What did you get out of the 2010 Annual Meeting of the American Society of Clinical Oncology (ASCO)?
Larry Rosenberg, Ian Hicks, Anthony Faustino and Thierry Devevey
Kantar Health
This major annual event is on a scale that is hard to imagine. Comprising 28,000 members, ASCO is representative of more than 100 countries, bringing together the world's largest collection of expertise and insight into the treatment and management of cancer patients. By its own description, “ASCO is the world’s leading professional organization representing physicians who treat people with cancer.” ASCO’s members set the standard for patient care worldwide and lead the way in implementing clinical research aimed at improving the prevention, diagnosis, and treatment of cancer. ASCO's efforts are also directed toward advocating for policies that provide access to high-quality care for all cancer patients and supporting the increased funding for clinical and translational research.
ASCO is committed to supporting the lifelong learning of oncologists and provides resources to enhance the professional development of members throughout their medical education. This year’s event in Chicago brought together nearly 30,000 highly diversified professional attendees, including pharmaceutical and biotech companies, students, investment banking firms, healthcare specialists, consultants, patient advocacy groups and others. This year’s meeting includes representatives from 127 countries as shown below (excluding exhibitors):
Note: adding manufacturers and spouses increases registrations to approximately 30,000
The net result is that the annual meeting represents different opportunities to learn, share and contribute for the attendees. From the vantage point of the supporting industry, i.e., pharmaceutical and biotech companies, and the various services organizations (including our own) in attendance, the meeting was a bonanza that captured a wide range of interests, including the following:
• Emerging technologies
• Evolution of patient treatment
• Healthcare reform
• Strategic and competitive knowledge
• Global considerations
Emerging technologies
What all participants, industry groups and physicians received at ASCO 2010 relative to emerging technologies was critical news about a wide range of product successes and failures. Two examples of some of the more exciting offerings include the following:
Novel ARQ 197-Targeted Therapy Holds Promise for Patients with Locally Advanced or Metastatic Non-Small Cell Lung Cancer
The investigational agent ARQ 197 from Daiichi Sankyo provides prolonged progression-free survival (PFS) when added to erlotinib for previously treated patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) without enhancing toxicity, as shown in a randomized, double-blind, placebo-controlled Phase II trial.
Chemosaturation Therapy via Percutaneous Hepatic Perfusion Shows a Substantial Increase in Median Hepatic Progression-Free Survival Compared to Control Arm for Patients with Hepatic Metastases from Melanoma
Delcath, a development-stage, specialty pharmaceutical and medical device company focused on oncology, highlighted the Phase III trial data presented on June 5 at the American Society of Clinical Oncology's 2010 Annual Meeting, comparing percutaneous hepatic perfusion (PHP) with melphalan to the best alternative care for patients with hepatic metastases from ocular or cutaneous melanoma.
"This year’s event in Chicago brought together nearly 30,000 highly diversified professional attendees..."
The above types of information are a critical first step in understanding the key success factors and overall commercial viability of the most promising products being developed in oncology. The opportunity for the companies concerned is more exciting when one realizes the level of review implemented by investment analysts, physicians becoming aware of new, promising developments and the possibility of patients reading about newer treatment potential when implementing their own research. Business development opportunities may arise as a smaller company might find interest in collaboration from a larger company, with subsequent benefit to both parties.
Evolution of patient treatment: Biomarkers and implications for personalized medicine
The future role of biomarkers in personalizing cancer patient treatments provided a common theme in several ASCO 2010 presentations. Researchers presented data and opinions on how biomarker analyses could potentially:
• Predict individual patient response, tolerance or resistance to targeted therapies
• Predict the likelihood of progression-free survival (PFS) or probability of overall survival (OS)
• Estimate more precisely an individual patient’s recurrence risk
A partial sample of biomarkers receiving coverage at this year’s conference included:
For example, exploratory biomarker analysis in NSCLC patients testing positive for the KRAS mutation and perhaps the EGFR wild-type suggests that combined treatment with erlotinib and ARQ 197 yields prolonged PFS and improvements in OS for this patient subpopulation.
