Suresh Ramalingam
Last summer, Dr. Suresh Ramalingam, executive director of Winship Cancer Institute of Emory University, received a standing ovation at the annual meeting of the American Society of Clinical Oncology. What stirred the audience were the striking results he had just presented for a drug that could become the primary treatment for a type of advanced lung cancer.
Lung cancer is the leading cause of cancer-related deaths worldwide, with close to 1.8 million people dying from it each year. Even as treatment options have improved, they have been largely ineffective for patients with mutations in a protein called epidermal growth factor receptor (EGFR). 'Early on in my career, we identified this EGFR pathway as one therapeutic opportunity to improve cancer outcomes,' says Ramalingam.
In the recent study, Ramalingam found that people with Stage III lung cancer who had EGFR mutations had an 84% lower risk of cancer progression or death when they took a drug called osimertinib after chemoradiation. 'There was a significant night-and-day difference in outcomes, and that has already resulted in [the Sept. 2024] FDA approval of osimertinib for Stage III disease' in people with these mutations whose cancers could not be surgically removed, says Ramalingam. 'To see a trial with this level of impact was truly a pleasant surprise for us,' he says.
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Yahoo
6 hours ago
- Yahoo
The leading risk factor for cancer isn't what you think
If you were to ask most people what causes cancer, the answer would probably be smoking, alcohol, the sun, hair dye or some other avoidable element. But the most important risk factor for cancer is something else: aging. That's right, the factor most associated with cancer is unavoidable — and a condition that we will all experience. Why is this important? Older adults are the fastest growing population in Canada and globally. By 2068, approximately 29 per cent of Canadians will be over age 65. With cancer being one of the most common diseases in older adults and one of the most common diseases in Canada, it means we need to think about how to provide the best cancer care for older adults. So how are we doing so far? The answer is: not great. This may be surprising, but we also have a great opportunity to innovate and prepare for this demographic shift in cancer care. International guidelines — including those from the American Society of Clinical Oncology — say that all older adults should have a geriatric assessment prior to making a decision about their cancer treatment. The most widely used models of geriatric assessment involve a geriatrician. Consultation with a geriatrician for an older adult allows the oncologist and older adult to engage in a conversation about cancer treatment armed with information. Things like how treatment might affect their cognition, their function, their existing illnesses (which most older adults have when they are diagnosed with cancer), and the years of remaining life. Importantly, geriatricians centre their assessment on what matters most to patients. This approach anchors any decision about cancer around the wishes of older adults and their support system. When diagnosed with cancer, older adults undergo many tests and measures of function, but the evidence supports that these are not as accurate as geriatric assessment for identifying problems that may be below the surface. In Canada, there are currently only a handful of specialized geriatric oncology clinics. The oldest clinic is in Montréal at the Jewish General Hospital, followed closely by the Older Adult with Cancer Clinic at Princess Margaret Cancer Centre in Toronto, led by Shabbir Alibhai, one of the authors of this story. As researchers, we are in touch with clinics in Ontario and Alberta that have told us they have geriatric oncology services under development, so we hope to see new programs soon. These clinics aren't just good for patients. In fact, a study led by Shabbir Alibhai demonstrated a cost savings of approximately $7,000 per older adult seen in these clinics. If we map this onto the number of older adults diagnosed with cancer in Canada every year, this represents a huge cost savings for our public health system. Despite this overwhelming evidence, this is still not routine care. In British Columbia, there are currently no specialized services for older adults with cancer. Over the last five years, Kristen Haase — also an author of this story — has been working with colleagues to understand whether these services are needed and how they could help older adults with cancer in B.C. This work involved conversations with more than 100 members of the cancer community. The research team spoke with older adults undergoing cancer treatment, who sometimes had to relocate for cancer treatment. Other participants included caregivers who cared for elderly family members during their cancer treatment and described numerous challenges they faced, and volunteers who ran a free transportation service — a service also mostly staffed by older adult volunteers. The research team also heard from health-care professionals: oncologists, nurses, physiotherapists and social workers. The latter group coalesced around the need