Leading experts in radiation oncology from Brigham and Women’s Hospital will present peer-reviewed abstracts and engage in interactive discussions about clinical advancements for the treatment of patients with cancer at The American Society for Radiation Oncology (ASTRO) 2019 annual meeting from Sept. 15-19. The meeting is expected to attract more than 10,000 oncologists, clinicians, researchers and other health care professionals from across the globe. Reporters can register to cover the meeting and news briefings at www.astro.org/ASTRO19press. Some of the highlights include:
A Prospective Phase I trial of Concurrent Cisplatin (CIS) and Radiation Therapy (RT) in Women with Stage II and III Triple-negative Breast Cancer (TNBC)
Who: Presenter: Jennifer Bellon, MD, Director, Breast Radiation Oncology
Summary: Patients with triple-negative breast cancer (TNBC) experience a higher rate of recurrence. Cisplatin (CIS) is an effective systemic chemotherapy in TNBC and is also an agent that makes tumor cells more sensitive to radiation therapy. This prospective, phase Ib trial was designed to assess safety and toxicity and establish the recommended phase 2 dose of concurrent CIS with adjuvant radiotherapy for women with stage II and III TNBC.
Artificial Intelligence Will Drive Who We Treat for Cure with Metastatic Disease and How We Treat Them
Who: Presenter: Raymond Mak, MD, Thoracic Radiation Oncologist
Summary: Radiation therapy is a potentially powerful tool to aid in the cure of metastatic cancer. The challenges of determining which patients will benefit and how best to treat them represents an increased complexity of both data and predictive models beyond the current state-of-the-art radiation therapy paradigms for localized disease control. In this session, Dr. Mak and his co-moderators will explore the use of artificial intelligence (AI) to aid in converting complex information to clinically actionable activities that seek to cure metastatic disease. They will debate the ability of AI to identify patients that will benefit from radiation; how AI can help select the appropriate care plans for a given patient to include localized and systemic therapies; and how AI can help design the ideal radiation therapy treatment, including which metastatic sites to target and when. Debate will be focused on the data and infrastructure necessary to utilize AI, the current understanding of patient outcomes, the required prognostic information about the patients, and the potential for the success of AI to support the charter towards curing metastatic disease.
Is There a Standard of Practice in Oncologic Care for Transgender Patients?
Who: Brigham presenter: Danielle Bitterman, MD, Resident Physician, Harvard Radiation Oncology Program
Brigham moderator: Daphne Adele Haas-Kogan, MD, FASTRO, Chair of the Department of Radiation Oncology; and a team of Brigham radiation oncologists
Summary: Presenters and moderators will discuss addressing the health care needs of transgender cancer patients, reviewing the current evidence about patients' experiences and outcomes. Speakers will explore how the oncology community utilizes a binary gender approach to cancer, such as strongly associating females with breast cancer and males with prostate cancer, and assess steps to make resources more inclusive of transgender patients. There will be a special emphasis on language and communication with transgender patients. The team will engage with participants to discuss collecting and publishing data to work toward a data-driven standard of care for transgender radiation oncology patients.
When Conventional Wisdom Leads Us Astray
Who: Brigham presenters: Alexander Spektor, MD, PhD, Department of Radiation Oncology, and Rifaquat Rahman, MD, Department of Radiation Oncology
Brigham moderator: Daphne Adele Haas-Kogan, MD, FASTRO, Chair of the Department of Radiation Oncology; and a team of Brigham radiation oncologists
Summary: This session will explore examples of where conventional wisdom has led the field of radiation oncology. It will touch on examples of where treatment intensification and de-intensification have led to surprising results, such as in trials of treatment for rhabdomyosarcoma and medulloblastoma in pediatric oncology and in non-small lung cancer. The panel will also address the pitfalls that can arise in the application of new technologies, such as intensity-modulated radiation therapy (IMRT) in mesothelioma, and the need for caution in such endeavors. The discussion will also address design or misinterpretation of clinical trials, including the use of surrogate endpoints, as seen in early phase trials of bevacizumab in glioblastoma, which showed positive results without anti-tumor effect.
Role of radiotherapy dose-escalation for high-risk neuroblastoma with post-surgical primary site gross residual disease: a report from the COG ANBL0532 study
Who: Presenter: Kevin Liu, MD, D. Phil, Resident Physician, Harvard Radiation Oncology Program
Summary: Neuroblastoma is the most common extracranial solid malignancy occurring in childhood. For patients with high-risk neuroblastoma, local recurrence continues to be a significant challenge despite aggressive treatments that include chemotherapy, autologous stem cell transplantation, surgery, radiation therapy, and immunotherapy. One of the main goals of the recent Children’s Oncology Group trial for high-risk neuroblastoma explored whether increasing the radiation dose for patients who had an incomplete surgical removal of their primary tumor would improve local control. The team found that there was no benefit to increasing the dose of radiation for those patients with an incomplete surgical resection and residual tumor after surgery. Therefore, the investigators recommend the standard dose of 21.6 Gy to the primary tumor site for all patients with high-risk neuroblastoma, including patients with gross residual disease after surgery.
The genomic landscape of anal cancer and its relationship to clinical outcomes: an exploratory analysis of NRG Oncology/RTOG 98-11
Who: Presenter: David J. Konieczkowski, MD, Resident Physician, Harvard Radiation Oncology Program
Summary: Over the past several decades, radiation oncology has made dramatic advances in spatial precision — tailoring treatment to the specific location of a patient’s tumor while avoiding uninvolved normal tissues. But genomic information may also allow us to tailor treatment to the biology of an individual patient’s tumor — thus bringing a “precision oncology” paradigm to radiation oncology. Investigators performed the largest-ever whole exome sequencing study of anal cancer and identified (1) frequent PI3K pathway alterations, which may be important in anal cancer development; (2) that EP400 mutations, which may influence HPV-driven cancer development, are associated with younger age at diagnosis; and (3) that mutations in FBXW7, a tumor suppressor, are associated with worse outcomes after definitive-intent chemoradiation. These results suggest how genomic information can enable a biologically informed vision of precision radiation oncology and help advance care for patients.
Left Coronary Artery Dose Exposure Predicts Major Adverse Cardiac Events in Coronary Heart Disease Negative Lung Cancer Patients
Who: Presenters: Raymond Mak, MD, Thoracic Radiation Oncologist and Katelyn M. Atkins, MD, PhD, Resident Physician, Harvard Radiation Oncology Program
Summary: Mak, Atkins and colleagues sought to identify cardiac substructure dose variables predictive of MACE (myocardial infarction, cardiac death, revascularization, heart failure) in patients with non-small cell lung cancer (NSCLC). The team conducted a retrospective analysis of 449 consecutive locally-advanced NSCLC patients treated with thoracic radiotherapy and without pre-existing coronary heart disease. The investigators found that left circumflex V15 Gy ≥15% and left anterior descending V15 Gy ≥23% conferred an 8- and 14-fold increase, respectively, in the 1-year cumulative incidence of MACE in patients without baseline coronary heart disease. The authors conclude that these newly identified left coronary dose-volume thresholds are worthy of further study for validation as critical cardiac substructure dose constraints for radiotherapy planning are currently lacking.
