From left, David Johnson, M.D., Alan Sandler, M.D., and Bruce Roth, M.D., after the opening Plenary Session at the 2005 annual meeting of the American Society of Clinical Oncology. Johnson and Roth co-chaired the session, during which Sandler presented an Eastern Cooperative Oncology Group study showing that bevacizumab added to chemotherapy can extend survival for a large subset of lung cancer patients.
photo by Todd Buchanan, ASCO
VICC takes lead role at cancer confab
ORLANDO, Fla. — The field of oncology will weather the coming storms created by the flattening of the federal research budget, ever-increasing regulatory pressures, scrutiny of research ethics and industry-physician relationships, and other challenges — if oncologists remain solely motivated by the quality of care they provide their patients.
So predicted David Johnson, M.D., in his presidential address at the 2005 annual meeting of the American Society of Clinical Oncology (ASCO), which drew more than 25,000 cancer specialists and industry representatives to this central Florida city to discuss the latest advances in the field.
Johnson, deputy director of the Vanderbilt-Ingram Cancer Center, noted that his year as ASCO's president was punctuated by a number of challenges, including the Medicare Modernization Act (MMA) that threatened to disrupt care of cancer patients. Under Johnson's leadership, ASCO worked closely with the federal government to develop a “common sense” policy to reimburse oncologists more appropriately, not only for administration of drugs but also the care provided to manage symptoms and side effects.
“Challenges imposed by reimbursement changes or regulatory burdens must retreat before our most fundamental charge, which is to put our patients first and to do all we can to treat their disease and to alleviate their suffering. Our real treasures … are our patients,” said Johnson, who dedicated his address to his brother-in-law and to his colleague Philip Browning, M.D., both of whom died of colon cancer during the past year.
Johnson's mark on ASCO was visible throughout the five-day meeting. ASCO observers attributed the theme of the meeting, “Advancing the Science of Clinical Oncology,” to Johnson, as well as program changes to foster that theme. These changes included adding an additional plenary session to highlight more “practice-changing” abstracts and a series of Presidential Science Forums to explore in depth important scientific advances that are poised to change the way cancer care is delivered.
The mark of the VICC was also apparent, with several of Johnson's colleagues playing prominent roles in the meeting, including Bruce Roth, M.D., who served as chair of a scientific program that included more than 3,800 abstracts. David Carbone, M.D., Ph.D., and Carlos Arteaga, M.D., chaired Presidential Science Forums on proteomics and genomics and epidermal growth factor receptor inhibition.
Vanderbilt faculty presented more than three dozen abstracts, including a plenary session by Alan Sandler, M.D., that the “targeted drug” bevacizumab (marketed as Avastin) can prolong survival for patients with advanced, non-small cell, non-squamous lung cancer. Adding the drug to a standard chemotherapy regimen extended median survival — the point at which half of the patients taking the drug have died — to 12.5 months, compared to 10.2 months for patients taking chemotherapy alone. “What's really meaningful to patients is that I can tell them that with this drug, they have a 23 percent better chance of being alive at one year and at two years later,” Sandler said.
The study was among the biggest newsmakers during the meeting, which drew more than 350 journalists from all over the world. The buzz about bevacizumab, which attacks cancer in a new way by interfering with the blood vessels that support tumor growth and spread, continued to grow as additional abstracts were presented showing benefit in breast, ovarian, renal and colorectal cancers. “All solid tumors require angiogenesis, the development of this supportive blood supply, so this should work in a number of tumor types,” Sandler said. “That's what we're seeing here.”
Bevacizumab is currently approved for use in advanced colon cancer. The FDA has not yet considered the drug for other indications, and it is not yet clear whether insurance companies will cover these other uses, but Sandler said he is hopeful that it will soon become the standard of care for this subset of lung cancer patients.
“In this setting, we're extending survival, not curing disease,” he said. “It will be even more exciting to see if we can use this drug in earlier stages of lung cancer and actually improve the cure rate.” Trials are planned to test bevacizumab in combination with other treatments, like surgery and radiation, in patients with earlier stages of disease.
Sandler said he agreed with the assessment of his colleague Roy Herbst, M.D., a faculty member at MD Anderson Cancer Center, that treating cancer through anti-angiogenic methods may one day be viewed as a “fourth modality” for therapy alongside surgery, chemotherapy and radiation.
Johnson said he was encouraged by the advances reported at the meeting, especially the application of molecularly targeted therapies to major cancer killers like malignancies of the lung, breast and colon. “Targeted therapies, about which we've been talking for a while, are now at the forefront,” Johnson said. However, he expressed concern that the “need for speed” in getting new drugs to market may interfere with the application of “good science” to clinical trial design. That, he said, would continue to result in a “waste of time, money and precious human resources.”
Over the past year, Johnson has worked closely with Hal Moses, M.D., and Lynn Matrisian, Ph.D., in a “Presidents' Initiative” to take advantage of the coincidence that the three friends and professional colleagues were leading three major cancer organizations at the same time. Matrisian's year as president of the American Association for Cancer Research ended with that organization's annual meeting in April. Moses continues as president of the Association of American Cancer Institutes through the fall.
Work on the initiative, which is focused on creating a new paradigm for designing and conducting “TIER 1” or “smart” cancer clinical trials, will continue as the three move into past-president roles. The project envisions a “team science” approach that links academicians, scientists and clinicians from across the entire spectrum of cancer research, government, regulatory agencies, industry, patient advocates, and others in a comprehensive way.
For more news about the meeting or to read Johnson's presidential address, visit www.asco.org.