For oncologists, the true power of biomarker screening is in determining better first-line therapy options for patients (i.e., bypassing standard chemotherapy) and moving straight to a targeted therapy. In addition, the role of biomarkers has strategic implications for pharmaceutical / biotechnology manufacturers and diagnostic testing companies, considering:
• What opportunities exist in bundling specific biomarker screening with selected drugs by tumor type?
• What types of strategic alliances could mutually benefit diagnostic companies and pharmaceutical / biotechnology manufacturers?
• How does biomarker testing present an opportunity in diversifying business lines (i.e., should Big Pharma increase activities to acquire diagnostic firms)?
Time and experience with more biomarker-driven clinical trials and clinical evidence showing improved patient outcomes in PFS and OS will be required to answer these questions.
According to ASCO.org, Daniel D. Von Hoff, M.D., said during his David A. Karnofsky Memorial Lecture, “The Last Twelve Weeks,” that the key is to look deep into the tumor genome in search of its Achilles’ heel, a mutation that defines a tumor’s vulnerability. “Rather than reach for the next agent to come along,” Dr. Von Hoff said, select one that is thought to have selectivity for the target based on the basis of either preclinical studies or activity in other cancers containing the same vulnerability. The result is an initial Phase I trial with one patient. “I believe that if we can work smarter, Phase I trials can be more therapeutic,” he said.
Dr. Von Hoff’s observations may provide a glimpse into how the pharmaceutical / biotech industry may decide to advance future drug discovery in not only cancer but also other diseases.
Healthcare reform: Practicing oncologists ask, who is going to protect us?
During the Q&,A portion of the healthcare reform special session, various oncologists representing state medical associations, group medical practices and solo private practitioners voiced concerns to J. James Rohack, M.D. (a session presenter and current president of the American Medical Association), that current healthcare reform does little to address physicians’ further loss of financial control to more powerful stakeholders (i.e., large hospitals and regional healthcare systems).
However, current practice economics and lack of negotiating power may require practicing oncologists to concede further control as reported by ASCO Daily News from the education session: “Clinical Practice: The Challenge of Financial Survival.”
For example, updated data presented from the National Practice Benchmark (NPB), a national survey of oncology practices, revealed that 2007 to 2008 practice revenue did not keep pace with total practice expenses (6% versus 16%).
Furthermore, Jeffrey Ward, M.D., of Puget Sound Cancer Centers and President of the Washington State Medical Oncology Society, discussed strategic moves in his state by oncology practices to merge with hospitals or regional healthcare groups and gain economies of scale and market share. “Basically, market share and market size are what matters,” he said. “You can provide the highest quality of care and make all the right business decisions, but if you are a nine-member group, you do not have enough market share to drive third-party payer contracts to a profitable position.”
These “market issues of practicing medicine” will lead to the increased proliferation of newly emerging oncology practice models ranging from disease-specific, multidisciplinary mega-groups to the implementation of evidenced-based practice guidelines or clinical pathways into practice. The changing market landscape will force oncologists to make these adjustments to economically survive.
Global considerations
If one phrase is required to define this year’s ASCO, it would be “the year of melanoma.” This has global implications for treatment, given the prevalence of this disease in various parts of the globe. Adding to the excitement were the long-awaited results of the humanized monoclonal antibody human Ipilimumab, which has fed stock exchange blogs and sites. It is a sign of the excitement this tumor type might eventually meet its demise.
We also noted with considerable interest the beneficial role of the bevacizumab in metastatic ovarian cancer. Considering therapeutic agents under development to treat relapsed metastatic ovarian cancer and continuing research, it becomes ever more apparent that bevacizumab plays a “reference role” in the management of patients with this tumor. Given that Avastin is increasingly accepted across the world, this might yield yet another confirmation of continued utilization and increase in business for the parent company.
