Expert Point of View: Sumanta K. Pal, MD, and Richard L. Schilsky, MD


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This study harnesses a specific biologic marker in cancer patients and treats them accordingly using a ‘tumor-agnostic’ approach, so a patient with pancreatic cancer may get a breast cancer drug.
— Sumanta K. Pal, MD

“This study harnesses a specific biologic marker in cancer patients and treats them accordingly using a ‘tumor-agnostic’ approach, so a patient with pancreatic cancer may get a breast cancer drug,” said Sumanta K. Pal, MD, ASCO spokesperson. Dr. Pal moderated the press conference where these data were presented.

“This approach is being tested in different trials at academic and community-based sites. It is too early to draw any conclusions, but this looks particularly promising for colorectal, bladder, and biliary tumors that are HER2-amplified and for BRAF V600–mutated NSCLC cancer treated with vemurafenib [Zelboraf]. As these results emerge, we may shift our paradigm to treat based on these alterations,” Dr. Pal stated.

During the question-and-answer session, Dr. Hainsworth was asked whether even higher responses would be expected if patients with these genetic alterations were treated earlier in the course of their disease. “Yes, I would expect that. For example, HER2-positive patients with early breast cancer have higher response rates with HER2-directed therapy than those with metastatic disease. You could infer that the way we are using these drugs in this study is not the optimal use,” he admitted.

Not Yet Ready for Prime Time

Dr. Hainsworth does not think that treatment planning based solely on molecular tumor abnormalities is close to prime time. “My prediction is this will happen slowly. As more evidence accrues and more targets are identified for which we have drugs, this will become a bigger part of cancer treatment,” he said.

Richard L. Schilsky, MD

Richard L. Schilsky, MD

“We are learning as we go,” said Richard L. Schilsky, MD, ASCO’s Chief Medical Officer. “Context is important. Not all tumor types behave in the same way. We are seeing more examples where a biologic aberration that is targetable is responding to treatment. Many of these types of studies are ongoing, including MyPathway, the National Cancer Institute MATCH [Molecular Analysis for Therapy Choice] trial, and the ASCO TAPUR [Targeted Agent and Profiling Utilization Registry] trial, and we hope to learn more about these issues from these studies.” ■

Disclosure: Dr. Pal has received consulting fees from Pfizer, Novartis, Bristol-Myers Squibb, Exelixis, and Genentech. Dr. Schilsky reported no potential conflicts of interest.


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