In this Q&A, Matt Zibelman, MD, a fellow at Fox Chase Cancer Center in Philadelphia, discusses research presented during the plenary session at the 2014 American Society of Clinical Oncology Annual Meeting.
What was the most significant research presented at the ASCO plenary session, from your perspective?
The presentation I found most interesting was the ECOG prostate trial (abstract #LBA2), presented by Dr. Christopher Sweeney of the Dana-Farber Cancer Institute. It was a phase 3 study looking at patients with metastatic castrate-sensitive prostate cancer who had not been previously treated, and who were randomized to treatment with androgen deprivation therapy (ADT) or ADT plus chemotherapy with docetaxel. What is interesting is that a lot of recent studies have been about pushing chemotherapy further back in the disease process, but this study kind of flipped that idea on its head—giving chemotherapy up-front and whether there was a benefit to that.
In this study, they randomized patients early, and I think what was also interesting was that the investigators stratified patients with low-volume and high-volume disease. What this study ultimately showed was that there was an overall survival benefit in all patients, but it seemed to be driven mostly by the patients with high-volume disease, and so there was certainly a suggestion that giving these patients docetaxel early will have a real survival benefit.
I do think that the definition of high-volume disease is going to have to be more strictly defined—this is a topic that was brought up by the discussant after the abstract presentation—in order to select those patients that will benefit most from chemotherapy. This certainly has a lot of implications and will change practice patterns for a lot of physicians.
Was there any other research presented that you thought was particularly significant?
I thought that the first abstract (abstract #LBA1) presented was also an important study. It compared ovarian suppression with an aromatase inhibitor (AI) versus ovarian suppression with tamoxifen in premenopausal women with early-stage breast cancer.
The investigators looked at a combination of results between two trials—SOFT and TEXT—and there did seem to be a slight benefit to ovarian suppression with AIs. There was also a tamoxifen-only arm included in this study; however, that data was not presented at this meeting.
I think this study shows that this is at least an option going forward for premenopausal women who, for one reason or another, may benefit more from AIs over tamoxifen—patients with prior deep-vein thrombosis or venous thromboembolism, for example.
It will be interesting to see the results from the tamoxifen-only arm, since in the United States, that is what we would give most often to premenopausal, early-stage breast cancer patients (without ovarian suppression). The results from that arm will add some information, but now this leaves open the potential for using AIs safely in premenopausal women.
What was your overall feeling and experience at ASCO?
This is my second ASCO meeting. It is overwhelming in many ways, and it can be difficult to figure out how to structure your days most efficiently! But it’s a very exciting event—there’s always a lot of interesting things going on. I do think it is a great experience for young physicians so they can get exposed to everything going on in oncology.
Matt Zibelman, MD, is a fellow at Fox Chase Cancer Center in Philadelphia, PA.