By Marin Martinis (left) and Michael Smith (right)
Standing ovations at medical congresses don’t happen daily, but they fit a trend in cancer research. The European Society for Medical Oncology (ESMO) held its 2022 congress in Paris in September. And like the Chicago equivalent of ASCO, a few months earlier, clinical innovation proved enough to lift delegates from their seats.
ESMO did not conform to the shouts and screams observed in Illinois, where a specific presentation animated a loud ten-minute ovation. But it has shown enough to verify that we are in an exciting time for cancer research. And, in the post-COVID era of hybrid events, he reaffirmed the price of classic medical congresses, highlighting a new opportunity for artistic communications to play an even greater role in transforming cancer care.
As always, ESMO’s program and accompanying exposure were rich and diverse, covering the full spectrum of the oncology category. It was to see everything. However, the experiment revealed 3 main trends.
1. Crowds are returning This was ESMO’s first user convention since the pandemic disruption and the number of attendees suggests delegates are still not convinced to trade their lanyards for a virtual pass. User engagement was impressive. ESMO says there were 22,000 registered participants and we don’t know what proportion were online, experience on the site showed that many were physically present. Anecdotally, some participants felt that the number of other people in the user exceeded ASCO 2022, the latter’s presidential symposia. generated two full auditoriums, while ESMO was not very successful in its capacity. Either way, the trend is clear: crowds are returning and this can only bode well for clinical practice.
The return to in-person meetings has positive implications at all levels, from an industry communications perspective. In-person participation naturally leads to higher attendance at the exhibition, more billboards, and more satellite symposia. These are massive opportunities for engagement and a possibility for artistic communications to drive learning. However, the nature of this commitment has been altered through the COVID-19 experience, creating a conundrum for medical associations, industry and agencies as we seek to stimulate healthcare professional (HCP) interaction in a new world.
The style of the upcoming medical convention will inevitably retain the hybrid combination of online and in-person engagement, but the balance of this combination would possibly want to replace to incentivize and maintain physical presence. Could organizers move towards a style where the presentation of key knowledge is only available on-site rather than remotely?Time will tell. This is a trend that will be attractive to maintain as in-person activities resume. For now, there is a wonderful artistic opportunity for the industry to raise the level of participation in the congress on both sides of the hybrid style.
2. Innovation: incremental, but incredible Compared to ASCO, ESMO 2022 didn’t offer as many major “practice change” moments. In Chicago, the presentation of the DESTINY-Breast04 study, which established a popular new overview of overall survival progression and overall survival for patients with HER-2 low metastatic breast cancer, drew a lengthy Oscar-worthy ovation from the entire audience. Cancer (CRC) (dMMR) showed impressive results, attracting applause from the audience.
In general, however, ESMO presented incremental advances in knowledge of ASCO as very attractive new studies. Findings include:
Enhertu is at the core level and growing. Enhertu was very useful at ESMO, with its prospective application fitting into the past and wider scope. expressing other degrees of HER-2. This again provides the next generation of antibody-drug conjugates (ADCs) through their significant bystander effect, and with new targets and payloads prospectively (e. g. , HER3 in lung cancer) to come. Toxicity is now more manageable and the mechanisms of number one or acquired resistance do not yet appear to be a primary or well-understood problem. Based on the effects we observed with immune checkpoint inhibitors (ICIs), it will be attractive to see how T-DXd behaves in the neoadjuvant. configuration. Accurate assessment of HER-2 expression is an ongoing discussion with potential synthetic intelligence and device learning solutions.
The promise of immuno-oncology (IO) shows no signs of slowing down, with existing efforts aimed at expanding response rates. Neoadjuvant and first-line IO with checkpoint inhibitors continues to provide benefits in reactive cancers, and there is now vital knowledge about new IO combinations for reaction rates and decreased toxicity, adding new bispecific monoclonal antibodies and bispecific T cell activators.
In terms of established IO combinations, as previously reported, impressive effects were reported in the neoadjuvant NICHE-2 study of nivolumab/ipilimumab in MMR-deficient CRC (approximately 15% of patients), resulting in a primary pathologic reaction of 95% and 67% complete reaction, with no disease recurrence at thirteen months follow-up. This adjusts practice in this patient population and reinforces the importance of biomarker testing and remedy personalization. Sequential immunotherapy and targeted therapies also demonstrate clinically significant survival benefits for patients with BRAFV600-mutated melanoma in SECOMBIT.
