Gone from the American Society of Clinical Oncology (ASCO) meeting were the packed halls of McCormick Place in Chicago and the excited bustle of scientists reacquainting with each other at the always data-rich event.
ASCO’s annual confab, held online because of the COVID-19 pandemic, still managed to pull off what former president Howard Burris called a “resounding success,” with about 40,000 registrants, similar to previous years. About half were ASCO members and about half reside outside the U.S., replicating past trends. Organizers did notice an uptick in sign-ups by professionals this time around. “One could surmise that, there [are] often folks who have to stay home and cover, for example, and now they didn’t have to,” he said.
Included were 250 oral presentations plus 2,500 posters. ASCO rolled out news of them Friday. “We know that the number of page views is well into the millions, north of 3 million as of Saturday afternoon,” Burris said. “It makes me think that, once some of this gets digested, there will be more debate and more commentary about some of the stories over the next week or so.” Half of the meeting – the educational component featuring lectures, symposia and debate sessions – was moved to the first weekend in August; it will be conducted virtually, too.
Asked to name a dataset that especially impressed him, Burris cited Cambridge, U.K.-based Astrazeneca plc’s Tagrisso (osimertinib), which appears likely to become standard of care in the adjuvant setting for early stage (IB, II and IIIA) EGFR-mutated non-small-cell lung cancer, thanks to phase III data from the study called Adaura. Tagrisso treatment turned up statistically significant and clinically meaningful improvement in disease-free survival after complete tumor resection with curative intent. Overall survival (OS) data have yet to mature. “The curves are widely separated,” he pointed out. “Do you wait for OS? My thought is, boy, if you can [treat] a disease like lung cancer with these EGFR mutations, and you can take a pill and prevent relapse … we’ll follow the patients out and maybe address it later, but I don’t think you can delay on that data,” he said. “Congrats to the investigators and to Astrazeneca.” He also mentioned the phase III Javelin trial testing Bavencio (avelumab, Pfizer Inc.) as a maintenance therapy in bladder cancer. The experiment met its primary endpoint of OS. “Platinum therapies are very effective but after four months or so, the toxicity” when balanced with efficacy becomes a problem “and patients are just kind of waiting around to relapse,” he said.
Burris is president and chief medical officer of Nashville-based Sarah Cannon Research Institute, as well as the executive director of drug development there. He is an associate of Tennessee Oncology PLLC, where he practices medical oncology. As of today, he’s passing the ASCO presidential baton to Lori Pierce, a radiation oncologist, professor and vice provost for academic and faculty affairs at the University of Michigan. Recognized as a national leader in breast cancer research, Pierce is also director of the Michigan Radiation Oncology Quality Consortium. Her presidency is timely, Burris said. “Lori is African American, and one of her themes for this next year is going to be about addressing health inequities and health disparities and trying to ensure equal care for every patient every day. We’re getting asked a lot of questions about that, and I think we’ll see medical societies make a statement,” he said.
Patients feel insurance squeeze
COVID-19 has meant “a big reduction in what I would call symptomatic cancers,” Burris told BioWorld. “Many people are staying home with stomach pain and chest pain and getting later diagnoses of gastrointestinal cancers and lung cancer. It will take a little while to sort out the impact” of the held-up diagnoses, he said. Also, patients have opted to postpone surgeries. “We think we’ll have more data on that to talk about by the end of the summer,” he said. Telehealth “became big very quickly” as the virus spread. “That actually worked out fine for people on surveillance and people that are taking pills. It also moved those people out of the clinics so there was more room for the patients that are getting the intravenous therapies,” he said.
Phase II and III trial accruals have dropped severely as a result of the pandemic “because people didn’t want to travel and have as many visits, and there are good standards of care, even though we prefer [patients take part in a] trial when possible.” The roller-coaster effect in accruals may have bad effects on statistical outcomes, he noted. “We didn’t see that drop in phase I studies. People that were desperate to get an investigational drug still found a way to get in.”
Another problem brought about by the virus is that many small private practices of six or eight doctors – “not even necessarily in super-rural areas,” Burris said – are going broke. “They were just like the restauranteurs.” Some practices have been bought or become affiliated with hospitals, themselves beset by major layoffs. “It’ll be interesting to see how quickly patients want to jump back in, particularly for more lucrative procedures like joint replacement,” he said. “There will probably be quite a delay in getting some of those going again. Practically speaking, with the nature of this virus, I think it’s going to take the vaccine to get things really back to where we’re going to feel comfortable traveling and the like.”
Burris said such a vaccine could arrive much sooner than historical guidelines have led the world to expect. “It’s tougher when you’re talking about measles and you’re trying to [vaccinate] newborns,” he said. “Frankly, we’ve had some tragedies with children.” COVID-19, though, is known to hit senior patients harder. They, and health care workers, would be among the first to get the vaccine so “it might be that we can go a little quicker and be more aggressive” in testing.
“One of the health care things that is not being talked about as much is the fact that we’re likely to have far more uninsured people in America over these next 18 months than we’ve had in quite some time,” Burris said. “It’s something we’re very concerned about.” ASCO has been “trying to get these systems to give patients some breaks [so they can] continue treatments while we figure this out,” he said. The meeting ended Sunday.