Education and Conference Round Up : eECE and eESMO 2020
First priority as with all educational events — is to be clear on the aim of attendance :
- as an attendee – you have the opportunity to consolidate knowledge and add to it – for yourself and those you represent
- as a speaker – you have a responsibility to share knowledge, what you do, and raise awareness, not just of the disease or condition, but the unmet needs of those living with it. Acknowledge collaborations and benefits of this.
- as an exhibitor – you have the responsibility of representing your community and organisation : raising awareness and showing how you work with the community to support, inform, educate, advocate and stimulate research – patients and professionals in partnership.
So re-check the programme — and match sessions with what you want to learn and what catches your interest and may be useful – and hope they don’t clash! It is also worthwhile to take time to look through the abstracts and posters – for key areas of interest that may not have made it, this year, to symposium or plenary level discussion.
ECE 2020
ESE represents a community of over 22,500 European endocrinologists, and works to shape the future of endocrinology to improve science, knowledge and health across Europe and beyond.
By uniting, supporting and representing the community, ECE can help drive better medical outcomes throughout endocrinology.
This year, the first online event attracted 4675 attendees from 112 countries who contributed to panel sessions covering 8 key focus areas and COVID-19.
Across the five days, more than 90 international speakers delivered high-quality lectures, symposia, Meet the Expert sessions, New Scientific Approaches, a dedicated COVID-19 session, alongside Industry exhibitors and, last but by no means least, Patient Advocacy Groups :
ESMO 2020
ESMO represents a community of over 25,000 European oncologists, and works to shape the future of oncology to improve science, knowledge and health across Europe and beyond.
By uniting, supporting and representing the community, ESMO can help drive better medical outcomes throughout cancer care.
This year, the first online event attracted more than 30,000 attendees from 150 countries.
Across three days, more than 230 international speakers delivered high-quality lectures, alongside Industry exhibitors.
“ESMO is committed to offer the best care to people with cancer, through fostering integrated cancer care, supporting oncologists in their professional development, and advocating for sustainable cancer care worldwide.”
Both Societies have a proven history in working collaboratively with Patient Advocacy and Support Organisations : not just in supporting Patient Advocacy/Organsiation stands, free passes to talks but also patient voice involvement in guidelines formation and information publications.
Both conferences held sessions on COVID-19 – with presentations from across the world
COVID-19 has had a huge affect on all of us : how we all live and work and has become the major focus of medical research, as the scientific and medical communities strive to understand it better, develop effective treatments and create a vaccine. Unsurprisingly this has led to a huge volume of information (proven or not) being pushed out to the public domain, including some that has not undergone the usual rigorous, scrutiny of peer review. There has been conflicting messages in the media and this has contributed to mistrust of experts. The COVID19 sessions at this year’s conferences, in particular ECE, utilised the expertise and knowledge of their invited speakers to review the evidence and information available
Key points from these presentations and discussions :
Increased susceptibility to COVID-19 – socioeconomic and health status ;
- deprivation – area as well as individual, access to healthy food, green space, gyms and parks, health services.
- pollution
- over-crowding and quality of housing
- employment : transport, health and food services
- diabetes, cardiovascular conditions and obesity – alongside history of smoking, alcohol excess and drug abuse
- (immunocompromise)
Source : Dr A Passaro Division Of Thoracic Oncology, IEO – Istituto Europeo di Oncologia, Italy. ESMO 2020 presentation.
Whilst those with cancer did, in some reports, have an increased risk of severity of disease if infected (depending on site of disease, age, health status including the factors mentioned above) – there was no significant increase in risk seen, due to cancer treatments.
COVID-19 Treatments : no current vaccine or anti-viral therapy :
- Rendesevir and Dexamethasone : trials ongoing – moderate benefit seen to date on reducing severity but not prevention.
- Chloroquine : low potential benefit
- Bleach : on work surfaces maybe – but never ingested!
But what of vitamin D ?
Deficiency has been seen in those most affected by COVID19 – so may increase risk of severity of disease if infected – but low vitamin D is more an indicator of general health status. Correcting deficiency can help improve general health status, but will not prevent or treat COVID19 itself.
At the time of writing – recommendations on Vitamin D are summarised below :
- WHO : no recommendation re COVID19 & Vitamin D
- NICE (UK) : “There is no evidence to support taking Vitamin D supplements to specifically prevent or treat COVID-19. However, all people should continue to follow UK Government advice on daily Vitamin D supplementation to maintain bone and muscle health during the COVID19 pandemic”
- Joint Guidance ASBMR-EndoSoc-AACE-ECTS-NOF-IOF July 2020 : ‘remind individuals of the importance of obtaining the daily recommended dosage of Vitamin D . . .For those unable to spend at least 15-30 minutes with direct sun exposure each day, the easiest way to acquire Vitamin D is through food supplemented with Vitamin D and /or Vitamin D supplements . . . Most adults 19yrs and older should obtain between 400-1000IUs of Vitamin D daily from food and/or with supplements . . .The current data do not provide any evidence that Vitamin D supplementation will help prevent or treat COVID19 infection”
Neuroendocrine Cancer
Surufatinib
Results from the phase III Chinese SANET-P study, revealed that Surufatinib, is the first of the new TKIs to show statistically significant benefit in pancreatic NETs (Abstract 1156O ESMO)
Earlier this year, a US phase I/II study presented at the American Society of Clinical Oncology (ASCO) annual meeting showed promising results of Surufatinib in those with GI and panNETs, pre-treated with everolimus and/or sunitinib, by mirroring the results of the SANET-P Chinese population.
