Susan Beck

The issue of value in cancer care was a prominent theme at the 2014 ASCO Annual Meeting. A question that inevitably arises in any discussion of value is what the professional and ethical obligations of practicing oncologists are in the current climate of escalating healthcare costs.

Results of two phase III trials, presented at ASCO, on the addition of bevacizumab (Avastin) to standard therapy in newly diagnosed glioblastoma found that the drug added no benefit.

The David A. Karnofsky Memorial Award, ASCO’s highest scientific honor, went this year to Dr. Martine J. Piccart, who is internationally recognized for her unflagging dedication and innovative approaches to the development of drugs and regimens that will truly make a difference in the lives of patients with breast cancer.

Building on the landmark studies of the immunotherapeutic agent ipilimumab just a few years back, ASCO 2013 saw the presentation of truly impressive data on two PD1 blockers, as well as noteworthy studies of other immunotherapeutic approaches to advanced melanoma.

At the ASCO annual meeting, researchers presented persuasive evidence that a new class of targeted agents-MEK inhibitors-may warrant inclusion in the growing armamentarium for patients with advanced BRAF-mutated melanoma.

Data from the phase III BREAK-3 and the phase II BREAK-MB trials of dabrafenib establish the drug as the second BRAF inhibitor for BRAF V600E-mutated melanoma.

The class of agents that target the Programmed Death 1 (PD-1) pathway was described at ASCO as “likely the most exciting new agents recently developed in melanoma.”

The new therapies that became available for advanced melanoma over the past year-the anti-CTLA4 antibody ipilimumab (Yervoy) and the selective BRAF inhibitor vemurafenib (Zelboraf)-represent promising new options for these patients, whose prognosis was heretofore almost universally dismal. However, the advent of new treatment strategies has made treatment decisions more complex.

In his plenary address as outgoing president of ASCO, Dr. George Sledge proposed that we are on the brink of a new era in cancer therapy – an era of genome-based treatment. He stressed that this new “genomic era” holds great promise for patients, citing as evidence a recent paper in JAMA that described a case in which the results of deep sequencing of a patient’s leukemic cells led to successful individualized therapy.

As early as 1932, physicians noticed an apparent association between type 2 diabetes and increased cancer risk. In recent years, the epidemiological evidence of such an association has mounted steadily-especially with the emergence of large databases, which have allowed us to document the link.

Clearly, the realities of current health care economics are bringing to the fore important questions in clinical trial design. Not only does the United States spend far more on health care than other developed countries, with significantly worse outcomes, but the costs of cancer care account for a large and steadily increasing chunk of that spending. One way in which this trend can be curbed-and the money spent on cancer be made to produce more “bang for the buck”-is through changes to our drug development processes.

At the opening session of ASCO 2011, Dr. Kenneth C. Anderson, the Kraft Family Professor of Medicine at Harvard Medical School and Director of the LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma at the Dana-Farber Cancer Institute, was awarded ASCO’s highest award-the David A. Karnofsky Memorial Award, which recognizes outstanding achievement in cancer research. Dr. Anderson was honored for his accomplishments in three decades of research in the field of multiple myeloma.