Behind the Breakthroughs and Practice-Changing Advances: Insights from ESMO 2024

This is Pharmaphorum web editor Nicole Raleigh. And I am on site at ESMO 2024 in sunny Barcelona. And today I have with me experts from EVERSANA, a parent company of Pharmaporum. Today we’ll be exploring the 2024 European Society for Medical Oncology Conference and looking at key trends and takeaways from that. First of all, please could you introduce yourselves? Let’s start with you, Barry.

Hi, I am Barry Vuscko, SVP of Strategic Development. And I’m here with a group of true experts because these are the group of people from our Oncology Center of Excellence, Gurdip Daffu. I am a VP of medical strategy with EVERSANA INTOUCH, Anne Marie Robertson, Executive Vice President and I run the outsourced commercialization for oncology. Vanitha Sankaran, VP of medical strategy at EVERSANA INTOUCH.

So one of the things that I saw, I think more than I’ve seen at ASCO or EA or ASH over the last few years, is the talk about AI. This has been big news here, and I know this afternoon it’s going to continue to be news in the Presidential Symposium three, but there’s been a short talk yesterday that talked about AI, but it’s also been just chatter on the floor. I mean, you can see that they’re talking about it more and more on the floor, just walking the floor. You hear people talking about it more seriously than they’ve ever talked about it before. In the short talk yesterday, they talked about practical ways to actually use AI, even in treating patients and how to come up with treatment plans for patients, which I’ve never actually heard a lot of talk about before. Seriously. And that’s the thing that I think is really exciting because I think the more we talk about that, the more that becomes a reality and the more we get closer to a cure. So purposeful AI, not just jumping on the bandwagon. Right.

Okay. So what about other sort of unique things we’ve been hearing at ESMO this year? Well, I can talk about how the promise of biomarker research is starting to come to fruition. We are starting to see, you know, on the floor, in the exhibit hall and in the talks, people talk about diseases as a continuum or a spectrum. It’s not just that a patient has a particular disease, they have it with certain biomarkers. And a lot of this biomarker research is fueled by AI. And, really digging into patient characteristics and how the presence of a biomarker now can impact the physician’s choice of treatment. They can say to their patient, you know, you have this disease, you have these biomarkers, so you’re gonna respond to treatment A much better than treatment B or C. And that’s really exciting because that means our response rates are gonna go up and patients are really getting that sense of personalized medicine.

Exactly. Bringing in this personalization, the individual, the patient as human individual at the center. Anne Marie, any insights into the unique trends at ESMO 2024?

One of the trends I’ve seen is really meaningful. Multidisciplinary interaction, like two of the presidential papers I thought were really great in terms of going out, being able to use what we learned immediately. One was in prostate with enzalutamide being combined with radium 223. And one was a really cool cervical cancer trial where radiation, chemotherapy and pembro were used together, and the trial was recruited all across the world. So I walked out of there thinking like that was learning that everybody in the room could go home and use right away.

Thank you. And we’ll come back to this sort of putting it center more women’s cancers actually, that’s for me personally, that’s come to the fore this year. And anything else?

Yes. Thank you. What I’ve really noticed is all the research and advances that we’ve seen with circulating tumor DNA or CT DNA, there’s been great advances. On day one we heard a talk where they reported that CT DNA will soon be informing staging with solid tumors. And that’s something new. And it just shows how far we’ve come over the last few years even. And just yesterday we heard a really great talk on CT DNA showing that the evidence is accruing where we can show the clearance of CT DNA before and after treatment or even surgery, that may be soon a surrogate for long-term clinical outcomes in patients. And that’s, that’s a milestone. And that, that’s really just promising.

So if we come back to your thought, Barry, about the AI and its purposeful implementation and how it could be used in the patient program as it were put together by the HCP, does anyone else have some thoughts that they’ve heard various things at the conference this year on AI in that regard, or in another regard?

