Interventional Oncology at ASCO 2016

The American Society of Clinical Oncology (ASCO) was held, as it has been every year, at McCormick Place in Chicago, Illinois, from June 3 to 7, 2016. As the world's largest oncology-focused meeting, it was an honor and a pleasure to attend both as a participant and a faculty member. ASCO boasts a membership of 40,000 oncology specialists and is considered the premier event for both scientific innovation and advancement of clinical care.

As a participant, it was exciting to learn of Volker Heinemann, MD’s presentation on key clinical data building upon the evidence and narrative of SIRFLOX.  In brief, SIRFLOX is an international multicenter open-label RCT in first-line patients with nonresectable, liver-only or liver-dominant colorectal liver metastasis (CRLM), showed that compared to FOLFOX (± bev) chemotherapy alone [arm A] FOLFOX (± bev) plus SIRT using Y-90 resin microspheres [arm B] did not significantly improve overall PFS (median 10.2 vs 10.7 months arm A vs B, HR: 0.93; 95% CI 0.77–1.12; P=.429). However, liver PFS by competing risk analysis was improved with the addition of SIRT (median 12.6 months vs 20.5 months in arm A vs B, HR: 0.69; 95% CI 0.55–0.90; P=.002), recently published in the Journal of Clinical Oncology. The publication raised awareness of the role of SIRT with respect to the treatment of colorectal liver metastasis in the first line setting, but was somewhat ambiguous due to its failure to reach primary endpoint of all site PFS. Due to the strength of signal relating to the control of liver disease, it has been largely accepted as encouraging, with an understanding that all site PFS may not be a feasible outcome in the population, due to the fact that 45% of patients had presented with their primary cancer intact, and 40% of patients had presented with extrahepatic disease.

Subsequent to the oral presentation of SIRFLOX (and prior to the publication), Peter Gibbs, MD, had presented at ASCO GI 2016 supplemental data to the effect that the trajectory of the disease is altered. The addition of SIRT to FOLFOX chemotherapy alone (± bev) reduced the frequency at which first disease progression occurred in the liver, and where first progression did occur in the liver, the addition of SIRT led to this more frequently being due to the appearance of new lesions (not evident on baseline imaging). These data suggest that SIRT used in conjunction with systemic chemotherapy provides prolonged control of evident liver disease. 

At the meeting, Dr. Heinemann presented data regarding the depth of response relating to liver specific disease revealing that in SIRFLOX, the use of radioembolization with SIR-Spheres Y-90 resin microspheres in addition to first-line chemotherapy significantly increased hepatic depth of response. This corresponded with a significantly longer PFS in the liver as first event in patients that received SIRT with patients demonstrating tumor burden >12% experiencing >100 days of delay in progression of liver disease (SIRT+FOLFOX 302.5d[+BEV], 224.0d[-BEV] vs FOLFOX 196.0d[+BEV],  176.0d[-BEV], P<.001).

As faculty, it was refreshing and exciting to present and share discussion on borderline resectable CRLM. Covering the spectrum of therapies and spectrum of patient profiles, discussion and debate included topics such as downstage to surgical resection (ablation, and embolization strategies), liver regeneration (utilizing portal vein embolization and SIRT) and the role of locoregional therapy in the setting of non resectable disease (ablation and SIRT). There were 2500 participants in attendance at the session, and further discussion on the role of IR emphasized the evolving role in the patient’s journey.

There is certainly an active effort by the ASCO leadership to bring interventional oncology into the conversation and educational stream.  Hope to see you there next year!

Overlooking the walkway from McCormick at ASCO 2016.

The Headliners for the multidisciplnary session on "Potentially Resectable Metastatic Colorectal Cancer: A Multidisciplinary Discussion"

Lecture Hall D1 before the educational session on management of borderline mCRC. Chaired by Gunnar Folprecht, MD (University Cancer Center (Dresden, Germany), Medical Oncology), with Laura Dawson, MD (University of Toronto, Radiation Oncology), Steve Nurkin, MD (Roswell Cancer Center, Surgical Oncology) and Dave Liu, MD (University of British Columbia, Interventional Radiology).