2018 ASCO Insights

We are pleased to present the ASCO Insights series, highlighting key presentations at the 2018 ASCO Annual Meeting on precision therapy in the management of cancer. The theme at ASCO 2018 was “Delivering Discoveries: Expanding the Reach of Precision Medicine,” and the perspectives in the ASCO Insights series will focus on the most important presentations in precision medicine, especially as it relates to metastatic melanoma and lung cancer. In addition, our experts will provide their insight into best practices in the use of molecular biomarkers to provide personalized care for patients with cancer.
Dr Sanjiv Agarwala predicts that the cancer biomarkers of the future may be “mobile biomarkers,” meaning measures of the tumor microenvironment or immune response that change with therapy and may be able to determine treatment efficacy.
Dr Sanjiv Agarwala discusses the usefulness of MSI and TMB as novel biomarkers for various cancer types. His argument is that the first FDA approval of a therapy based on MSI rather than tumor type makes this biomarker useful, but TMB is not yet ready for “prime time.”
Dr Sanjiv Agarwala describes best practices developed at St. Luke’s Cancer Center, where a committee has been formed in which clinicians and pathologists meet to reach consensus on reflex testing of molecular biomarkers, as well as the value of biomarker testing in enhancing patient care.
Dr Sanjiv Agarwala argues that much of the biomarker data in melanoma presented at ASCO 2018 are around the value of PD-L1 testing; however, even PD-L1–negative melanoma patients seem to respond to anti–PD-1 therapy, although some studies suggest PD-L1–negative patients may be better candidates for combination immunotherapy.
Dr Sanjiv Agarwala reviews real-world data presented at ASCO 2018 on immunotherapy of melanoma that serve to reassure providers regarding current treatment approaches, but do not offer any significant practice-changing results.
Dr David Spigel discusses challenges and solutions to incorporating cancer biomarkers into patient care, including finding pathology resources to do the testing, issues around reimbursement, and educating colleagues on the value and operational aspects of biomarker testing in delivering personalized therapy to patients with cancer.
Dr Sanjiv Agarwala talks about exciting new results presented at ASCO 2018 in melanoma, including the durability of anti–PD-1 therapy in providing 40% overall survival at 5 years, updates on adjuvant therapy showing superiority of anti–PD-1 over anti–CTLA-4, and new results in combining immunotherapies.
Dr David Spigel talks about currently available and emerging biomarkers that predict the greatest sensitivity to immunotherapy, including his insight into PD-L1, MSI, and TMB.
Dr David Spigel discusses how medical oncologists and the rest of the cancer care team can best communicate with pathologists to help make informed treatment decisions for individual patients and set up new assays for emerging biomarkers as they are discovered.
Dr David Spigel reviews 3 of the most important, practice-changing topics at ASCO 2018: new therapies targeting RET in a number of tumor types, a prognostic biomarker assay to predict whether patients with breast cancer will need adjuvant hormonal therapy or chemotherapy, and the minimum level of PD-L1 positivity required to predict outcomes with immunotherapy in lung cancer.
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