for additional supports within the cancer care system so they could do their job well, and best support older adults. The results indicate that both those working in the system and those using the system want and need better support. So where are we now and why don't we have these services across Canada? Cost is obviously a barrier to any health-care service. But with evidence that any costs will be offset by demonstrated cost savings, this is a non-starter. Health human resources are one huge restriction. Geriatricians are in high demand and there is low supply. However, nurse-led models have also been shown to be successful. With the expanding role of nurse practitioners across Canada, this option has huge potential to innovate care, and at a lower cost. Another reason is good old inertia. Our clinical care model in oncology has remained mostly intact for over three decades. It is primarily a single physician-driven model. Although modern therapies for cancer have emerged at a breathtaking pace and have been introduced into clinical practice, it is much harder to change the model of care, particularly for strategies such as geriatric assessment that are harder to implement than a new drug or surgical/radiation technique. The last, and perhaps the most difficult to pin down of all potential reasons for the absence of specialized cancer services for older adults, is agism. Agism is discrimination based on age. It is one of the most common forms of discrimination and it is deeply embedded in many of our systems. 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This article is republished from The Conversation, a nonprofit, independent news organisation bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Kristen Haase, University of British Columbia and Shabbir Alibhai, University of Toronto Read more: Preventing delirium protects seniors in hospital, but could also ease overcrowding and emergency room backlogs For cancer patients, maintaining muscle is vital to health and treatment, but staying strong is complicated The risk of lung cancer for young breast cancer survivors The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
Medscape
a day ago
- Medscape
Emerging Treatment Strategies Benefit Older Adults With ALL
CHICAGO — Acute lymphoblastic leukemia (ALL) remains challenging to treat in older adult patients due to biological factors and poor treatment tolerance. But a variety of treatment approaches beyond chemotherapy-only regimens are making inroads in this challenging disease. That's the message Elias Jabbour, MD, of MD Anderson Cancer Center in Houston, delivered during an educational session at American Society of Clinical Oncology (ASCO) 2025. 'Our data show that 5-year overall survival (OS) for patients aged 65+ years remains less than 20, despite all the treatment advances we've seen in the past decade,' Jabbour told attendees. Referring to a review article he co-authored that was published recently in JAMA Oncology , Jabbour noted that these poorer outcomes are due to both disease characteristics and patient characteristics. Regarding disease characteristics, ALL in older adults is more likely to be of B-cell origin, with a greater co-expression of myeloid antigens. It may also have more adverse cytogenetic abnormalities, including Philadelphia positivity, t(4;11), low hypoploidy/near triploidy. It may also have less high hyperdiploidy, t(12;21), and normal karyotype. These traits make ALL in older adults more refractory to primary chemotherapy, Jabbour said. Patient characteristics that contribute to poorer outcomes in ALL include lower male to female ratio, reduced renal function, and a tendency to have worse mucositis. A history of cardiovascular disease (CVD) is common, Jabbour said, noting the importance of establishing a baseline ejection fraction before beginning treatment. With an estimated past malignancy rate of 8%-16% in this population, these factors all combine to lead to more early deaths, Jabbour added. Jabbour noted that immunotherapies like blinatumomab and inotuzumab have shown promise, with similar response rates in older and younger patients. He summarized results from the trials that established immunotherapy as standard of care in relapsed or refractory ALL. Data published in The New England Journal of Medicine (NEJM) in 2017 showed that the median OS for patients in the blinatumomab group was 7.7 months vs 4.0 months for those in the standard chemotherapy group. More patients had a marrow complete response (CR) in the blinatumomab group than in the chemotherapy group, at 44% vs 25%. Data published in the NEJM in 2016 found that patients who received inotuzumab were more likely to have a marrow CR than those in the chemotherapy group (74% vs 31%). Jabbour also shared data from two studies that stratified patients by age. With blinatumomab, the overall response rate (ORR) was 56% in patients aged 65 years or older compared with 46% in patients younger than 65 years, according to data published in Cancer. Jabbour also shared data from one of his own trials published in Cancer that found that inotuzumab had an ORR of 81% in patients aged 55 years or older vs 80% in those younger than 55 years. 