Tag Archives: overtreatment

Progress is made at the boundaries of disciplines

anna portrait  pic

Anna Wagstaff

I’ve been feeling rather smug. Among the 16 sessions taking place on the Sunday evening of the European Cancer Congress (ECC2015), I took a chance on an ASCO–ECCO joint symposium entitled “New Frontiers in Imaging: The solution to individualised treatment”.

Of the 18,000 participants gathered at that congress, I was surprised to find myself as one of only around 25 people at that session, in a hall that could have accommodated 200 times that number. Either I had misjudged the importance of this topic – it wouldn’t be the first time – or I could congratulate myself for having picked up on something of strategic significance that the vast majority of congress goers had completely overlooked.

In this instance, I think I got it right, and this is why.

Treating “the right patient with the right treatment at the right time” has been the mantra of the cancer community for more than a decade now. Yet most of the research highlighted at cancer conferences still speaks to the old agenda.

Typically, the data from the clinical trials show a wide range of responses – some patients barely responding, others deriving a clear benefit. But the presentations are still about the apocryphal “average” patient – if doctors want to give these therapies to “the right patients” they’ll still have to give them to the wrong patients as well.

So this is why, when I spotted a session that focused on “the solution to individualised treatment”, I thought it sounded important.

The presenters offered an alternative approach to personalising therapies that uses the ability of increasingly sophisticated imaging techniques to give a whole-body picture not just of the extent of disease but of many aspects of its biological behaviour.

Some of this is cutting edge science – apparently every one of Hanahan and Weinberg’s “hallmarks of cancer” can now be visualised by different types of imaging.

But what really caught my attention was a creative use of an old nuclear medicine technology to address the problem of overtreatment of patients with colorectal cancer.

Imaging can guide treatment

Around eight out of ten colorectal cancer patients recommended for adjuvant FOLFOX treatment do not benefit from this highly toxic regimen. In some cases this is because they have already been cured by surgery and the additional treatment is redundant ‒ identifying these patients remains a challenge. But in around four patients out of ten the disease comes back because FOLFOX doesn’t work for them.

The solution? Take advantage of the short period between diagnosis and surgery to treat the cancer with FOLFOX, and gauge its level of response by comparing FDG-PET images taken before and after. If FOLFOX has no impact before surgery, it’s unlikely to work as an adjuvant afterwards. That’s the theory, anyway, and it’s currently being tested by Alain Hendlisz and colleagues at the Jules Bordet Institute in Brussels.

If it works in practice, this could be a big deal that would make a significant difference to a sizeable patient group, and open up new approaches to achieving the goal of individualising treatment. It would also be a great example of how important progress so often comes from a creative interplay between different disciplines.

So I’m left wondering why so few people turned up to the session, even though its billing as a joint ASCO–ECCO symposium should have flagged up the importance of the topic.

Was I witnessing the silo mentality in action? Were all the other delegates so focused on their own speciality that they didn’t connect with possibilities coming from elsewhere?

If so, it shows how right the organisers of ECC2015 were to take “Reinforcing multidisciplinarity” as their theme for the conference, but it also shows how much work is need to achieve that goal.

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The European Cancer Congress is a great place for people to connect across the boundaries of discipline and specialism – but you have to want to. Photo: Peter McIntyre