This year, a tropical setting provided the back drop for delegates from around Australia, New Zealand and further afield to get down to business at the 19th Australasian Gastro-Intestinal Trials Group (AGITG) Annual Scientific Meeting held in Cairns, Queensland on 4-6 October.
Under the guidance of Professor Eva Segelov, Meeting Convenor, and the Annual Scientific Meeting (ASM) Executive Organising Committee, the AGITG Meeting continues to provide a forum for mutual exchange of knowledge to improve the treatment of patients with gastro-intestinal cancer.
Professor Eva Segelov presenting at the 19th AGITG Annual Scientific Meeting
Our invited speakers from across the globe represented a distinguished group of experts from multi-disciplinary fields. We were privileged to host:
- Medical Oncologist – Associate Professor Thierry Alcindor, McGill University, Canada (representing AGITG Collaborative Partner the Canadian Cancer Trials Group);
- Medical Oncologist – Professor John Bridgewater, UCL Cancer Institute, UK;
- Medical Oncologist – Dr Ian Chau, Royal Marsden Hospital, UK;
- Radiation Oncologist – Professor Karyn Goodman, University of Colorado, USA;
- Surgeon – Professor John V. Reynolds, St James Hospital and Trinity College, Ireland; and
- Pathologist – Professor Sean Grimmond, University of Melbourne/Victorian Comprehensive Cancer Centre, Australia.
L to R: Professor Reynolds, A. Professor Alcindor, Professor Goodman – presenting at the Super MDT session
A Keynote Breakfast Session sponsored by Merck started the first day. In the pursuit of precision treatment of colorectal cancer, biomarker discovery has had a major impact on selection of therapy. However biomarkers and consensus molecular subtypes still fail to fully inform treatment decisions. Sidedness of primary tumour has emerged as an additional and potent factor in identifying which therapy should be offered to which patient. Dr Ian Chau explored data related to confirmed and potential biomarkers, impact of consensus molecular subtypes on therapy, and the role of tumour sidedness and other clinical features in aiding the practising clinician chose the best possible treatment for their patient.
The AGITG Opening Plenary, sponsored by the Meeting Platinum Sponsor Amgen Australia, which featured three esteemed speakers: Prof Sean Grimmond, Prof John Bridgewater and Prof John Simes presenting a forward looking view of the major issues confronting clinicians and patients with gastro-intestinal cancer in the modern era. Presentations focussed on personalised medicine; why recent advances in other cancers have not been replicated in GI cancer and how to design trials and therapies to be more effective.
Following the Opening Plenary was the Translational Science Symposium, also sponsored by Amgen Australia and co-chaired by Professor Bridget Robinson and Dr Jayesh Desai. We were delighted to have four prominent national speakers who are focused on translational research across a range of GI cancers, including neuroendocrine tumours, pancreatic cancer and colorectal carcinoma. This continues the recent AGITG ASM tradition of exploring how we can both develop bench-science into clinical trials, as well as explore how cutting edge translational platforms in Australia can help address key translational questions in locally-led, AGITG trials. Exciting new developments presented included “What you see ain’t what you NET” by Dr Ben Lawrence; “New Translational approaches and technologies: optimal use for maximal benefit” Prof Sean Grimmond; “The promise of ctDNA in GI cancer – from screening to advanced disease” by A/Prof Peter Gibbs; and “Somatic Mutations, Infiltrative Immune Cells and Prognosis in DNA Mismatch Repair Deficient Subtypes of Colorectal Cancer” by Dr Dan Buchanan.
The Study Coordinators Forum provided an overview of oesophagogastric cancer with an emphasis on the use of new targeted therapies in a changing clinical trial environment and the impact these new treatments have on overall quality of life.
The New Concepts Symposium sponsored by Specialised Therapeutics Australia was held at the end of Day One. The Symposium is designed as a novel way to reach out to a wider spectrum of the AGITG membership. Delegates have an opportunity to present embryonic new concepts for feedback and discussion with the audience as well as comments from international guests in terms of perspective, international interest and relevance.
