ESMO 2020

[medgator]

Wow that’s high; is that changing with pacific results now?

I would say that these pharma companies are expanding the groups they apply immunotherapy to purposely keeping the group huge and hoping that 20-30% that derive big benefit will power the full group. And med oncs totally buy into that and become their defacto shills. We need to give some push back where it’s due

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Way lower in my neck of the woods.... Mostly incidental pN2 disease

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[evilbooyaa]

Ok, I watched the stream now.

My comments:

1. Only 11% got IMRT --> potential issues with cardiac/pulmonary toxicity?

2. 500 patients recruited over 11 years in 4 countries. I counted something like 40+ investigators on the last slide, meaning quite a few of those institutions probably included less than 1 patient/year. Quality of delivered treatment?

3. A lot of the patients had incidental N2, they actually represent the biggest subgroup in the study with over 40%, despite the fact that 90% of all patients had preoperiative PET. This means that a lot of the patients in the trial had single, small positive N2 nodes. This certainly influences lowers overall risk for recurrence.

4. Accrual goal was revised from 700 to 500 patients after the investigators felt they wouldn't be able to get enough patients in the trial. The hypothesis was conveniently altered to facilitate this. This is bad.

5. DFS was the primary endpoint. Death counts as an event in DFS.
Without PORT there were 19 additional deaths due to tumor progression, with PORT there were 21 additional events due to cardiac/pulmonary toxicity, treatment toxicity and other primaries. This raises the question if:
a) PORT actually killed patients through toxicity
b) There was an inbalance between the groups with more "sick" patients getting PORT.
With a median follow up time of less than 5 years, I do not think that secondary primaries because of PORT would actually become an issue. Cardiac/Pulmonary toxicity might however be an issue within such a timeframe.

6. Incomplete resected tumors and extracapsular spread in N2 nodes were exclusion criteria, meaning if you based your indication for PORT based on these two factors, LungArt is basically irrelevant. The only relevant issue is the apparent excessive toxicity with PORT.

11% IMRT for post-op lung RT is lower than ideal, IMO. Not carving dose around esophagus and just blasting through it to 54Gy is giong to lead to some bad toxicities. V20 probably higher with 3D post-op as well. Maybe cardiac mortality an issue if more lower lobe tumors in terms of coverage of bronchial stump?

Point 4 is most frustrating. This trial should be able to accrue just fine. Thanks for the analysis - I'm going to wait for the full paper before changing my practice.

 

[FrostyHammer]

I would say that this number is definetely a lot higher in Europe.
In stage III patients, about 50% get surgery after neoadjuvant chemo, 25% are treated with chemo/rads and then another 25% actually receive some kind of palliative treatment, being too unfit for radical treatment. That is my assumption.

Very neat! Although that 10-12% number was referring to the % of people that meet those 4 "criteria" in my post above and not necessarily the % of patients that go to surgery. Even in the US there are many more than 10-12% that go to surgery but many of those patients wouldn't meet those 4 "criteria" and so it may be a waste.

 

[Radonc90]

Thanks Palex80 for the list.
Appreciate it.

PS: I was scheduled to give a talk at ESMO in Barcelona, but as you guys know, it was virtual.
Barcelona is beautiful, if you guys/girls ever go to Spain, make sure you visit BCN.

 

[Palex80]

PS: I was scheduled to give a talk at ESMO in Barcelona, but as you guys know, it was virtual.
Barcelona is beautiful, if you guys/girls ever go to Spain, make sure you visit BCN.

Wait, wait, wait...

ESMO 2020 was supposed to be in Madrid and then went virtual.
ESMO 2019 was in Barcelona last year and took place physically. I was there.

Anyways, Barcelona is beautiful indeed!

ESMO 2021 is scheduled to take place in Paris, but I presume it's going to be virtual too.

 

[Radonc90]

The email I got from ESMOGI was for BCN for Summer of 2020.
Now they say "glad we will return to BCN in 2021" lol, probably with masks, but in person.
I guess they had enough with Zoom lol...

Home

www.worldgicancer.com

 

[Palex80]

The email I got from ESMOGI was for BCN for Summer of 2020.
Now they say "glad we will return to BCN in 2021" lol, probably with masks, but in person.
I guess they had enough with Zoom lol...

