By Dorys Lopez
Our team was present at the American Society of Clinical Oncology (ASCO) annual meeting that took place from June 3 – 7, 2022.
Perhaps the most impactful moment for breast cancer oncologists and researchers at the conference took place during the plenary session when Dr. Shanu Modi presented the results of the DESTINY-Breast04 trial.
The trial tested trastuzumab deruxtecan (T-DXd) – an antibody drug conjugate (ADC) directed towards the human epidermal growth factor receptor 2 (HER2) – against the physician’s choice of chemotherapy in patients with HER2-low unresectable and/or metastatic breast cancer. T-DXd extended both the time to disease progression and the overall survival by 4.8 months [HR:0.5] and 6.6 months [HR:0.64], respectively, in all patients compared to patients receiving chemotherapy. This reduction in risk of disease progression and death for patients with metastatic disease led to a standing ovation and at least a full minute of continuous applause.
The excitement continued with a discussion of the abstract by Dr. Patricia Mucci LoRusso. At the end of the discussion, she posed the question of whether standard-of care for patients with HER2-low metastatic breast cancer should change as a result of the Destiny-Breast04 results. Her answer, “Absolutely!”. Although she did emphasize the need for more sensitive tools to properly select HER2-low patients.
The excitement took over social media as well, with numerous posts on twitter celebrating the results and posting pictures and videos of the ovation that Dr. Modi received after her talk. One tweet, however, stood out from the crowd. Dr. Enrique Soto, a Mexican oncologist, brought some perspective with his tweet “… the Destiny of MOST women with #bcsm [breast cancer] worldwide will be NOT to get Trastuzumab Deruxtecan since they cannot even access surgery, radiotherapy, endocrine therapy or trastuzumab.” His last remark “We need to do better”.
Indeed, there is need for better approaches for global implementation of precision oncology, which was a topic of discussion in some sessions at the conference. There is no infrastructure for precision oncology in low- and mid-income countries, according to Dr. Ya-Chen Tina Shih. Dr. Shih projections of cancer incidence, according to the sociodemographic index (SDI), showed that by 2040 around two-thirds of cancer cases would occur in low- and mid-SDI countries.
Affordability and accessibility of cancer drugs play an important role in the cancer disparities between low-/mid- vs. high-SDI countries. The rising cost of cancer drugs has led to what in high-income countries, like the U.S., is referred to as financial toxicity; for low- and mid-income countries, Dr. Shih called it catastrophic spending.
Dr. Sana Al Sukhun touched on creating resource stratified guidelines in order to improve the way countries utilize their resources. She explained that no correlation has been found between cancer-specific expenditure and outcomes, and more awareness is needed around the benefits of more affordable interventions that provide real value and benefits for patients. While she did mention that patients are worried about potential high toxicity of lower priced drugs — thus the need for more education around them — Dr. Al Sukhun mentioned de-escalation and optimization clinical trials for countries of limited resources as an excellent option to make unfunded drugs available. These types of trials have already shown success and such approaches would be easy to adapt in clinical practice, Dr. Al Sukhun said.
We are not where we need to be in terms of precision medicine for all. However, there is awareness and motivation to move in the right direction. At SimBioSys we believe in democratizing precision medicine. At ASCO our team presented a poster on the feasibility of implementing our technology, TumorScope, in community hospitals. It is at these institutions, and not academic centers, where the majority of cancer patients are treated. Scalable and accessible precision medicine tools are needed. Our data shows how our technology could support treatment selection at community hospitals and help doctors visualize the outcome of the patient with the treatment they select, thereby optimizing patient treatment.
The conference was proof that there is great innovation in cancer therapeutics, but it also showed that new drugs will not be enough if basic cancer care is not available for all.