Here's a breakdown of some of the highlights from the first day of the 2021 European Society for Medical Oncology (ESMO) congress.
European Society for Medical Oncology (ESMO) 2021 Congress kicked off with a diverse selection of educational, multidisciplinary sessions exploring a variety of topics and highlighting clinical trial data and emerging research in the field of oncology.
Below are some of the highlights from Day 1 of ESMO’s 2021 Congress.
The Role of Complementary Therapies & Cannabinoids in Cancer Treatment
What do we know about the role of complementary therapies in cancer treatment? On day one of the European Society for Medical Oncology’s annual congress, Andrew Neil Tippings Davies, Professor Consultant of Palliative Medicine chaired the “Complementary therapies and cannabinoids: Evidence is gathering” session on emerging research diving into the impact of complementary therapies and cannabinoids on cancer treatment.
In this session, Professor Davies himself began by taking a look at some of the current standards of care in cancer treatment and where complementary therapies come into play. And while emerging evidence is giving us a clearer perspective on the efficacy of these therapies, Davies argues that complementary therapies aren’t frequently assessed with the same security as a standard of care therapies and are often lumped in with “wacky” therapies such as coffee enemas.
According to Cancer.net, complementary therapies such as acupuncture can help relieve pain, reduce chemotherapy-induced nausea and vomiting, and help limit side effects of treatment such as hot flashes, fatigue, and sleep problems. And while we still have limited data on the use of cannabis/cannabinoids, patients have found that these options help treat chemotherapy-induced nausea and vomiting and other treatment-related side effects. But Davies stresses that these complementary therapies should be the second line of treatment, not a replacement to chemotherapy, immunotherapy, or any other standard of care.
Following Professor Davies, Eva Katherina Masel, Professor at the Medical University of Vienna, took an in-depth look at the chemical makeup of a cannabis plant. And while there’s a lot of literature available on cannabinoids, there are still very few clinical trials.
Professor Masel took some time to explain the key differences between the two primary types of cannabinoids: tetrahydrocannabinol (THC) and cannabidiol (CBD), including:
- THC is a psychotropic, while CBD is an anti-psychotropic
- THC is frequently used for appetite, pain, and sleep, while CBD is often used for anxiety, convulsions, and inflammation pain
- THC can have more of an impact on attention and memory and might impact motor performance, while CBD doesn’t have the same effect
And while more research is needed, Professor Masel believes that the addition of cannabinoids to cancer treatment can lead to anti-cancer and anti-tumor activity and increase rest and relaxation for our patients.
And finally, Penelope Schofield, Professor at the Swinburne University of Technology, shed some light on the impact of “fake news” on complementary therapies and cannabinoids. She encourages clinicians to get a better understanding of all types of complementary therapy, including acupuncture, massage, reiki, Chinese herbs, and cannabinoids, as patients will see their clinicians as their primary resource for information on all of these therapies.
Professor Schofield provided a set of questions to help clinicians better understand and explain the role of complementary therapies and cannabinoids to their patients:
- Understand – What is your current understanding of complementary therapies and cannabinoids?
- Respect – How do people from your patient’s cultural background treat this illness?
- Ask – Is your patient currently doing anything else for this condition?
- Explore – Ask your patient if they can tell you more about their current approach to treatment
- Respond – Empathize with your patient and ask them how they’re feeling emotionally
- Discuss – How soon does your patient expect to see benefit from these types of therapy?
- Advise – Encourage, accept, and discourage. Offer your insight on whether or not the patient’s current treatment strategy is effective or not
- Summarize – Ask your patient if they can summarize the main point of what you just covered so you know you explained everything correctly
Concern remains around the efficacy and safety of complementary therapies and cannabinoids given the lack of clinical trial data and in-depth research, but Professor Schofield is eager that emerging research will help shed some light on these therapeutic options.
Exploring Personalized Medicine in Non-Colorectal Gastro-Intestinal Cancer
For patients with non-colorectal gastro-intestinal cancer, is the concept of personalized medicine applicable to non-colorectal gastrointestinal cancer? In this session, “Is the concept of personalized medicine applicable to non-colorectal gastrointestinal cancer?” Fatima Carneiro, Director of the Pathological Anatomy Service at the University Hospital Centre of São João, lead a discussion on the impact of personalized medicine in various different types of non-colorectal gastrointestinal cancers.
The session began with Dr. Michael J. Pishvaian, Associate Professor at Johns Hopkins University, who focused on personalized medication in pancreatic cancer. According to Dr. Pishvaian, personalized medicine should become the standard of care for patients with pancreatic cancer, as standard chemotherapies and newer targeted therapies can be expensive.
Precision medicine can help us identify distinct, targetable, molecular abnormalities, and while pancreatic cancer remains one of the most difficult to treat, Dr. Pishvaian encourages clinicians to use both germline and somatic/tumor testing on all of their patients with pancreatic cancer.
