Editor’s note: Dr. Hudis hosts the ASCO in Action Podcast, which focuses on policy and practice issues affecting providers and patients. An excerpt of a recent episode is shared below; it has been edited for length and clarity. Listen to the full podcast online or through iTunes or ASCO's Podcast Page.
I'm delighted today to have as my guest the Society's chief medical officer and executive vice president Richard L. Schilsky, MD, FACP, FSCT, FASCO. He's also an executive editor for the 2020 Clinical Cancer Advances report. In this report, ASCO identifies the most important clinical research advances of the past year, across the full trajectory of the disease—from prevention and screening to treatment and survivorship. The report also announces ASCO’s Advance of the Year and debuts a list of research priorities that have great potential to accelerate progress against cancer.
CH: This year, ASCO has recognized refinement of surgical treatment of cancer as the Advance of the Year, and this is an area of clinical cancer research that has demonstrated the most significant progress in a year's time. Can you tell us what brings this back to the forefront this year?
RS: Over the years, we've seen a great deal of progress in developing the new systemic therapies for cancer. This, I think, illustrates the prescient work of Dr. Bernard Fisher in his seminal research on adjuvant therapy for breast cancer, because a lot of the advances that we're seeing in surgical approaches now are driven by better systemic therapies. These treatments have improved survival outcomes and quality of life for our patients, and they've now begun to transform the role of surgery in cancer management by reducing the amounts of surgery in some cases, and even eliminating the need for it in others—or, conversely, by increasing the number of patients who can undergo surgery when it is needed to help in the treatment of their cancer.
CH: That’s great to hear. What are some are the specific advances that you would cite as supporting this recognition of surgery this year?
RS: There are some interesting reports summarized in this year's Clinical Cancer Advances that really speak to this issue. In melanoma, for example, there are two studies that examine the efficacy and safety of neoadjuvant treatments for patients with locally advanced disease. Australian researchers examined the combination of two molecularly targeted drugs—dabrafenib and trametinib—given before surgery in patients with stage IIIC melanoma that has the BRAF V600 mutation. Not only did 86% of patients on the trial experience a response by the time of resection, almost half experienced a complete response, either obviating the need for or simplifying the surgical treatment. In another study, patients with stage III melanoma that was still treatable with surgery received ipilimumab and nivolumab for two cycles prior to surgery and experienced a pathologic response rate of 77%, respectively.
So, this really is the year where we're seeing highly effective systemic therapies that are making surgery more possible, where surgery can contribute to achieving better cure rates or obviating the need for surgery, or where surgery is no longer necessary given the effectiveness of systemic treatment.
CH: As you look at both our Clinical Cancer Advances for this year and the totality of public health data, what role would you ascribe to federal funding in generating these advances?
RS: This year's Clinical Cancer Advances Report includes 10 studies that were supported, directly or in part, by funding from the National Institutes of Health (NIH), which highlights the important role of federal funding. Not only is there the discovery work, but there is also the work through National Cancer Institute (NCI)-funded cooperative group studies that are helping to translate those basic science discoveries into clinical trials. And more importantly, helping to design clinical trials that are not likely to be pursued by commercial interests, but that answer important clinical questions that directly impact the way patients are treated by their physicians.
CH: This is the second year that ASCO has included with its Clinical Cancer Advances report a specific set of research priorities. Can you tell us a little bit about the motivation for creating this research agenda for the country?
RS: With as much progress as we're making, there still is substantial unmet need, and so we need to continue to accelerate progress in many areas and focus our resources. We launched ASCO's list of research priorities to accelerate progress against cancer by sparking momentum in those areas of research where the opportunity is ripe to spur new advances. The goal in doing this is to provide the cancer community with insight as to where to focus their investments and resources. The research priorities represent areas that have the potential to significantly improve the knowledge base for clinical decision-making and help us address vital needs in cancer care that remain unfulfilled.
CH: What are some of the research priorities that made the list this year?
RS: There are eight priorities this year and they fall into three major thematic areas. The first of those is getting treatments to the patients who can benefit from them the most and sparing the toxicities and costs of treatment for the patients who would benefit the least.
The next set of priorities focus on improving the treatment and care of special populations and emphasize the importance of improved representation of these populations in clinical trials, so that we have reliable data to better inform treatment approaches.
And last, but not least, our next set of research priorities focus on reducing one’s risk of cancer by spotting and catching it early.
CH: Our hope with these priorities is that we stimulate the entirety of the research and treatment ecosystem to think about these studies, to support them, design them, and enroll patients on them given the opportunity, right?
RS: That's exactly right. The whole ecosystem has a role to play in bringing drugs from the discovery phase, to the development phase, and to commercialization. Then the effectiveness research follows on after so that we understand how the drugs perform in real-world populations, many of whom never get the opportunity to participate in the pivotal clinical trials.
CH: Fundamentally, this can all be understood as advocacy. In that regard, it's reasonable to wonder what steps our readers and members can take to urge Congress to support policies and support the critical cancer research that we're highlighting.
RS: The easiest thing for our members is to contact their Members of Congress through ASCO's ACT Network. From there, they can easily generate a letter advocating for federal support for cancer research to their Congressional representatives. I can't stress enough how important it is that all members get involved in this advocacy work. There are also opportunities for people to come to Washington, DC, to participate in ASCO's Hill Days and to get involved in ASCO's other activities through the Government Relations Committee and other work that their Society is doing on their behalf.
CH: Rich, thank you again, both for leading the production of this report, and for joining me today. I encourage everyone to read the full report.
RS: Thanks, Cliff. This is really a fun project for me to work on every year with wonderful ASCO volunteers, and I hope our members will enjoy reviewing all the advances summarized in the report this year.