After 2 Years of Online Meetings, Oncologists Gathered for the Largest Oncology Congress

The world's largest cancer conference is finally returning to conference halls after being held online for 2 years because of the Covid-19 pandemic. It appears that most people are eager to attend the annual meeting of the American Society of Clinical Oncology (ASCO) in person.

By early May, 30 thousand people had already registered for ASCO, with 27 thousand hotel reservations.

ASCO Chief Medical Officer Julie Gralow said, “This number is almost the same as at this time in 2019.”

Registrations are likely to increase considerably by the end of May. In previous years, there was a surge in registrations just before the meeting began.

The annual meeting began on Friday, June 3, at its usual location in Chicago and will continue until Tuesday, June 7. The meeting will again take place at McCormick Place, whose grounds were converted into hospital wards during the height of the pandemic in 2020.

The meeting will also be available virtually for those unable to attend in person, as it has been for the past 2 years.

Gralow said, “I think the hybrid model will continue. We can reach many participants who cannot travel, or cannot easily travel, particularly from very distant places, and we have learned how to make the experience better for them as well.”

Participants may also change their minds; for example, rising Covid cases as the meeting approaches could influence their decisions.

Gralow, previously a professor of global health and now a breast cancer oncologist and clinical researcher, says the event has been organized to take the best possible care of attendees' health.

To attend in person, ASCO requires a vaccination card (meaning two vaccine doses in the United States). Gralow also said, “If you prove in advance that you are vaccinated, we send you a badge so you do not have to stand in line.”

“When it comes to masks, we are currently following Chicago's rules, which means masks are not mandatory indoors. We recommend wearing masks because we are a group of doctors treating immunocompromised patients.”

This decision prompted some backlash on Twitter from both doctors and patient representatives. Some people expressed surprise that masks would not be mandatory.

Radiation oncologist Fumiko Ladd Chino commented against this decision: “I know that masks will come off at most ‘mask-optional’ meetings; I saw exactly that as one of the few people wearing a mask at the last meeting I attended. There is still time to change #ASCO22 policies. We are there for patient health.”

Manju George, a patient advocate who survived rectal cancer, was campaigning for a policy change by drafting a letter others could sign: “ASCO leadership is being flooded with pleas from concerned healthcare providers.”

Asked whether it was considering a change regarding masks, ASCO responded: “When it comes to health and safety, our protocols meet or exceed current WHO, CDC, and City of Chicago guidance. ASCO is also working closely with both the city and convention center and actively monitoring local conditions.”

The organization also said: “To protect the health and safety of everyone attending the meeting, our protocols require attendees to be fully vaccinated within 48 hours before their arrival at the meeting and to have a negative individual Covid-19 test. In addition, we expect all attendees to wear masks indoors and encourage regular individual self-testing. We expect community members to do their part to help everyone stay safe, and we make compliance with our policies easier by providing medical masks and both rapid antigen and PCR Covid-19 tests.”

There is also a notification system so attendees can choose how to indicate their comfort with proximity. The colors mean:

• Red: keep a social distance, no hugging, no handshakes.
• Yellow: a more moderate level
• Green: hugging and handshakes are fine

Gralow noted that this system had already been used at ASCO's subspecialty meetings earlier this year and that feedback from delegates was positive.

Advancing Equitable Care

Set by ASCO President Everett Vokes, this year's meeting theme is advancing equitable cancer care through innovation. This theme builds on the previous year's theme, “Equity: Every Patient,” set by President Lori Pierce.

Gralow commented that some relate to disparities in equity. This was the focus of the premeeting press briefing on May 26, which would highlight several abstracts focusing on disparities and what can be done to address them.

One study (out of 6511 abstracts) focuses on telemedicine, whose use increased during the pandemic; however, the results show that not all US patient populations can access the specialized care they need in this way.

Reducing Treatment

Gralow said, “Reducing the dose or frequency of treatments is another theme running throughout the meeting. There are some cancers in which we achieve such good results that it is time to look at reducing treatment, because we know we are probably overtreating a portion of these patients… So we are looking at whether we can work out which patients can have their treatment doses reduced.”

The LUMINA study (abstract LBA501), examining omission of radiotherapy after surgery in breast cancer, is one example. This study tested the approach prospectively, lowered the patient age range, and better defined which patients might benefit.

On the study, Gralow commented that “We already do this in standard practice, not on the basis of robust data, but on an accumulation of retrospective analyses and similar evidence .”

Another example (abstract LBA-100) is the DYNAMIC study, which investigates omission of chemotherapy after colorectal cancer surgery based on circulating tumor DNA (ctDNA) levels. Gralow noted that these patients have stage 2 disease and generally do very well with surgery and adjuvant chemotherapy. She added that the study aims to find the subgroup of patients who can do just as well without chemotherapy and might also identify patients at the other end of the spectrum who perhaps need a little more treatment.

Focus on Innovation

Focusing on innovation includes exploring drugs developed outside the United States. One example is nimotuzumab, which is already approved in China for nasopharyngeal cancer but is also being investigated in other cancer types. Data on patients with KRAS wild-type pancreatic cancer will be presented at ASCO (abstract 4011). This study, like other studies of nimotuzumab, was conducted in China.

Gralow noted that this raises an important point about the data the US Food and Drug Administration (FDA) needs for new drug approvals. She also said that the FDA recently rejected the application for sintilimab, another drug developed in China, because all trial data submitted for approval came from China. The agency said it wanted to see multiregional clinical trials reflecting the US cancer patient population.

Advice for Attendees

A large trial in a rare cancer promises to establish a new standard of care where a range of different regimens had previously been used in different parts of the world and even at different hospitals within the same country. These are the results of an international trial in children and adolescents/young adults with Ewing sarcoma (LBA-02). Gralow commented that “Experts in the field have told me that these results will change practice… (and) have a global impact .”

In addition to scientific sessions presenting new data, there are educational sessions addressing difficult problems doctors sometimes face. One session will discuss “Microaggressions, Bias, and Equity in the Workplace,” while in another session, “Strategies to Relieve Moral Distress in Physicians: What to Do When We Do Not Know What to Do?” will be discussed.

There is also a special session on “Cancer Beginnings: Addressing Global and National Disparities in Cancer Care.” This is a movement led by Bishal Gyawali of Brigham and Women's Hospital in Boston, with the aim of “eliminating cancer as we know it.” In a 2016 blog post, Gyawali said: “Forget space; let us return to the flesh-and-blood reality on earth and to research that can be applied immediately to every global community.”

Gyawali also has some advice for attendees at this year's ASCO annual meeting:

1. Reach out to people you respect
2. Trust that connections will happen
3. Examine the data
4. Listen critically to technical language
5. Perhaps most importantly, have fun

“There is more to life than your work. Do not stress. Think about the big picture. Think about your patients. And remember, life is beautiful even when it does not feel that way.”