I was fortunate to be one of the 31,000 in-person participants at the annual meeting for the American Society of Clinical Oncology – ASCO.
ASCO 2022’s theme was Advancing Equitable Cancer Care Through Innovation – a timely concept, as the COVID-19 pandemic has been demonstrated to exacerbate cancer care disparities for racial, ethnic, and underserved populations. Everywhere you turned at the meeting, held in the 2.6 million square foot McCormick Center in Chicago – there were data, presentations, and messaging about doing more to ensure no patient is left behind the amazing advancements happening every day in oncology.
In fact, the biggest news and most heralded presentation at the meeting demonstrated equitable care at its best. The Plenary session held at each ASCO annual meeting features oral presentations of clinical data that are deemed to be “practice changing” – a common question among presenters and attendees after the Plenary session is “What are you going to do on Wednesday?” – meaning, how will you change your treatments based on these findings?
At this year’s session, one of the four presentations was on the Destiny-04-Breast study. These were the results of a Phase III study in advanced breast cancer comparing traditional therapy with an innovative drug, Enhertu ® (trastuzumab deruxtecan) that combines toxic chemo with a targeting antibody to the HER2 protein found on breast (and other) cancer cells. It drops the toxic payload directly onto the tumor cells, avoiding healthy tissue. There is a great deal of interest in these drugs – known as antibody drug conjugates – since the launch of the first, Adcetris, in 2011 (with support from the Syneos Health Communications oncology advertising agency!). This drug was studied against the physician’s choice of agents normally used in this setting – mainly, forms of chemotherapy. In this study, Enhertu® enabled patients with advanced breast cancer to live half a year longer than those on the traditional therapy.
No wonder there was a prolonged standing ovation, right? But the real power of this study is in who these patients are.
This study was done in patients who had “low” expression of the HER2 protein – so low, in fact, that they would not be considered positive for HER2. And if they are not positive for HER2, nor for hormone receptors, then their cancer is considered “triple negative” – a type of cancer with a very poor prognosis. DESTINY-04-Breast included more than 10% of patients with this type of breast cancer.
But this study demonstrated that the legacy cut off to determine HER2 positivity can now be extended to these HER2 Low patients – which means approximately 50% more patients are now candidates for an exciting and effective innovation.
Of course the question remains – will all the patients who are now eligible for this treatment get access to the treatment? That remains to be solved. But the results of this study now give them equal eligibility and a powerful benefit from innovation – a key step towards equitable care.