Breast Cancer Symposium

BCS 2013 Daily News Sunday

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S U N D AY, S E P T E M B E R 8 , 2 0 1 3 | I S S U E 2 | S A N F R A N C I S C O , C A Optimizing the Treatment of Breast Cancer: 2013 Gianni Bonadonna Award Bestowed on Dr. Larry Norton INSIDE THIS ISSUE ASCO Adopts Wiki Technology for Guideline Dissemination, Process Improvement 2 ASTRO's 55th Annual Meeting Focuses on Patients, Quality Care 3 Audience Response System–Enabled Session 4 Expert Editorial: The Susan G. Komen® Tissue Bank at the IU Simon Cancer Center 5 ASTRO Public Awareness Campaign Includes Award-Winning Patient Brochures, Video 5 In Memoriam: ASCO Remembers Former President Emil "Tom" Frei III, MD 6 From Where I Sit: A Medical Oncologist's Perspective 6 New Resources about Fertility Preservation 7 Drs. Moo, Manjoros, Wehner Receive 2013 ASBrS Scientific Session Awards 7 Dr. Peter Beitsch Elected as President of the American Society of Breast Surgeons 8 Latest ASCO-SEP® Edition Features All-New Self-Assessment Questions, Digital Offerings 8 Plans Underway, Call for Abstracts Open for 2014 ASBrS Annual Meeting 9 Dr. Saima Hassan Receives First YIA in Memory of Evelyn H. Lauder 9 Continuing Education with ASCO University® Courses focusing on Breast Cancer 9 The Conquer Cancer Foundation of ASCO Announces the 2013 Merit Award Winners 10 ASBrS Members Earn CME through Society's Mastery of Breast Surgery Program 10 cancer therapy for many decades. Some of the ideas that have been influenced by this work include giving treatments often, rather than infrequently, at Dr. Larry Norton high-dose levels; the sequential use of combinations and single agents, when appropriate; simultaneous rather than sequential use of combinations of chemotherapy with molecularly targeted therapies; and the use of drugs and intermittent scheduling to overcome feedback mechanisms of resistance. For these among other contributions, Dr. Norton has been named the recipient of the 2013 Gianni Bonadonna Breast Cancer Award and Lecture. His lecture, titled "The Co-Evolution of Clinical and Basic Science in Oncology," will be presented today, 10:00 AM-10:45 AM (PDT). The award, first presented in 2007, recognizes an active clinical and/or translational researcher with a distinguished record of accomplishments in advancing the field of breast cancer. The Concepts of Dose Density and Self-Seeding As a clinical oncologist, Dr. Norton has spent his career exploring why some patients are helped enormously by drug therapy while others have not benefitted from such treatments. His goal has always been to maximize the benefits of treatment while minimizing toxicities, which seemed to him early in his career to be an engineering problem. He recognized that engineering requires a mathematical understanding of a process, which in this case is tumor growth. During the 1970s in collaboration with Richard Simon, Sc.D., at the National Cancer Institute, Dr. Norton used experimen- tal data to formulate the Norton-Simon Hypothesis, which states that the rate at which a cancer shrinks in response to therapy is proportional to its growth rate: faster growth means faster shrinkage, and slower growth means slower shrinkage. Since the growth rates of cancers vary depending on their size, this led directly to the concept that effective doses of drugs need to be given often— "dose density"—which conflicted at that time with the idea that giving very high doses was most important. "A problem that needs to be solved has to do with regrowth of the tumor between cycles of treatment. If you can treat more often with a good dose, you would do better than if you took that same dose or even a higher dose and used it less often," Dr. Norton explained in an interview with ASCO Daily News. "Another big problem with eradicating cancer is that you have to treat more aggressively when the tumor is below the See Dr. Norton, Page 2 Recommendations for Evaluating Clinical Validity and Clinical Utility of Molecular Diagnostic Tests Gary H. Lyman, MD, MPH, FASCO, FRCP (Edin) Expert Editorial T here are several molecular assays available in clinical oncology practice that are used for either prognostic classification of patients or the selection of targeted therapeutic interventions. Despite the understandable excitement around these assays and potential therapies, a universally agreed upon approach to defining their clinical validity and utility in actual practice has been lacking. Although defining the analytic validity of a molecular diagnostic test to determine that it yields consistent results is often established, demonstration that the test accurately predicts outcome or discriminates patients with different outcomes (clinical validity), or that the test leads to improved patient outcomes (clinical utility) is often unclear. Fig. The ACCE Evaluation Process for Genetic Testing11 ICAL UTILIT Y CLIN Effective Quality Intervention (Benefit) Establishing Clinical Validity and Utility Natural History Assurance CAL VALIDIT INI Y Clinical CL Pilot Trials Sensitivity Work from the EvaluaPrevalence Clinical tion of Genomic ApplicaSpecificity PPV NPV tions in Practice and PreEthical, Legal, & DISORDER Health vention Working Group Social Implications & Risks Penetrance (safeguards & impediments) SETTING has been foundational in Analytic Assay defining many of the imSensitivity Robustness Analytic Quality portant methodologic isA N Specificity Control Economic Monitoring T sues and how they can be AL Evaluation & Evaluation Y T I C VA L I D I implemented (see Fig.).1,2 Initially convened by the Education Facilities National Cancer Institute (NCI) and the European Organisation for Research and Treatment of Cancer, an international committee previously See Evaluating Clinical Validity and Utility, Page 4 Y T here is a theme running through the work of Larry Norton, MD, of Memorial Sloan-Kettering Cancer Center: quantitative, mathematical approaches to studying cancer. His goal is to better understand the growth patterns of these diseases and thereby plan optimal treatment with established and novel drugs, focusing on breast cancer. This approach has led Dr. Norton and his collaborators to broadly influence TARG E T I NG C A NC E R C A RE

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