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Feb 27, 2020

Welcome to the ASCO Daily News Podcast. I'm Geraldine Carroll. I'm delighted to welcome back Dr. James Gulley, co-chair of the recent Immuno-Oncology Symposium in Orlando. Dr. Gulley is chief of the Genitourinary Malignancies Branch at the National Cancer Institute at NIH, where he also leads the immunotherapy group. Dr. Gulley, welcome back to the podcast.

Dr. James Gulley: Thanks so much, Geraldine. Delighted to be with you.

ASCO Daily News: Dr. Gulley, do you have any conflicts of interest that you'd like to disclose that are relevant to our conversation?

Dr. James Gulley: The National Cancer Institute has several cooperative research and development agreements with pharma industry that are focused on immunotherapy, including EMD Serono and Bavarian Nordic.

ASCO Daily News: All right. Thank you. Well, the recent Immuno-Oncology Symposium was the last co-sponsored by ASCO dedicated to immunotherapy. So what is the legacy of the meeting?

Dr. James Gulley: Well, one of the main goals of this meeting was to be able to make treating oncologists comfortable with giving therapy. And in order to do that, they needed to really understand the mechanism of action of the immunotherapy. They needed to understand how to diagnose and treat immune-related adverse events. And then they also needed to understand the level of effectiveness of these agents and the difference in what they might expect compared with chemotherapy.

Dr. James Gulley: For instance, immunotherapy is associated with rapid, deep, and durable responses, but it is the durability of these responses that often set it apart from other standard of care approaches and also offers the chance for potential cure of patient. I think that when we look at this from five years ago, we had a few approvals of immunotherapy, and we had a lot of interested treating oncologists, but I don't think that they had the level of comfort that they now have with giving multiple agents that are approved for multiple different indications and have really fundamentally changed the way we treat cancer for many common cancers, like lung cancer.

ASCO Daily News: You believe that the original goals of the I-O Symposium were met. In fact, we've gone far beyond expectations.

Dr. James Gulley: I would agree with that. I would say that we have really made a good major milestone, and that is the comfort level of the treating oncologists in being able to give these agents. And that is clear by how many times they are given in the US. I think this has been driven, in part, by patient demand and by outcomes of patients. It's also been driven by the ASCO-SITC meeting and allowing the treating oncologists to develop understanding and comfort level with giving these agents.

Dr. James Gulley: However, I really believe there is much work left to do. I think we have seen, over the past five years, there's been a dramatic increase in interest in clinical immunotherapy in meetings such as ASCO, and AACR, and ESMO, and others that are focused on immunotherapy. Of course, SITC has always been focused on immunotherapy.

Dr. James Gulley: But we're always going to have cancer with us. And I think that we need to develop better ways of diagnosing, preventing, and treating cancer. And I think that from an immunotherapy standpoint, earlier treatment and prevention, and there may be opportunities for diagnosis there too. But largely in the treatment setting, I think what we need to do is focus on opportunities to cure patients.

Dr. James Gulley:  I think that going from a three-month improvement in survival for somebody that is 45 years old is much different than going for a cure where they could live into their 80s. I'd also like to highlight something that I left the attendees within the closing remarks of this last ASCO-SITC Symposium. Number of sessions-- 18. Number of impressions on Twitter-- 7.3 million. Impact on the immunotherapy field of the ASCO-SITC Symposiums-- incalculable.

ASCO Daily News: Yes, indeed. So how do you see the field advancing? Where do we go from here in immunotherapy?

Dr. James Gulley: Geraldine, I think that's a really important question. So clearly, we have work ahead of us. I think we need to focus on smart combination therapies. I think that we are going to see immunotherapy moving earlier on in the disease course, as we can see that we can get good outcomes with lower levels of toxicity than other treatment approaches.

Dr. James Gulley:  And I think we're going to be able to look at clinically annotated correlative studies in the tumor microenvironment, especially as we go into the neoadjuvant settings where we can get really rich data sets, and this is also going to drive smarter combination therapies.

Dr. James Gulley: As we understand the impact of the therapy on the immune microenvironment and what regulatory mechanisms are at play, we can continually improve upon our ability to give smarter combination therapies that are going to have better impact in patients. And I would like to see this really being used as not just an incremental improvement in outcomes, but really pushing towards a cure for patients with advanced cancers, and also for patients with localized cancers, a decreased chance of the cancer coming back.

ASCO Daily News: Well, that sounds like a very good call to action. Thank you, Dr. Gulley, for joining us today on the Daily News Podcast.

Dr. James Gulley: Thank you so much. It was my pleasure.

ASCO Daily News: Thank you to our listeners for tuning into the ASCO Daily News Podcast. If you're enjoying the content, please rate and review us on Apple Podcasts.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.