Gastrointestinal Cancers Symposium

GI 2018 Daily News Saturday

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ASTRO's New Strategic Plan 5 Why I Attend: Early-Career Perspective 5 Radiographic Response to a Checkpoint Inhibitor in MMR-Expressing mCRC 5 ASCO Supports Women in Oncology 11 Managing Metastatic Small Bowel Cancer 12 Certificate Programs for Advanced Practitioners 14 ASCO TAPUR Expands 14 Why I Attend: A Medical Oncologist's Perspective 15 Symposium Essentials 15, 21, 22, 25 SSO's International Collaborations 16 Novel Therapies in Pancreatic Cancer 18 Optimal Timing for MSI, MMR, PD-L1 Testing 21 SSO's Dynamic Future 21 Maximizing SSO Membership 22 ASCO Roundtable Address Financial Barriers to Clinical Trial Participation 24 HAI Use in Patients After Complete CLM Resection 25 Approaching Cystic Pancreatic Tumors in 2018 Manish S. Bhandare, MS, MCh; and Shailesh V. Shrikhande, MS, MD, MBBS, FRCS (Hon) P ancreatic cysts are diag- nosed with increasing frequency because of the widespread use of cross- sectional imaging. Detection of such lesions often puts clinicians in a quandary owing to uncer- tain implications of the presence of, or risk of progression to, ma- lignancy. Pancreatic cysts may be detected in more than 2% of patients who undergo abdomi- nal imaging with multidetector- row computed tomography or MRI for unrelated reasons, and this frequency increases with age. 1,2 Pancreatic cystic neo- plasms account for more than 50% of pancreatic cysts, even in patients with a history of pan- creatitis. 3,4 Pancreatic cystic neo- plasms are categorized using the World Health Organization his- tologic classification. There are four major subtypes, which have varying malignant potential: serous, mucinous, intraductal papillary mucinous neoplasm (IPMN), and solid pseudopapil- lary epithelial neoplasms. Management Strategies and Guidelines The management strategy largely depends on two impor- tant factors: symptoms and the risk of malignancy. Cysts larger than 4 cm are more likely to produce symptoms such as pain and obstructive jaundice. Over- all, the risk of malignancy in incidentally detected pancreatic cysts is low. A recent review from the American Gastroenterologi- cal Association (AGA) suggested that the risk of malignancy in a pancreatic cyst at the time of diagnosis is 0.01% (0.21% for cysts greater than 2 cm) with an annual risk of malignant Multidisciplinary Collaborations Key to Progress in Pancreatic Cancer Immunotherapy S teven D. Leach, MD, the director of Dartmouth-Hitchcock Norris Cotton Cancer Center (NCCC) and the former found- ing director of Memorial Sloan Kettering Cancer Center (MSKCC)'s David M. Rubenstein Center for Pancreatic Can- cer Research, will present a keynote lecture on immunotherapy in pancreatic cancer on January 20. Dr. Leach has spent more than 25 years researching pancreatic cancer; he's studied its development and behavior in depth and has seen a lifetime of advances and set- backs in its treatment. Today, Dr. Leach sees plenty of room for progress for the cancer's treatment—much of which lies in biomarker-directed therapies and personalized immunotherapy. Oncologists will need to embrace a wide range of perspectives to make this progress a reality. During his keynote lecture, Dr. Leach will discuss the discovery of a subset of pancreatic tumors that effectively engage with the body's immune system. The basis for this discussion will be an article Dr. Leach et al recently published in Nature 1 highlighting unique neo- antigen qualities in long-term survivors of pancreatic cancer. "The article defines the principles by which pancreatic cancer is or is not recognized by the immune system," Dr. Leach said. "Ex- cept for the 1% to 2% of patients with pancreatic cancer who have certain mismatch repair genes, pancreatic cancer is entirely resis- tant to the new wave of immune checkpoint inhibitors." The next step is to discover why this resistance occurs and to identify a way to target the mechanism of resistance. Dr. Leach and colleagues have defined a subset of patients with pancreatic cancer whose tumors actively engage the immune system. "Those patients can enjoy remarkable long-term survival," he said. "The question is, how do we get the rest of the patients' tumors to behave similarly?" Dr. Leach believes oncologists will reach an answer only with an interdisciplinary approach to their research, since siloes prevent breakthroughs. The Nature study is a premiere example of the mul- tidisciplinary, interdisciplinary collaboration that will shape progress. "We had investigators from multiple labs at MSKCC, Mt. Sinai, and the Institute for Ad- vanced Studies at Princeton, along with contributions from surgical and medical oncologists, immunologists, and computa- tional biologists," among others, he said. Dr. Leach cited this interdisci- plinary approach as one of the motives behind his recent move to the Dartmouth NCCC—a transition he made in September 2017. Dr. Leach said the NCCC's extensive integration into Dartmouth's greater academic medical center and the university at large makes both an interdisciplinary and a multidisciplinary approach to can- cer research possible. "One of the most rewarding parts about my recent move to Dart- mouth has been reentering a university community in which we can draw upon expertise not just in the biomedical sciences, but also in the physical sciences, the social sciences, the arts, and the humani- ties," Dr. Leach said, adding that this synergy allows oncologists and students "to gain a deeper understanding of cancer not only as a problem of genes and cells, but as a problem that impacts virtually every dimension of human life." Dr. Leach believes this mindset will continue to shape whatever comes next in pancreatic cancer research—which at the moment is focused on "achieving the reality of biomarker-driven identification See Keynote, Page 16 See Cystic Pancreatic Tumors, Page 3 INSIDE Dr. Steven D. Leach For Oncologists in Iraq's Disparate Regions, Conflict Dictates Priorities P rior to the 1980s, the Iraqi health care system had taken progressive steps to support the field of oncol- ogy. Iraq had procured three linear accelerators and estab- lished oncology institutes in Baghdad and Mosul, as well as a low-dose–rate brachytherapy facility. All systems were a-go for the government to fully sub- sidize sophisticated hospitals and provide free health care to all patients with cancer. 1 Had nearly 4 decades of war not transpired, Iraq might have one of the strongest cancer care systems in the Middle East to- day. 1 But the sweeping effects of internal and external con- flict hit pause on Iraq's prog- ress. Beginning with the Persian Gulf War in 1990 and spanning decades to the Islamic State of Iraq and Syria (ISIS) invasion of See Oncologists in Iraq, Page 4 T A R G E T I N G C A N C E R C A R E DAILY NEWS SATURDAY · JA N UA RY 20 · SA N F RA N C I SCO Gastrointestinal Cancers Symposium 2018 ■ ■ Pancreatic cystic neoplasms have four major subtypes. ■ ■ Management depends on symptoms and the risk of malignancy. ■ ■ Guidelines have become more conservative; the risk of malignancy in an asymptomatic cyst is very low. ■ ■ The decision to recommend surgery should consider the patient's age and general health, the malignant risk of a spe- cific lesion, and when malignancy is suspected. ARTICLE HIGHLIGHTS Attendee Tip of the Day Listen to the ASCO Daily News Podcast Series, where oncologists discuss the lat- est research and therapies in their areas of expertise. Download the ASCO Daily News podcasts to your iOS or Android device on iTunes or Google Play.

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