5 Takeaways From the National Comprehensive Cancer Network's 23rd Annual Conference

The National Comprehensive Cancer Network (NCCN)’s 23rd Annual Conference, held March 22-24 in Orlando, Florida, brought together stakeholders from across the oncology landscape. Here are 5 key takeaways from the meeting:

1. People with HIV are less likely to receive cancer treatment

Gita Suneja, MD, of Duke Cancer Institute, said that, in a 2015 survey she conducted among 500 US oncologists, 20% to 25% of respondents reported that they would not offer standard cancer therapy to a patient who had HIV, 70% said that sufficient guidelines for treating these patients were not available, and 45% said that they rarely or never discussed a management plan together with an HIV specialist. Further compounding the problem is the fact that patients with HIV are often excluded from clinical trials, leading to a gap in knowledge about these patients.

“HIV status alone should not be used for cancer treatment decision-making,” said Suneja, who encouraged oncologists to work closely with patients’ HIV specialists in developing a treatment approach.

2. Supportive care is still key in treating multiple myeloma (MM)

“Even though we have all these fancy, effective drugs,” said Shaji K. Kumar, MD, of the Mayo Clinic Cancer Center, “supportive care still plays an important role” in treating patients with MM. Patients should be given bisphosphonates or denosumab, and the oncologist should monitor for renal dysfunction and osteonecrosis of the jaw. Plasmapheresis can be used for symptomatic hyperviscocity, and erythropoietin is appropriate in cases of anemia. To guard against thrombosis, “I think it’s important to make sure these patients are on a full dose of aspirin,” said Kumar.

3. Neurotoxicity is a significant concern with chimeric antigen receptor (CAR) T-cell therapy, especially in acute lymphoblastic leukemia (ALL)

Bijal Shah, MD, of Moffitt Cancer Center, said that patients with ALL seem to have higher rates of neurologic toxicity when treated with CAR T-cell agents than do patients with other cancers. This observation suggests that there are some disease features of ALL that are linked with adverse events. Furthermore, adults with ALL appear to have even more neurotoxicity than younger patients do, though the reasons for this phenomenon remain elusive.

4. Temporarily holding immune checkpoint inhibitors to address toxicities doesn’t jeopardize anticancer treatment

In an overview of immunotherapy-related toxicities and their management, John A. Thompson, MD, of the Fred Hutchinson Cancer Research Center and the Seattle Cancer Care Alliance, warned that, when a toxicity emerges with the use of immune checkpoint inhibitors, “one of the first things to do is stop the therapy” to allow the toxicity to resolve. While patients may be reluctant to temporarily discontinue their anticancer regimen or to receive steroids to address skin, lung, endocrine, or other immune-related adverse events, Thompson said that available data demonstrate no statistical difference in overall survival if therapy is temporarily paused to address a toxicity.

5. Biosimilars can bend the cost curve in oncology

During a symposium on biosimilars in oncology, Lee Schwartzberg, MD, FACP, of the University of Tennessee Health Science Center, estimated that half of annual spending on oncology comprises the cost of drug therapies, driven by “an increase in both usage and potentially the cost of drugs.” A single year of trastuzumab therapy can cost $70,000 to $80,000 per patient, he said, and without the advent of biosimilars, that cost would likely continue to rise; the cost of trastuzumab has increased by approximately 78% in the past 10 years. Using biosimilar trastuzumab, said Schwartzberg, has the potential to bend the cost curve and reduce the price tag associated with cancer care.