Here's a breakdown of some of the highlights from day 6 of the 2021 European Society for Medical Oncology (ESMO) Congress.
The European Society for Medical Oncology (ESMO) 2021 Congress continued with its wide 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 6 of ESMO’s 2021 Congress.
Population Risk Stratification for Early Detection & Personalized Breast Cancer Treatment
The genomic basis of breast cancer in diverse populations was one focus of day 6 of the ESMO Congress with the “Population Risk Stratification for Early Detection & Personalized Breast Cancer Treatment” session, which featured cancer risk assessment expert Dr. Olufunmilayo Olopade from the University of Chicago.
Dr. Olopade began by noting that the rising mortality associated with breast cancer demands global solidarity and action, especially since the highest mortality is in some African countries. In fact, a recent survey found an overrepresentation of triple-negative breast cancer in indigenous African women who were much younger than the average age of diagnosis in Asian and European countries.
Other research efforts showing that age is no longer a viable way to determine which patients are offered genetic testing include a study of more than 1,000 young women in Nigeria. This study found a very high proportion of patients had BRCA1 and BRCA 2 mutations and that those mutations were more prevalent in women who reported no family history of breast cancer. These findings were replicated when a similar study was done across the African Diaspora.
Beyond BRCA mutations, Dr. Olopade also discussed research on TP53 and GATA3 mutations, which are mutually exclusive and early drivers. In fact, Nigerian patients with the GATA3 mutant subtype were diagnosed an average of 10.5 years earlier.
Due to these molecular subtypes seen across different patient populations, Dr. Olopade stressed the importance of race- and ethnic-specific studies. In fact, it’s now possible to identify 5 percent of women in the 90 to 99 percentiles before the age of 40 with the help of African-specific polygenic risk scores. This is especially important since when it comes to breast cancer, there’s no one-size-fits-all treatment approach.
Once breast cancer is detected early, Dr. Olopade argues that genetics can then be used to inform treatments in the clinic. And since there are now a few PARP inhibitors developed for BRCA1 mutation, she believes genetics should be integrated into clinical cancer care.
To conclude, Dr. Olopade noted that now is the time to think and apply precision healthcare, and if the root of the germline that’s determining the progression of tumors is identified, and if clinical trials are placed where patients are, accelerated advancements in precision care can be achieved.
ESMO Women for Oncology & Broader Perspectives on Gender Equity
The “Gender equity: A broader perspective” session was led by Dr. Pilar Garrido, Committee Chair of ESMO Women for Oncology.
The session began with Dr. Garrido sharing ESMO Women for Oncology’s objectives, including:
- Monitor and sensitize the oncology community to the gender imbalance in leadership positions
- Educate and train female oncologists to support the creation of female leadership in oncology
- Provide resources and establish collaborations to support access to training and career development opportunities for female oncologists
Dr. Garrido shared a few of the committee’s 2020 key achievements and 2021 upcoming projects, as well as spoke about how the COVID-19 pandemic shed light on gender imbalances because fewer women were asked to participate in advisory committees or groups regarding the pandemic.
Following Dr. Garrido, UN High Commissioner for Human Rights, Dr. Michelle Bachelet, spoke about the importance of the fight for gender equality in oncology. She encouraged female oncologists to reach for leadership positions in this male-dominated field and urged them to mentor younger female oncologists to do the same.
She advocated that health systems will only be stronger if women have an equal say in the design of national health plans, policies, and systems.
After that, Dr. Ophira Ginsburg, an IARC Senior visiting scientist, led a session on “Women, Power, and Cancer Divide,” exploring disparities in care for patients with breast and cervical cancer. In poorer countries, specifically in sub-Saharan Africa, cervical cancer continues to be a major public concern.
In her session, Dr. Ginsburg said, “Where a woman lives, and her socioeconomic, ethnocultural, or migration status, should not mean the difference between life and death from these common cancers from which cost-effective, life-saving interventions exist.”
Dr. Ginsburg took a look a modifiable risk factors of cancer in women, including tobacco and alcohol advertising and marketing, highlighting the need for effective policies and public awareness of the link between alcohol consumption and cancer risk.
In low-income countries, very few cases are diagnosed at earlier stages, and most are diagnosed at either stage three or four. And when these women were asked why they hadn’t received care earlier, many of them said they didn’t have the option to seek help due to financial, social, or other barriers.
Dr. Ginsburg then shared a few of the ESMO Women for Oncology committee’s goals to take an intersectional approach to cancer:
- Investigate the preventable burden of cancer in women
- Apply a more inclusive economic analysis to estimate the true costs of cancer’s impact on women, families, and society
- Take stock of the absence of women leaders in oncology and the hidden role of women as caregivers in the formal and informal workforce
- Broaden the evidence base to inform a key set of recommendations for policymakers
Dr. Ginsburg concluded by stressing the importance of multidisciplinary action and effort to help reach gender equity in cancer research and outcomes.