However, some complex cancers are less vulnerable to first-line immune checkpoint inhibitors or even first-line immune checkpoint inhibitors in combination with antibody conjugates and drugs, as in the case of complex urothelial cancer. L1 maintenance treatment is now obviously established as the popular care.
Above: John Haanen, Netherlands Cancer Institute and Professor of Translational Cancer Immunotherapy at Leiden University, Scientific Co-Chair of the ESMO IO Congress from 2016 to 2019 and Scientific Chair of ESMO 2020 Tumor-infiltrating lymphocytes (TILs) arrived from age
Generation of associated IO directed to longer-lasting/curative responses evaluated in the first randomized versus anti-CTLA-4 study in metastatic melanoma refractory to anti-PD-1. The bottom line? The generation works, but it is still not unusual due to the need for conditioning and hospitalization of patients. However, the information is very impressive in patients who no longer respond to checkpoint inhibitor blockade and, depending on this generation, may provide more treatments available.
Real World Evidence (RWE) is playing a vital role in curative decision-making, across the cancer bureaucracy. The first approved CDK4/6 inhibitor, palbociclib (IBRANCE) presented the most comprehensive real-world first-line comparative study at ESMO Breast 2022, where it demonstrated significant overall survival (OS) merit at John Haanen, Netherlands Cancer Institute and Professor of Translational Cancer Immunotherapy at Leiden University, He was scientific co-chair of the ESMO IO Congress from 2016 to 2019 and scientific chair of the combination of the ESMO Congress 2020 with Endocrine Therapy and follow-up at ESMO 2022 with other RWEs that appear to solidly maintain the quality of life of patients with complex breast cancer receiving this treatment.
Galleri created the gallery: it works, but can we do it? MCED uses circulating tumor DNA methylation (ctDNA) schemes to assess the possible presence of cancer. older than 50 whose cancer was unknown, and cancer was shown in 38% of other people who tested positive. Of the other 6290 people without cancer, 99. 1% tested negative. This will have vital implications for expanding cancer diagnoses, which can only be a smart thing given that early diagnosis is usually linked to better outcomes. However, progress is not without its challenges, highlighting the need for fitness systems to ensure they have the resources and means to handle the expected backlog in patient numbers. diagnosed at an early level of cancer.
3. Advances in virtual fitness and cancer go hand in hand Another compelling trend highlighted at ESMO 2022 was the increased concentration on virtual fitness and its developing application in oncology. It’s clear that the long-term advances that will reshape cancer care are likely to be maximum. ed through virtual innovation such as AI and device learning. This was indeed reflected at the convention level where many presentations signaled an increasing openness to the use of AI in diagnosis and treatment. We’ve come a long way in the ten years since IBM Watson was first used for decision-making in lung cancer care. Today, virtual fitness equipment ranges from drug progression and clinical trials to diagnosis, treatment, radiology and pathology.
ESMO highlighted how, at a time when cancer drugs are becoming increasingly personalized, AI is helping to accelerate the identification of patients with ultraspecific (and ultra-rare) cancers.
Pharma’s investment in immuno-oncology, mobile remedies and antibody-based remedies embodies a preference for personalizing drugs and survival rates. But, as ESMO made clear, this is an investment that comes with a commitment to virtual health. Industry, in partnership with academia, is throwing in the towel on virtual innovation to expand best-match (biomarker-based) clinical trial algorithms, best-match remedies, and greater personalized attention. One of the big headlines of ESMO 2022 is that those algorithms deserve to be held until 2025-2030. It will only mean that the newly demonstrated incremental innovation will, over time, produce even greater results.
The return home? The true promise of virtual fitness has yet to be realized, but evidence increasingly suggests that it is the most productive supplement to cancer treatment. ESMO has proven that the broad spectrum of virtual fitness improves research, improves treatment and, most productive of all, improves patient outcomes.
For the first time in over 3 years, ESMO 2022 brought together the European cancer network for a much-needed plenary session. He revealed a category of oncology that would possibly have been kind to face-to-face engagement, but that hasn’t. It prevented him from being rich in healing advances. There is much to applaud. And many more things to come that will cheer up the crowd.
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Michael Smith is Group Chief Scientific Officer at VMLY