I mean, there was a great talk yesterday about AI in terms of not only that, what we’ve been hearing about over the years and the impact it’s going to have with pathology and radiology, but also now with medical oncologists and how it’s going. It may, you know, impact their role and their day-to-day functions. I think the jury’s still out though to see where the chips land with all of these roles. But we’re slowly making progress, and we’re seeing where it can be most utilized to be of benefit to the healthcare provider, but also for patients. And it, and it sometimes it’s even just the day-to-day function, right? Like transcribing, what’s happening in the clinic that can save hours on healthcare provider’s day. So it’s, it’s also, you know, these other things that we don’t necessarily see research on or presentations on. But I think just that day-to-day function will be interesting.

There were some cool jokes about how you should not put your patient’s name into AI because of the data privacy concerns and some really cool jokes about like whether or not you can ask what the appropriate regimen is and like how to ask that question to actually get viable information versus vocabulary words that might lead you to information that’s less really impactful.

Yes. I would also add there that there are a lot of different kinds of AI models and, you know, some of these have been tested and approved for a particular type of setting, with regards to the regulatory rules and whatnot. And there was some statistic about how, a few years ago there were hundreds of these models that were being tested and approved. Now there are thousands. And so it’s a little bit of a cautionary tale, like we want to make sure that we’re using the best of this technology. But like my colleagues have said, we don’t want to go awry, we don’t wanna rely on the new version of Dr. Google.

No, exactly. I also had something coming back to the women’s cancer focus about also avoiding that gender bias in the training of the AI still. And it referenced back to the Amazon debacle a while ago now. So AI very much still has to have the human in the loop and has to have very careful training and as you say, no names into the system when, and also not just the gender bias, but racial and ethnicity bias. Yes, exactly.

So if we switch now to diagnostics, one thing I noticed was incredible patient engagement in the ALK area of lung cancer, which is a little bit interesting because I saw less patient engagement in areas where you would normally expect it, like breast cancer. But there were multiple talks here that talked about the Ross determinant inside the ALK area and really powerful women speakers talking about how advocacy makes a big difference in asking for those tests and understanding what exact type of lung cancer you have.

Yes. Bringing this patient voice in for advanced. No, you know, speaking of patient voice through doctors this time is there’s a very interesting exhibit out on the floor now asking people to come help design the trials that they want to see. You know, we talk a lot about diversity in trials and enrichment of trials, but here they’ve got, this company has their pipeline there and they’re inviting commentary from all the attendees. What do you want to see in these trials? What demographics are you looking for that you haven’t seen before? And that’s kind of an interesting take.

It’s important because we still hear quite a lot broadly how clinical trials aren’t yet hitting all those demographics. And there is, there are pockets of medicine that haven’t actually looked at particular pockets of society and it’s no longer acceptable and should never have been acceptable.

Let’s go more generally. So rapid advancements, there have been multiple that have been spoken about obviously within the field of oncology this year. What do we want to speak about and sort of highlight from the conference?

So yesterday there was a great presentation in the presidential symposium about using a PD one inhibitor for anal cancer. And really exciting because these, these inhibitors have been around for a numbers of years now in different oncology indications. Never seen it before in anal cancer. And to have a success with what we might consider an older type of drug in a new space, it’s just really exciting, very exciting. And excitement has been a word as well. So if we think about excitement, we think about rapid advancements and maybe pass the mic along Anne Marie, for example, do you want to go back to some of the developments that we’ve heard about in women’s cancers? You mentioned cervical cancer earlier. Are there any other cancers you wanted to highlight?

Progression in one of the larger talks yesterday was about whether or not you do both an IO checkpoint inhibitor prior to surgery in triple negative breast cancer as well as post-surgery. And I think everybody watching was really intrigued by the data, but that’s some, certainly an area we’re going to have to look and see what happens with like authorization reimbursement. And does that actually become practice changing?

Yes. And reimbursement with these new advancements also has been talked about at the conference, the practicalities of it. So there is access eventually. Well in terms of for women’s health, I attended a presentation the day before yesterday where the OS data read out for the PARP inhibitors, Zejula and Ruba, and they were negative. So it was pretty astounding when you have such a positive result with PFS and that alone is helping so many patients. So it begs the question if OS is the right endpoint in this area. There was great discussion about that following the presentations. But you know, we see patients benefiting from these drugs, so it’s disappointing to see that we didn’t see the OS benefit.