ESMO 2019 in 6 questions

Fresh off the back of a busy ESMO 2019, Sean McGrath (Director of Oncology at OPEN Health) had a few moments to pause and answer our pressing questions about his experience:

So, Sean. You’re back from Barcelona and ESMO – how was it?

ESMO is always good. I have been going to ESMO for a long time, and it’s great to see the progress the meeting has made over the years. Especially the last 10 years. It has real credibility and it’s great to catch up with everyone from the research, clinical, industry and patient charity sectors.

How has it evolved over the years?

Well it’s much bigger for a start. This year had 27,000 delegates – 10 years ago I suspect it was around 5,000 or 6,000. But more importantly than sheer numbers, is the undeniable fact that the data presented is truly ground breaking.

Some years ago, I think companies and some institutions would want to wait until ASCO, to make the biggest impact at what was by far the biggest and most important cancer meeting. As more and more excellent data is being released, people aren’t waiting anymore and ESMO has been a beneficiary of this. This means more people attend, making it more attractive as a meeting and the whole process gets bigger and better. Importantly, I have sensed a change in where the delegates come from. It used to be a European affair – now there are many delegates from the USA, Asia and elsewhere, making it far more ‘global’ than it used to be.

What were some of the clinical highlights this year from Barcelona?

Well firstly to say that there was a big reminder that small molecule science is alive and well. After many years of anti-PD1 and general immunotherapy domination, it was good to see some great data from many small molecule candidates, particularly the PARP inhibitors. In the Saturday Presidential Symposium there were three papers presented, all involving PARPs in the maintenance setting, following initial successful platinum therapy. This, for me, was the highlight of the weekend and it was a privilege to be in the hall. But the PARPs weren’t only showing off in ovarian cancer, they are also starting to make their mark in prostate cancer.

Away from the PARPs, there was more evidence what good drugs the CDK4/6’s are in ER+ breast cancers, with both Novartis (ribociclib) and Lilly (abemaciclib) attempting to catch Pfizer (palbociclib) with some reassuring and quality data.

Lilly’s LOXO-292, which impressed in RET altered thyroid cancer but the initial PI data from Amgen’s much anticipated KRAS inhibitor (AMG510) was underwhelming.

And away from small molecules?

Well the immune-oncology (IO) bandwagon rolls on and on. It’s hard to comprehend oncology treatment without immunotherapy, led mainly by the anti-PD1s.

Pembrolizumab achieved a higher response rate in triple negative breast cancer, when combined with chemotherapy, versus chemo alone, which is a big win for patients with this form of breast cancer. This was in neo-adjuvant setting, before surgery and I suspect in time this will show a survival benefit.

Nivolumab plus ipilimumab showed that you can improve survival with this combination in NSCLC, when compared with chemotherapy – offering a non-chemo option, particularly in patients with high expressing PD-L1.  This same combination improved survival too in 1^st line unresectable melanoma, but nivolumab alone did not fare that well in HCC when compared with the current standard of sorafenib.

Finally, another antibody drug conjugate (ADC) is beginning to make its mark in bladder cancer when combined with pembrolizumab (vs pembrolizumab alone), with very impressive response rates. We will certainly hear about this drug a lot more in the future.

Are these data available now?

Yes, absolutely. Some of the bigger trials are already in peer review journals, published in conjunction with the actual presentation – very slick! In addition, all posters and data are available on the ESMO website.

So, what’s next?

The data calendar doesn’t really stop for our clients. Tumour specific meetings go on all the time. In terms of general multi-tumour meetings, we have ASH in December and already have our ear to the ground about potential data for ASCO at the end of May. There’s lots to look forward to!

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