Late October saw the annual gathering of oncologists and industry in Madrid for ESMO 2023, bringing with it a wave of new clinical results across cancers and a fresh round of questions concerning pricing, access and reimbursement.
What are the key clinical takeaways raised by physicians?
Identifying the right patient
- Advances in mapping cancer genomes and identifying druggable targets are continuing to open the door to personalized medicine.
- Nowhere perhaps provides a better example of the proliferation of biomarker-targeted drugs than NSCLC, where physicians are now targeting mutations that are specific to a patient’s cancer.
- However, several of the current “sub-groups” identified in cancers, such as pMMR in gynecological cancers, are still seen as too broad and heterogeneous.
- Clearly, many more targets need to be identified and – importantly – routinely screened for, to further identify and characterize patients.
Using the right drugs
- Importantly, just as ESMO 2023 highlighted, drugs that were suited well to the cancer they were targeting, such as several combinations in bladder cancer, it also provided data on drugs that perhaps were not performing as strongly as hoped, such as in the area of renal cell carcinoma (RCC).
- Although physicians and patients value efficacy and prolongation of life, much discussion was had on preserving a patient’s quality of life and a thorough examination of the side-effect profile of drugs, particularly combinations.
- With more suitable drug options in each line of treatment, consultation with patients and the element of choice is likely to increase, which could lead to “softer” regimens being selected ahead of more toxic treatment options, even if the efficacy benefit is not as strong.
- Adverse events, such as fatigue and peripheral neuropathy, which are perhaps not regarded as seriously as events like neutropenia, sepsis, or diarrhea by some observers, are likely to play a much bigger role when patients are brought in as decision makers on the caliber of life they wish to live.
Intervening at the right time
- Cancer therapies are now firmly breaking out of the metastatic disease mold, expanding into earlier stages of disease.
- Numerous sessions at ESMO 2023 were dedicated to the use of targeted treatments, chemotherapies and combinations in neoadjuvant and adjuvant settings across tumor types.
- Although debate continues on whether a particular drug should be “reserved” for later line use, to provide a patient with treatment options, many physicians expressed their desire to use the most effective treatments as early as possible whilst the patient is healthiest.
- On the topic of “rechallenging” a patient with the same drug in a later stage of disease, many physicians expressed their willingness to use this approach, providing a period of 6-12 months has passed before reusing a drug.