ESMO-MCBS: Can We Keep It Free from Bias?
For tools like ESMO’s Magnitude of Clinical Benefits Scale (ESMO-MCBS), it’s critical to maintain objectivity. That’s why there are protocols and other measures in place to help ensure this tool remains unbiased, as demonstrated in the “ESMO-MCBS: Can We Keep It Free from Bias?” session that was held on day 6 of the ESMO Congress.
Medical oncologist Dr. Sjoukje Oosting from the University Medical Center Groningen in the Netherlands began by explaining that the ESMO-MCBS’s grading system is based on the benefits of a treatment that help patients live longer and better. To support this grading system, the forms below are available for different situations:
- Form 1 is for curative treatments
- Form 2A is for therapies that are not likely to be curative with overall survival (OS) as the primary endpoint
- Form 2B is for therapies that are not likely to be curative with progression free survival (PFS) as the primary endpoint
- Form 2C is for therapies that are not likely to be curative with a primary endpoint other than OS or PFS
- Form 3 is for single-arm studies in orphan diseases and for diseases with high unmet need when the primary endpoint is PFS or overall response rate
These forms show that quality of life is a very important consideration for the ESMO-MCBS tool. In fact, a checklist was created for the ESMO-MCBS based on multiple quality of life guidelines to ensure that reliable and valid quality of life data is used for its scoring.
Following Dr. Oosting was palliative and supportive care specialist Dr. Nathan Cherny from Israel, who discussed the dynamic nature of the ESMO-MCBS. Dr. Cherny explained that the tool’s accountability for reasonableness is based on the following criteria:
- Wide applicability
- Statistic validity
- A transparent process of development with scope for peer review, appeal, and revision
The fifth and final criterion reflects the idea that the tool was developed with openness to the need for specific revisions. Based on continual feedback from physicians, industry leaders, and patient advocates, the tool will be improved, which is another way the tool remains free from bias.
Dr. Cherny reminded attending oncologists that the complete, updated ESMO-MCBS can be found on the ESMO website, and those revisions—along with the central focus on patients’ quality of life—are two key ways this tool maintains its objectivity.
Assessing the Impact of Frailty on Cancer Management
The “Impact of frailty on cancer management in older patients” session began with opening remarks from Demetris Papamichael, the Director of Medical Oncology at the Bank of Cyprus Oncology Center.
Following that, Dr. Siri Rostoft, professor at the Oslo University Hospital, gave a presentation on “Aging-related frailty: What does it mean?”
Dr. Rostoft began by explaining frailty, which is defined by an increased risk of adverse events due to a multisystem reduction in reserve capacity. Frail patients are vulnerable to stress, which can lead to:
- Surgical complications
- Chemotherapy toxicity
- Functional decline
Frailty does not disqualify patients from further care but it is in fact an entry point for adapted care and is potentially reversible. So, when older patients are screened for frailty, they need to meet the following criteria:
- Geriatric 8 score (G8) of less than 15
- Slow walk speed (four meters)
- Need help getting dressed
- Have fallen three times in the last six months
- Weight loss of 6 kg in the last six months
What does frailty mean in oncology? According to Dr. Rostoft, it means that the risk of negative outcomes is higher, so we need to assess our patients more carefully, tailor treatment to our patient’s vulnerability, and follow our patients more carefully.
Following Dr. Rostoft, Dr. Papamichael shared a colon case. The patient, an 80-year-old farmer, was suffering from worsening constipation and episodes of PR bleeding and had a cT4N sigmoid colon tumor and multiple bilobar liver lesions. The patient was referred for surgery and a palliative colostomy because of a clinical large bowel obstruction and ended up with a laparoscopic sigmoid colectomy.
Dr. Papamichael explained that these case results highlight the lack of clinical trial data on older patients with cancer, but that the G8 screening tool can help predict outcomes in similar patient cases.
He also walked us through another patient case: a patient with an ECOG PS of 2, with limited walking, difficulty taking medication, and difficulty hearing. This patient has a G8 score of 10 which, according to Dr. Papamichael, is quite low. And based off of this patient’s frailty, he recommended best supportive care, single-agent anti-EGFR, or an immune-checkpoint inhibitor with caution.
He emphasized that we need to be aware that the expectations of and our approach to older patients must be different than in our younger patients.
To conclude, Dr. Rostoft shared her final remarks on frailty in older cancer patients and encouraged clinicians to keep frailty in mind when managing and treating our patients, while also still prioritizing the goals and desired outcomes of our patients.