Oncologists Flock to Chicago for ASCO, After 2 Years Online

The biggest cancer conference in the world is back in person after 2 years online during the COVID pandemic. And it appears many are eager to attend the American Society of Clinical Oncology (ASCO) annual meeting in person now that they can.

By early May, ASCO already had 30,000 registrations, of which 80% were in person — there were 27,000 hotel reservations.

“That’s almost identical to where we were in terms of numbers in 2019 at the same point in time,” Julie Gralow, MD, chief medical officer at ASCO, told Medscape Medical News.

These figures, which are from May 11, are likely to increase. In past years, there has been an upswing in registrations right before the meeting starts.

The annual meeting begins on Friday, June 3, and runs until Tuesday, June 7. It will be held in Chicago, yet again, in the vast McCormick Place, sections of which were transformed into field hospital wards when the pandemic hit in 2020. 

But the meeting will also continue to be transmitted virtually, as it has been for the past 2 years, for those not attending in person.

“I do think that the hybrid model will move forward,” Gralow said. “We can get a lot of attendees, especially from very distant places, who can’t travel, or can’t easily travel, and we have learned how to make that experience better for them as well.”

Attendees can also change their minds if, for example, rising numbers of COVID cases as the meeting nears put them off traveling. “We are allowing people to change to virtual. So I think there may be a little bit of that, depending on what happens to COVID in different parts of the world,” Gralow commented.

For those who do attend, the organization is “doing the best that we can to keep people safe,” said Gralow, who was previously a professor of global health and is now a breast medical oncologist and clinical trialist.

To attend in person, ASCO is mandating proof of vaccination (which in the United States means two doses of the COVID vaccine). “If you prove in advance that you are vaccinated, we will send you your badge, so you don’t have to stand in line,” she added.

“As far as masks go, we are saying right now that we are complying with Chicago’s rules, which mean there is no mandatory indoor masking,” she continued. “We are recommending masking because this is a group of physicians who treat immunocompromised patients. So we are recommending that.”

This stance has gotten some push-back on Twitter from both physicians and patient advocates, with some surprised that masking is not mandatory.

“I know that ‘mask optional’ meetings mean most will omit masks; I literally just saw this at my last meeting as one of the few masked MDs,” commented radiation oncologist Fumiko Ladd Chino, MD. She appealed to the organizers with a plea: “There’s still time to change #ASCO22 policies. We’re in it for patient health.”

Patient advocate Manju George, MVSc, PhD, a rectal cancer survivor, was also campaigning for a change in policy by setting up a letter that others could sign, adding that “ASCO leadership is being flooded with pleads from concerned HCPs.”

When asked whether it was considering a change in mask policy, ASCO replied: “As far as health and safety go, the protocols we’ve put in place meet or exceed current WHO, CDC, and city of Chicago guidelines. ASCO is also closely coordinating with both the city and the convention center and we are actively monitoring local conditions.”

“To protect the health and safety of all meeting attendees, our protocols require attendees to be fully vaccinated and self-test negative for COVID-19 within 48 hours prior to their arrival at the meeting. In addition, we expect all attendees to be masked when indoors and are encouraging regular self-testing. We fully expect members of our community to do their part to help keep everyone safe, and we’re making it easy for attendees to comply with our policies by providing medical-grade masks as well as both rapid antigen and PCR COVID-19 tests,” the organization told Medscape Medical News.

There will also be a notification system so attendees can select how they identify for closeness, with red meaning stand back, no hugs, no handshakes; yellow signifying something more intermediate; and green signaling the person is okay with contact with a handshake or a hug. This system has already been used during smaller ASCO subspecialty meetings earlier this year, and feedback from delegates was positive, Gralow commented.

Advancing Equitable Care

The theme of this year’s meeting, chosen by ASCO President Everett Vokes, MD, is advancing equitable cancer care through innovation.

It builds on the theme of equity from last year, chosen by previous president Lori Pierce, MD, which was “Equity: Every Patient. Every Day. Everywhere.”

Some of this relates to disparities in equity, commented Gralow. This is the focus of a pre-meeting press briefing on May 26 that will highlight a few abstracts that focus on disparities and what can be done to address them. One study (abstract 6511) focuses on telemedicine, which was increasingly used during the pandemic, but the results show not all US patient populations could access the specialty care they needed in this way.

De-escalation of Therapy

De-escalation of therapy is another theme running through the meeting.

“There are some cancers where we have achieved such good outcomes that it is time to look at de-escalating therapy because we know that we are probably way overtreating a component of those patients….So we are looking at whether we can find subpopulations where we can back off on therapy,” commented Gralow.

One example is the LUMINA trial in breast cancer (abstract LBA501), which looked at omitting radiotherapy after surgery. “In standard practice we have already been doing this, not based on solid data, but based on an accumulation of retrospective analyses and similar evidence,” commented Gralow. This trial tested the approach prospectively, lowered the age range of patients, and better defined which patients were likely to benefit.

Another example is the DYNAMIC trial in colorectal cancer (abstract LBA-100), which looks at omitting chemotherapy based on levels of circulating tumor DNA (ctDNA) after surgery. These patients had stage 2 disease and generally do very well with surgery and adjuvant chemotherapy, Gralow stated. This trial aims to find the subset of patients who could do just as well without the chemotherapy; it may also identify those patients at the other end of the scale, who perhaps need a bit more treatment, she added.  

Spotlight on Innovation

The focus on innovation includes exploring drugs developed outside the United States. One example is nimotuzumab, which is already approved in China for use in nasopharyngeal cancer but is also being explored in other cancer types. At ASCO, data will be presented in patients with KRAS wild-type pancreatic cancer (abstract 4011). This study, like the other trials with nimotuzumab, was conducted in China.

This brings up an important point about the data the US Food and Drug Administration (FDA) requires for new drug approvals, commented Gralow.

She noted that the FDA recently rejected an application for sintilimab, a drug also developed in China, on the basis that all trial data submitted for approval were from China. The agency said it would like to see multiregional clinical trials and trials that reflect the US cancer population.

Advice for Attendees

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

In addition to the scientific sessions that will see new data, there are a number of educational sessions that will tackle tricky issues that clinicians sometimes face. “Microaggressions, Bias, and Equity in the Workplace” will be discussed in one session, while another promises, “Strategies to Address Moral Distress in Clinicians: What Should We Do When We Don’t Know What to Do?”

There is also a special session featuring the “Cancer Groundshot: Addressing the Global and National Inequities in Cancer Care.” This is a move spearheaded by Bishal Gyawali, MD, PhD, from Brigham and Women’s Hospital, Boston, Massachusetts, who was reacting to the lofty goals of the presidential Cancer Moonshot, including the aim of “ending cancer as we know it.” In a blog post in 2016 he suggested “forget the moon; let’s get back to blood and flesh reality on the ground…[and] research that can be immediately applied to every global community.” He recounts the journey from ‘Blog Post to ASCO Session’ in a recent Medscape commentary.

Gyawali also has some advice for those attending the ASCO annual meeting this year: reach out to people you respect, trust that connections will happen, scrutinize the data, listen critically for jargon, and perhaps most importantly, have fun.

“There’s more to life than your job,” he writes. “Don’t stress. Think about the bigger picture. Think about your patients. And remember, life is beautiful, even when it feels like it isn’t.”

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