Looking back at ASCO 2019

Fresh off the back of a busy ASCO 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’ve recently returned from ASCO – was it a good trip?

Yes of course. Not only good, I think it’s essential for anyone interested in this complex, multi-tumour, rapidly changing environment we call oncology. With 40,000 delegates made up of oncologists, scientists, industry and others all there for the same reasons, it’s vital that we are there to experience and understand this environment if we are to partner our industry colleagues and their healthcare professional customers in an effective, professional and productive manner.

So yes, a good trip. Tiring for sure, but worth it.

You’ve been to ASCO very many times – how has it evolved over the years?

Well it’s certainly got bigger over the years. I think in terms of content I have noticed a few things – it’s a lot more patient-centric, and this of course works well with this year’s overall ASCO theme “Caring For Every Patient, Learning From Every Patient". That may sound obvious but meetings such as these used to be just about clinical data, but now, especially ASCO, is very patient focused and the data, the presentation of the data, the exhibitors, the parallel sessions are much more cognisant that, at the end of the day, we do this for patients, and obviously that is a good thing.

The other thing I have noticed is that ASCO now also informally has become much more of a trade fair, where business is done alongside all the data presentations. Doctors talking with doctors and pharma, pharma talking with pharma, biotechs talking with pharma and investors, everyone discussing clinical trials, agencies doing lots of new business activities, and the like.

So what were some of the clinical highlights this year from Chicago?

Well, I’ll first tell you about some of the general observations that were made by me and, consistently, others that I chatted with throughout the congress. There was a lot of focus on pathology, in the widest sense. Many sessions dedicated to pathology; biomarker testing, mutations, exon insertions and deletions, protein expression, how the biology can and does evolve through treatment, and what that means to the overall treatment plan for the patient.

Also, liquid biopsies where one can detect a present cancer via blood, is currently a hot area with the obvious advantages in areas such as lung cancer, which is notoriously diagnosed far too late.

And any specific disease and drug highlights?

Yes a few, in my opinion. In bladder cancer we have had some success with the PD-1s recently but there was a Phase II trial in bladder cancer with enfortumab vedotin, an antibody drug conjugate (ADC), which essentially is a clever way of getting the drug to where it should be. This drug acts on a substance called nectin-4 which is a cell-adhesion molecule present in almost all urothelial cancers. Following failed platinum chemotherapy and a PD-1 – i.e. at the end of the road, this single arm study showed an overall survival (OS) of 11.7 months, and the manufacturers are hoping for an accelerated approval based on these data. Almost a year’s survival at this stage of the disease and previous treatment bearing in mind that the best on offer is 13 months with first line chemo! This is effectively 3^rd line and getting almost 12 months…

Another very interesting read out, and one we highlighted in our ASCO predictions. Was from Amgen’s AMG 501, which is a KRAS targeted treatment. A Phase I, so very small, but with patients who had at least 2 lines of treatment and they achieved a 50% partial response in 10 lung cancer patients. This is an Amgen compound but the results caused the stock price of a tiny biotech called Mirati to soar, as they have a very similar compound called MRTX849.

There were 2 big, positive prostate cancer trials, both in the NEJM on the day showing benefits of apalutamide in one, and the addition of enzalutamide to existing, earlier treatment in another.

Although less glamorous, it’s important to recognise the failures too. Olaratumab failed to meet its endpoint in soft tissue sarcoma, and pembrolizumab in liver cancer – Keynote 240 – also didn’t quite make the grade. Keynote 62 - pembrolizumab in gastric cancer was a positive trial but only just, and the chatter afterwards confirmed my thinking that usage in this setting would be modest.

Finally from the data, and another area we highlighted prior to getting on the plane, was the racial disparity in time to treatment. Another interesting point was the impact that the expansion of Medicaid was having in the USA. Medicaid is essentially the government / tax funded system in the USA, which is liked and loathed along political party lines. This expansion was implemented in 33 states and where this was done the racial disparity virtually disappears.

Are these data available now?

Yes, absolutely. Some of the bigger trials are already in peer review journals, but everything is available on the ASCO website. Obviously we can’t cover the details here, but it’s available to those who wish to dig a bit deeper.

So, what’s next?

Well, it’s already June and the data calendar doesn’t really stop – for our clients. We will be focusing on the big general congresses, so we have ESMO in September and ASH in December, both of which will be lining up a huge amount of new data for us to look forward to.

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