Dr Katherine Geddes won the Best of New Concepts Award for her concept presentation “The prevalence and significance of sarcopaenia in patients with operable adenocarcinoma of the stomach or gastro‐oesophageal junction undergoing treatment with curative intent and the impact of altered body composition on chemotherapy delivery.”
Dr Geddes receiving her Best of New Concepts Award from Professor Tim Price, Chair AGITG and Nikoletta Mcleod, Specialised Therapeutics Australia
AGITG trials were presented in sessions across the three days:
- Colorectal and Anal Cancer Trials including updates on ICECREAM, SCOT, ASCOLT,
InterAACT, CO.23 and plans for our newest trials MONARCC, SPAR, and LIBERATE.
- Oesophagogastric trial updates included TOPGEAR, DOCTOR and INTEGRATE II.
- The Hepatobiliary, GIST and NET trial session included presentations on ALT-GIST, ACTICCA-1, NABNEC, CONTROL NETS and NABCAPABIL.
Day Two of the conference was held in collaboration with the Australia & New Zealand Gastro Oesophageal Surgery Association (ANZGOSA), an association for surgeons to provide a vehicle for improving the surgical management of diseases of the stomach, oesophagus and upper gastrointestinal tract.
The day started with a Keynote Breakfast. Prof Reynolds presented on “Obesity, Diabetes and Oesophageal Adenocarcinoma: Lessons from the Bench and the Bedside.”
The theme for the Plenary – “One swallow does not a summer make: State of the art considerations in management of OG cancer” – involved three of our international invited speakers from the fields of medical; radiation and surgical oncology, this opening session laid the foundation for cross discipline discussion that is a highlight of the meeting. The session covered new management options for systemic chemotherapy with A/Prof Alcindor. New technology and methods to improve the therapeutic outcomes for patients undergoing radiotherapy for oesophageal cancer was outlined by Prof Goodman. The impact of multimodal therapy on surgical outcomes and how to strive for the best outcome for our patients was explored by Prof Reynolds.
Joint sessions held Day Two – AGITG and ANZGOSA – Plenary Session
“Responding to response – Challenging the paradigm” was a thought provoking session that considered the role of Molecular markers of prognosis and prediction presented by Prof Andrew Barbour; and Clinical and imaging predictors of response presented by Dr Chau. Surgeon Dr Paul Cashin and radiation oncologist Prof Goodman battled it out in the debate “That complete clinical responders still require surgery for oesophageal cancer.”
A “Super MDT” session was held with Chairs, A/Prof Nick Pavlakis (AGITG) and Prof Mark Smithers (ANZGOSA), presenting a selection of upper GI cases covering oesophago-gastric malignancy and areas of controversy. The MDT panel provided input and insights and included:
Surgery – Prof John Reynolds, Prof David Watson, Prof Mark Smithers
Radiation Oncology – Prof Karyn Goodman, Prof Trevor Leong and Dr David Pryor
Medical Oncology – A/Prof Thierry Alcindor, Dr Ian Chau and Dr Chris Jackson
Beginning Day Three was a Keynote Breakfast sponsored by Shire. Prof Bridgewater presented “New data, new standards: BILCAP and new EPOC”. The New EPOC investigated
whether the addition of cetuximab systemic chemotherapy in patients with resectable colorectal liver metastasis was of benefit to disease free survival. Unexpectedly, cetuximab appeared to adversely affect outcome. The mature survival data and translational analyses to date was shown. The BILCAP study whether capecitabine improved overall survival compared to surveillance in patients following resection of biliary tract cancer. The outcome data was presented, including cost economic and quality of life analyses.
Radiation Oncologists also gathered for a breakfast session, chaired by A/Prof Andrew Kneebone with Prof Karyn Goodman leading a Radiation Oncology Contouring Workshop. We were honoured to host Prof Goodman who is a prominent member of the Radiation Therapy Oncology Group (RTOG) GI community and regularly chairs RTOG GI contouring workshops.
