Blog June 22, 2020

ASCO 2020: Part 1

Bionest experts review the highlights of the 2020 ASCO cancer conference

The COVID-19 pandemic has disrupted many events this year, including the ability to hold major scientific, medical and business conferences in their usual formats. In response to most people’s inability to travel long distances and the inadvisability of many thousands of people gathering under one roof, conferences including ASCO, BIO, and more are going digital – internet streaming key sessions and making recordings of many available “on demand” to conference registrants. This move has had both positive and negative effects. 

On the positive side, by putting the meetings online, many more people can “attend” important presentations due to much lower expense and the lack of need to travel, sometimes internationally, to the event. Moreover, those who normally go to the conferences “in-person” can access a greater number of sessions than they can usually accommodate when multiple competing events demand their attention for a single time slot.

On the negative side, however, a digital conference limits the personal interaction between attendees and the opportunity for spontaneous meetings and exchanges. Technical glitches and overloaded servers can make downloading or streaming presentations occasionally frustrating. Additionally, a reported 46% of the globe currently has no stable internet access, let alone video streaming capacity, thus limiting digital participation from many countries, especially in the Southern Hemisphere and Africa. Still, given the benefits for many of holding such events online, it seems likely that major conferences will continue to offer digital access to at least some of their events in the future, even when “in person” conferences can resume.

ASCO’s virtual conference was held over three days, from May 29-31, and generated the usual amount of news from the world of oncology drug development. Some of the news we found most interesting included:

First Clinical Data on Allogeneic CAR-T Treatments

One of the most eagerly anticipated sessions was the presentation of initial data from a Phase 1 trial of the allogeneic, or “off-the-shelf,” CAR-T treatment from Allogene Therapeutics and its French partner Servier. Nineteen patients with either large diffuse B cell lymphoma or follicular lymphoma were treated with ALLO-501, following a pre-treatment with chemotherapy and the antibody ALLO-637 to destroy some of the patient’s own T cells and lymphocytes so that the CAR-T cells could expand and attack the cancer. Twelve of those patients responded (75% ORR), with nine achieving a complete response (44% CRR)– a result comparable to that expected for the approved autologous CAR-T treatments, Yescarta and Kymriah. The reported safety profile for ALLO-637 was very good, with no instances of graft-vs-host disease, only one Grade 3 case of cytokine release syndrome, and no neurotoxicity. Questions remain about the durability of response, but at a median follow-up of 3.8 months, all the CRR patients remained in remission.

One of the big limitations of autologous CAR-T therapies has been the complicated manufacturing process, requiring an average of 14 days from initial T-cell harvest to treatment, during which the patient remains hospitalized. In contrast, patients participating in the Allogene study waited a median of five days after enrollment before receiving treatment with ALLO-501. Even though more data are needed, these early results suggest the allogeneic CAR-T therapy may offer an easier-to-administer, potentially less costly alternative to autologous treatments, including the possibility of eventually providing CAR-T as outpatient therapy. Other allogeneic CAR-T treatments from Precision Biosciences and CRISPR Therapeutics are also in Phase 1 trials for non-Hodgkin’s lymphoma, with results expected by year end.

Real-World Data Providing Insights on Patient Management, Treatment Experience

Collecting and analyzing real-world data helps to both better understand disease and monitor medical practice and overall care with the aim of improving outcomes for patients. New real-world evidence from three clinical practice studies presented at ASCO showed how physicians play important roles in patient well-being that go beyond cancer treatment itself. The presented studies provided insights into important issues affecting breast cancer patients, including BRCA testing, financial toxicity, and treatment delays.

The breast cancer studies were conducted by Belong.Life, a developer of social networks for managing and navigating cancer treatments, and the creator of “Belong Beating Cancer Together,” the world’s largest social network for cancer patients, caregivers and health care providers. In the first study, company researchers reported that about a third of participants (110/302) did not undergo a BRCA test, despite the importance of that test in directing therapy. Two-thirds of those who weren’t tested were not advised by their doctors to do so, even though a third of the study participants met the U.S. Preventative Services Task Force Guidelines for recommending BRCA testing. Most of the patients who did not undergo testing were age 50 or older. The researchers concluded that the study demonstrates the importance of encouraging physicians to follow established guidelines, especially when determining the appropriate treatment for older breast cancer patients.

The second study looked at issues of financial toxicity resulting from high medical co-payments, loss of income, and high drug or treatment co-payments in patients receiving cancer immunotherapy. Financial toxicity was most prevalent in patients older than age 61, 41% of whom were insured by Medicare or other HMOs. About half of the study participants were unaware of possible financial issues that could result from their treatment, and only 29.3% received any pre-treatment financial advice from their doctors. A 41% reduction in financial toxicity was reported for patients who did receive such counseling. Based on these findings, the researchers recommend that physicians become aware of the possible financial risks to patients arising from a recommended therapy and give appropriate advice before initiating treatment.

The third presentation resulted from a retrospective study of Israeli patients with advanced non-small cell lung cancer (NSCLC) that showed significant variability in the start of first line treatment due to the varying time to obtain molecular test results needed to define a targeted therapy. The study concluded with a recommendation that a standardized time-to-treatment protocol be developed.

Our next ASCO post will include observations on the continued advances in liquid biopsy technology and a wealth of new clinical results with Keytruda, both on its own and in combination with a variety of other treatments.