Abstract
The recognition that cancer is a ‘spectrum’ of diseases, and that medical oncologists should achieve ‘convergence’ from ‘divergence’ to treat cancer patients was the main theme of the 2014 European Society of Medical Oncology (ESMO) Congress. The meeting assembled 19,859 participants from nearly 134 countries worldwide. The educational content was centered on precision medicine in cancer care, from mutational burden to the immunome, through the epigenome and the proteome. Precision medicine has been defined as the tailoring of medical treatment to the characteristics of an individual patient. Knowing an individual’s genomics has created a remarkable and unprecedented opportunity to improve medical treatment and develop preventative strategies to preserve health. Clinical oncologists across the range of diseases recognise that for precision medicine to take hold, it will require intensive, rigorous validation that these new approaches do indeed improve patient outcomes. Not all molecular alterations are predictive of response to a specific targeted treatment nor are they all druggable, raising issues of cost–benefit, validation of specific biomarkers, and of managing patient expectations. Addressing all these issues will be essential for the medical community to embrace any given opportunities. Along with it, it will also require educational programmes that squarely address the knowledge chasm that currently exists for practicing physicians. The promise of genomic and precision medicine has created greater demands for both those providing the scientific expertise—bioinformatics, statisticians, molecular biologists—and those delivering clinical care—physicians, nurses, psychologists—to the patients. This ESMO 2014 report will highlight the major findings of this outstanding meeting.
Highlights
The availability of next-generation human genomic sequencing tools and the progress in sequencing and bio-computational technologies will enable genome-wide investigation of somatic mutations in human cancers at diagnosis and during their natural history [1, 2]
These results suggest that continued VEGF inhibition with further bevacizumab is a valid treatment option for patients with locally recurrent or metastatic HER2-negative breast cancer whose disease was stabilised or responded to first-line bevacizumab with chemotherapy
Subclones frequently arise, which results in differences in the proportion and pattern of specific aberrations between the primary tumour and the metastases or recurrent tumours that originate from it
Summary
The availability of next-generation human genomic sequencing tools and the progress in sequencing and bio-computational technologies will enable genome-wide investigation of somatic mutations in human cancers at diagnosis and during their natural history [1, 2]. Sandra Swain of the Medstar Washington Hospital Centre, Washington Cancer Institute, reported that first-line treatment with pertuzumab/trastuzumab/docetaxel significantly improved overall survival (OS) for patients with HER2-positive metastatic breast cancer compared with placebo/trastuzumab/docetaxel, providing a 15.7 month increase in the median values. 808 patients with HER2-positive metastatic breast cancer were randomised to receive first-line placebo/trastuzumab/docetaxel or pertuzumab/trastuzumab/docetaxel.
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