Step into the future

Daily Editorial by Erica Martinelli, Associate Editor of the ESMO Congress Daily - Monday October 2nd 2012

Congratulations on making it through the past five days of information overload! But what a spectacular, positive and encouraging time it has been. Events like these are vital for us as we balance the daily pressures of our clinical caseload with the necessary task of keeping abreast of the latest research findings and trial results. Now we begin the tough task of translating what we have learned into our everyday practice. We have all heard important updates and seen trial results that could affect our standard treatments for some cancers. In my own field of gastrointestinal (GI) cancer, for example, data was presented from the CORRECT trial on the survival of patients treated with the oral multikinase inhibitor regorafenib (REG) in patients with metastatic colorectal cancer whose disease had progressed after all approved standard therapies. Median overall survival (OS) was 6.4 months (95% CI: 5.8−7.0) in the REG arm versus 5.0 months (95% CI: 4.4−5.9) in the placebo arm. OS rate at 6 and 12 months was 52.2% and 24.1% in the REG arm versus 43.1% and 17% in the placebo arm, respectively. It is important to stress the significance of this drug on a population with an unmet medical need before regorafenib. After standard chemotherapy you can usually only provide the best supportive care, but regorafenib actually gives patients hope for the future.

Regorafenib was approved by the FDA while we ́ve all been here at the ESMO Congress. We now hope that the EMEA will be quick to approve as well. Improvements in clinical outcomes are always encouraging, but I have also been struck by several ‘null results’. For example, we heard in the first Presidential Symposium that the addition of cetuximab to capecitabine + cisplatin showed no benefit compared with capecitabine + cisplatin alone in the first-line treatment of advanced gastric cancer (LBA3). While results like these may seem disappointing, they also inform our work as much as positive trial results as we try to balance toxicity, efficacy, simplicity, quality of life and costs in patient treatment. Looking at the study from an academic point of view it could be useful to implement these negative results with a biomarker analysis, which could indicate the populations to target for future trials. In this sense we need to push research so that the effort that the patient made to take part in the study was not made in vain.

Similarly, in the first Presidential Symposium, we also learned about the disease-free survival (DFS) and OS results and subgroup analyses of the PETACC8 intergroup phase 3 trial. Adding cetuximab to FOLFOX4 offered no benefit to patients with resected, stage III, KRAS wild type colorectal cancer. However, subgroup analyses in this large trial suggest that patients with pT4N2 tumours may receive some benefit from cetuximab in this setting.

As young oncologists, our motto should be ‘do research and understand biology’. Only with biological classification of each tumour will we gain a greater understanding on how to stratify adjuvant treatment, thus avoiding unsuccessful chemotherapy and negative trial results. I am excited to see what the future holds in terms of what will come out of research to allow us to choose the best treatment for cancer patients.

One of the overriding messages that we have heard in many of the sessions is the increasing importance of genetic and molecular profiling and the scope that the analysis of tumour biomarkers can have in optimising and personalising treatments to maximise efficacy. We may have heard it before but the significant number of oral and poster presentations including data on biomarkers has been overwhelming. Such a plethora of data emerging from ESMO gives me real hope that we may soon have more validated biomarkers that can be incorporated into the clinic to support our treatment decision-making.

The ESMO congress brings together such a large group of experts; there is no better way to facilitate the rapid dissemination of new information coming from laboratories and clinical trials. In this way, ESMO facilitates knowledge uptake and the standardisation of the highest level of patient care across Europe.

This year we can boast the active participation of over 16,300 delegates, with the Congress Programme comprising 140 different sessions delivered as part of 18 Proffered Paper sessions, 21 Poster Discussion sessions, 20 Special symposia, 18 Patient cases sessions, 15 Educational sessions, 9 Joint Symposia, 4 Keynote sessions, 3 Poster sessions covering 23 different categories, and for the first time ever at ESMO, 2 Presidential Symposia. There was also and an entire programme dedicated to young oncologists.

I now encourage you to browse back through the abstracts to see what gems you have missed. Then continue your debates and discussions with your colleagues at work and online. Let us keep the discussion alive to fuel research and scrutinise results for clinical significance.

Who knows what two more years of progress will look like when we meet again at ESMO 2014 in Madrid. I am certain, however, that there will be much to celebrate.