This post has been updated.
CHICAGO — With 38,000 oncologists converging on the sprawling McCormick Place for the annual meeting of the American Society of Clinical Oncology, the halls in the convention center are as crowded as Manhattan sidewalks at Christmastime. Watch out or you'll get run over as attendees rush to the next meeting of the minds.
The conference, which opened Friday and wraps up Tuesday, features hundreds of sessions and poster presentations ranging from the highly technical (“Predictive biomarkers of ipilimumab toxicity in metastatic melanoma”) to tips for everyday practice (“Patient communication: Balancing hope versus reality"). While most of the topics are as serious as, well, cancer, there are some lighter moments. Here's a look at a few things that have been getting play:
Targeting the combinations: Efforts to harness the immune system to fight cancer have yielded some big successes, but only in a minority of patients. The way to get the therapies to work in more people, researchers now say, is to use them in combination with something else. That means putting two immunotherapy medications together, or trying them with targeted therapies or conventional treatments such as chemotherapy and radiation. Those approaches have moved to center stage, though some researchers say they're a bit like throwing spaghetti at the wall to see what sticks.
A new report by EP Vantage, a news service that covers the pharmaceuticals and biotech industries, counts 765 combination studies involving the most prominent kind of immunotherapy listed on the federal database ClinicalTrials.gov. That's more than triple the number 18 months ago.
Merck's drug, Keytruda, leads the pack with a role in 268 combo studies. Roy Baynes, senior vice president and head of global clinical development at Merck Research Laboratories, is blunt about the state of knowledge: “We have no idea what the best combinations are,” he said. “Anyone who tells you that they do is fibbing.”
Richard Pazdur, director of the Food and Drug Administration's Oncology Center of Excellence, said he's optimistic about the field. “They're trying everything under the sun, including chicken soup,” he said.
A Windy City papered by drug ads: Pharmaceuticals ads decorate airport concourses, tucked between promotions for the Chicago Cubs and White Sox. They appear on huge downtown billboards, placards at bus stops and the little envelopes that hold hotel keys.
And at hotels serving as “official” ASCO lodging, goody bags filled with drug-company pamphlets are delivered right to the doors of attendees who are checked in.
The looming “new epidemic”: Partly because of the possibility of expensive combination therapies, many doctors are fretting about costs and whether their patients will be able to afford promising new drugs. Already, they say, "financial toxicity" is hitting some patients hard.
“This is the new epidemic — people going under to pay for their drugs,” said Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Research Center in Seattle.
Ramsey supports a “pay-for-performance” model in which drug prices are reduced if the treatments aren't as effective as touted. Also, he said, “We've got to allow insurers to say no when the price is too high and the benefit is too small. Otherwise, I don't know how we'll put pressure on the drug companies.”
Location, location, location — but maybe less for tumors: Recently, the FDA approved a Merck cancer drug for any type of malignancy, as long as the tumor tested positive for a specific genetic defect. At the meeting here, Loxo Oncology presented results that showed a drug called larotrectinib shrank tumors in 17 different cancers with a defect called a TRK fusion. The company plans to use the findings and other data to seek FDA approval for the therapy.
If larotrectinib gets the nod, it will be another step toward basing treatments on genetic characteristics rather than the parts of the body where tumors originate.
Hitting harder at advanced prostate cancer: The latest clinical trial results showed that adding a Johnson & Johnson drug called Zytiga, or abiraterone, to standard hormone therapy for men with newly diagnosed advanced prostate cancer reduced their chance of death by about 40 percent.
“This will clearly result in the earlier use of abiraterone and should spur rapid FDA approval for this additional indication,” said Nancy Dawson, an oncologist at Georgetown Lombardi Comprehensive Cancer Center who was not involved in the research. The medication already is approved for men whose prostate cancer worsens during the standard hormone treatment.
Lattes, cookies and pie pops: To lure doctors to their booths in the gigantic exhibit hall, pharmaceuticals companies have been offering free lattes and all kinds of snacks. Genentech hands out vanilla cookies with the company name emblazoned on the back in chocolate. Takeda Pharmaceuticals serves up Key lime pie pops, and AbbVie features “Madagascar vanilla bean mini cupcakes with vanilla butter cream icing,” according to the server there.
A big splash out of China: The little-known Chinese company Nanjing Legend Biotech surprised conference attendees on Monday with eye-popping results involving an experimental immunotherapy for multiple myeloma. In an early-stage study by doctors at Xi’an Jiaotong University, all 35 patients responded to some extent to the CAR T-cell therapy. And of 19 patients who have been followed for more than four months, 14 are still in complete remission, and five have had at least a partial remission.
"While it's still early, these data are a strong sign that CAR T-cell therapy can send multiple myeloma into remission," said Michael S. Sabel, a cancer surgeon at the University of Michigan who wasn’t involved in the study. “It's rare to see such high response rates, especially for a hard-to-treat cancer.”
The treatment involves removing T cells from patients’ blood, genetically altering them to boost their cancer-fighting potential and infusing them back into the patients. About 30,000 people a year in the United States are diagnosed with multiple myeloma, a cancer of the plasma cells. Only half survive five years after being diagnosed.
Encouragement from the “Emperor” author: In comments to reporters after his opening speech at the conference, Siddhartha Mukherjee, author of “The Emperor of All Maladies” and “The Gene,” struck an optimistic note. Cancer treatment is entering a promising, if challenging, adolescence, he said, and his fellow oncologists, after years of being hamstrung by a lack of technological tools and treatments, now have therapies to deploy in a “thoughtful, reasoned and compassionate way.”
Always keep in mind, Mukherjee urged the physicians, “what it feels like to be a patient in this world.”