Grace Wong - ASCO Summary Report

The 2018 American Society of Clinical Oncology (ASCO)’s Gastrointestinal (GI) Cancers Symposium took place in the stunning city of San Francisco, California, from January 18 to 20. Each year, this symposium encompasses the latest science in gastrointestinal cancers, and hosts an international audience of health care professionals and researchers alike. Against the balmy backdrop of the Bay Area, attendees engage in specialized education sessions, case-based discussions, debates about therapeutic controversies, and research presentations. (Note: for those who missed the conference, check out #GI18 on Twitter for tidbits and videos to be in the know! Slides and presentations from the symposium may also be purchased from ASCO University.)

Cancers of the esophagus and stomach were covered on the first day of the symposium. Highlights included a debate between surgery versus watchful waiting following neoadjuvant therapy for esophageal adenocarcinoma, a panelist discussion on global perspectives regarding surveillance and management of early gastric cancer, and sessions on locoregional therapies in stage IV disease. The utility of the FLOT regimen (5-fluorouracil (5-FU), leucovorin, oxaliplatin and docetaxel) for gastric cancer was addressed, with proponents highlighting its outcome improvements (ex. survival benefit over epirubicin, cisplatin and 5-FU or capecitabine seen in the FLOT4 trial), while detractors took issue with its toxicity profile, amongst other details.  Evidence around the use of adjuvant imatinib for moderate/high risk gastrointestinal stromal tumors was another breakout topic.  Abstract sessions prompted consideration of the unintended consequences of chemoradiation on survival amongst esophageal cancer patients, and brought updated research regarding ramucirumab (in combination with cisplatin and capecitabine/5-FU) to light, as a potential addition to therapy for metastatic gastric adenocarcinoma.  

The second day of the symposium covered cancers of the pancreas, small bowel and hepatobiliary tract.  The importance of accounting for variables such as primary site and staging of disease when treating biliary tract malignancies was reinforced, as results from the trials PRODIGE-12 (post-surgery observation vs. gemcitabine and oxaliplatin) and BILCAP (post-surgery observation vs. capecitabine) were presented. Advances in targeted therapies for cholangiocarcinoma (including ongoing trials with agents such as ivosidenib, ramucirumab, merestinib and varlitinib) and systemic therapies for advanced hepatocellular carcinoma (sorafenib, lenvatinib, regorafenib, nivolumab and cabozantinib) were discussed. Abstract sessions presented results from the CELESTIAL trial (cabozantinib vs. placebo in advanced hepatocellular carcinoma (HCC), post-sorafenib therapy), the LAPACT trial (nab-paclitaxel plus gemcitabine in locally advanced pancreatic cancer) and TACTICS (transarterial chemoembolization (TACE) with or without sorafenib in HCC).  

Cancers of the colon, rectum and anus took center stage for the final day. Most screening programs for colorectal cancer (CRC) recommend starting at age 50; however, CRC incidence has increased by 1.5% each year since 1992 in the United States, and similar trends have been noted across the globe.  For this reason, early-onset CRC was a hot topic, with screening, management and survivorship issues being discussed. Controversial topics presented included the duration of adjuvant therapy for colon cancer (with a majority of oncologists in the United States, Europe and Japan now preferring 3 months of treatment for low risk stage III disease), and the use of neoadjuvant therapy for rectal cancer. Notable abstract topics included the effect of tumor sidedness and chemotherapy duration on disease free survival, the effect of physical activity trackers on quality of life for colorectal cancer survivors, and the use of nivolumab with or without ipilimumab in metastatic CRC (CheckMate-142). Watch out for the upcoming results of the EMT2 and SUNSHINE trials, which tackle the effects of omega-3 fatty acids or vitamin D on CRC outcomes, respectively!

Over the course of ASCO’s 2018 GI Cancers Symposium, I learnt a tremendous amount of information about GI cancers; my summary above just barely scrapes the surface! Attending this conference gave me valuable insight into the research and clinical decision-making processes that support the treatments our patients receive, and gain perspective on the unique and shared obstacles that other countries must manage when it comes to cancer care. Moreover, I was fortunate to have the opportunity to grow as a researcher as well, by presenting research on proton pump inhibitors and XELOX/FOLFOX treatment in early-stage CRC. Thank you CAPhO for helping me reach this symposium; it was an amazing experience, and I highly recommend it to anyone interested! 

Grace Wong