Oct 23, 2019

ASCO Daily News: Welcome to the ASCO Daily News Podcast. I'm Lauren Davis. And joining me today is Dr. Gilberto Lopes, a medical oncologist and Medical Director for International Programs. He's also the Associate Director for Global Oncology at the Sylvester Comprehensive Cancer Center. And he's an Associate Professor of Clinical Medicine at the University of Miami.

Dr. Lopes has also served as co-chair of the organizing committee for ASCO Breakthrough, an event that brought together innovators in evolving science, technology, and research. Dr. Lopes, welcome to the podcast.

Dr. Gilberto Lopes: Thank you, Lauren. It's a pleasure to be here. And it's a pleasure to discuss all the findings that we had in Bangkok last week.

ASCO Daily News: We're glad you're here. Overall, how was the inaugural ASCO Breakthrough meeting?

Dr. Gilberto Lopes: It went as well as we could have expected. We had a wonderful meeting. And our co-hosts at Thai Society of Clinical Oncology did a superb job of making sure that everything worked on the ground. And all of our presenters, moderators, and panelists did a superb job about bringing to the fore things that will be in the reality of oncology in the next few years.

ASCO Daily News: So specifically drilling down into sessions, what did you find during ASCO Breakthrough that was really compelling?

Dr. Gilberto Lopes: Lauren, in reality, every section was really compelling, starting with the opening session by Dr. Steven Yang from WuXi AppTec. He actually kind of painted the general picture of what we wanted to discuss in the meeting. He talked about all of the innovations that we have already seen in cancer diagnosis and treatment over the last couple decades, with some emphasis on the beginnings of immunotherapy, kinase inhibitor, and target agents, but specifically talking about what we're going to see in the next five to 10 years, and what are the technologies that will help us truly have new breakthroughs in the management of cancer so that we can improve outcomes for our patients in years to come.

He very specifically emphasized the number of cancer drug targets that we have now in 2019 compared to just two years ago, 2017. While we had 263 targets in the pipeline two years ago, this year, we have 468 targets in the pipeline. So that's a number that is mind-boggling and shows us how fast the field of cancer drug development is actually moving forward.

And in terms of the numbers of immunotherapy trials, since 2014, the number has actually skyrocketed as well. In 2014, we had barely a little bit more than 200 trials with immunotherapy agents.

And in 2018, we had more than 800. So it's amazing to see how the volume of new trials and new discoveries seem to be accelerating as we move forward.

Beyond his general session and general discussion, he also mentioned the technologies that are likely to help us move forward, including artificial intelligence, the use of telemedicine, use of new preclinical models to develop new cancer drugs. And he didn't forget to mention one of the main issues that we have moving forward, which is how sustainable we can actually be in our health care systems, as the cost of these medications can now easily reach $500,000 to $1 million per patient.

Dr. Gilberto Lopes: So these are all issues that were truly discussed at length in most of our subsequent sessions from the opening. And that opening talk pretty much gave us a very good start to see what we would expect. We had sessions that were discussions. And these were TED-like talks in which presenters would show us what they're working on and discuss and review aspects of technology and innovation that are coming into oncology, including artificial intelligence and telemedicine, social media.
And we also had abstract sessions as well. And there's variety and always done in a way that the audience could have discussions-- this was a very open talk-type meeting, which is quite different than what we're used to seeing at the annual meeting. So we had enough time for the discussions to be quite deep and broad in each of these subjects.

So in general, as an example, most sessions get about 30 to 45 minutes in discussions and 30 to 45 minutes in open questions and participation from the audience as well. So this was a very, very interactive meeting. And we hope that that's going to be reflected in future ASCO meetings as well.

ASCO Daily News: That's great. It sounds like this new format's really working. Did you hear any practice-changing results from the studies?

Dr. Gilberto Lopes: We had a few abstracts that are actually hopefully going to be practice-changing in the next couple years-- nothing that truly changes the way we practice today. But again, this is a meeting for innovations that are on the horizon, not really for innovations that we can apply in clinic on Monday after the meeting ended. But a few things should definitely be mentioned.

So the use of plasma cell-free DNA methylation patterns as a way of detecting cancer early with a single blood sample, especially for cancers for which we don't have good screening, was one of the most important abstracts. That was an abstract represented by Dr. Ochsner with number 44.

But what's fascinating about this abstract that we should just mention quickly is that this is a study of more than 15,000 patients. And these 15,000 patients had blood samples, tissue samples, and were followed up for more than five years. And the investigators were able, using machine learning algorithms, to find patterns of methylation that were very interestingly useful in the diagnosis of cancers across stages from one to four. And using a specificity of 99.3%, they were able to actually take about 55% of cancers with a simple blood test.

So this is something that, of course, needs a lot more work, and we'll need prospective clinical trials for us to be able to bring to the clinic. But this is certainly one of the most exciting abstracts we had presented. And this is certainly one of the most exciting innovations that we hope to have in the next few years, which might be an amazing blood test to screen for cancers in the general population.

ASCO Daily News: That's very exciting. So based on the meeting, what do you think is on the horizon for artificial intelligence and machine learning in oncology?

Dr. Gilberto Lopes: So there's a broad use of machine learning and artificial intelligence across every aspect that is important in cancer today. We have studies looking into machine learning and pathology in specifics about molecular analysis to find factors that maybe predict the prognostic in specific malignancies. And we also have other areas, including drug development.

But I think that the area that seems to be the most advanced, and we will likely start seeing tools coming into the clinic in the next year or two, are radiology-related artificial intelligence advancements. We had another interesting abstract that was presented on deep learning in the detection of lung nodules in patients who have been screened for lung cancer. So this is one of the most underused screenings that we have approved in the US today. Fewer than 5% of patients who are actually eligible for low-dose computed tomography screening in the country are actually getting those screens done.

And our colleagues in China were able to access that very large database of imaging scans. And with that, they were able to use artificial intelligence to actually detect these nodules automatically. And while the results are not yet good enough for us to be able to use this as a tool, they do show that there is proof of concept.

And I think that's the level where we are for machine learning and artificial intelligence in general in oncology today. I think we have a number of studies in radiology and pathology and in other areas showing that we have proof of concept for the use of artificial intelligence. We now need to continue developing this technology so that it can become useful in clinic.

The discussions centered around if this is something that would substitute for the work of physicians. But it's more likely that these new technologies will be able to actually enhance what we do as clinicians.

ASCO Daily News: That's terrific. It sounds very exciting for the future of oncology care.

Dr. Gilbert Lopes: Absolutely.

ASCO Daily News: Again, today, my guest has been Dr. Gilberto Lopes. Thank you so much for being on our podcast today.

Dr. Gilberto Lopes: My pleasure, and I encourage everybody who's listening to actually access the meeting presentations from ASCO's website, which will give you a much, much broader and deeper view of everything that we discussed in Bangkok. Thank you very much for listening.

ASCO Daily News: And to our listeners, thank you for tuning into the ASCO Daily News Podcast. If you're enjoying the content, we encourage you to rate us 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.