As the sun set opposite the rising moon over Madrid, I reflected on the reasons I’ve enjoyed this year’s ESMO annual conference so much.

Not only can we be the first to see results of the latest cutting-edge research in oncology, but we hear directly from the experts involved in those trials, and it is an opportunity for discussions that bring us back to the science.

Key highlights for me

Presidential Symposia:
It is awe-inspiring to hear the paradigm-shifting results from clinical trials, and I was thrilled to see so many of the trials Pharmora has supported being showcased at this conference.

Meetings:
I’ve really enjoyed the opportunity to meet up with some of our clients in person. It’s great to finally have a face to face conversation with people I’ve worked with over the years, inviting feedback on the work of Pharmora medics and scientists. I love finding any areas where we could improve, but it’s so heartwarming to hear how much our teams have been appreciated!

Hot topics from this year’s conference:

KRAS: 

Many moons ago I supported a product that worked really well for some patients with tumours driven by KRAS. Disappointingly, we were unable to find a statistically significant difference between treatments in that study, despite some amazing responses. 

I’ve been following the KRAS story ever since, and we now know there are many sub-types of this biomarker. 

Since ASCO showed us amazing results with daraxonrasib in metastatic pancreatic ductal adenocarcinoma just a few months ago, this product has already been approved for use in US and EU, and the KRAS story is getting very interesting. There is now a lot of work going on to find products that combat these important tumour drivers, particularly the G12D sub type, with data pouring out for the G12C subtype – watch this space!

Theranostics:

These are radio pharmaceutical treatments (RPTs), also known as “radioligands”, “radionuclides” and “radioconjugates”, which are a form of radiotherapy that can be targeted to the tumour and administered into the bloodstream. They can be used as therapy and also act as diagnostics (hence the term “theranostics”!)

There were numerous presentations on this topic, including:

• an excellent basic introduction and a discussion of the potential uses of RPTs, illustrated with scans and real patient stories,

• the advantages of using RPTs for diagnosis and treatment,
• conditions where they are most effective,
• specific safety considerations for these agents,
• novel delivery methods,
• the importance of modelling to determine the best dose,
• and the massive predicted market for these products!

In the satellite symposium discussing PSMA use in prostate cancer, the auditorium and the overflow areas were filled with attendees standing at the back, which speaks to the high level of interest in this therapy area!

WGS:

Around the world people are crying out for better diagnostic testing to determine which actionable genetic abnormalities (AGAs) are driving their tumours. 

I heard from one of the Clinical Scientists (Navodya Gamage) that UK Oncologists can now request whole genome sequencing (WGS) as a standard request within the NHS. This leads to a much faster and more accurate diagnosis, reducing the anxiety-provoking wait for patients, and informing treatment decisions for their clinicians, including determining which study they are eligible for. 

Another great reason to come to the UK to conduct clinical trials!

The immune system:

Our own incredible immune systems can be influenced to fight tumours in many ways, mimicked (e.g. manufactured antibodies or cytokines) or enhanced by adapting our own cells. It was fascinating to hear so many innovations in this area but this deserves a whole series of blogs!

My favourite parts of the event are the discussions, both on and off the stage.

Particular shout outs to:

Dr Emile Voest, whose brilliant suggestion for Governments was that they should provide incentives for rare cancers in the same way as they incentivise paediatric medication development. 

Dr Benjamin Besse gave an entertaining and enlightening discussion of 2 of the studies, and received several spontaneous rounds of applause part way through, as he expressed frustration (was clearly shared around the room), with the regulatory agency insistence on overall survival (OS) endpoints. 

He pointed out this means patients on standard treatment are not allowed to try the investigational product when their cancer progresses, as they are not allowed to cross over onto the other arm of the trial as it could interfere with OS. Waiting for the OS results can take many years, meanwhile results from other endpoints might show that the product has advantages over standard therapies, but patients in trials are not allowed to try it. 

He also received applause when he compared the missing parts of the safety data to the arms of Venus de Milo👏!

My favourite quote:

“Real world is not always real good” – Dr Christopher Booth

It’s been wonderful to catch up with so many friends, some of whom I haven’t seen for years, and to meet lovely new people here. 

See you all in Barcelona next year!