Following Dr. Pishvaian, Dr. Angela Lamarca, a medical oncologist, explored the role of precision medicine in biliary tract cancer, or BTC. The incidence rate for this type of cancer continues to rise, but molecular profiling through precision medicine can have clinical benefits for our patients.
However, she finds that there are still many challenges when it comes to using precision medicine, such as:
- Limited access to testing
- Inadequate tissue sample quality
- Poor study recruitment
- Primary and secondary resistance
BTC is generally subtyped as intrahepatic cholangiocarcinoma, and according to Dr. Lamarca, targeting fibroblast growth factor receptors, or FGFR, in intrahepatic cholangiocarcinoma plays a significant role in using precision medicine for patients with BTC.
Dr. Arndt Vogel, Managing Senior Consultant and Professor in the Department of Gastroenterology, Hepatology, and Endocrinology at Hannover Medical School, then took us through precision medicine in hepatocellular carcinoma. According to Dr. Vogel, multiple drugs are available for systemic therapies in hepatocellular carcinoma, or HCC, but only targeted therapies have demonstrated efficacy and received approval by the European Medicines Agency and the U.S. Food and Drug Administration. To date, there are no positive predictive biomarkers are available to guide system treatments in HCC.
In order to better incorporate precision medicine into the treatment of HCC, Dr. Vogel believes we need the following:
- Thoughtful transitional programs in clinical studies
- Preclinical models for pharmacological and genetic screenings to identify tumor cell dependencies amenable to pharmacological targeting (such as EGFR)
- Biomarker-driven proof of concept trials to validate targeted therapies in defined molecular subgroups (such as FGFR4/FGF19)
And finally, Dr. Ian Chau, Consultant Medical Oncologist in the Gastrointestinal and Lymphoma Units at Royal Marsden Hospital, reviewed precision medicine in the treatment of squamous esophageal cancer. Based on the result from the CheckMate 648 trial, clinicians have been using a checking inhibitor in combination with chemotherapy for their patients with squamous esophageal cancer. But when it comes to precision medicine, Dr. Chau noted a few things clinicians should keep in mind, such as microsatellite instability and tumor mutation burden.
He also emphasized that clinicopathological factors such as age and ethnicity play a role in precision medicine, as patients’ mutational landscapes can differ from one another.
More research is needed to better understand all of the clinicopathological factors we need to take into consideration and other molecular targets we need to keep in mind to establish precision medicine as a treatment option for squamous esophageal cancer.
Multidisciplinary Perspectives on a Case Study in NSCLC
In a session led by Dr. Noemi Reguart, Oncology Department Oncologist at the Hospital Clínic Barcelona, three clinical experts reviewed a case study and shared their various perspectives on management approaches and treatment strategies.
The patient was a 76-year-old female, retired teacher, who was a former smoker with a history of cerebrovascular accidents and coughing. Dr. Reguart walked us through the patient’s initial CT scan results, MRI, EBUS-TBNA, and molecular studies from cytology. The patient was given platinum-based chemotherapy concurrent with radiotherapy followed by ten months of durvalumab. The patient was then put on Pembrolizumab single agent.
After 14 months of remission, a FUP PET/CT scan revealed two new lesions on the right lung and left suprarenal gland, which required complete NGS molecular testing. The patient then continued Pembrolizumab for four more months, but after her brain scan showed several more metastases, she discontinued Pembrolizumab, and treatment with Capmatinib and WBRT was deferred.
Dr. Jurgen Wolf, the Medical Director of the Center for Integrated Oncology at the University Hospital of Cologne, shared his perspective from a medical oncologist’s point of view, offering some of the following recommendations: for this patient, one with N2 NSCLC, he recommends CRT + durvalumab maintenance in PD-L1+standard. And in order to treat the brain metastases, he recommends if the patient has no or mild symptoms to start with TKI and defer to WBRT if that doesn’t work alone.
Dr. Percy Lee, Chief of Thoracic Radiation Oncology at the MD Anderson Cancer Center, shared his perspective from a radiation oncologist’s point of view. After reviewing the results from the PACIFIC Phase III study, he recommends cCRT followed by consolidative durvalumab, which he believes to be the new standard of care for patients with unresectable stage III NSCLC.
Dr. Lee noted that local ablative therapy with SBRT is an attractive bridging therapy that could be recommended for this patient. However, the data on this is currently too limited to be sure.
And finally, Dr. Ramon Rami-Porta, Clinical Chief of the Department of Thoracic Surgery at Hospital Universitari Mútua Terrassa, shared his point of view as a thoracic surgeon. According to him, earlier intervention with surgery could have been beneficial for this patient, and could’ve played a role in the following:
- Standing the tumor with the highest certainty
- Restaging the tumor after induction therapy
- Resecting the tumor if nodal downstaging has been pathologically confirmed after induction Ch-Rt or Ch-Rt-IO
- Resecting metastases at oligoprogression
Dr. Rami-Porta believes earlier surgical intervention could’ve changed the course of this disease in our patient case.