June 11, 2004

Research offers hope for hard-to-treat cancers; Johnson assumes clinical oncology society presidency

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David Johnson, M.D., deputy director of the VICC.

Research offers hope for hard-to-treat cancers; Johnson assumes clinical oncology society presidency

NEW ORLEANS — Doctors who treat patients with hard-to-treat cancers like advanced lung and prostate cancer or kidney cancer saw important progress during the 40th annual American Society of Clinical Oncology meeting held earlier this week.

Bruce Roth, M.D., of the Vanderbilt-Ingram Cancer Center, characterized as “pivotal” two plenary session abstracts that showed the chemotherapy docetaxel can prolong survival in men with metastatic prostate cancer that has grown resistant to control with hormone therapy.

It was an outcome that Roth, with self-deprecating humor, acknowledged in his plenary discussion came as a complete surprise.

“Is this a small step or a giant leap?” Roth asked. “Yes. It’s a small step because a 2- to 2.5-month improvement in median survival and a 20 to 24 percent improvement in overall survival are modest at best and no one is content with that. But it is a giant leap because this challenges the perception of urologists and medical oncologists that prostate cancer is not sensitive to chemotherapy.”

The studies represent a new standard of care for patients with advanced prostate cancer, he said, and sets the stage for trials of chemotherapy in earlier stage disease.

Similarly, two studies added more convincing data to that presented at last year’s meeting showing that chemotherapy in addition to surgery can prolong survival in patients with advanced non-small cell lung cancer.

“These studies will convince even the most skeptical,” said David Johnson, M.D., deputy director of the VICC. “This work shows that chemotherapy given as an addition to surgery can benefit patients with non-small cell lung cancer, just as it does for patients with breast cancer or colorectal cancer.”

And study after study was presented to illustrate the promises and the significant challenges for the so-called “targeted” drugs like gefitinib (Iressa), erlotinib (Tarceva) and bevacizumab (Avastin).

These studies included work by Alan Sandler, M.D., other VICC investigators, and colleagues at M.D. Anderson Cancer Center, that was the first to combine two targeted agents, bevacizumab and erlotinib, in this case in patients with non-small cell lung cancer.

The study found a greater response rate and longer survival among patients who took the combination when compared to other trials involving patients who took the combination when compared to other trails involving patients treated with traditional therapy or erlotinib alone. They also included a study of the same combination in renal cancer a less common but often lethal disease that is strongly resistant to chemotherapies conducted by Jeff Sosman, M.D, at VICC in collaboration with colleagues at the Sarah Cannon Cancer Center.

Again, an impressive survival benefit was seen. The hope for these drugs, which target specific molecular features associated with cancer, is that because they are “targeted,” they will be more effective against cancers with fewer toxic side effects to healthy tissue. But investigators are acknowledging, and studies were presented to show, that these agents may be less “targeted” than was initially believed.

Mace Rothenberg, M.D., Ingram Professor of Cancer Research and director of Phase I Drug Development, noted that early reports about these agents in the lay media may have painted them as less toxic than they are proving to be in actual use. Physicians have a challenge to help patients understand that “we weren’t as smart as we thought we were.”

The message repeated throughout the meeting: more work is needed to understand all the complexities of these targeted agents so that they can be best used in the right patients and in the right setting — alone, in combination with chemotherapy or in conjunction with other novel agents and so that subsequent generations are designed even more intelligently.

“I think what we’ve seen in this meeting is that the targeted therapies are really coming of age,” said Roy Herbst, M.D., Sandler’s co-investigator from M.D. Anderson. “We are learning that all cancers are not the same, and some of these targeted agents have activity against multiple signaling pathways in the cell. Ultimately we need to combine therapy based on tumor characteristics.”

Vanderbilt-Ingram Cancer Center will host a post-ASCO Review symposium Saturday, June 26, at the Loews Vanderbilt. For more information on the daylong event, call Donna Key at 936-3581.

Roth is the Paul V. Hamilton, M.D., and Virginia E. Howd Professor of Urologic Oncology. Johnson is the Cornelius Abernathy Craig Professor of Oncology.

David Johnson named president of American Society of Clinical Oncologyby Cynthia Manley

NEW ORLEANS — For a history buff like David H. Johnson, M.D., taking the reins of the American Society of Clinical Oncology as ASCO celebrates its 40th anniversary in this historic city is more than appropriate, it‚s almost poetic.

Johnson, Cornelius Abernathy Craig Professor of Oncology and deputy director of the Vanderbilt-Ingram Cancer Center, officially took the gavel this week as president of the world‚s largest organization of cancer physicians during its annual meeting here. He will serve in that position through the organization’s next annual meeting in Orlando next May.

“I am really honored to be the next ASCO president and to follow in the footsteps of some outstanding men and women,” Johnson told members of the press at the opening news briefing of the meeting. He urged the reporters to visit the ASCO museum exhibit put together to showcase the progress — and ASCO’s role — in the field of oncology since six men and one woman came together to start the society that now boasts more than 20,000 members worldwide.

“We tend to measure our progress a year at a time, but if you look back 40 years ago and look at where we’ve come, the progress is stunning, really.”

Johnson, who is also a cancer survivor, said that his goals as ASCO president include maintaining a strong focus on quality patient care, education for new as well as experienced oncologists, and ensuring a robust clinical research program, “without which none of this progress would be possible.”

His installation puts Vanderbilt-Ingram in the unique position of having faculty lead three major cancer organizations at the same time. Lynn Matrisian, Ph.D., is current president of the American Association for Cancer Research, and Harold Moses, M.D., is current president of the Association of American Cancer Institutes.

The three presidents are working together on a joint initiative to develop a strategy for improving the way new discoveries move from the basic science laboratory through translation in clinical trials to new advances for patients. A retreat to develop a “clinical trials blueprint” is being organized this fall that will include basic scientists, clinical and translation investigators, clinicians, cancer center leaders, and representatives of industry, government and patient advocacy.