Annual Meeting Proceedings Part 1 - American Society of Clinical ...

2s Special Awards
also “normalize” them, creating a window of opportunity to attack the cancer more effectively. Moreover, tumor
blood vessels’ normalization and improvement in tumor perfusion was associated with longer patient survival.
These observations led to a number of clinical trials aimed at identifying biomarkers of response and resistance to
antiangiogenic drugs. Our findings also opened doors to treating other vascular diseases, such as age-related wet
macular degeneration, a leading cause of blindness, and neurofibromatosis-2, which can lead to deafness. More
recently, we discovered that drugs capable of normalizing the extracellular matrix improve the delivery and
efficacy of molecular and nanomedicine. We are currently exploring this as a potential means of enhancing the
delivery of chemotherapeutics to desmoplastic tumors (e.g., pancreatic ductal adenocarcinomas).
ASCO–American Cancer Society Award and Lecture
Saturday, June 2, 3:00 PM
Reducing breast cancer risk: Progress toward resolution.
Rowan T. Chlebowski, MD, PhD; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center,
Torrance, CA
Randomized, full-scale clinical trials have 1) addressed lifestyle change in adjuvant breast cancer; 2) changed
concepts regarding menopausal hormone therapy and breast cancer; and 3) identified new approaches to breast
cancer risk reduction. The Women Intervention Nutrition Study (WINS) randomly assigned 2,437 women to
standard therapy � a lifestyle intervention targeting fat intake. Intervention participants reduced fat intake, lost
weight, and experienced a statistically significant increase in disease-free survival (HR 0.76, 95% CI
0.60–0.98, p � 0.03). Long-term follow-up is underway and the European SUCCESS-C study will evaluate the
emerging hypothesis that weight loss and increased physical activity will improve breast cancer outcome. The
Women’s Health Initiative (WHI) placebo-controlled trials randomly assigned 16,000 women with no prior
hysterectomy to estrogen plus progestin and 10,739 postmenopausal with prior hysterectomy to estrogen alone,
and opposite breast cancer findings were seen. Estrogen plus progestin significantly increased breast cancer
incidence, delayed diagnosis, and increased breast cancer mortality (mortality HR 1.96, 95% CI 1.00–4.05,
p � .048). Estrogen alone significantly reduced breast cancer incidence and breast cancer mortality (mortality
HR 0.37, 95% CI 0.13–0.91). The findings led to a worldwide reduction in hormone therapy use with substantial
reduction in breast cancer incidence seen in many countries. In the MAP.3 randomized primary prevention trial,
breast cancer incidence was significantly lower in the exemestane versus placebo group (HR 0.35, 95% CI
0.18–0.70, p �0.002). Emerging studies evaluated additional agents for chemoprevention. In cohort analyses
in 154,768 WHI study participants breast cancer incidence was lower in bisphosphonate users (HR 0.68, 95%
CI 0.52–0.88, p � 0.01). In cohort analyses in 68,019 WHI clinical trial participants, women with diabetes
using metformin had lower breast cancer incidence (HR 0.75, 95% CI 0.57–0.99, p � 0.04). These findings
support consideration of combination regimens for breast cancer risk reduction with toxicity profiles favorable for
board implementation.
B. J. Kennedy Award and Lecture for Scientific Excellence in Geriatric Oncology
Sunday, June 3, 9:45 AM
Geriatric oncology: Realities and hopes around a patient’s history.
Matti S. Aapro, MD; Clinique de Genolier, Genolier, Switzerland
One of the significant milestones in the development of geriatric oncology was in 1988 when B. J. Kennedy
commented in his Presidential Address at the ASCO Annual Meeting about the gaps in our knowledge in this
important field. Recognition of the situation by a major society like ASCO boosted the efforts of the research
community. The French GELA group demonstrated the feasibility of standard high-grade lymphoma chemotherapy
in elderly patients, and CALGB showed its importance in adjuvant treatment of breast cancer (Aapro M.
Launching the Journal of Geriatric Oncology: A historical milestone. J Geriatric Oncol. 2010;1:2–3). This
presentation will address the many prejudices and sad realities of geriatric cancer patients, by following a slightly
modified true patient history. We should recognize that there is a lot to do to overcome the obstacles that continue
to mean that older individuals do not receive the best possible care. But evidence for treatments tailored to the
real status of the patient and the true nature of the cancer is accumulating. The International Society for Geriatric
Oncology has identified three key areas of priority in this field: education, clinical practice, and research
(Extermann M, Aapro M, Audisio R, et al. Main priorities for the development of geriatric oncology: A worldwide
expert perspective. J Geriatric Oncol. 2011;1:270–273). Education should be targeted at both the professional
and the population levels. In clinical practice, pilot models of multidisciplinary collaboration should be expanded
first to key reference centers, and a two-step approach to screening and evaluation should be used to optimize
resource use. In research, several strategies can render trials more relevant for older patients. These priorities are
fully detailed in a monograph that can be viewed online at www.siog.org or ordered from siog@genolier.net.