ASCO 2009|May 15, 2011 9:45 pm

Overall ASCO summary 2009

I have been going to ASCO for years and I’m still waiting for that “a-hah!” moment when somebody presents something for melanoma that is so revolutionary and effective that we all have something tangible and exciting to come home with and build on in the future. I feel like we are getting closer as a “melanoma community.”  I know that in my own clinical experience and current practice, I am able much more frequently to walk into someone’s exam room and tell them, congratulations, the tumors are shrinking. Honestly, there were many years where that **never** happened.

However, for all the hopes extended each year towards ASCO as the ultimate cancer meeting, I honestly can say that there was nothing presented over the last few days that will immediately change therapy or even holds out hope for some drug or combination of drugs posterizing DTIC or Temodar. (Posterizing somebody is a reference to pro basketball, when you savagely dunk the basketball over an opponent with such force and superiority that it becomes an instant classic athletic poster. Like the Michael Jordan slam dunk contest when he still had hair, took off from the foul-line, and the open mouth, wide-eyed stares of the sideline onlookers were forever captured.)

The closest we came in my career was the early data  from about 2004 on Sorafenib/Nexavar, but that has melted away with larger scale, multicenter studies and is just a footnote at this point.

I will provide more detailed updates in other posts, but unfortunately there are no new treatments that show undeniable improvement over existing treatments. There are a few things that suggest the potential for improved therapy, but these are best described as “hypothesis-generating” or in other words, deserving of further, large scale, testing.

I know that this is frustrating to the melanoma patient community also; we’re just not there yet. We have new drugs coming down the road and they do have promising early results but the emphasis has to be on the word, promising.

The two take home words this year from the ASCO melanoma presentations were “Biomarkers” and “Targeted therapy”. In that regard, I don’t think the melanoma talks were that different from other disease areas. Biomarkers are things that can be measured, either in the blood or tumor tissue (or even in normal tissue) that classify an individual’s cancer by its behavior or potential to resp0nd to specific therapies. A biomarker could also monitor a patient’s response to therapy. A good example of this is the PSA level for prostate cancer. Finally, biomarkers could also identify patients either at risk for bad outcomes or those likely to respond to specifc treatments.

Targeted therapy refers to drugs that alter cellular biochemical pathways that are believed to influence a cancer cell’s ability to survive, grow, and/or resist therapy. Presumably, targeted therapy would have fewer side effects that standard chemotherapy but this exaggerates our true knowledge about these various pathways and their role in normal, non-cancerous, tissue. The other caveat about targeted therapy is that many of the ones that look most promising (to me) act by increasing cancer cells’ responsiveness to standard chemotherapy. As a result, these targeted agents often have no effect by themselves (ie monotherapy) and require simultaneous (concurrent is the medical word) chemotherapy drugs which obviously cause a range of side effects.

As you read my other summaries of ASCO papers and posters, keep biomarker and targeted therapy in the back of your mind; they came up over and over again.

Eric D. Whitman, MD

Senior Editor


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