Dr. Gilberto Lopes Highlights Key Presentations from ASCO Breakthrough

10/23/19 • 9 min

ASCO Daily News: Welcome to the ASCO Daily News Podcast. I'm Lauren Davis. And joining me today is Dr. Gilberto Lopes, a medical oncologist and Medical Director for International Programs. He's also the Associate Director for Global Oncology at the Sylvester Comprehensive Cancer Center. And he's an Associate Professor of Clinical Medicine at the University of Miami.

Dr. Lopes has also served as co-chair of the organizing committee for ASCO Breakthrough, an event that brought together innovators in evolving science, technology, and research. Dr. Lopes, welcome to the podcast.

Dr. Gilberto Lopes: Thank you, Lauren. It's a pleasure to be here. And it's a pleasure to discuss all the findings that we had in Bangkok last week.

ASCO Daily News: We're glad you're here. Overall, how was the inaugural ASCO Breakthrough meeting?

Dr. Gilberto Lopes: It went as well as we could have expected. We had a wonderful meeting. And our co-hosts at Thai Society of Clinical Oncology did a superb job of making sure that everything worked on the ground. And all of our presenters, moderators, and panelists did a superb job about bringing to the fore things that will be in the reality of oncology in the next few years.

ASCO Daily News: So specifically drilling down into sessions, what did you find during ASCO Breakthrough that was really compelling?

Dr. Gilberto Lopes: Lauren, in reality, every section was really compelling, starting with the opening session by Dr. Steven Yang from WuXi AppTec. He actually kind of painted the general picture of what we wanted to discuss in the meeting. He talked about all of the innovations that we have already seen in cancer diagnosis and treatment over the last couple decades, with some emphasis on the beginnings of immunotherapy, kinase inhibitor, and target agents, but specifically talking about what we're going to see in the next five to 10 years, and what are the technologies that will help us truly have new breakthroughs in the management of cancer so that we can improve outcomes for our patients in years to come.

He very specifically emphasized the number of cancer drug targets that we have now in 2019 compared to just two years ago, 2017. While we had 263 targets in the pipeline two years ago, this year, we have 468 targets in the pipeline. So that's a number that is mind-boggling and shows us how fast the field of cancer drug development is actually moving forward.

And in terms of the numbers of immunotherapy trials, since 2014, the number has actually skyrocketed as well. In 2014, we had barely a little bit more than 200 trials with immunotherapy agents.

And in 2018, we had more than 800. So it's amazing to see how the volume of new trials and new discoveries seem to be accelerating as we move forward.

Beyond his general session and general discussion, he also mentioned the technologies that are likely to help us move forward, including artificial intelligence, the use of telemedicine, use of new preclinical models to develop new cancer drugs. And he didn't forget to mention one of the main issues that we have moving forward, which is how sustainable we can actually be in our health care systems, as the cost of these medications can now easily reach $500,000 to $1 million per patient.

Dr. Gilberto Lopes: So these are all issues that were truly discussed at length in most of our subsequent sessions from the opening. And that opening talk pretty much gave us a very good start to see what we would expect. We had sessions that were discussions. And these were TED-like talks in which presenters would show us what they're working on and discuss and review aspects of technology and innovation that are coming into oncology, including artificial intelligence and telemedicine, social media.
And we also had abstract sessions as well. And there's variety and always done in a way that the audience could have discussions-- this was a very open talk-type meeting, which is quite different than what we're used to seeing at the annual meeting. So we had enough time for the discussions to be quite deep and broad in each of these subjects.

So in general, as an example, most sessions get about 30 to 45 minutes in discussions and 30 to 45 minutes in open questions and participation from the audience as well. So this was a very, very interactive meeting. And we hope that that's going to be reflected in future ASCO meetings as well.

ASCO Daily News: That's great. It sounds like this new format's really working. Did you hear any practice-changing results from the studies?

Dr. Gilberto Lopes: We had a few abstracts that are actually hopefully going to be practice-changing in the next couple years-- nothing that truly changes the way we practice today. But again, this is a meeting for innovations that are on the horizon, not really for innovations that we can apply in clinic on Monday after the meeting end...

Dr. Gilberto Lopes: Thank you, Lauren. It's a pleasure to be here. And it's a pleasure to discuss all the findings that we had in Bangkok last week.

