Gastrointestinal Cancers Symposium

GI 2017 Daily News - Saturday

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Global Curriculum for Surgical Oncology 5 Making the Science of GI Cancers Accessible to Patients 6 Is Your Practice Prepared for MACRA? 6 Dr. Christopher Lieu Takes on RAS-Mutant Colorectal Cancer 12 My Meeting Experience: A Medical Oncologist's Perspective 12 Management of Obesity 16 Big Data Comes to Radiation Oncology Research 17 Symposium Essentials 17, 18, 21 ASCO's TAPUR Study Grows 18 ASCO Launches JCO PO 18 ASCO Research Community Forum Annual Meeting 20 Molecular Biomarkers in CRC Guideline 21 Highlights of GI-Related Articles From JCO 21 Distinguishing Between Hyperplastic and Sessile Serrated Polyps 22 ASCO's Global Oncology Initiatives 23 PracticeNET 24 Recent Perioperative Studies in Gastric Cancer: More Is Not Better Geoffrey Y. Ku, MD, and David H. Ilson, MD, PhD I n the past 15 years, com- pleted phase III studies have clearly established that peri- operative strategies improve outcomes in patients with lo- cally advanced, resectable gas- troesophageal junction (GEJ) and gastric cancers. Broadly speaking, the two approaches are pre- or perioperative che- motherapy and surgery or up-front surgery and either adjuvant chemotherapy or chemoradiation. In the United States and Western Europe, the strong preference is for periop- erative chemotherapy, whereas East Asian oncologists prefer initial surgery and adjuvant treatment. Recently, several phase III studies have attempted to re- fi ne these strategies in one of several ways, including in- corporating additional che- motherapy drugs or targeted agents, varying the duration of chemotherapy, and adding chemoradiation to chemo- therapy. With few exceptions, strategies that have attempted to augment current therapies have not yielded any benefi t, although an indirect inference from some of these studies is that the addition of radiation to preoperative strategies may facilitate complete surgical re- section for patients whose tu- mors involve the GEJ. Preoperative Chemotherapy In Europe, perioperative che- motherapy is the predominant approach, based primarily on the phase III MAGIC trial per- formed in the United Kingdom. 1 This trial randomly assigned 503 patients with gastric can- cer (85% of whom had tumors in the GEJ/stomach) to three cycles (9 weeks) each of pre- and postoperative epirubicin, cisplatin, and 5-fl uorouracil (5- FU; ECF) and surgery or surgery alone. Perioperative chemo- therapy resulted in signifi cant improvement in 5-year overall survival (OS; 36% vs. 23%, p = 0.009), establishing this regi- men as a standard of care. A similar degree of benefi t was also noted in the contempora- neous French FFCD 9703 trial of 224 patients with esophagogas- tric adenocarcinoma (89% had GEJ/gastric tumors). 2 Patients were randomly assigned to 18 weeks of perioperative 5-FU and cisplatin and surgery or surgery What Role Do Bacteria Have in the Development of Colon Cancer? Dr. Cynthia L. Sears to discuss role of the microbiome during keynote address F or more than 40 years, it has been postulated that bacteria pres- ent in the colon contribute to the development of colon cancer. However, only with the emergence of the genomic revolution and the microbiome fi eld has it become more feasible to begin to ask questions about the role of the microbiome—the collection of microbes or microorganisms that exist in the human body—in the development of colon cancer. Cynthia L. Sears, MD, professor of medicine, oncology, and mo- lecular microbiology and immunology with Johns Hopkins Univer- sity School of Medicine and Johns Hopkins Bloomberg School of Public Health, has devoted much of her recent career to exploring how colonic microbiota induce chronic colonic infl ammation and colon cancer. Dr. Sears will discuss the latest developments in this area during her keynote address, "Microbes, Microbiota, and Colon Cancer" (January 21, 10:00 AM-11:00 AM). Dr. Sears received her medical degree from Thomas Jefferson Medical College and trained in internal medicine at The New York Hospital. She entered into the infectious disease fi eld during her training at Memorial Sloan Kettering Institute and the University of Virginia School of Medicine, where she was a faculty member until 1988. She subsequently joined the faculty of Johns Hopkins Univer- sity School of Medicine. Her interest in tumor immunology began with her studies of a par- ticular bacterium called enterotoxigenic Bacteroides fragilis (ETBF). "Over a decade, we did several studies of [ETBF] that repeatedly led us to pathways that were, in fact, being published in the colon can- cer fi eld by Bert Vogelstein and his group at Hopkins," Dr. Sears said. "As a result, we ended up asking if it was possible to colonize a sus- ceptible mouse with ETBF … if a diarrheal pathogen might also be tumorigenic in the colon." Their studies showed clear evidence that ETBF was, in fact, a carcinogen—at least in mice— which piqued Dr. Sears' interest in the emerging fi eld of the mi- crobiome and colon cancer. During her lecture, Dr. Sears will discuss the components of the microbiome that are proposed as critical contributors to the initia- tion and progression of colon cancer, as well as how different colon cancer disease states provide unique insights into the complexity of these mechanisms. "There has been stunning growth in our recognition that the mi- crobes we carry with us appear to be critical to our health and to disease development, offering the possibility of novel approaches to disease prevention, diagnosis, and therapy," Dr. Sears said. For example, ETBF was originally viewed as an animal pathogen but was later described as a cause of diarrheal disease in young chil- dren in the United States and abroad. Dr. Sears' work in human colon cancer and controls led to the realization that many people are colonized with one or more strains of ETBF. According to Dr. Sears, there is evidence that ETBF is in 85% to 90% of patients with colon cancer. "This does not make it causal, but it does mean that it is common," she said. Dr. Sears has also researched the role of biofi lms, dense clusters Attendee Tip of the Day Listen to the ASCO Daily News Podcast Series. Podcasts feature renowned oncologists discussing the latest research and therapies in their areas of expertise. Download the ASCO Daily News podcasts to your iOS or Android device for listening anytime, anywhere ( news-podcast). See Role of Bacteria, Page 12 See Perioperative Studies, Page 4 T A R G E T I N G C A N C E R C A R E INSIDE Dr. Cynthia L. Sears DAILY NEWS SATURDAY · JA N UA RY 21 · SA N F RA N C I S CO Gastrointestinal Cancers Symposium O 2017 Immunotherapy for Hepatobiliary Malignancies Thomas Karasic, MD, and Arturo Loaiza-Bonilla, MD, MSEd H epatobiliary cancers, pre- dominantly hepatocellu- lar carcinoma (HCC), are the second leading cause of cancer deaths worldwide— accounting for approximately 750,000 deaths across the world in 2012. 1 In the United States in 2016, an estimated 39,000 patients will be diagnosed with hepatobiliary cancers, and 27,000 patients will die of the disease. 2 The death rate from hepatobiliary tumors in the United States has risen steadily since 1980, even as the death rates of more common cancers have declined. Despite universal screening guidelines for patients with cir- rhosis and for high-risk patients See Hepatobiliary Malignancies, Page 3

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