ASCO meeting

Townsend Letter for Doctors and Patients,  August-Sept, 2004  by Ralph W. Moss

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I have just returned from the 40th annual meeting of the American Society for Clinical Oncology (ASCO). The meeting coincided with my 30th anniversary in the cancer field, as I was hired as science writer at Memorial Sloan-Kettering Cancer Center on June 3, 1974. And so this trip was a very good time for me to reflect on the status of complementary and alternative medicine (CAM) and the changes that I have witnessed in the war on cancer over the past three decades.

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The first word that comes to mind in reference to ASCO's meeting is "huge." There were over 25,000 participants, mostly medical oncologists, and they took over New Orleans' cavernous 1.1 million square foot Convention Center. They came to lecture and be lectured to about the latest advances in cancer treatment. In addition to the gargantuan plenary sessions, there were hundreds of smaller sessions and approximately 1,500 poster and oral presentations, and 8,500 other research summaries given as Abstracts. Oncologists swarmed around the towering commercial exhibits, read and discussed the latest research and of course schmoozed, dined and did whatever professionals do when they assemble for a collegial good time.

Although I was aware of the featured papers I was more interested in gathering information on unusual, unconventional and out-of-the mainstream treatments than on those that grabbed the headlines. I must say that I came away disappointed.

The takeaway message of the meeting, repeated in a thousand stories, was that "little by little, new targeted therapies are helping cancer patients live longer, even if they do not offer miraculous cures ..." (Borden 2004).

The New York Times, on its front page, featured an anecdote about a single patient who appeared to have benefited from a new Bayer drug in a clinical trial (Pollack 2004a). I guess I have been down this road too many times in the last 30 years to put my faith in such anecdotes, until I see the promising results confirmed in rigorous clinical trials. In the meantime the public is kept from seeing the real picture which is that advanced cancer is no more curable today than it was 30 years ago, a sobering truth that was fully examined in a recent Fortune magazine article: Click or go here for a discussion of the Fortune article: http://www.cancerdecisions.com/040404.html

There are a million clever ways to dance around this central fact, but none of them can ultimately obscure this depressing truth.

You would think that in the face of this conspicuous lack of success the oncology profession would be eager to reach out for new ideas and concepts. And, as I have shown throughout my career, there are abundant new ideas in the world of CAM. But instead of welcoming CAM, they react to it as if it were a competitive challenge rather than an opportunity.

The majority of presentations at ASCO still concern cytotoxic chemotherapy, but the new twist is to add 'targeted' drugs, such as Iressa and Erbitux, to the mix. The existence of these new targeted drugs does raise some interesting possibilities, but one shouldn't put all one's eggs in one basket. The typical treatment protocol used to be based on the hypothesis 'What happens if we add drug A to conventional drugs B and C?' Now the question has become, 'What happens if we add targeted agent A to conventional drugs B, C and D?' The differences in outcome are tiny. Meanwhile, the combinations become more complicated and much more expensive--too expensive, The New York Times even suggested, for society ultimately to bear.

Meager Findings

Something radically new is needed. But, once again, the number of presentations on non-toxic or alternative treatments was meager. First, a word of caution. Like the three blind men studying the elephant, everyone comes away from a meeting this huge with their own distinct impression. Although I spent three days at the meeting I readily admit that I might have missed a few relevant presentations. (The Meeting Program itself runs to 341 pages and the Proceedings total over 1,000.) Nevertheless, the absence of CAM was conspicuous--and somewhat mystifying, also, in view of the fact that CAM treatments for cancer are generally acknowledged to be extremely important to patients and to society as a whole. For instance, a study presented at this year's ASCO meeting showed that fully "91% of patients surveyed reported using at least one CT [complementary therapy, ed.] since diagnosis" (Yates 2004). Ninety-one percent! Yet despite this, I found only a single lecture (out of many hundreds) that included a discussion of CAM. This was the Saturday (June 5) presentation on "Complementary and Palliative Care for the Treatment of Pediatric Cancer." Two speakers talked at length about palliative care as a distinct issue. Only one speaker, Kara Kelly, MD, an Assistant Professor of Pediatrics at Columbia University, New York, and co-chair of the Complementary Therapies Committee of the Children's Oncology Group (COG), then spoke about complementary medicine.