Sydney, Australia held the 17th Australasian Gastro-Intestinal Trials Group (AGITG) Annual Scientific Meeting (ASM). On September 2-4th 2015, the conference attracted 330 delegates to hear the latest advances in gastro-intestinal cancer research worldwide, to share results of completed trials and to discuss and plan for future studies.
The ASM included leading Australian and New Zealand medical and radiation oncologists, surgeons, consumers, research nurses, study coordinators, biostatisticians and other trials management staff. The co-convenors A/Prof Eva Segelov and A/Prof Niall Tebbutt have once again delivered an excellent program, highlighted by informative presentations and discussions by our international attendees. Expert international attendees included:
- A/Prof Alberto Bardelli – University of Torino, Italy
- Dr Johanna Bendell – Sarah Cannon Research Institute, USA
- Dr James Fleshman – Siteman Cancer Center, USA
- Dr Hagen Kennecke – British Colombia Cancer Agency, Canada
- Dr Scott Kopetz, MD Anderson Cancer Centre, USA
- Prof Tim Maughan, University of Oxford, UK
- Prof Bruce Minsky, MD Anderson Cancer Centre, USA
The first day of presentations focussed on Upper GI cancers and principal investigators of several AGITG led trials provided a progress update and a synopsis of key lessons learned for these trials. The opening keynote sessions highlighted the importance of patient selection for a range of novel therapies and the technological advances in radiotherapy and how best to integrate these into clinical practice. Prof Maughan discussed the incorporation of immune checkpoint inhibitors into chemoradiotherapy schedules, ATR inhibition to radiosensitise tumours and PI3K-AKT axis blockade to reverse hypoxia. Prof Minsky discussed a changing treatment paradigm of using radiotherapy for asymptomatic oligometastases at disease progression and technological advances in radiotherapy delivery such as stereotactic radiotherapy and MR-guided radiotherapy.
The study-coordinators forum, a popular session covered topics such as the practical challenges of rare tumour trials, imaging-based translational studies and an overview of prognostic and predictive markers. These sessions are often found useful by study coordinators as it enhances their ability to communicate with the participants on the importance of clinical trials’ participation and how they can contribute to the advancement of medical understanding.
The first afternoon session delivered a summary of AGITG led, new trials and trial concepts in various stages of development. An update on the progress of trials in rare tumour types such as ALTGIST in gastrointestinal stromal tumours, and CONTROL NETS in neuroendocrine tumours were presented. CONTROL NETS has generated considerable interest and is championed by the UNICORN foundation. A/Prof Eva Segelov also spoke about a new AGITG initiative; the Commonwealth Neuroendocrine Tumour Group (COMMNETS), which will bring together clinicians, researchers and consumers with an interest in NETs from Australia, New Zealand and Canada in a meeting in November 2015. It aims to identify gaps in neuroendocrine tumour research globally. The session closed with Dr Hagan Kennecke providing an overview of neuroendocrine tumour (NET) research in Canada, and an update on NET research priorities.
In the afternoon the focus turned to oesophagogastric cancer with a Radiation Oncology Workshop chaired by A/Prof Trevor Leong. Concurrently, Dr Kopetz and Prof Maughan discussed the role of molecular tumour profiling, and their integration into the treatment of stage 2, 3 and advanced colorectal cancer. The day closed with a keynote session from Dr Bendell, who spoke on the successes and failures of immunotherapies in the treatment of gastrointestinal malignancies.
The second day of the meeting was focused on Facing the Future. It started with two parallel breakfast sessions: a Radiation Oncology Breakfast symposium with a focus on discussing difficult cases, and a Keynote breakfast session summarising the evidence and ongoing debate around first line treatment options for metastatic colorectal cancer patients.
The next session provided an update on leading translational research, covering specifics pertaining to a particular tumour type, such as targeting p53 mutations in oesophageal cancer as well as more generalizable concepts such as molecular stratification of clinical trial patients.