ASCO Daily News: We're glad you're here. Overall, how was the inaugural ASCO Breakthrough meeting?

ASCO Daily News: So specifically drilling down into sessions, what did you find during ASCO Breakthrough that was really compelling?

And in terms of the numbers of immunotherapy trials, since 2014, the number has actually skyrocketed as well. In 2014, we had barely a little bit more than 200 trials with immunotherapy agents.

And in 2018, we had more than 800. So it's amazing to see how the volume of new trials and new discoveries seem to be accelerating as we move forward.

ASCO Daily News: That's great. It sounds like this new format's really working. Did you hear any practice-changing results from the studies?

Previous Episode

Challenges and Solutions to Establishing a Mutually Respectful Workplace

Welcome to the ASCO Daily News podcast. I'm Lauren Davis, and joining me today is Dr. Charles R. Thomas, Jr., Chair of the Department of Radiation Medicine at Oregon Health and Science University, who served as chair of the very important education session at the annual meeting this year. It's titled, Establishing a Mutually Respectful Workplace.

Also joining me today is Dr. Colin Weekes, a GI medical oncologist at Massachusetts General Hospital, who co-wrote an educational book article related to topics around interactions in the workplace that leave lasting effects. Dr. Weekes also presented his personal stories about being discriminated against by patients based on his race during the session.

The session also included stories about inappropriate comments made by a colleague about a person's ethnicity, gender, and sexual identity, and also some solutions to how to counter them.

Sometimes people make these comments, and they think they're perceived as jokes by the person saying them. But they are not, and they have long-lasting, negative consequences, and they can impact morale. With that being said-- Dr. Thomas, Dr. Weekes, welcome to the podcast.

Thank you for having me.

Yeah, this is great. Thank you.

Dr. Weekes, as education program chair, what were some of your hopes for the outcomes following the presentation? Do you think it led to meaningful discussion about how people treat each other at medical institutions?

Yeah, so I think for me the real goal of this session was to just, I think, initiate conversation and to provide a platform in which individuals of different backgrounds and perspectives in the workplace can have an open and honest conversation about how to address some of these issues-- and I think simultaneously provide tools, as Dr. Thomas said, to go beyond just a conversation, but implementation of problematic processes to try to address this topic.

Since the annual meeting, I have gotten feedback from members of my own institution about how much they enjoyed watching the session online and how impactful it was. And I've also received similar types of feedback from individuals from across the country.

So I think at the end of the day, it served a nice purpose to once again initiate this conversation and to be thoughtful about how we as practitioners in our work lives can help one another to make everyone's experience better.

So we're hearing a lot about microaggressions. But how do you define that? And how should someone handle these types of comments?

Basically, microaggressions represent verbal, behavioral, and/or environmental indignities that really can communicate hostile, derogatory, and really negative slights that insult a target person, or really a group. These type of messages can result in either individual or group marginalization and, in some respects, isolation. And at the end of the day, cumulative microaggressions can impact the quality of care given to patients.

And it really goes back to probably the first thing you asked at the beginning of this podcast-- why do this? Ultimately, we want optimal patient care to be delivered to our oncology patients. Suboptimal behavior, which includes microaggressions, can take away from delivering high quality care. So at the end of the day, it's about the patient.

Absolutely. Civility and respect in the workplace has made some inroads, but it seems like there's a long way to go. Your educational book article, Dr. Weekes, talks about uncivility. Can you explain what that is? And also, what is cultural humility, and how does one work towards that?

So uncivility is really the action of being discourteous or impolite, so treating others with malcontent. And this can be done in a lot of different ways. And it can be sort of a disrespectful gesture. It can be jokes, as we hear every now and then. And so there's lots of ways this can happen. And even sometimes, it also could be a form of incivility when you see someone being mistreated and you remain silent.

So I think that's the framework to think about civility and respect within the workplace. It's really, how would you like to be treated, and being respectful of others, regardless of what their station in the practice or the setting in which you're working is.

And I think the goal of that then, at the end of the day, is if we're treating others with respect for manners, I think, as Dr. Thomas said, the patient experience, the patient outcomes are all better, because people are interacting with each other from a positive standpoint.

I'd like to add to Dr. Weekes' comment. This may involve we practitioners having some intentionality, meaning being somewhat conscious that behavior is suboptimal. Let me give you a specific example. We have two new women faculty here in the Department of Radiation Medicine at OHSU, who started this academic year. One of the things t...

