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ASCO Annual Meeting: I got plenary of nothing!
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Here we are, back from another bigger, better, more extreme ASCO Annual Meeting.
Every year, about this time, I return from what is billed as the biggest and best cancer meeting, often feeling more than a little disappointed.
The object of my greatest displeasure is almost always the plenary session. Year after year, the ASCO program committee, which consists of clever and committed volunteers who spend hours reading abstracts and trying to rank them appropriately, seems to swing and miss on the plenary session.
This session, attended by somewhere near 40,000 oncologists and acolytes, is supposed to portray the most important observations of the year, culled from the more than 2,400 presented abstracts and 3,000 or more that are listed in the abstract book (presumably to attract their authors to show up for the meeting).
This year’s plenary abstracts
The first presentation was a retrospective big-data study that showed quite convincingly that implementation of the Affordable Care Act matters, and those anti-Obamacare states that did not expand the ACA have had obviously worse outcomes.
I often write about disparities and inequity of care, and I think that this is a moderately important observation for consumption in the United States, mostly because it proves what I already know from decades of work and publication in this space.
However, as several of my European colleagues commented, having spent thousands of their own (or institutional) euros to attend the hottest scientific meeting on the planet, why was this item worthy of plenary presentation? What crucial science or major breakthrough did it portray?
It really just reflected a political statement, promulgated on a large national stage, which smacked the anti-Obama forces (who didn’t care anyway) and reminded them that failure to care adequately for the underserved leads to delays in treatment and increased death rates.
The next session was very thoughtfully presented by Christopher Sweeney, MBBS, no stranger to ASCO plenary sessions.
I was very pleased when he presented the CHAARTED study some years ago, perhaps the only truly paradigm-shifting study that year. CHAARTED was the first major study to show that the addition of an extra agent (in this instance, docetaxel) to combined androgen blockade has a very substantial impact on survival among men with poor-risk metastatic prostate cancer.
His presentation this year — which followed on the heels of CHAARTED, the British STAMPEDE trial and several others — basically confirmed that combined androgen blockade, when augmented by another active agent (this year, enzalutamide [Xtandi; Astellas Oncology, Pfizer], but also docetaxel, apalutamide [Erleada, Janssen Oncology] and several others) performs better than combined androgen blockade alone.
OK, OK ... I get it, we all do!
We also heard results of TITAN (combined androgen blockade plus apalutamide; see related article), ALLIANCE AO31201 (combined androgen blockade plus enzalutamide or combined androgen blockade plus enzalutamide plus abiraterone plus prednisone), and so on in the genitourinary sessions of the meeting, and I expect that we believe the base concept. Yup, for poor-risk metastatic prostate cancer — and in some trials, all metastatic prostate cancer — and perhaps even after hormonal failure, adding something good to combined androgen blockade produces better results.
Fine. Agree. But is it worthy of a plenary presentation? No, this is not an earth-shattering, paradigm-shifting concept.
By now, I was shifting restlessly in my seat, and several of my colleagues had left.
The next presentation reported data from the ANNOUNCE randomized trial, which tested the hypothesis that olaratumab (Lartruvo, Eli Lilly) — a human IgG1 antibody targeting PDGFR-alpha — plus doxorubicin improves OS compared with doxorubicin alone.
What a cool concept to test, and certainly one that represented rather strong translational science.
So, what’s my problem?
My problem is that this study did not confirm the hypothesis. So, 40,000 oncologists sat breathlessly to hear the results of a late-breaking abstract that showed nothing positive nor exciting.
I was about to edge to the door, but my former colleague, Hedy L. Kindler, MD, was due to present results of the POLO randomized trial in BRCA-mutant pancreatic cancer, so I stayed.
I was delighted that she was invited to present at a plenary session, as she has been a longtime contributor to gastrointestinal and mesothelioma trials and deserved the spotlight.
Unlike her previous plenary study on mesothelioma — which was paradigm-shifting (although it was actually presented by someone else) — this study reflected the treatment of only 154 of more than 3,000 screened patients, which led to a PFS difference of only less than 4 months and an absence of OS benefit in the interim analysis.
This is important work and very interesting to the GI oncology community. However, it is hardly worthy of a plenary session.
Time for self-review
I want to be clear. Nothing in this editorial is intended to show disrespect to the presenters nor to the plenary discussants. They wrote good studies, presented them effectively and discussed them thoughtfully. Rather, it was the topic selection for plenary application, which reflects directly on ASCO.
Wouldn’t it have been more interesting to hear presentation of the updated surrogacy analysis of 18,886 patients with colorectal cancer; the immuno-oncology study in hepatocellular cancer, which showed a 20% reduction in tumor-specific deaths; or of the novel agent capmatinib (INC280, Incyte) for mutated non-small cell lung cancer, with a high response rate irrespective of line of treatment, to name just a few better options?
It’s time for ASCO, which is not really known for dispassionate self-review beyond the confines of its inner circle, to consider carefully the redevelopment of the plenary session as a mirror of high-quality, paradigm-shifting research, which is what it has not been for most of the past decade.
If you doubt me, look online at the plenary topics for the past several years.
To adapt from “Porgy and Bess”: I got plenary of nothing, and nothing is plenary for me!
References:
The following were presented at ASCO Annual Meeting: May 31-June 4, 2019; Chicago:
Adamson BJS, et al. Abstract LBA1.
Chi KN, et al. Abstract 5006.
Finn RS, et al. Abstract 4004.
Kindler HL, et al. Abstract LBA4.
Morris MJ, et al. Abstract 5008.
Shi Q, et al. Abstract 3502.
Sweeney C, et al. Abstract LBA2.
Tap WD, et al. Abstract LBA3.
Wolf J, et al. Abstract 9004.
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 Atrium Health. He can be reached at derek.raghavan@atriumhealth.org.
Disclosure: Raghavan reports no relevant financial disclosures.