ASCO GI: 2014 Symposium Highlights

Lisa A. Kachnic, MD

As part of our coverage of the American Society of Clinical Oncology (ASCO) 2014 Gastrointestinal Cancers (GI) Symposium, which was held January 16–18, we are speaking with Dr. Lisa A. Kachnic, chief of the department of radiation oncology at Boston Medical Center and professor of radiology at Boston University School of Medicine, who is the program committee chair of the ASCO GI 2014 meeting.

-Interviewed by Anna Azvolinsky, PhD

Cancer Network: Dr. Kachnic, can you discuss some of the themes of the research that was presented at this year’s meeting?

Dr. Kachnic: Sure, I would be delighted to. As always, the ASCO GI Cancers Symposium provides a unique forum to present state-of-the-art multidisciplinary clinical and scientific research findings, as well as best practices as they relate to gastrointestinal cancers. This year’s theme was “Science and Multidisciplinary Management of GI Malignancies,” and this theme really mirrors the overall goals of our yearly cancer symposium nicely.

Cancer Network: Can you talk about some of the components of multidisciplinary management of GI cancers and how that has evolved in the last few years?

Dr. Kachnic: So, as GI cancers in general become more complicated, the management involves the expertise of many different physicians and health supportive groups. For example, our meeting incorporates many of these groups, including medical oncology, surgical oncology, radiation oncology, gastrointestinal physicians, radiologists, and specific scientific experts, who are in the lab trying to set the groundbreaking science and bring that into the clinic for us to use, as well as healthcare providers, nurses, and research assistants.

Cancer Network: Can you talk about any exciting research trends that came out of this meeting?

Dr. Kachnic: There are quite a few, but I will give one as an example. The role of immunotherapy as a potential treatment for GI cancers is one of the exciting new avenues of research. During the meeting, researchers presented a phase II clinical trial of 90 patients with metastatic pancreas cancer who were receiving a new anticancer vaccine therapy. We know that the overall prognosis for metastatic pancreatic cancer is poor, and the use of this vaccine, called CRS-207, was shown to improve patient survival and hopefully will be assessed further in a large phase III study.

Cancer Network: Are there any particularly important pilot or large studies that could be practice-changing that were presented at the meeting?

Dr. Kachnic: I think the immunotherapy example I just provided was a good example of a phase II pilot trial, and I think that there are some excellent examples of phase III trials that will hopefully change the standard of care. First, there was a phase III global randomized trial of ramucirumab, which is a monoclonal antibody against the VEGF receptor 2, for advanced gastric or gastroesophageal junction adenocarcinomas, which is known as the RAINBOW trial. It was discussed at the meeting by the lead investigator, Dr. Hansjochen Wilke, from the Kliniken Essen-Mitte Center of Palliative Care in Germany. The use of this antibody was shown to significantly improve survival from 7 to 9.3 months when added to paclitaxel vs paclitaxel alone, and this was for the second-line setting of systemic therapy for this cancer type. I think the data from this study, as well as another recently published trial, called the REGARD trial, of this monoclonal antibody vs best supportive care, demonstrates how this agent can be an effective new drug for the treatment of patients with advanced gastric and gastroesophageal junction cancers after prior chemotherapy.

And second, a study well known by me in my daily job as a radiation therapist, is the National Surgical Adjuvant Breast and Bowel Project (NSABP) R-04 trial, which is a phase III randomized trial whose mature results were presented by Dr. Carmen Allegra on behalf of the NSABP at our meeting. Combining preoperative radiation with oral capecitabine was shown to be equally as effective as our old standby, which was infusional 5-fluorouracil chemotherapy, in terms of local-regional recurrence rates for patients who are receiving neoadjuvant therapy for locally advanced rectal cancer. To my knowledge, this is the largest clinical trial showing that there is no difference in clinical benefit between an oral and infusional treatment, which is great because this provides for better quality of life for patients. This makes them not tied down to getting a catheter treatment and able to take an oral chemotherapy agent. This trial also showed that adding oxaliplatin to either treatment did not improve clinical response rates.

Cancer Network: Lastly, what are some of the important events that occurred this year in terms of gastrointestinal cancers and what can we expect in the next few years?

Dr. Kachnic: In addition to immunotherapy, which I provided a preview of, some of the extremely exciting advances may come from emerging cancer screening technology. Dr. Thomas Wang from the University of Michigan Health System provided a really wonderful presentation on how novel and noninvasive molecular imaging strategies may aid in the diagnosis, as well as potentially in the management and follow-up, of esophageal cancers. I believe that similar platforms are being developed for many solid cancers. We should probably see some of these come into the clinic in the next 5 years.

Cancer Network: Thank you so much for joining us, Dr. Kachnic.

Dr. Kachnic: Thank you for having me.