GI ASCO 2012 Abstract Synthesis and Updates

Greetings Foundation Supporters and Affiliates,

I had the unique opportunity to attend the 2012 GI Cancers Symposium: Science and Multidisciplinary Management of GI Malignancies in San Francisco as volunteer support for Marion’s advocacy and outreach. This confernece brings together and international community of researchers, physicians, and partners in addressing gastrointestinal forms of cancer. Having had the loss of my mother, Nancy Galarneau, at the tender age of 52 in a 2 and a half month assault of cholangiocarcinoma in spring-summer 2009 I have grown since then in my awareness and concern at the level of uncertainty of viable treatment and knowledge creation on seeking new methods for intervention. The technical jargon was more accessible then I imagined in reviewing poster abstracts and proceedings once orientated to a few pointers from Marion. There were three days of sessions with the second day featuring more content relative to Cholangiocarcinoma. Below is a synthesis of related poster presentations and abstracts I thought would be useful for those supporting treatments for loved ones dealing with this cancer or for those brave souls serving as advocate and patient themselves. The entire proceedings can be accessed through this link https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B3nbi8Y3dWuXZGY2OTFmYjEtZGZmYi00N2EwLWI0ZDctNDc4Mjg2N2Q0NDdk&hl=en_US so folks can look through the posters and session paper presentations in their entirety for those wanting to dig deeper.

Overall I found the experience to speak to an untapped potential that Marion and her volunteer network is attempting to realize: one in which international and domestic researchers and oncologists can advance treatment and diagnostic tools for addressing this horrid cancer. One of the challenges as with many other cancer treatment processes, is reconciling the private and company driven trial and research with the more open and transparent task forces comprised of the GI field of experts in combating through public and government based funded procedures. Knowing how much $$ it costs to bring a drug to the market tells me we’ll have to somehow reconcile the private and public to work together on this, and more then likely, the findings of related and greater diagnosed cancers will help pave the way for advancing the foundation’s agenda.

Selected Abstract and Poster Recap (more detail in the link to full proceedings)
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B3nbi8Y3dWuXZGY2OTFmYjEtZGZmYi00N2EwLWI0ZDctNDc4Mjg2N2Q0NDdk&hl=en_US

• (Abstract # 158) SBRT as an alternative to RFA for the treatment of primary and metastatic liver tumors. Presenting Author: Erqi Liu, University of Michigan, Ann Arbor, MI.

Background: Radiofrequency ablation (RFA) is a widely used local therapy for small, unresectable liver tumors (LT). Stereotactic body radiotherapy (SBRT) has been used for similar patients, and has the advantage that it can be used when lesions are adjacent to blood vessels, are difficult to reach and cannot be imaged on ultrasound. Conclusions: SBRT is a safe alternative to RFA, can be used in a wider variety of patients, and may be more effective than percutaneous RFA at locally controlling larger liver tumors.

• (Abstract #176) Value of preoperative biopsy and radiological assessment for the diagnosis of mixed hepatocellular cholangiocarcinoma (HCC-CC). Presenting Author: Mohamed Bouattour, Department of Oncology, Beaujon University Hospital, Clichy, France

Background: Mixed tumors with hepatocellular and cholangiocarcinoma component (HCC-CC) are rare variants of primary liver tumors. In this study, we aimed to describe clinical, radiological and histopathological features of patients with resected HCC-CC. Conclusions: Mixed HCC-CC are not accurately identified by preoperative biopsy using only morphological features and CT scan/MRI assessment. Following resection, mixed HCC-CC behave more like CC than HCC.

• (Abstract #207) This one is funded by the foundation and Marion noted in her announcement on the website. Significance of CEACAM6 expression in biliary tract carcinoma. Presenting Author: Flavio G. Rocha, Virginia Mason Medical Center, Seattle, WA

Background: The entire biliary tree is at risk for malignant change, but little is known about differences in molecular pathogenesis with respect to anatomic site. CEACAM6 is a membrane protein involved in cell adhesion and signaling that is overexpressed in pancreatic adenocarcinoma and associated with poor prognosis. This study examines CEACAM6 expression in the entire spectrum of biliary carcinomas and its relationship to outcome. Methods: Tissue microarrays containing triplicate Conclusions: CEACAM6 may serve as a marker of poor outcome in patients with intrahepatic cholangiocarcinoma and should be further evaluated as a means of selecting patients for adjuvant therapy after resection

•(Abstract #255) Randomized phase II trial of gemcitabine plus S-1 combination therapy versus S-1 in advanced biliary tract cancer: Results of the Japan Clinical Oncology Group study (JCOG0805). Presenting Author: Chigusa Morizane, National Cancer Center Hospital, Tokyo, Japan

Background: Gemcitabine plus cisplatin combination (GC) therapy is the standard therapy for advanced biliary tract cancer (BTC). In previous trials, gemcitabine plus S-1 combination (GS) therapy and S-1 monotherapy had shown considerable efficacy in patients with BTC. The aim of this trial is to evaluate the efficacy and safety of the two regimens and to determine which is more promising as a test arm regimen for a subsequent phase III trial. Conclusions: The GS arm was superior in %1-year survival to S-1. Here we consider GS to be more promising as the test arm for a subsequent phase III trial comparing with GC.

