LOS ANGELES, Calif. -- Physicians and researchers from the University of Southern California (USC) Norris Comprehensive Cancer Center at Keck Medicine of USC are presenting multiple abstracts at the 2016 American Society of Clinical Oncology Annual Meeting, which takes place June 3-7 in Chicago, Ill. USC Norris's presence at the meeting includes 22 poster sessions (three of which are by ASCO MERIT award recipients), four poster discussion sessions, one oral presentation and an educational symposium from Stephen Gruber, MD, PhD, MPH, director of USC Norris. In the spirit of the meeting's "Collective Wisdom" theme, researchers have also collaborated with other institutions on several studies.
Among USC Norris's contributions to the meeting's collective wisdom, not-to-be-missed presentations include:
Panel Testing, Somatic Sequencing, and Genetic Implications (Extended Education Session: Genetic and Genomic Testing in Oncology Care)
Testing cancers for specific mutations that inform clinical decision making is the hallmark of precision oncology, but sometimes it is not clear whether mutations are uniquely driving the behavior of the cancers or happen to be inherited mutations present since birth. In this educational session, Stephen Gruber, MD, PhD, MPH, director of the USC Norris Comprehensive Cancer Center, provides specific clinical examples that illustrate the principles of somatic sequencing to care for patients, and the meaningful information that accompanies genomic testing. Incidental findings can extend beyond the typical practice of oncology, yet can offer unanticipated information to patients and families. This presentation highlights not only the specific actionable mutations that influence cancer care, but the perspectives of the patients and families who learn this information.
The Genomics of Young Lung Cancer Study, led by Barbara Gitlitz, MD, associate professor of clinical medicine, has drawn significant interest for its subject matter and novel methodology. The study hoped to show that young, stage four adenocarcinoma patients had a higher prevalence of targetable genomic alterations of interest than the Lung Cancer Mutation Consortium. Recruitment for the study occurred online, where subjects who met the criteria could provide their consent and tissue samples to USC Norris or mail the samples from anywhere in the world. While the study is still accruing, thus far 83% of the study's stage four adenocarcinoma patients indeed have an actionable mutation. Gitlitz will present the final results of her study and discuss next steps after two years of accrual.
Traditionally, surgery for localized gastric cancer is complemented by one of three adjunctive therapies: chemoradiation after surgery (adjuvant chemoradiation), chemoradiation before surgery (neoadjuvant chemoradiation), or chemotherapy before or after surgery (perioperative chemotherapy).
Afsaneh Barzi, MD, PhD, assistant professor of clinical medicine, presents her analysis of data from the National Cancer Data Base comparing the outcomes of these three modalities. Data from 20,000 patients who received one of these adjunctive therapies revealed that adjuvant chemoradiation had the most successful outcomes with a 17% survival advantage when compared to neoadjuvant chemoradiation and 13% advantage when compared to periopertaive chemotherapy. These results were not changed when patients were stratified for cardia vs. non-cardia tumor locations. Barzi's work highlights the importance of choice of adjunctive therapy in the outcome of patients with gastric cancer and underlines the needs for further investigation into ways to improve outcomes and, therefore, quality of care for gastric cancer patients.
Multiplex gene panels (MGPs) enable analysis of high- and moderate- penetrance genes at a much faster rate than testing individual genes. However, the value of screening for such a wide spectrum of potential genetic risks had not yet been analyzed. In his oral presentation, Gregory Idos, MD, assistant professor of clinical medicine, will report on his results from a collaboration with researchers at Stanford Cancer Institute. After evaluating a 25-gene MGP on 1,000 patients undergoing cancer risk assessment, they found that a significant portion of patients tested carried pathogenic mutations in unsuspected genes. This illustrates that MGPs can contribute greatly to clinical cancer risk assessment.