“The impact of surufatinib on PFS and RR was similar to that of sunitinib in its phase III regulatory trial. However, an important difference is that a proportion of patients in SANET-P had previously received everolimus, compared with none in the sunitinib trial,” comments Dr Nicola Fazio from the European Institute of Oncology (IEO), Milan, Italy. “SANET-P provides the first evidence in a phase III trial that a TKI is effective after progression on an mTOR inhibitor.”
However, a concern is the side effect profile – specifically hypertension – with a not insignificant incidence of Grade 3 toxicity – SANET-P trial investigators concluded that toxicity was clinically manageable, similarly to the US colleagues’ conclusion in their phase I-II study.
In the US study : 9 pts discontinued due to progression of disease, 2 withdrew consent and 2 discontinued due to adverse event – 19 patients completed it
SANET-P : the most common grade ≥3 treatment-emergent adverse events (TEAEs) was hypertension (38.9% in S arm vs. 8.5% in P arm), amongst others, leading to drug discontinuation in 10.6% (12) pts vs. 6.8% (4) pts in S and P arm respectively. (S arm had 113 patients, P had 59)
Neither abstract commented on quality of life/patient experience during treatment, beyond reporting toxicity incidence.
Additional potential new therapies for Neuroendocrine Cancer were presented including results on:
- PRRT involving the somatostatin antagonist 177Lu-satoreotide tetraxetan (Abstract 1160O ESMO)
- Phase I/II ARROW trial of anti-RET pralsetinib in RET mutation-positive medullary thyroid cancer (Abstract 1913O ESMO) and findings from
- the DUNE trial of durvalumab plus tremelimumab in advanced GEP or lung neuroendocrine neoplasms were less encouraging (Abstract 1157O ESMO).
There was also reference to the DART trial of ipilimumab plus nivolumab in patients with rare tumours including Neuroendocrine Cancer, in which tumour response was reported earlier this year.
DART trial : Ipilimumab plus nivolumab demonstrated a 44% overall response rate in patients with nonpancreatic high-grade neuroendocrine carcinoma with 0% in low/intermediate grade disease.
(The total number of patients included in this trial was 32, 18 had high-grade disease – so 44% = 8 patients showed response. No response in any of the 14 with low/intermediate grade)
Patient Experience
The are well-recognised challenges in Neuroendocrine Cancers including adequate and timely diagnosis, this was highlighted at ESMO, through the results of a global survey.
Including 2,795 healthcare professionals, patients with NETs and their carers from 68 countries, the study reported that 44% of patients had been misdiagnosed : which would suggest that misdiagnosis is worryingly common and poses a threat that could jeopardise the advances made in the research of new and more effective treatments .
Bouvier CV et al. Survey of challenges in access to diagnostics and treatment for neuroendocrine tumour (NET) patients (SCAN): Healthcare quality evaluation. ESMO Virtual Congress 2020, Abstract 1168P
“Sadly, this survey reveals the reality for patients with NETs globally,” admitted Dr Nicola Fazio from the European Institute of Oncology (IEO), Milan, Italy. “Because of the rare and heterogeneous nature of NETs, the ideal approach for any patient is to have access to a NET-dedicated MDT. These findings should provide the impetus for scientific societies to work towards providing a dedicated MDT for every patient, regardless of their geographical location.
He added “While on the one hand I believe that NET expertise should be focused in centralised sites, offering multimodal, high-level clinical and technical management, on the other hand, I would also like to see dispersal of knowledge from referral centres to community practices, so that misdiagnoses or delays in diagnoses are avoided, and appropriate therapeutic approaches are followed right from the start.”
These comments echo NCUK’s vision and mission :
- Our vision is of a world in which people know how to recognise, diagnose, treat, care for, and ultimately, cure patients with Neuroendocrine Cancer.
- Our mission is to support and inform patients and families from diagnosis, enabling access to the best care and treatment, whilst stimulating Neuroendocrine Cancer research, increasing national awareness and influencing improvements in outcomes.
And for those who couldn’t tune in live to MENETS 2020 : WORLD NEN Lives Congress – talks are available here : https://menets.org/downloads-קבצים-الاسبوعيه