View From ASCO: Cancer Advances Made in Baby Steps

By Charlene Laino
WebMD Guest Blogger

(Chicago) -- As Len Lichtenfeld, MD, deputy chief medical officer at the American Cancer Society, likes to remind me almost every time we speak, the field of cancer advances not overnight, but in a series of baby steps. And such was the case at the annual meeting of the American Society of Clinical Oncology (ASCO), which started Friday and ended Tuesday.

I go every year. It's a five-day cancer marathon, with some 33,000 attendees racing to hear as many of the 4,000-plus presentations as possible; all the regulars know to bring their running shoes. The abstract book is the size of the Manhattan telephone directory; just figuring out where you want to be (and then actually finding the room in the colossal McCormick Place Convention Center without injuring your shoulder carrying your overstuffed conference bag) is a major challenge.

In the enormous exhibits area, pharmaceuticals companies offer everything from personalized ballpoint pens to the latest computer gadgets to well-needed jolts of espresso in an effort to attract doctors to hear about -- and hopefully then prescribe -- their drugs and diagnostics. At publication booths, the giveaways are typically less extravagant -- chocolate's quite popular. But all they're asking is that you consider signing up for their journal or buying their book.

As the world's largest cancer gathering, ASCO is also considered the forum to unveil new research. It's the place where we first hear of those rarest of events -- true breakthroughs that will transform practice. And indeed, we got spoiled for a while, with breakthrough targeted drugs like Herceptin, Gleevec, Erbitux and Avastin hitting home runs every year.

This year was more typical; there were few real surprises. We heard about some new ways to use existing drugs. And perhaps more importantly, we got a baby step closer to the holy grail of personalized medicine -- tailoring treatment to each individual based on his or her genetic makeup.

"They might not have been huge breakthroughs, but there were some real wins," says Julie Gralow, MD, chair of ASCO's communications committee and a cancer specialist at the University of Washington.

Top on her list: Research "defining who will respond to targeted therapies like Erbitux, as least in colorectal cancer."

Gralow is referring to a large international study that showed that that the two-thirds of patients with colon cancer who have a normal, or wild type, version of a cancer-associated gene are more likely to respond to initial treatment with Erbitux plus chemotherapy than to chemo alone.

People with a mutated KRAS gene, on the other hand, gain no benefit from Erbitux. So why is that so important?

Since treatment with drugs like Erbitux can cost thousands and thousands of dollars, KRAS testing will allow doctors to predict the two-thirds of patients who will benefit. There's no sense giving it to the other third.

There was other news about Erbitux this week too -- it prolonged survival in advanced lung cancer patients, albeit for only a little over a month. To the cynic, the fact that a four or week five improvement in survival made headlines at all might make it seem like we were desperate for news.

And as a one-liner, it is just a blip on the landscape. But when you start delving into the details of the research, you'll see that the researchers are already beginning to pinpoint who will benefit and who won't -- yup, another step toward personalized medicine.

Caucasian patients, for example, lived a median of 10.5 months when they got Erbitux plus chemo -- survival rates previously unheard of in advanced lung tumors. Asian patients, on the other hand, appeared to gain no benefit from the targeted drug. Further testing that may better define who will benefit and who won't is underway.

There were other advances it personalized medicine as well.

Researchers showed that a genetic fingerprint in the blood may be able to spot lung cancer in smokers early, when there is still a chance of a cure.

David M. Johnson, MD, deputy director of the Vanderbilt-Ingram Cancer Center in Nashville, says that researchers at Vanderbilt are testing a similar type of test, one designed to determine whether lung cancer patients will benefit from the targeted drug Avastin.

"The idea of all these personalized medicine studies is help us to better detect and select patient patients for treatment," he says.

Lichtenfeld says that no matter which cancer you're talking about, small steps will eventually mean big gains. His favorite example is colon cancer, where people with advanced disease had a 50-50 chance of living six months in the early 1970s. Now, with targeted, more personalized treatment, half of them can expect to live nearly two years.

Baby steps.