Harold Burstein, MD, PhD shares key highlights of research advances from the American Society of Clinical Oncology annual conference #ASCO22 .
I'm Dr. Harold Burstein from Dana Farber Cancer Institute and I'm glad to be sharing with you some of the important concepts that I think we saw emerge at Asco 2022, which are going to change the direction of oncology care in the future. First let's talk about the very exciting report for the use of Starla Mob, a checkpoint inhibitor in the treatment of patients who had rectal cancer with mismatch repair mutations. Now this is only a small subset of all colorectal cancers. It's about five or 8% of such tumors. But in those tumors that had mismatch repair deficiencies, they were able to use single agent of Starla Mab. And 12 out of 12 of the patients treated achieved a complete clinical response, suggesting that in the future this may be a standard part of our treatment program and that we can finally start to move away from chemotherapy in the routine management of upfront treatment of rectal cancer. Interestingly, the investigators are following these patients without surgery or radiation treatment. So it's just drug therapy alone, which again, would be a remarkable accomplishment, especially if we can get away from the debilitating rectal surgery that usually associates with diagnosis of rectal cancer in that same space of colorectal cancer. There was another important study also co published in the new England Journal of Medicine, which looked at using cell free or circulating tumor DNA to guide adjuvant treatment for stage two colon cancer. So stage two colon cancer is an area where there's been a lot of controversy over the years as to whether or not adjuvant chemotherapy is helpful in this study. Investigators use cell free DNA to stratify patients into what kind of treatment they would need. There was a randomization to standard approach or to sell free D. N. A guided approach. If their cell free DNA was tested and it was absent, then no chemotherapy was offered. What they found is that the results were exactly the same for all these groups. But if you use the cell free DNA to test you are able to spare the majority of patients unnecessary adjuvant chemotherapy. Again, an exciting new molecular diagnostic tool that's going to point the way for how we think about treating patients with Stage two colon cancer and presumably more and more tumors like it in the future. Finally, a study co published in the Journal of Clinical Oncology from our own breast cancer group, where they again looked at Cell free DNA in women who were five years out from diagnosis of breast cancer. What they found is about 10% of those patients actually had detectable circulating tumor DNA, suggesting the presence persistently. Now, at five years after treatment of occult locations of metastatic breast cancer, 75% of the women who had this finding eventually rickard and the DNA analysis allowed them to find the recurrence on average, a year earlier than clinical investigation would have otherwise shown. Meanwhile the women without the cell free DNA had a very low risk of recurrence after five years. So this too suggests a very powerful way for us to begin to think about risk stratification for a very common problem early stage breast cancer. Now five years out to both provide reassurance to many women and perhaps to start earlier interventions for women at higher risk of eventually developing clinical recurrence to guide their therapy better. I think both of these studies the use of the selective immunotherapy and a small but well defined cohort and the growing use of cell free DNA is a molecular diagnostic tool point the kinds of directions that investigators at Dana Farber and around the world are moving in the next wave of cancer care. Mm