Home

www.worldgicancer.com

Oh, thats ESMO-GI! All good. I thought you were talking about the ESMO Congress (the big one).

 

[medgator]

Thanks Palex80 for the list.
Appreciate it.

PS: I was scheduled to give a talk at ESMO in Barcelona, but as you guys know, it was virtual.
Barcelona is beautiful, if you guys/girls ever go to Spain, make sure you visit BCN.

Maybe when i get to go again, sagrada familia will be finally finished!

 

[seper]

So no signs of doctor’s conferences returning in 2021 yet? I have CME allowance for time off and some money, and was thinking just to spend it on virtual stuff

 

[Palex80]

So no signs of doctor’s conferences returning in 2021 yet? I have CME allowance for time off and some money, and was thinking just to spend it on virtual stuff

Organizing conferences in the national or continental level is possible. We have had a few of those since the beginning of the pandemic, but only with a few hundred people.
Organizing events like the ASCO or ESMO with tens of thousands of participants on the other hand is a lot more tricky.

There are three other major issues:

1. Almost all countries have imposed travel restrictions for travelling to certain countries based on how bad the situation is there at the present time. But the problem is that it is impossible to predict what the situation will look like in 6 months or 1 year. ESMO could simply state they will hold the conference in Barcelona in 1 year, given the situation looks good right now, but noone knows what it will be like in 1 year from now. We don't even know what's it gonna be in 3 months. Planning is impossible.

2. With conferences growing so big only a certain amount of cities can actually support conferences of that size.
The list shrunk in the past years, as the conferences got larger. The infrastructure in terms of transportation, hotels, etc is simply not there.
And because of the size some cities were striving to get those conferences to happen in their turf in the past, since they served as a nice boost to local economy, But nowadays? Explain to the people of Barcelona that inviting 1k (let's say, but you can pick any country with a high viral load) Brazilians (even if they are doctors!) is a good idea... People will protest that the city put money before safety and the conference may be responsible for a local COVID outbreak.

3. Next to countries imposing travel restrictions, the same applies for hospitals and companies.
If the industry doesn't commit itself to a conference out of fear their employees may fall sick, who's gonna pay for it all?

I envision that it's gonna stay all virtual at least for 2021 and perhaps even 2022, depending on how the whole vaccine game plays out. We may see some kind of hybrid-conferences in the future with a lot more interaction possible out of your office and only a select number of speakers present on site.

It's going to be a whole different world.

 

[Phantom1]

This year's ESMO Congress is kicking off. It's virtual and no abstracts have been published yet.

Here are my radiation oncology related picks:

• Consolidation ipilimumab and nivolumab vs observation in limited stage SCLC after chemo-radiotherapy – results from the ETOP/IFCT 4-12 STIMULI trial

• Patient reported outcomes from a randomized phase II trial comparing standard-dose with high-dose twice daily (BID) thoracic radiotherapy (TRT) in limited stage small cell lung cancer (LS SCLC)

• Pembrolizumab versus cetuximab, concomitant with radiotherapy (RT) in locally advanced head and neck squamous cell carcinoma (LA-HNSCC): Results of the GORTEC 2015-01 “PembroRad” randomized trial

• Primary results of the phase III JAVELIN head & neck 100 trial: Avelumab plus chemoradiotherapy (CRT) followed by avelumab maintenance vs CRT in patients with locally advanced squamous cell carcinoma of the head and neck (LA SCCHN)

• 3-years follow-up of double-blind randomized phase II comparing concurrent high-dose cisplatin chemo-radiation plus Debio-1143 (Xevinapant) or placebo in high-risk patients with locally advanced squamous cell carcinoma of the head and neck

• Osimertinib adjuvant therapy in patients (pts) with resected EGFR mutated (EGFRm) NSCLC (ADAURA): central nervous system (CNS) disease recurrence

• An international randomized trial, comparing post-operative conformal radiotherapy (PORT) to no PORT, in patients with completely resected non-small cell lung cancer (NSCLC) and mediastinal N2 involvement. Primary end-point analysis of Lung ART (IFCT-0503, UK NCRI, SAKK) NCT00410683.

Thanks for these selections. These are some really good trials and data both positive and negative that we need to learn from and incorporate.