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Word salad: What’s for dessert?

Issue: July 25, 2016

ByDerek Raghavan, MD, PhD, FACP, FRACP, FASCO

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I enjoyed this year’s ASCO Annual Meeting.

The program committee has finally taken very seriously the entreaties from Lowell E. Schnipper, MD, and the gang, incorporating an assessment of value into programmatic content. I had the honor of acting as a value discussant for several strong presentations on the use of taxanes in the prostate cancer oral abstract session, and I was pleased to see that the presentations truly advanced our state of the art.

Advances in prostate cancer

Hannes Cash, MD, who reported the first results of the PRINCE study, demonstrated that it is safe — and less toxic — to offer intermittent docetaxel-based chemotherapy for castrate-resistant metastatic prostate cancer.

Oliver Sartor, MD, reported from the FIRSTANA study that there is no difference in survival between first-line docetaxel vs. cabazitaxel (Jevtana, Sanofi) for castrate-resistant advanced prostate cancer, although he noted a possible reduction in toxicity based on the use of docetaxel at 75 mg/m². Could someone show me the evidence that this dose is actually better than 60 mg/m² for prostate cancer?

Johann de Bono, MD, FRCP, reported data from the PROSELICA study that showed a 20-mg/m² dose of cabazitaxel works as well for castrate-resistant metastatic prostate cancer as a 25-mg/m² dose — saving thousands of dollars in a standard treatment course — and the research group led by Christopher Sweeney, MBBS, updated the CHAARTED study to confirm a survival benefit without loss of quality of life from the addition of docetaxel to castration for first-line treatment of high-volume metastatic prostate cancer.

Although not on my list for discussion, other important presentations included a discussion of the SPCG12 study by Goran Ahlgren, PhD, which showed that adjuvant docetaxel does not improve survival after radical prostatectomy, and the presentation on the PROFIT study by Charles N. Catton, MD, FRCPC, showing that a shorter fractionation schedule is noninferior to a longer duration of radiotherapy for localized prostate cancer.

Progress in years

The other pleasing aspect of the meeting was the expansion of the renaissance of tumor immunotherapeutics beyond melanoma and renal cell carcinoma. Many presentations showed pragmatically meaningful increases in median and long-term survival measured in years rather than days.

Instead of silly short-term increments predicated on P values and life extensions of days that translate to seemingly impressive HRs, pembrolizumab (Keytruda, Merck) induced a 22.5% objective response rate in third-line treatment for PD-L1–positive head and neck cancer, sacituzumab govitecan (Immunomedics) had a greater than 30% response rate in a salvage phase 1/phase 2 trial for non–small cell lung cancer, and rovalpituzumab tesirine (AbbVie) induced a 50% ORR — with 30% 1-year survival — in relapsed small cell lung cancers that expressed DLL3, a dipeptide linker.

Doubly pleasing was that each presenter emphasized the limitation of their data and expressed cautious optimism in their results. Median PFS of only 6 to 8 weeks was apparently an exclusion for presentation of data.

However, the one thing that really bugs me is the names of the new generation of drugs. What fool came up with the idea that prescribing doctors or their hapless patients need to have the mechanism of drug action embedded in the generic or marketing names?

Why not just call the new agent for bladder cancer “atezo”? Similarly, how about “pembro” for pembrolizumab, “ipi” for ipilimumab (Yervoy, Bristol-Myers Squibb) or “saci” for sacituzumab govitecan, etc. Surely this will reduce the risk for error and confusion among the people who prescribe, dispense and use these agents.

I suppose that, once upon a time, physicians enjoyed the mystique of medicine, with illegible handwriting and mystical names of drugs and diseases that kept patients in a dependent and uninformed situation.

We have progressed well beyond that, and as part of the increasing transparency and clarity in medical practice and communication, it is time to develop a new approach to the word salad that constitutes the compendia of prescribing of new drugs.

To read more ASCO coverage, click here.

References:

The following were presented at ASCO Annual Meeting; June 3-7, 2016; Chicago:

Ahlgren G, et al. Abstract 5001.

Cash H, et al: Abstract 5005.

Catton CN, et al. Abstract 5003.

Patrick-Miller LJ, et al. Abstract 5004.

Sartor O, et al. Abstract 5006.

For more information:

Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Edi­tor for Oncology. He also is president of Levine Cancer Institute at Carolinas HealthCare Sys­tem. He can be reached at derek.raghavan@ carolinashealthcare.org.

Disclosure: Raghavan reports no relevant financial disclosures.