Evolution and revolution of clinical trials in GI cancer: endpoints and magnitude of clinical benefits
The gold standard for establishing the efficacy of new cancer therapies is a phase III randomized controlled trial. Over the past 3 decades, there has been a marked shift in the primary endpoint of cancer clinical trials with increasing use of surrogate endpoints, as well as an increase in trial sample size. Several reports have shown that the incremental gain of new cancer therapies is getting smaller over time. The expanding number of systemic therapy options has raised important considerations regarding patient-reported toxicity and financial toxicity. It is therefore imperative that regulatory bodies carefully consider which treatments will offer the largest clinical benefit within a sustainable health care system. To this end, both ESMO and ASCO has established task forces to rank the magnitude of benefit of the new anti-cancer agents.
Radiation Oncology Workshop – Oesophageal Cancer
Co-Chairs: Meredith Johnston and Dominique Lee
Gullets and Mullets: What’s changed in 30 years of oesophageal cancer treatment (and hairstyles)?
It has been almost thirty years since the RTOG 85-01 trial established definitive CRT as the standard management for non-operative localised oesophageal cancer. During this time, patient demographics and tumour subtype distribution have changed, additionally radiation techniques an organ support during chemotherapy have improved dramatically. Despite a lack of randomised data directing radiation oncologists, greater interest in elective nodal irradiation, dose escalation, organ preservation, altered concurrent chemotherapy regimes and immunotherapy have laid the foundations for oesophageal and GOJ cancers to be increasingly complex. In this interactive radiation workshop, we discuss these controversies through case presentations.
Panel discussion: Karin Haustermans and Trevor Leong
Keynote Session: Practical Genomics in GI Cancer – Sponsored by Servier
Co-Chairs: Stephen Ackland and Oliver Sieber
Geoff Cooper first imagined Ras mutations as a driver of cancer at the cusp of the 1980s. “A Genetic model of colorectal carcinogenesis” by Fearon and Vogelstein published in 1988 had a huge impact as measured by ~14,000 citations; expanding our attention to three genes. DPD deficiency causing 5FU toxicity was first reported in 1985. These landmark reports are 4 decades ago and perhaps now is a good moment to reflect on how to exploit the massive amount of subsequent genomics knowledge into practice.
Screening for DPD deficiency: Should it be done before starting fluoropyrimidine?
Presenter: Julien Taieb
Genomic sequencing in GI Cancer: What you need to know in the clinic
New Concepts Symposium – Sponsored by Amgen
Co-Chairs: Lorraine Chantrill and Katrin Sjoquist
The New Concepts Symposium is designed as a novel way to reach out to a wider spectrum of the group. This session provides an opportunity for delegates to present embryonic new concepts for feedback and discussion with the audience as well as comments from international guests in terms of perspective, international interest and relevance. A good idea can be tested and a perception gained on whether to take the concept forward to a more formal review by the Upper or Lower GI Working Party. The identification of other AGITG members who may wish to assist in progressing the concept as an AGITG supported protocol is also possible. The winner of the Best New Concept Award, sponsored by Amgen, will receive a $3,500 prize and a framed certificate. The runner up will receive a $1,500 prize and framed certificate. The Awards are presented at the Annual Scientific Meeting Awards Session taking place on Friday 15 October, and details of the Award recipients are published on the AGITG website and in the Annual Report.
1 . A phase 1 study of a novel drug-eluting polymer implant for intra-tumoural delivery of 5FU, Folinic Acid, Irinotecan and Oxaliplatin (FOLFIRINOX) in combination with systemic chemotherapy for inoperable locally advanced pancreatic cancer (ILAPC).
Presenter: Morteza Aghmesheh
Faculty reviewer: Yu Jo Chua
2.BIOMARCER1 (Biomarker informed optimal management of advanced ras wild type colorectal cancer)
Presenter: Shehara Mendis
Faculty reviewer: Sina Vatandoust
3.Amivantamab activity in Colorectal carcinoma previously treated with an EGFR monoclonal antibody – The ACE study
Presenter: Tim Clay
Faculty reviewer: Connie Diakos
Best of the Best – Sponsored by Servier
Co-Chairs: Stephen Ackland and Oliver Piercey
The AGITG Annual Scientific Meeting accepts abstracts for posters for selection by the Executive Organising Committee. Posters are displayed in the exhibition area. Four posters are chosen for presentation in the Best of the Best Session. Each presenter has seven minutes to present with three minutes for questions. Four posters are also chosen for Fast Forward presentation.