"If one phrase is required to define this year’s ASCO, it would be 'the year of melanoma.'"
In the field of hematology, when chronic myelogenous leukemia (CML) becomes refractory to imatinib (Gleevec®), data demonstrates the value of the newer molecules dasatinib and nilotinib. This reflects the increasing number of options for patients and the dream that eventually cancer may be reduced to management of a chronic condition! This is further supported when one considers the potential use of lenalidomide in the maintenance treatment of multiple myeloma.
The challenge arising with all of these advances is the demand for increased healthcare coverage and the challenges posed to governments in their efforts to manage national healthcare costs. We face an exciting and challenging future.
What is the global impact of ASCO?
The value of ASCO resonates loudly around global oncology communities. Few congresses come close to matching its global legitimacy
We noted the substantial presence of mass and specialized media at ASCO. The French media alone was represented by 15-20 journalists covering this year’s event. Numerous articles, pre- and post-ASCO, and blogs have been noted, TV stations have picked up on news releases, and several articles have appeared in local newspapers.
At least 50% of the registered attendees are from overseas, demonstrating the respect and value of sharing oncology information. In addition to clinical discussions, the cross-fertilization and sharing of best practices drives global values in patient care, with positive impacts in treatment outcomes.
Oral sessions, posters and other discussions involve researchers and practitioners from around the world, highlighting the “global village” impact of ASCO.
What is the global economic impact of ASCO?
Publication of both promising and disappointing results of new or emerging products involves financial analyses of publicly traded companies with subsequent increases or decreases in market capitalization. This effect may be felt rapidly. An example is the impact of the positive announcements of Bristol-Myers Squibb’s (BMS) new melanoma product, Ipilimumab, is demonstrated below:
Bristol-Myers Squibb Company: Evolution of stock price during ASCO: +8%
An additional consideration is the potential impact of ASCO events on government healthcare plans and costs. As overall survival of cancer patients increases so do healthcare costs.
Strategic and competitive knowledge
Competitive intelligence is a common feature of large conferences such as ASCO, where there is an opportunity to learn the latest information pertaining to drug development and translate the knowledge into an understanding of the future pipelines and product positioning of competitors. Clinical presentations: oral, poster discussions, posters, handouts, satellite symposia and the Exhibit floor are fertile grounds for developing the following types of strategic knowledge:
• Changes to current standards of care
• Competitor activities and messaging
• New and emerging targets / compounds
• Third-party analyses and opinion
• Implications for the client
Kantar Health was one of the consulting groups assisting clients participating in this ritual at ASCO 2010. We accomplished what our clients needed to achieve from ASCO. Our reports and presentations will follow quickly after the close of the event.
In closing, it is worth mentioning the comments of a physician from a major oncology practice who attended the conference, he was asked why he attended and what benefit he received. His perspective was different from the above but not inconsistent with what would be expected.
For this doctor, the business meetings represented the greatest opportunity. He cited two examples: (1) one with representatives of a Chinese research oncology group and (2) another with key individuals from a large pharmaceutical company. For both meetings, he was most pleased with his learning and the significant degree of open discussion and the potential opportunities that may develop.
He added, “The attraction of ASCO remains the large diversity of registrants and the magnet effect where one can usually catch up with a number of key persons with relative ease.”
About the authors:
The authors are with the Commercial Development practice of Kantar Health, a leading healthcare-focused global consultancy and marketing insights company. Larry Rosenberg (larry.rosenberg@kantarhealth.com) is Vice President, Ian Hicks (ian.hicks@kantarhealth.com) is Senior Vice President, Anthony Faustino (anthony.faustino@kantarhealth.com) is Account Manager, and Thierry Devevey (thierry.devevey@kantarhealth.com) is Director, Europe.
What did you learn from ASCO 2010?
