This transcript has been edited for clarity.
I am Mark Lewis, director of gastrointestinal oncology at Intermountain Healthcare. Welcome to Medscape Oncology Insights. I'm speaking from the 2023 ASCO Gastrointestinal Cancers Symposium in San Francisco, where we've seen some exciting developments in GI oncology. I'd like to tell you about a few of the themes that I discerned at this conference.
The first one is the importance of biomarker-driven care and the fact that we have an important dyad in oncology: our partnership with our pathologists. If I am going to take one thing home from this conference, it's that I really need to fortify my relationship with my pathologist to have a biomarker-informed approach to care. We saw several examples of that at this meeting.
The one that really jumps out to me is a relatively novel biomarker, Claudin 18.2 expression, in upper GI malignancy. This was a crucial marker and one that's quite elegant in its expression. This is a marker that normally lives in the tight junctions between cells of the stomach lining. The tumors that arise in the stomach disrupt that tight junction, and then those proteins are visible on the surface and targetable with an antibody like zolbetuximab.
We saw the same importance of biomarker testing in colorectal cancer regarding HER2 expression. Again, you can argue that the HER2-positive colorectal cancers are a minority, and that is true, but it's a small fraction of a large number, and we're only going to find what we look for. I think the approval of the combination of tucatinib and trastuzumab in HER2-positive colorectal cancer is an important call for biomarker testing in that disease as well.
For years, of course, we've known it's important to determine MSI [microsatellite instability]-high status in a host of solid tumors. At this meeting, we also found out that there's hope for the MSS [microsatellite-stable] colorectal cancers as well. We saw that the novel combination of an anti-CTLA-4/anti-PD-1 can actually render these cold tumors hot. Botensilimab may have a relatively new way of stimulating immunotherapy candidacy, even in the MSS population.
We saw an interesting focus on quality of life. Sometimes I come away from these meetings and I wonder if the endpoints that we discuss are germane to the patients under our care. If we really step back and ask them what matters to them, they'll tell us overall survival and quality of life. I applaud ASCO for putting a spotlight on symptom management and pain control at this meeting.
We saw new roles for palliative radiation to the celiac plexus for pancreatic ductal adenocarcinoma and also to the liver for patients who are suffering from capsular stretch. Again, I think it is so refreshing to see an organization of ASCO's stature really turn the spotlight on quality-of-life issues. They really, really matter to our patients.
I also particularly like the fact that these are noninvasive approaches. Normally, when I think about celiac plexus blockade, I'm asking either an interventional radiologist or a complex endoscopist to intervene in a manner that is necessarily invasive. Having a noninvasive approach with radiation, in terms of global equity, is more accessible everywhere and is really a step in the right direction.
Finally, leaving a conference like this, I'm often feeling like we're walking a tightrope between hope and hype. We don't want to overpromise and underdeliver to our patients. It's important to acknowledge when major trials actually have negative findings.
To me, the most obvious example at this conference was SWOG 1815, the long-maturing SWOG trial looking at biliary tract cancer to see if the addition of nab-paclitaxel to the traditional backbone of gemcitabine/cisplatin improves survival. Soberingly, it did not. Dr Shroff spoke very movingly about her decade-long investigation, hoping that the triplet would advance survival over the doublet. It didn't, and she was very candid about that.
In the subset analysis, we saw that gallbladder primaries may benefit more than other biliary tract primary sites. We also saw that it might induce a higher response rate in patients who are on the verge of visceral crisis. As ever, I think it's important that we acknowledge these negative studies as cul de sacs. They don't entirely knock us off course, but they tell us that we should be heading in a slightly different direction.
As we leave this conference, again, I'm filled with a new, measured optimism. For years, our field has been weighed down with a sense of therapeutic nihilism. I leave this conference feeling hopeful, going back to clinic and really feeling quite confident that I can offer new, better ways to manage my patients' pain, their symptoms, and try to give them longer, better lives.
Thank you for joining me. This is Mark Lewis for Medscape.
Mark A. Lewis, MD, is director of gastrointestinal oncology at Intermountain Healthcare in Salt Lake City, Utah. He has an interest in neuroendocrine tumors, hereditary cancer syndromes, and patient-physician communication.
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Cite this: 2023 ASCO GI Symposium: New, Measured Optimism - Medscape - Mar 06, 2023.
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