A/Prof Kneebone and Prof Goodman during the Radiation Oncology Contouring Workshop
The Best of the Best/Fast Forward session was sponsored by Ipsen. The AGITG Annual Scientific Meeting accepts abstracts for posters for selection by the Executive Organising Committee. Posters were displayed in the exhibition area. Four posters were chosen for presentation in the Best of Posters Session. Dr Jennifer Mooi was Awarded Best of the Best for her poster and presentation “Exploring Consensus Molecular Subtypes (CMS) as predictors of benefit from bevacizumab in first line treatment of metastatic colorectal cancer: retrospective analysis of the MAX clinical trial”.
Dr Jennifer Mooi with her winning poster
Rounding out the three days of ideas and exchange of information were the final sessions, following the close of the conference; the ever increasing in popularity Trainees Workshop and the Joint Consumer/Study Coordinator Forum were held. Both of these sessions were well attended with the Trainees Workshop led by Prof Segelov and the Consumer/Study Coordinator session chaired by Jan Mumford, Chair of the AGITG Consumer Advisory Panel.
The Closing Plenary sponsored by Roche Closing Plenary sponsored by Roche was entitled “Implementation v Innovation – What rules in my world?” With all the changes in oncology ‘hot off the press’, how do we go from concepts to implementation? This session presented by leaders in each field who highlighted the challenges and ‘quick wins’ in bringing advances through to the clinic.
The John Zalcberg OAM Award for Excellence in AGITG Research was presented to Professor Michael Findlay, for his tireless service in AGITG clinical research since the 1990’s and for his contributions to the leadership of AGITG.
Professor Tim Price (L) with Professor John Zalcberg (R) presenting the John Zalcberg OAM Award for Excellence in AGITG Research to Professor Michael Findlay (Centre)
The AGITG Innovation Fund was awarded to A/Prof Chris Karapetis for his study; Prospective Study of ‘Watch and Wait’ Strategy in Patients with Rectal Cancer who have Developed a Clinical Complete Response with concurrent Chemo‐radiotherapy: RENO trial (REctal cancer No Operation).
Rectal cancer comprises a third of the cases of colorectal cancer. Most patients with rectal cancer receive chemotherapy and radiotherapy (chemo‐radiation) followed by surgery. Surgery can lead to life‐long side effects and many patients will need permanent stoma construction (a stoma is an artificially created hole in the abdomen so that faeces can leave the body). In approximately 25% of patients, chemo‐radiation lead to a complete response without any evidence of cancer when they undergo surgery. These patients may not need to have surgery and can safely be monitored with close follow up, (in a small number of patients, the disease
patients, the disease reappears: in such patients, surgery can be done safely). With this strategy, a considerable number of patients may be spared unnecessary surgery and its life‐long complications (including stoma construction). Investigators from US, Europe and Brazil have reported on the safety of this approach in a small number of patients. A/Prof Karapetis and colleagues have designed a study to evaluate this treatment approach in the Australian setting. The target population includes patients with rectal cancer who are planned to have chemo‐radiation, and consent to participate in the study. Eight to ten weeks after completing chemo‐radiation, a colorectal surgeon will review the participants and if no signs of disease are found (also confirmed by MRI scan) then the patient will be enrolled into the ‘Watch & Wait’ arm. From this point, the participants will be carefully monitored for any signs of recurrence during regular follow up reviews. If any sign of recurrence is detected, surgery will be offered immediately. The Study Investigators will evaluate the safety and efficacy of the ‘Watch & Wait’ strategy and assess multiple aspects of participants’ quality of life through validated questionnaires. Another aspect of the study is to define molecular markers and scan findings that can potentially help identify patients who may benefit from this approach in the future. In summary, the Investigators believe this study will pave the way for a more personalized treatment approach in patients with rectal cancer and may help avoid unnecessary surgery in a considerable number of patients, sparing them from the risk of life‐long side effects including the need for permanent stomas.
Professor Tim Price (L) congratulating A/Prof Karapetis (R) upon receiving the Innovation Fund for his rectal cancer study.
The 2017 AGITG Outstanding Site Award was awarded to the Orange Hospital Clinical Trials Centre for their support and recruitment for AGITG clinical trials and for leading the way to pilot the Tele-Trials model with Secondary Site, Dubbo Hospital, for the ASCOLT trial.