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Each year nearly 30,000 oncologists and oncology-related healthcare professionals come together at the annual meeting of the American Society of Clinical Oncology (ASCO). ASCO 2011 featured nearly 4,500 abstracts (research summaries) and sessions covering every aspect of cancer, including highly anticipated research news and drug studies that could change current standards of care for patients. Attendees include a few hundred patient advocates who represent their constituents in the cancer community. I was fortunate to take part in the Focus on Research program of the Research Advocacy Network's Advocate Institute.
A study specifically related to BRCA (Abstract 1512) suggested that women with DCIS and a family history of breast and/or ovarian cancer have an increased chance of having BRCA mutations regardless of age, and should consider genetic counseling and testing even though they do not have invasive cancer. Another study (Abstract 1517) showed that BRCA-positive men are more likely to have aggressive prostate cancer with lymph node involvement and metastases. These study results underscore the importance of knowing BRCA status when determining treatment.
Hormone replacement therapy (HRT) by women who have undergone a prophylactic oophorectomy is of great interest to the HBOC community. Promising news from the Prevention and Observation of Surgical Endpoints (PROSE) study indicated no increased risk of breast cancer risk when HRT is used after risk-reducing salpingo-oophorectomy (Abstract 1501). Another study (Abstract 1510) suggested that women with paternally-inherited BRCA gene mutations (mutation passed from the father) are diagnosed with cancers at earlier ages compared to women who inherit gene mutations from their mothers.
Researchers presented promising findings from the OCEANS (Abstract LBA5007) and ICON7 (Abstract LBA5006) trials, two studies that examined use of the drug bevacizumab (Avastin) to treat ovarian cancer. While overall survival benefits were not indicated, patients in these studies did experience improved "progression-free survival." The concept of progression-free survival (PFS) compared to overall survival (OS) were common themes throughout the conference. PFS refers to the chance of stabilizing a disease without further progression after a particular treatment. OS measures the specific length of survival after treatment. Scientists use these terms to measure the success or efficacy of new cancer therapies. There is great debate about whether or not a drug should be approved if it doesn't demonstrate OS benefits. For patients facing advanced disease, PFS may seem like an acceptable endpoint.
A number of ASCO meeting sessions focused on quality-of-life issues. One abstract described the development of a standard method for including patient-reported outcomes in oncology drug clinical trials that compare drug effectiveness. Additional studies focused on developing tools to foster enhanced physicianpatient interaction. Researchers reported that early palliative care (care or treatment that concentrates on reducing the severity of symptoms) results in increased overall survival and reduced depression. A session on "Assessing Patients' Psychosocial Needs" highlighted an area needing improvement by many medical professionals; at least a quarter of cancer patients are thought to experience significant depression or anxiety.
A Weighty Issue
Numerous studies have looked at the issue of lifestyle, weight or Body Mass Index (BMI) in relation to cancer — especially breast, prostate and colorectal cancer. The "Overview of the Current Evidence Supporting Body Weight Status, Adiposity, and Weight Loss on Cancer Outcomes" session explained that obese and overweight people are more likely to develop and die from cancer and have an increase in risk of recurrence. Presenters made a provocative point: Overweight patients often receive the same level of chemotherapy as leaner individuals, and may in fact be underdosed, which leads to poorer treatment response rates. The good news is that most people can improve their treatment outcomes by modifying their lifestyle (Abstract 167); research indicates that individuals who lose weight experience a decreased risk of cancer recurrence.
Throughout the meeting, I was struck by the fact that genetics was a topic of numerous sessions and studies. Many researchers are focusing their efforts on identifying biomarkers and genetic changes in cancer tumors. This evolving area of science, in which genetics is linked to cancer biology, is very promising.
Improvements in gene sequencing and targeted therapies will ultimately help guide cancer treatment and move us toward more personalized medicine — the goal is for doctors to know exactly what treatments to give which patients — resulting in better outcomes. That is certainly something to strive for. Access the abstracts at the ASCO website.