I’ve just returned from the 2010 ASCO meeting, where I underwent a transition in job titles from President-Elect to President of our society. I had a fascinating meeting, and there are several topics arising from the meeting that I will cover in this and future blogs. As a breast cancer specialist I tend to focus on the breast cancer sessions when I attend the meeting. My duties at this meeting kept me away from the breast cancer sessions this year, so I will have to attend an ASCO review course to get up to date on this. But I did attend Sunday’s plenary session, and found it absolutely fascinating.

While all the presentations were excellent, two stood out for me. First was the presentation by Dr. Yung-Jue Bang regarding a new drug called crizotinib. This talk alone was worth the price of attendance. Crizotinib targets a fusion gene (EML4-ALK) that is found in 4-5% of patients with non-small cell lung cancer. In a population of relatively heavily pre-treated patients, this agent induced remissions in over half of patients, with some remissions lasting over a year. This is the wave of the future: the progressive segmentation of common diseases into finely granular therapeutic niches. Find what is driving the tumor, measure it in the clinic, inhibit it with (relatively) nontoxic agents, and kill the tumor. Final results from this trial are not yet in, but this is an exciting advance. Lung cancer is beginning to resemble breast cancer: a disease where “one size fits all” is replaced with “targeted therapy for disease subsets.”

The other showstopper involved a new agent for melanoma called ipilimumab, presented by Dr. Steven O’Day (I’ve also heard this agent called unpronouncumab.) A Phase III trial compared it with a gp100 vaccine, and demonstrated a survival advantage of close to 4 months; the first time in a long time where we’ve had a ray of hope in advanced melanoma. There are some questions about the study: in particular, the gp100 vaccine arm may not be a true control, and the population of patients treated was in an HLA-A2 restricted population, rather than a general population. Nevertheless, the results are positive, and this is indeed exciting for the community of melanoma doctors and their patients, who have seen so many negative Phase III trials over the years. Can we mobilize the body’s immune system in other diseases, or is this a finding restricted to a subset of melanoma patients? Can we move this approach into an earlier and potentially more curable population? Time will tell.

Finally, as part of the same session, Dr. Frank McCormick, this year’s recipient of the Science of Oncology Award, gave a wonderful presentation regarding the ras oncogene as a therapeutic target. This turns out to be a hard target, for a variety of reasons, though an exceptionally important one given its ubiquity in several important human cancers (e.g., pancreatic cancer). I left this talk both depressed by all of the past failures in this area, and hopeful that emerging therapies (siRNA attacks on the oncogene, as well as inhibitors of downstream mediators) may turn this into a useful therapeutic target.