Repeated NOS2 Polymorphism Sequence May Contribute to More Positive Outcomes in Metastatic Colorectal Cancer (Abstract 294, MERIT Award Winner)
The inducible form of nitric oxide synthase encoded in the NOS2 gene is related to immune response. Conflicting studies have linked NOS2 to both beneficial and detrimental effects, and the expression of NOS2 has had similarly polar positive and negative effects on tumor progression. In this ASCO MERIT Award-Winning submission, Marta Shirripa, MD, analyzes the role of a repeat sequence polymorphism in the gene NOS2 among metastatic colorectal cancer patients treated with FOLFIRI and bevacizumab in the TRIBE trial. Patients with a higher number of repetitions in this specific region of NOS2 derived increased benefit to treatment than those with fewer repetitions. The effect of the number of repetitions seemed to be even more pronounced in a specific subgroup of patients carrying RAS mutations. The gene variation appears to increase expression of NOS2, which may indicate the gene's role as a tumor suppressor in metastatic colorectal cancer.
The Opportunity Cost of Radical Prostatectomies Performed by Low-Volume Providers (Abstract 6509)
A previous study led by Sarmad Sadeghi, MD, PhD assistant professor of clinical medicine, presented at the 2014 ASCO Genitourinary Cancers Symposium and published in Prostate Cancer and Prostatic Disease in 2015 demonstrated that performing radical prostatectomies at high volume centers is associated with societal cost savings as a direct result of fewer treatment failures. These savings, estimated to be about $1800 per prostatectomy over 20 years, could be allocated towards the referral costs for patients to receive their care at a high volume center.
This year Sadeghi and colleagues present the results of their research into the geographic distribution of prostatectomies in Medicare population across the US to determine the physical distance between surgeries performed by providers with below median volumes to those performed by providers in top 10 percentile of surgical volume. They argue that considering a 100 mile radius as reasonable travel distance with minimal referral costs, 18% of surgeries by providers with below median annual volume could be redirected to providers in the top 10 percentile of volume. This could result in significant societal savings and, more importantly, better outcomes for patients and higher quality of care delivered in our healthcare system.
Click here for a full list of presentations from USC Norris physicians and researchers.
ABOUT USC NORRIS COMPREHENSIVE CANCER CENTER
USC Norris Comprehensive Cancer Center has been leading the fight to make cancer a disease of the past. As one of the eight original comprehensive cancer centers in the United States, its mission is to treat and prevent cancer by advancing and integrating education, research, and personalized patient care. For 40 years, USC Norris has been revolutionizing cancer research with innovative surgical techniques and novel cancer treatments. The cancer center's breakthroughs and discoveries in the field of epigenetics have led the way to a greater understanding of the underlying causes of cancer and new methods of prevention, detection, and treatment. With a multidisciplinary team of more than 250 dedicated scientists and physicians, USC Norris Comprehensive Cancer Center offers patients hope in the battle against cancer.
For more information, visit uscnorriscancer.usc.edu.
ABOUT KECK MEDICINE OF USC
Keck Medicine of USC is the University of Southern California's medical enterprise, one of only two university-based medical systems in the Los Angeles area. Encompassing academic, research and clinical excellence, the medical system attracts internationally renowned experts who teach and practice at the Keck School of Medicine of USC, the region's first medical school; includes the renowned USC Norris Comprehensive Cancer Center, one of the first comprehensive cancer centers established by the National Institutes of Health (NIH) in the United States; has a medical faculty practice, the USC Care Medical Group; operates the Keck Medical Center of USC, which includes two acute care hospitals: 401-licensed bed Keck Hospital of USC and 60-licensed bed USC Norris Cancer Hospital; and owns USC Verdugo Hills Hospital, a 158-licensed bed community hospital. It also includes more than 40 outpatient facilities, some at affiliated hospitals, in Los Angeles, Orange, Kern, Tulare and Ventura counties.
U.S. News & World Report ranked Keck Medical Center of USC among the Top 10 in ophthalmology (No. 9), and among the Top 25 hospitals in the United States for urology (No. 20) and cancer care (No. 23).
For more information, go to http://www.