'Then, we asked if we could take these drugs to the frontline and spare the need for intensive chemotherapy for older patients and those with comorbidities,' Jabbour said. 'In 2010, we designed the mini-hyper-CVD regimen with significantly trimmed chemotherapy, then added inotuzumab. Subsequently we added blinatumomab as a consolidation approach and the 10-year follow-up data looked good.' Jabbour shared a list of seven teams of researchers currently testing frontline blinatumomab and inotuzumab combinations in newly diagnosed ALL in older adults. 'All are reporting promising results compared to historical data,' he said. 'We've made progress and survival of older patients is approaching 50% where historically were at 20% overall survival.' The next frontier has been to remove chemotherapy altogether, Jabbour said. 'As investigators, we have to make every effort to move into a chemotherapy-free approach for these vulnerable patients.' This chemotherapy-free approach combining blinatumomab and inotuzumab with TKIs has yielded encouraging results, Jabbour said. 'We know immunotherapies are better than chemotherapy; therefore, it's time to combine them with TKIs,' he said. 'We must prevent central nervous system (CNS) relapses because patients are living longer, and these CNS relapses are what's limiting our progress.' Jabbour highlighted the TKI ponatinib, noting that his and other groups have shown that the use of ponatinib has increased minimal residual disease (MRD)-negative CRs, as well as significantly increasing event-free survival. Ongoing trials are evaluating further optimizations, including integrating CAR T-cell therapy. 'We are measuring MRD by next-generation sequencing (NGS) at 10-6. If a patient is NGS MRD-negative, then we maintain the TKI and do not go for transplant,' Jabbour said. 'In patients who are NGS MRD-positive, we are offering them CAR T cells. If they become MRD-negative, we maintain the TKI; otherwise, we go for transplant.' That means, Jabbour said, that ALL has gone from a disease where transplant was the only way to cure patients to potentially being able to offer CAR T and the promise of finite therapy to these patients. 'We are walking away from chemotherapy because the combination of blinatumomab and a TKI are inducing survival at 4 years of 80%-90%,' he said. 'Moving forward, it's time to integrate immunotherapy fully into the frontline setting, along with bispecific antibody-drug conjugates and CAR T cells.' Jabbour noted that randomized studies are ongoing, with results expected by 2027. 'I hope we will then have a new standard of care for these patients,' he later told Medscape Medical News . Jabbour disclosed having relationships with AbbVie, Adaptive Biotechnologies, Amgen, Ascentage Pharma Group, Astellas Pharma, Bristol Myers Squibb, Genentech, Incyte, Pfizer, and Takeda.
Yahoo
2 days ago
- Yahoo
I attended the world's biggest cancer conference. Doctors gave standing ovations to 2 major breakthroughs.
The biggest cancer conference in the world — ASCO — wrapped up earlier this month in Chicago. Stunning new data suggested exercise, if done the right way, can be a colon cancer treatment. AstraZeneca was a perennial star, with new uses for its drugs in early-stage disease. Recently, I landed on what felt like another planet. Planet cancer research. Technically, this planet was within the city of Chicago, inside the biggest convention center in North America, McCormick Place, which straddles two sides of a highway. It was filled to the brim with premier cancer experts from around the world. At the American Society of Clinical Oncology (ASCO) annual meeting, 44,000 doctors, drugmakers, scientists, and patients, gathered both in person and online, spent four days collecting, sharing, and debating the best ways to prevent, treat, and attack cancer. There were two big announcements that rose above the rest and brought attendees to their feet, cheering and clapping in appreciation. Doctors were buzzing afterwards, with a few telling me they were inspired to think about new ways to treat their cancer patients. Both breakthroughs pave the way towards a smarter, more targeted future for treating and preventing all kinds of cancer. There was one talk at ASCO this year that stunned, invigorated, and even angered some doctors. A team of Canadian scientists showed that a methodically-prescribed exercise routine, performed consistently three to four times per week, could outperform ongoing chemotherapy treatments for patients who'd had colon cancer and gone through initial treatment. "This is so new and different and really incredible," Dr. Paul Oberstein, a medical oncologist specializing in gastrointestinal cancers at NYU Langone, told Business Insider. Doctors routinely recommend exercise to their cancer patients, but there hasn't been a rigorous scientific trial studying the effects. Until now. The researchers, from Queens University in Ontario, studied nearly 900 colon cancer patients in a gold-standard randomized trial. Each patient's cancer had been removed, and they'd gone through chemotherapy. The goal of the exercise program was to prevent high-risk stage 2 and stage 3 colon cancer from coming back, and to keep the patients alive. Half of the patients, a control group, were given the same exercise advice that