Oncologists who attended this year’s ASCO annual meeting (held virtually June 4-8 2021) indicated that the data presented at the conference was strong and represented meaningful clinical progress.
Nearly half of oncologists who attended indicate that ASCO21 provided major progress in the field of oncology, a sentiment comparable to the two prior ASCO annual meetings.
Source: ZoomRx survey with n=80 U.S. oncologists who attended ASCO's 2021 annual meeting, survey conducted June 18-28, 2021
The “Equity: Every Patient. Every Day. Everywhere,” theme resonated with physicians.
Ensuring equity in access to quality care, testing, and clinical trials in oncology, articulated through ASCO21’s official theme “Equity: Every Patient. Every Day. Everywhere,” resonated with many oncologists who see this as a high priority that needs to be addressed. About half of oncologists who attended the conference believe that it’s as important as scientific progress in oncology.
“We have made some advancements in cancer care in recent years. We should be working to make these advancements available to all.”
“No one should be disadvantaged in their fight against cancer because of how much money they make, the color of the skin, their gender identity.”
“I think that advances in cancer treatment are less meaningful, if a large segment of society is not able to receive those treatments.”
Among clinical topics, new data in early settings and continued development of immunotherapies stood out to oncologists as areas that can change their practice in the immediate future.
Adjuvant (and neoadjuvant) settings were an area of focus as a great deal of progress in earlier stages captured attendees’ attention and provided hope for more curative treatments.
Immunotherapy, and specifically PD-1/PD-L1s, continued to dominate even with new targeted treatments and new immunotherapy pathways featured during the annual meeting. Several years after their introduction, PD-1/PD-L1 still captured attention with longer-term data on overall survival benefits, completely new indications, new combinations, and new PD-L1 entrants.
Advancements in the adjuvant settings were seen as offering immediate practice changing impact.
Several high profile studies showcased data on the benefits of adjuvant therapy, including olaparib’s OlympiA trial in BRCAm HER2- early breast cancer patients, pembrolizumab’s KEYNOTE-564 in RCC, and atezolizumab’s IMpower010 in (PD-L1+) NSCLC among others.
These data were met with high levels of excitement with 65% of oncologists reporting that they believe adjuvant treatments have the potential to deliver cures for patients rather than just delaying ultimate disease progression.
Traditionally, overall survival (OS) has been the gold standard for changing practice and adopting new therapies in early and advanced settings. However, as new data emerge with compelling disease free survival (DFS) benefits, this gold standard may well be shifting, underscored by last year’s high-profile approval of osimertinib in EGFRm NSCLC adjuvant settings based on its impressive DFS benefit. Nearly half of oncologists now believe that DFS is sufficient for adoption of new treatments in adjuvant settings, compared with about a quarter of oncologists who would require an OS benefit in order to adopt.
Despite some differences of opinion, a large majority of oncologists plan to start using the new adjuvant treatments in their practices.
PD-1/PD-L1s continue to deliver and are seen by many oncologists as the most important class of therapies.
The vast majority (89%) of oncologists see this class as one that will continue to change clinical practice, and 50% of oncologists view it as the single most important class of therapies. Other classes of therapies mentioned as important included CAR-T cells, KRAS inhibitors, TKIs, and ADCs.
Data on new indications showed the continued relevance of the class. Among the new indications and combinations that captured attention in metastatic settings were key data for PD-1/PD-L1s including:
- Nivolumab (NIVO) plus ipilimumab (IPI) or NIVO plus chemotherapy (chemo) versus chemo as first-line (1L) treatment for advanced esophageal squamous cell carcinoma (ESCC): First results of the CheckMate 648 study
- Pembrolizumab plus trastuzumab and chemotherapy for HER2+ metastatic gastric or gastroesophageal junction (G/GEJ) cancer: Initial findings of the global phase 3 KEYNOTE-811 study
- Relatlimab (RELA) plus nivolumab (NIVO) versus NIVO in first-line advanced melanoma: Primary phase III results from RELATIVITY-047 (CA224-047)
There is a good amount of enthusiasm indicating these data may prove practice changing for some in the immediate term, with an additional half of oncologists hoping to see more data (and perhaps FDA approval) in order to change their practices.
Updates on long-term survival data provided further confidence in the PD-L1/PD-1 class.
Updated long-term survival data was presented for several PD-1/PD-L1s, including:
- Five-year survival outcomes with durvalumab after chemoradiotherapy in unresectable stage III NSCLC: An update from the PACIFIC trial
- Pembrolizumab (pembro) versus investigator's choice of paclitaxel, docetaxel, or vinflunine in recurrent, advanced urothelial cancer (UC): 5-year follow-up from the phase 3 KEYNOTE-045 trial
- Nivolumab (NIVO) plus ipilimumab (IPI) versus chemotherapy (chemo) as first-line (1L) treatment for advanced non-small cell lung cancer (NSCLC): 4-year update from CheckMate 227
Nearly all oncologists had a positive impression of the long-term survival data. About half said they provide further confidence in PD-1/PD-L1s as a class, whereas about 40% said their opinions did not shift since they already had a high opinion of this class of therapies.
“I don't think it's changed my confidence or opinion of these agents as I know they have significant potential and we are using them extensively already.”
“I already had confidence in these medications.”
“My confidence has grown because the data shows improved outcomes with the addition of these drugs.”
“It has definitely increased my interest in using IO in early stage disease.”
Despite the excitement generated by continued clinical progress, engagement with the conference generally was somewhat depressed.
ASCO’s 2021 Annual Meeting saw somewhat lower attendance this year when compared to 2020 (32.5k vs. 42k), as oncologists became more selective about their engagement with virtual conferences.
Despite the ease of access to presentations and convenience of participating from home, ASCO21 demonstrated the challenges associated with generating interest and participation in a virtual environment. It has proven difficult for physicians to fully engage with a meeting when they are trying to fit conference ‘attendance’ into their already busy professional schedules and personal lives (as opposed to taking the dedicated time off for an in-person conference).
Even as ASCO and other major medical conferences appear committed to retaining the positive aspects of the virtual conference format (notably increased ease in access to presentations), including in-person components will be necessary to get back to previous levels of engagement and community building.
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