Next Episode

Dr. Andrew S. Epstein Highlights Key Sessions from the 2019 Supportive Care Symposium

ASCO Daily News: Welcome to the ASCO Daily News Podcast. I'm Lauren Davis and joining me today is Dr. Andrew Epstein of Memorial Sloan Kettering Cancer Center. Dr. Epstein served as the program committee chair for the recent Supportive Care in Cancer Symposium. Dr. Epstein, welcome to the podcast.

Dr. Andrew Epstein: Thanks for having me.

ASCO Daily News: So the final Supportive Care Symposium has concluded. How has this meeting impacted oncology care as a whole?

Dr. Andrew Epstein: It's been a really nice opportunity to answer that question. Looking back at the five years that we've had the Supportive Care Symposium has put it into context that we've really grown as a field. Supportive oncology has been one of collaboration, teamwork, and research between oncologists, palliative care clinicians, and researchers, and many others.

Dr. Andrew Epstein: And I think one main takeaway is that all the stakeholders involved-- patients, families, clinicians, researchers-- have collaborated and really worked as teams in order to research and improve better outcomes for patients and families living with serious illness. And I think over the last five years, we've really arrived at a much better understanding as a field, and even as a broader community, that palliative care is something that can and should be used early and often. And it really cements the synergy between oncology and palliative care as something that can improve outcomes for patients with cancer and their families, and not mutually exclusive from one another as was once often thought.

ASCO Daily News: Absolutely. Were there any sessions that were of key interest to you?

Dr. Andrew Epstein: There were. I am biased, of course, as having been the program committee chair, but I really think that the audience came away with a lot of education into the state-of-the-art practice and research in the field. And I'd like to discuss several sessions if time permits.

Dr. Andrew Epstein: Perhaps one of the most interesting ones, the session on CAR T-cell therapy, which was called "Driving Palliative Care Forward Into the Era of CAR T." And it was a good example because it's one of the many, if not the flagship, emerging novel therapeutic we have in oncology highlighting the need for sufficient knowledge of such a novel therapeutic and a way for not only oncologists, but palliative care clinicians to understand novel therapeutics and the way that patients and families are going to experience cancer and cancer treatments.

Dr. Andrew Epstein: And so there were a wonderful handful of people on the panel and presentations given. And Dr. Jagannath from Mount Sinai Hospital in New York City gave a very nice overview of the therapeutic, as well as toxicity landscape from CAR T-cells. And we see that toxicities remain a large issue and challenge for clinicians, and patients, and family. Among others, fever, as well as neurotoxicity often related from the cytokine release that occurs after the initiation of the therapy presents a major therapeutic challenge for all involved.

Dr. Andrew Epstein: And so there was ample discussion and review of how steroids may be used, but can also unfortunately downregulate the therapeutic effect of the CAR T-cell therapy. So of the several issues moving forward in this field, one of them is if it's possible to give medication such as steroids before CAR T-cell therapy in order to mitigate the side effects.

Dr. Andrew Epstein: And there was a really excellent presentation that followed by Dr. Areej El-Jawahri from the Massachusetts General Hospital about how we navigate prognostic uncertainty with novel cellular therapeutics, such as CAR T-cells. And it was built upon the foundation, which I and many people are fascinated by, that prognostic awareness is a crucial and yet really tricky thing in oncology for patients, and families, and clinicians. Specifically, we know that prognostic awareness helps patients and their families decide how they want to spend time and time that is often limited for patients with cancer.

Dr. Andrew Epstein: And the challenge is how we cultivate prognostic awareness in many settings of oncology, particularly this one where someone with a serious and often rapidly progressing advanced hematologic malignancy might want to spend their time and how we, as clinicians, can cultivate adequate prognostic awareness during that time.

Dr. Andrew Epstein: And making matters even more complicated is that CAR T-cell therapy is a treatment for which there are strict entry criteria and there's a somewhat binary nature, as Dr. El-Jawahri commented on, of the treatment of CAR T-cells. It's often a last-line therapy. And in a very rapid clinical-paced setting, as she calls it, we're in a race against time often. And so there's a binary nature to this pretty complex rapid course of the treatment either working or not working. And the fact tha...