“Caring from every patient, learning from every patient” was the principle underlying the 2019 ASCO Annual Meeting. The programme was inclusive, with tracks dedicated to virtually all tumour types as well as focused on translational and outcomes research. Covering all key presentations is beyond the scope of this news piece; the most relevant will no doubt be discussed in this journal in the near future.

Credit: Simon Bradbrook/Springer Nature Limited

“We place a great deal of emphasis on the search for new therapies to combat cancer and rightly so, because a deeper understanding of tumour biology is producing some exciting new approaches,” explains Monica Bertagnolli, who was President of ASCO during the meeting. “However, it is also important to consider the great advances that are possible if we find a way to apply what we already know to benefit our patients,” she adds.

The commitment to address how to deliver optimal health care was evidenced by the selection of the first presentation of the plenary session (abstract LBA1). In a study of health records from ~34,000 patients in the USA, Blythe Adamson and collaborators found that, before the expansion of Medicaid in 2014, African American patients were 4.8% less likely to receive timely treatment than white patients. After Medicaid expansion, no significant differences in access to treatment were found between groups.

Although not a dominating theme, several reports of efficacy outcomes with immune-checkpoint inhibitors (ICIs) were presented during the meeting. In the phase III KEYNOTE-062 trial (LBA4007; n = 763), frontline systemic pembrolizumab after surgery was found to be non-inferior to chemotherapy in patients with gastric or gastroesophageal junction carcinomas and a combined positive score (CPS) ≥1 (median overall survival (OS): 10.6 months versus 11.1 months) and to be superior to chemotherapy in patients with a CPS ≥10 (median OS: 17.4 months versus 10.8 months). Long-term outcomes of the phase Ib KEYNOTE-001 trial (n = 550, LBA9015) revealed that frontline pembrolizumab has a favourable effect in patients with non-small-cell lung cancer and PD-L1 levels ≥50%, with a 5-year OS of 23.2%).

Owing to the promising activity they have shown in recent years, CDK4/6 inhibitors were also discussed in ASCO 2019. In MONALEESA-7 (LBA1008), the addition of ribociclib to frontline endocrine therapy for premenopausal women with hormone-receptor-positive, HER2-negative advanced-stage breast cancer (n = 672) resulted in longer progression-free survival durations (23.8 months versus 13 months with the addition of placebo).

Other therapeutic classes receiving increasing attention include antibody–drug conjugates. In the EV-201 phase I study (LBA4505), the response rate of patients with previously treated locally advanced or metastatic urothelial cancer (n = 128) receiving the nectin-4-directed agent enfortumab vedotin was 42%, with a complete response rate of 9%.

Novel treatment strategies can also be devised by repurposing drugs approved for other indications. In a single-arm phase II trial, the addition of the angiotensin I receptor blocker losartan to neoadjuvant FOLFIRINOX and chemoradiotherapy enabled disease downstaging in patients with locally advanced pancreatic ductal adenocarcinoma: 42 of 49 patients previously deemed ineligible for surgery underwent surgery, with R0 resection achieved in 34 patients.

…great advances … are possible if we find a way to apply what we already know to benefit our patients…

The results of these and other preliminary studies of new approaches to the care of patients with cancer are awaited in order to confirm whether they could be incorporated into routine clinical practice. However, approval does not automatically mean access for all. “We need a dedicated effort to eliminate disparities in access to care, and this will require new research and supportive health policy decisions”, concludes Bertagnolli, who passed the baton of ASCO Presidency to Howard ‘Skip’ Burris III during the meeting. We hope that, during his service, innovation and inclusion remain key principles of ASCO. We look forward to next year’s Annual Meeting to confirm whether this is the case.