Another conference season is over and sarcoma researchers have reported on their activities in laboratories and clinics across the world. I am no longer able to attend all these events like I used to. After a couple of years watching from afar you begin to get a slight sense of detachment and start to look at the entire field of activity in a different way.
Sarcoma research is focused on delivering a cure. It is an admirable aim but the search for a cure gets increasingly complex as tumours are better understood. Most of the different histological types of sarcoma now have a list of primary mutations but few have an affordable targeted therapy able to inhibit or correct these mutations in a real patient.
We have a good understanding of the way cancers respond to targeted therapies. GIST has been treated by imatinib for more than 15 years now. As early as 2003 there was work going on to discover why new metastatic tumours showed resistance and this uncovered new mutations, some of which are treatable and some are not. More than 10 years on this work continues but GIST patients with advancing disease eventually run out of treatment options. Can we anticipate that every sarcoma is going to head in this direction?
The recent study of oloratumab with/without doxorubicin in first-line chemotherapy resulted in EMA approval for the drug. Many doctors have reservations about the design of the study and the interpretation of the results. From a patient viewpoint the side effects of the additional drug were worse than doxorubicin on its own and there was no quality of life survey undertaken. Patient numbers were very small and there is the real possibility that some of the statistics reported were open to error. A Phase 3 study is now underway. Immunotherapy is showing great promise with a number of cancers and is being used in clinical trials in sarcoma. We must hope that it will do better than other much hyped ‘breakthroughs’.
Research must start to deliver higher degrees of patient benefit than has previously been possible, otherwise why should patients continue to support research. It is time for the research emphasis to shift. We need to look at better treatment in a more holistic manner while we keep our eye on finding a cure.
We must get patients to initial treatment more quickly, we know it can be curative. We need maintenance therapies which prevent recurrence following initial treatment, based on the better understanding of genetics across the range of sarcoma sub-types. Some patients will still develop metastasis so we need to explore better surgical and ablation therapies and make these more readily available. Chemotherapy must become the last resort in a menu of options for patients at this stage, not a sole choice as it is today for so many. On top of this we must build a better understanding of quality-of-life and develop systems which route patients to supportive care when they need it.
It’s a package of ideas which takes patient benefit forward, reduces the demand for toxic drugs and by researching what best helps patients, sets the tone for whatever the scientific community may offer next on the route to a cure.