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Highlights from the European Multidisciplinary Cancer Congress

Oct 12, 2011

By J. Gordon McVie, MD, FRCP, FRCS Ed, FMedSci, DSc (Hon)
Istituto Europeo di Oncologia
Milan, Italy

The European Cancer Organisation (ECCO) is the umbrella organisation collectively shading and encouraging crosstalk between the trade unions of European oncology: surgeons (ESSO), radiation therapists (ESTRO), medical oncologists (ESMO), scientists (EACR), pediatricians (SIOPE), and so on. The ECCO meeting was renamed this year as the “European Multidisciplinary Cancer Congress,” and that’s what it turned out to be—unquestionably the premier world meeting of all the different specialties, with 17,000 people attending.

Surgeons led multidisciplinary sessions on the use of near-infrared (NIR) fluorescence techniques in sentinel node identification, the absolute necessity of pre-surgical histology in sarcomas, and the best clinical situations for resection in the treatment of liver metastases (for all tumor types).

Elsewhere in the meeting, radiation therapists organized multidisciplinary programs on partial breast radiation—definitely coming of age—while underlining in several tumours that chemoradiation is state of the art. In breast cancer, giving cyclophosphamide/methotrexate/fluorouracil 5FU (CMF) with radiation showed improved survival over sequential modalities in a phase III trial, and in head and neck cancer, chemoradiation led to superior survival compared with “very” accelerated radiotherapy.

Basic scientists showed that ALK therapy plus DNA vaccination approaches may be more promising than drugs (e.g., crizotinib) alone. They dissected circulating tumor cells and pointed to their potential use for stratifying patients with lung cancer to receive an ALK-targeted therapy, or a patient with melanoma to receive a BRAF inhibitor. Peroxisome proliferator-activated receptor (PPAR)-gamma molecules were claimed to be good radioprotectors in the lab, and hypoxia seems to limit efficacy of drugs such as mTor inhibitors, though this can be blocked in the lab by using chloroquine to inhibit autophagy and kinase inhibitors to block the unfolded protein response (UPR) pathway. En passant, there were superb molecular imaging sessions illuminating, among others, those hypoxia pathways.

An interesting clinical approach in estrogen receptor-positive metastatic breast cancer (MBC) resistant to conventional aromatase inhibitors involved giving an mTor drug, everolimus, plus exemestane, or exemestane alone. The combination improved survival over the single drug. An analogous trial design in patients with HER2-positive MBC resistant to trastuzumab involved comparison of trastuzumab plus docetaxel to trastuzumab emtansine (which increases intracellular uptake of the active drug). In a phase II randomised trial the new approach was superior in progression-free survival to the combination treatment, and less toxic.

In prostate cancer, radium-223 plus standard care was superior in terms of survival to best standard care in patients with castration-resistant prostate cancer (CRPC) with bone metastases. The radium-223 regimen delayed onset of progression of metastases or prostate-specific antigen (PSA) increase. Denosumab maintains its effect and is now approved in this indication, and ibandronate and single-shot spot irradiation in sequence was effective in a phase II randomized crossover study as well as in painful bone metastases.

Abiraterone data are holding up since the ASCO Annual Meeting, as is ipilimumab data in randomized trials in melanoma. A comparison of the drug with dacarbazine versus placebo plus dacarbazine showed clear advantages in progression-free and overall survival out to three years for the ipilimumab combination.

We also were presented with minor victories in metastatic colorectal carcinoma for aflibercept improving survival with FOLFIRI over FOLFIRI alone, while sorafenib failed to improve on response rates in MBC when combined with docetaxel or letrozole.

All in all a busy, buzzing meeting, truly multidisciplinary and most successful.
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