The AGITG recognises excellence in the Posters Sessions at each annual meeting. The winning presenter in the Posters Session receives a $3,500 prize and framed certificate. The winning presenter in the Fast Forward session receives $1,500 and a framed certificate. The Awards, sponsored by Servier are presented at the Annual Scientific Meeting Awards on Friday 15 October, and details of the Award recipients are published on the AGITG website and in the Annual Report.
Long term survival and toxicity in patients with progressive advanced neuroendocrine tumours treated with Lutetium-177-Octreotate Peptide Receptor Radionuclide Therapy: A Western Australian long term follow-up study
Real-world characteristics and outcomes of potentially resectable oligometastatic colorectal cancer
Health economic evidence for circulating tumour DNA guided adjuvant chemotherapy in stage II colorectal cancer
Yat Hang To
Comprehensive genomic profiling reveals novel opportunities for treatment-refractory gastrointestinal cancers
Wei Yen Chan
Translational Science Symposium – Sponsored by Bayer
Co-Chairs: Robert Ramsay and Laura Jenkins
Determinants of patient outcome, therapy response and new targets
It is proving unhelpful to consider colorectal tumours as a single entity. This is clearly demonstrated by genomic analyses into definable consensus molecular signatures that underpin marked differences in responses to standard of care therapies. Beyond these signatures the deep delving into the genetic drivers of CRC has been de rigueur and some are now showing exquisite and surprising responses to targeted agents. All that said it is truly remarkable how the immune milieu so impressively governs patient outcomes. Putting all this together, it is highly likely that advances for our patients will depend heavily on embracing these exciting developments as best practise.
Where to next with stratifying CRC by consensus molecular signatures?
Presenter: Jonathan Loree
At last there are agents to target the RAS/RAF pathway with precision Presenter: Jayesh Desai
The tumour immune microenvironment over-arching our understanding of CRC – the development and implementation of the “Immunoscore” platform Presenter: Jerome Galon
Current and Emerging Multimodality Treatment Options for Hepatocellular Carcinoma Co-Chairs: Chris Nahm, Sumitra Ananda and Dominique Lee
The management of patients with hepatocellular carcinoma (HCC) is complex where treatment options are determined both by disease extent and the severity of underlying liver disease. Additionally, no single staging system is applicable to all patients and a wide variety of treatments are offered by different specialties: surgery, radiation oncology, medical oncology, hepatology and interventional radiology. New treatments and indications are also evolving rapidly, challenging attempts to generate algorithmic approaches to the treatment of HCC. It is therefore critical that individual patients undergo multidisciplinary evaluation and planning to generate an optimal management plan.
Treatment sequencing in patients with advanced HCC: Is there an optimal strategy? Presenter: Ghassan Abou-Alfa
Emerging and novel therapeutic approaches in advanced HCC
Presenter Simone Strasser
The role of SBRT in HCC
Management of early HCC multi-focal HCC
Chris Nahm, Sumitra Ananda, Dominique Lee, Simone Strasser and Pierce Chow
AGITG into the Future: Strategy, Culture and Trial Design
For 30 years, the AGITG has been the premier cooperative GI trials group in the region, but the COVID-19 pandemic has shown that no one is immune from the need to adapt. Many current and future issues could affect the group’s survival and sustainability. Led by a panel of next-generation leaders, this session invites all members to ponder and discuss the future of the AGITG: What trial designs will we undertake in the next 5-10 years? How can we position ourselves to deliver them in the best possible way? How do we engage new talent to join the Group?
ACTA’s perspective on cooperative trials groups in the future
Presenter: John Zalcberg OAM
UK Trials and Tribulations: Perspectives from the overseas AGITG fellow
Presenter: David Lau
Panel Discussion: Belinda Lee, Jan Mumford, Ros Murphy, Sweet Ping Ng, Oliver Piercey, Belinda Steer and Deborah Wright