BITE
technology, while AstraZeneca used the Oculus Rift to describe the how and why
around various cellular pathways they were developing treatments for to great
effect.
Overall, ASCO15 was a great place
to be this year with all the exciting innovations in cancer treatments that
were announced. However, oncology specialists and healthcare practitioners more
generally will have their work cut out for them in taking this information on
board and incorporating these new treatment options into their practise.
Questions around cost and value still need to be urgently addressed by the
medical community if the goal is to deliver personalised cancer treatment to
patients across the world.
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These are the topics we discuss at
Blue Latitude, both internally and externally, with our clients and a range of
stakeholders whom we carry out primary research with. If you would like to
discuss ASCO15 or immuno-oncology with us further, please reach
out to Matt, our Head of Commercial at: matt.bolton@bluelatitude.net.
References:
[1]
PD-L1 Expression as a Predictive Biomarker in Cancer Immunotherapy. Patel SP et
al Mol Cancer Ther 2015
[2]
Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma. Larkin
et al 2015 NEJM
[3]
NCI Prepares to Launch MATCH Trial. Cancer Discov. 2015
[4]
NCT01985126 An Efficacy and Safety Study of Daratumumab in Patients With
Multiple Myeloma… 2015