• (Abstract #268) Cholangiocarcinoma: A joint cancer database analysis. Presenting Author: Yehuda Ethan Deutsch, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL

Background: Cholangiocarcinoma is an uncommon malignancy. In addition,only 10-30% of patients are eligible for curative surgical resection due to advanced disease at diagnosis. The role of adjuvant therapy is not yet established. The objective of this analysis is to assess the outcome of patients with cholangiocarcinoma managed with surgery, chemotherapy, radiation, and/or chemo-radiation. A total of 800 patients with the diagnoses of biliary cancer were reviewed. Conclusions: Chemotherapy and chemo-radiation had a positive impact on survival in patients with late stage cholangiocarcinoma. Surgery improved survival in both early and advanced stages.

• (Abstract #328) An interim evaluation of efficacy and safety of the combination of panitumumab, gemcitabine, and irinotecan in patients with advanced or metastatic cholangiocarcinoma: A phase II study. Presenting Author: Weijing Sun, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA

Background: Cholangiocarcinoma is an aggressive neoplasm. Current chemotherapy approaches suggest that combinations may be superior to single agents in this disease. Over-expression of epidermal growth factor receptor (EGFR) is associated with tumor stage and prognosis. This study was designed to evaluate the efficacy and tolerability of the combination of panitumumab, a monoclonal anti-EGFR antibody, with gemcitabine and irinotecan in patients with advanced and metastatic cholangiocarcinoma. Conclusions: The data of this on-going study showed encouraging results of the combination of panitumumab with gemcitabine and irinotecan in both tolerability and efficacy. The pre-specified efficacy criteria to continue enrollment were met. Further analysis by biomarker status (KRAS/BRAF/EGFR) is forthcoming

• (Abstract #377) Evaluation of chemotherapy with cisplatin plus gemcitabine after failure of gemcitabine alone for unresectable or recurrent biliary tract cancer. Presenting Author: Ryo Kameda, Division of Gastroenterology, Kanagawa Cancer Center Hospital, Yokohama, Japan

Background: As there was no standard chemotherapy for advanced biliary tract cancer before ABC-02, we had treated our patients with gemcitabine alone. However, recently cisplatin plus gemcitabine became standard as first line chemotherapy. We assessed the benefits of chemotherapy with cisplatin plus gemcitabine after failure of gemcitabine alone before ABC-02 era. Conclusions: Cisplatin plus gemcitabine can be an optional therapy for unresectable or recurrent biliary tract cancer after failure of gemcitabine alone.

Additional Abstract titles to look at in the proceedings:
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B3nbi8Y3dWuXZGY2OTFmYjEtZGZmYi00N2EwLWI0ZDctNDc4Mjg2N2Q0NDdk&hl=en_US
• (Abstract #161) Endoscopic ultrasound-guided fine needle core biopsy versus aspiration for gastrointestinal mass lesions: A randomized trial. Presenting Author: Nam Q. Nguyen, Royal Adelaide Hospital, Adelaide, Australia
• (Abstract #267) Patterns of recurrence after resection of intrahepatic cholangiocarcinoma: Results from a multi-institutional cohort of 449 patients. Presenting Author: Ioannis Hatzaras, Johns Hopkins University, Baltimore, MD
• (Abstract #288) Biliary tract cancer: A large institutional experience. Presenting Author: Mairead McNamara, Princess Margaret Hospital, Toronto, ON, Canada
• (Abstract #343) 90Y radioembolization for neuroendocrine cancers liver metastases provides sustained therapeutic effect with minimal toxicity. Presenting Author: Andrew S. Kennedy, Cancer Centers of North Carolina, Cary, NC
• (Abstract #346) Developments of treatment of advanced intrahepatic cholangiocarcinoma: An analysis of systemic and local therapy modes in 57 patients. Presenting Author: Patrick Stuebs, Otto-von-Guericke-University, Magdeburg, Germany

Good luck to all those out there in the midst of facing this cancer and keep up the good fight!

Tim