In our previous post, Making Sense of ASCO 2015 Findings: Part 1, we began our report on specific studies presented at The American Society of Clinical Oncology (ASCO) 51st Annual Meeting.
How should this information be interpreted?
At conferences like ASCO, scientific discoveries are usually presented before publication and without complete peer review process. This means that the early and final results of research are not presented in complete form that can be reviewed by medical and scientific peers and by journal editorial processes.
Therefore, everything should be taken with a grain of salt. Soon enough, papers will be published in upcoming journals for most of these early announcements and presentations.
In any case, we must emphasize to the reader: You must not take action without consulting your doctor/physician.
ASCO15 Interesting Highlights
This is part 2 of a 2-part post. Click here to view part 1.
Can exercise improve outcomes in cancer patients?http://am.asco.org/exercise-alterations-host%E2%80%93tumor-interaction
The risk of cancer recurrence following treatment is a major obstacle to successfully eliminating tumors. Regular exercise is believed to reduce the risk of cancer recurrence in 10-50% of cancer patients. This is thought to be due to the effect of exercise on levels of glucose (blood sugar) and insulin (hormone that reduces blood glucose concentration) and on the immune system.
An ongoing clinical trial called The Colon Health and Life-Long Exercise Change (CHALLENGE) trial is currently investigating whether regular exercise can reduce recurrence and mortality in patients with colorectal cancer who have previously received surgery. If results are positive, it may suggest that regular exercise should be used in combination with current treatments.
Will complete lymph node removal become a thing of the past for melanoma patients?
For melanoma that has spread to the sentinel lymph nodes (the nodes that are most likely to be reached if the cancer begins to spread), patients’ lymph nodes are often completely surgically removed. However, new evidence presented at the ASCO meeting may mark the end of complete lymph node removal in these patients. The new research found that there was no survival benefit associated with undergoing complete lymph node removal, compared to observing patients and acting if the cancer progressed.
This finding is based on findings to date which means that the research study has not concluded. More research is needed to support the preliminary findings.
Should Nivolumab plus ipilimumab be the first-line drug choice for advanced melanoma?
This study compared the effectiveness of nivolumab (Opdivo) plus ipilimumab (Yervoy) to nivolumab only or ipilimumab only in patients with advanced skin cancer (melanoma). The researchers measured how long it took for the disease to progress after each treatment. Patients who received nivolumab plus ipilimumab survived the longest without progression (11.5 months). Patients who received nivolumab alone progressed after an average of 6.9 months and patients who received ipilimumab alone progressed after an average of 2.9 months.
Moderate to severe adverse events were more common after receiving the combination of both medications, occurring in 55.0% of patients, compared with 27.3% of patients who received ipilimumab alone and 16.3% of patients who received nivolumab alone.
It is still too early to know if it there is a difference in patient survival time after the treatments. Though the results of this study so far have been positive, there are still questions surrounding the high costs of these drugs.
Non-Melanoma Skin Cancer
Vitamin B3: can it reduce tumor numbers in patients with non-melanoma skin cancer?
Nicotinamide is a form of vitamin B3 which is available as an oral supplement. In a clinical trial, 193 patients with non-melanoma skin cancer received 500 mg nicotinamide twice daily, while 193 patients received a placebo (a substance with no therapeutic effect). The placebo group developed an average of 2.4 new tumors per year and the nicotinamide group only developed 1.8 new tumors per year. This suggests that nicotinamide can reduce the formation of new tumors by 23% per year.
Nicotinamide was equally effective in patients with basal cell carcinoma and squamous cell carcinoma (both are forms of skin cancer). However, there are still unanswered questions regarding the optimal dosing and the effects of longer-term treatment.
Discussions on general patient care
Are advances in patient care beyond medications occurring?
Beyond the advances in drug treatments discussed throughout the conference, speakers also highlighted the importance of other aspects of patient care. A study result describing the effect of exercise on people with colon cancer can be found in Making Sense of ASCO Findings: Post 1.
Patients are included at ASCO Annual Meetings. This, plus the patient-centric movement in all of medicine has increased the level of discussions around communications and support. Several sessions occurred dealing with the importance of supporting caregivers and the value of clearly explaining and counseling before and after specific genetic testing for patients and/or their family members.
Finally, experts also discussed the opportunities and challenges of implementing technology into clinical care. Advances are occurring in search engines, which improve patients’ and doctors’ access to health information online. One such example is the collaboration between Google and the Mayo clinic, where health information is now presented directly in the search results page. Improvements in the accuracy of Wikipedia were also noted.
In addition, panelists noted that communication through social media tools provides opportunities to educate patients.
Finally, tools, apps and wearable technologies are available to capture and monitor how a patient may be dealing with their illness on a daily basis. Researchers noted that these tools could provide a more realistic impression of how much energy a patient has and their level of activity than standard questionnaires.
The ASCO 51st Annual Meeting has highlighted some of the various avenues of research currently being investigated for treating patients with cancer. The new information presented suggests a number of key findings in conditions from melanoma to breast, prostate, colon and lung cancer: In patients with melanoma, there was no survival benefit of undergoing complete lymph node removal, compared to observing patients and acting if the cancer progressed, however these results are only preliminary. In advanced melanoma patients, a combination of nivolumab with ipilimumab may increase survival. Finally, advances in patient care beyond medications was part of the discussion.
Encouraging also was the focus on improving the wider aspects of patient care. Notably, improved communication efforts were recommended to help patients and families understand results of genetic testing. Additionally, opportunities for monitoring patients with apps, wearables and other tools are available and may improve the collection of patient information. This could help researchers and physicians not only understand disease conditions more clearly, but may also help them treat these conditions more effectively.