Letter from the Editor

Dear Colleagues,

I am delighted to introduce Medicom’s current ASCO 2020 conference report.

This could have been a yearly routine – but as everywhere in our private and professional life, COVID has changed it all! No live meeting this year – confinement obliges... Instead a huge virtual meeting with a record number of attendees. And, along with some remarkable study results in the treatment of solid tumors, this was the first major oncology conference to present results from the oncology community concerning management of our “high-risk” patients during times of the pandemic. Reassuringly, and with little surprise, mortality in cancer patients seems to correlate with advanced cancer stage, poor performance status and higher age…

To my mind, the general picture hasn’t become all that clearer, as “high-risk subgroups” are not necessarily the same according to different studies and results are still often based on retrospective data and generalized conclusions with little influence on patient management: If 78% of patients with lung cancer AND COVID needed to be admitted to the hospital (in the TERAVOLT registry), does this mean that all patients with lung cancer were screened for COVID? All registered? (certainly not!). So, what shall be the take-home message?? In COVID-times we are even more bombarded with sometimes immature or very partial results than before, with – to my mind – often little practical value, and a certain taste of the sensationalism and alarmism we got so familiar with in the lay press. Let’s hope that sound, thorough science and research will survive COVID…

Favorable pandemic “collaterals” are the advances of implementing telemedicine and home care, showing ever more the advantages beyond quality of life, as 2 interesting studies from the US and Italy show. There’s a lot more in ASCO 2020, here’s a sample:

• E2108 should settle the question of breast surgery’s benefit in systemically treated advanced breast cancer patients.


• Are all checkpoint inhibitors alike? Maybe not so. At least that’s what the most recent published study involving standard chemotherapy and immunotherapy, here pembrolizumab, seems to underline: unlike the studies with durvalumab and atezolizumab (both PD-L1 inhibitors), pembrolizumab did not show a survival benefit in advanced small cell lung cancer patients..


• Big news: the ADAURA study, showing very significant disease-free survival benefit using osimertinib in EGFRmutant resected lung cancer patients (after adjuvant chemotherapy): a first establishing an indication of targeted agents in the adjuvant treatment of oncogene-addicted localized non-small cell lung cancer.


• In bladder cancer, immunotherapy might be better administered as “adjuvant” after first line chemotherapy – a significant survival benefit: this is what JAVELIN Bladder 100 suggests with avelumab.., and it might also become a standard in adjuvant treatment of muscle invasive disease (atezolizumab in the IMVigor 010 study).


• ARAMIS and SPARTAN – and THeraP: hormonal and radionuclide treatment with big benefits in castration-resistant metastatic prostate cancer; Lu-PSMA has been widely used in countries where it is available – unfortunately without sound comparative survival data…

Check it out!

Yours, sincerely,
Stefan Rauh

Biography

Dr Stefan Rauh is currently working as haemato-oncologist in the oncology department of Centre Hospitalier Emile Mayrisch, Esch, Luxembourg. He is mainly involved in clinical work but also in research and teaching activities and is interested in public policy and international cooperation projects in oncology. He is member of the ESMO Practicing Oncologist’s Working Group since 2011 (chair 2014-2018), member of the ESMO Public Policy Committee, and has been an ESMO Executive Board member in 2015-2016. He is co-author of the 2017 ESMO European Cancer Patient Coalition (ECPC) Patient Survivorship Guide and an invited expert for the ECPC.

Conflict of Interest Statement: Nothing to declare.