cancer patients often hear from their doctors. The other half were written an exercise prescription. They were given a trainer or physical therapist who designed a personalized exercise regimen that each patient liked, and that they were likely to stick with for the three-year study. Some kayaked, others biked or swam, but most of the patients (median age of 61) embarked on just a few more walks each week — 45 to 60 minutes at a brisk pace. After three years of prescribed, sustained exercise, patients saw results that were just as good as — in some cases better than — disease-free survival rates for the chemotherapy drugs that are typically used to treat cancer in this same context, to prevent recurrence. Oxaliplatin is a common colon cancer chemotherapy drug which costs $3,000 to $6,000 per treatment — cheap in the context of cancer care. The drug delivers an overall 10-year survival boost of 5%. The exercise program? 7% survival boost after eight years. Patients who were just given the fitness advice had significantly more cancer recurrence, and more deaths than the exercise group. "For every 16 patients exercising, exercise prevented one case of cancer," Chris Booth, a medical oncologist and the lead researcher of the study, said while presenting his results at ASCO. "For every 14 people that were on the exercise program, exercise prevented one person from dying." Doctors attending ASCO were stunned. After Booth's presentation, a surge of excitement simmered through the crowd of oncologists. A standing ovation began slowly, then swelled to thunderous and enthusiastic sustained applause. Some of the attendees wondered if this strategy could ever work for their own patients. Could they ever really be motivated to make this kind of change? For Booth, the study provides a powerful lesson. "Knowledge alone is likely to be insufficient to allow most people to make meaningful and sustained change," Booth said. Exercise needs to be treated like a drug, he said. A prescription needs to be filled out, a trainer allotted, and a schedule adhered to. Oberstein, the NYU Langone oncologist, told Business Insider that the panel had a profound impact on him. He's already talking internally about how his cancer center could implement this kind of program, perhaps with grants from major cancer philanthropy groups or patient support groups who would be willing to pay for tools like wearable trackers and virtual trainer sessions. "It's a lot easier to get a drug that costs $200,000 a year," Oberstein said. "Than to get insurance or someone to pay for a trainer to help someone do exercise." The other big insight in cancer treatment that shone through at ASCO was in immunotherapy. Doctors and drugmakers are starting to use these drugs to harness the immune system against earlier-stage cancers, with promising results. The star of the show was drugmaker AstraZeneca, which had an impressive slate of top-level plenary talks geared toward using drugs earlier on for breast, gastric, and lung cancer survival. The biggest splash I saw was from AstraZeneca's drug Imfinzi (durvalumab), which trains a patient's body to attack a protein in their cancer. Imfinzi's already routinely used in some late-stage, recurrent and metastatic cancers (in the treatment of solid lung and liver tumors, for example), but it hasn't been a go-to treatment for earlier-stage cancers. In results from the company's late-stage phase-3 "Matterhorn" trial presented at the conference, Imfinzi, taken with chemo after surgery, boosted gastric cancer patients' two-year survival rates from 70% (without the immunotherapy) to nearly 76% — a significant jump. The news — just one of AstraZeneca's big wins at the conference — highlights a growing trend in cancer treatment. Increasingly, drugmakers are pursuing early immune therapy treatments. These treatments can either complement — or even, in rare cases, completely replace — radiation and chemotherapy. The goal is to minimize the lifelong side effects of toxic cancer treatment (like lifelong organ damage and fertility issues) while also improving treatment outcomes. In April, doctors at Memorial Sloan Kettering published results showing a monoclonal antibody treatment that's typically reserved for advanced-stage mismatch repair-deficient rectal tumors can completely replace chemo in earlier stages of disease. "What was amazing, and is still amazing, is that all the patients in the rectal group had a complete response to just immunotherapy," Dr. Andrea Cercek, a medical oncologist at MSK, told BI during ASCO. "Everyone's organs were completely preserved — very minimal toxicity." AstraZeneca senior vice president Mohit Manrao, head of the company's US oncology program, told BI that he envisions immunotherapy treatment as a great complement to traditional cancer treatment. Old-school treatments like chemotherapy and radiation go after cancer directly, aiming to kill cancer cells, while the newer drugs "engage the immune system to do better work." "We cannot just keep treating metastatic cancer patients," Manrao told BI. "We've got to ensure, yes, we serve them, but we need to start getting into early disease where the possibility to cure is really, really high." Read the original article on Business Insider