The next session of the day was a study co-ordinator/ consumer advisory panel (CAP) joint session which ran in parallel with the Best of Posters session. The joint session covered a range of topics from a summary of lifestyle factors in survivorship to one on how to interpret published clinical trial results. The Best of Posters session ranged from diagnostic concepts such as ERCP in individuals with increased risk for pancreatic cancer to sub-studies within the ASPECCT study – a randomised phase III study comparing panitumumab and cetuximab in chemorefractory metastatic colorectal cancer.
The day closed with an enthralling ‘New Concepts Symposium’ with five concepts presented:
- Neoadjvuant vs Adjuvant gemcitabine/abraxane in resectable pancreatic cancer
- Increasing the operability of borderline and inoperable pancreatic cancer with extended cycles of gemcitabine plus abraxane, followed by IMRT concurrent with 5-fluorouracil
- A ‘watch and wait’ strategy in patients having attained a complete clinical response to concurrent chemoradiation in rectal cancer
- Assessing the safety and tolerability of first line panitumumab, irinotecan and TAS-102 in patients with RAS wildtype metastatic colorectal cancer
- An online dietary advice intervention for managing bowel symptoms after colorectal cancer
- An immunomodulatory vaccine in colorectal and adenoid cystic carcinoma
This was followed by the Fast Forward session which kept everyone on their toes with ten presentations, each restricted to 3 minutes.
Each year, the AGITG honours its members and researchers for their research contributions. Dr Rebecca Tay from Eastern Health was awarded the Best of Posters for hers entitled Survival impact of adjuvant chemotherapy for resected early stage rectal adenocarcinoma. Prof Rob Ramsay from the Peter MacCallum Cancer Centre won the Best New Concept award for his concept entitled Vaccination against Adenoid cystic and Colorectal Carcinoma using MYB cDNA – VACCUMeD clinical trial. In addition to these, a number of awards were presented at the Annual Dinner.
The inaugural John Zalcberg OAM Award for Excellence in AGITG Research was presented to the AGITG Consumer Advisory Panel Chair Mr Dan Kent, in recognition of his years of leadership of the CAP and his many contributions to the success of AGITG.
The Kristian Anderson Award was awarded to Dr Sina Vatandoust from Flinders Centre for Innovation in Cancer in support of the project entitled Prospective Study of ‘Watch and Wait’ in management of Rectal Cancer Patients with Clinical Complete Response to concurrent Chemoradiotherapy: RENO trial. Lastly, the AGITG Outstanding Site Award, introduced in 2015, was awarded to Central West Cancer Services, Orange Health Service. This award recognised their strong recruitment to the ASCOLT trial site as well as their involvement in the Engage Community Forum.
The final day focused on colorectal cancer and opened with a stimulating keynote breakfast session by Prof Bardelli. He challenged the concept of a static mutational tumour profile and summarised research in the use of liquid biopsies to demonstrate clonal evolution and potential mechanisms of acquired resistance to EGFR blockade.
This was followed by a plenary session discussing how patient information and outcomes obtained from registries compared to results from clinical trials.
The morning ended with a session comprised of AGITG trials in lower GI cancers. Some exciting results were disclosed in this area including the reporting of results from the A La CaRT and Z6051 trials, both comparing laparoscopic and open resection in rectal cancer. The highly anticipated results of the G13D arm of the ICECREAM study, addressing whether patients with this rare molecular subtype derived benefit from cetuximab. A possible research collaboration with the UK on the use of neoadjuvant chemotherapy for high risk rectal cancer, CREATE was also discussed.
The meeting closed with an entertaining debate session focused on rectal cancer management controversies, chaired by Dr Jackson. Topics of debate included: local excision and adjuvant radiotherapy compared to organ removal; clinical complete responders, including MRI assessment to avoid surgery for rectal cancer, and the lack of evidence to support adjuvant chemotherapy in node positive rectal cancer.
The AGITG ASM strives to provide an opportunity for the research and multidisciplinary clinical community to meet in a common, friendly and focussed forum. The next AGITG ASM will be held on 14-16 September, 2016 in Melbourne.
[hr] Written by Dr Subotheni Thavaneswaran and Dr Howard Chan for Co-Convenors A/Prof Niall Tebbutt and A/Prof Eva Segelov. Visit the AGITG website.