The 24th AGITG Annual Scientific Meeting was the first in-person meeting in three years.

Held in Melbourne between 14–17 November, the conference was attended by over 500 delegates – a record number for an in-person ASM. For the first time, delegates could choose to attend the presentations, panel discussions and interactive sessions in person or to join online through an app.

This ASM, the theme was big data, artificial intelligence and precision oncology – reflecting the fast-growing role of the three disciplines in GI cancer research.

Read the wrap-up report of the conference below, courtesy of our AGITG Fellows.

Monday 14 November

Before the first day of the ASM began, three full-day programs that ran on Monday: the AGITG Preceptorship in Advanced Colorectal Cancer, the Community and Study Coordinator Forum and the inaugural Surgical Workshop.

Preceptorship

This year’s AGITG Preceptorship on Advanced Colorectal Cancer ran in a dual-hub format, based in Melbourne, Australia and Auckland, New Zealand and linked via Zoom. It covered surgical and medical oncology aspects as well as translational science with presentation and discussion of seminal papers on diagnostic and molecular markers of colorectal cancer, resectable metastatic disease with curative intent, first line and maintenance treatments in unresectable metastatic colorectal cancer and also subsequent line options and novel therapies.

AGITG Fellow Deborah Zhou was particularly impressed by the in-depth and succinct critical evaluation performed by all the preceptees, which improved her appraisal of the seminal papers.

“It was an extremely valuable and educational experience being able to interact with the fellow preceptees and learn from knowledgeable preceptors,” Ms Zhou said.

Community and Study Coordinator Forum

The 2022 Community and Study Coordinator Forum held presentations and panel discussions on experiences and strategies to increase equity in clinical trials.

Presentation topics included how big data and AI apply in research, case studies from Australian and New Zealand First Nations, culturally and linguistically diverse populations and decentralised trials, genetic testing and personalised medicine and value-adding substudies.

Presenters were also part of two panel discussions. The first panel featured Dr Peter Summons, Associate Professor Reema Harrison, Dr George Laking and Anne Woollett. Associate Professor Harrison noted in particular that there was a tendency to create resources for the main cultural groups in communities, rather than for groups who needed them the most.

The second panel featured Associate Professor Lara Lipton and Associate Professor Richard De Abreu Lourenço.

Surgical Workshop: The Guts of GI Surgery from Data to Distant Disease

The inaugural Surgical Workshop was the first session of the ASM’s first-ever complete surgical oncology program, featuring topical themes such as artificial intelligence and big data, minimally invasive surgeries and other adjunctive techniques, colorectal metastases as well as pearls from and barriers to surgical engagement in AGITG trials.

The all-day program featured three presentations from eminent Invited International Faculty Professor Tim Pawlik, Chair of Surgery at The Ohio State Wexner Medical Center and the Urban Meyer III and Shelley Meyer Chair for Cancer Research.

Other notable presentations include Dr Saxon Connor on digitising health, Professor Mark Smithers on lessons from one of Australasia’s most successful surgical trials, Dr George Laking on ensuring that clinical trials address the population most at risk and David Downs on a patient perspective of clinical trials.

Tuesday 15 November

The first day of ASM sessions began with keynote breakfast sessions divided into three disciplines: medical oncology, radiation oncology and surgical oncology. The conference was officially opened by returning MC, cancer survivor and advocate Julie McCrossin, with Welcome to Country performed by Uncle Perry Wandin on Wurundjeri lands.

The Opening Plenary saw International Invited Faculty Professor Håvard Danielsen, Dr Eugene Koay and Professor Tim Pawlik introduce this year’s theme, artificial intelligence, big data and precision oncology, and how they might be applied in future to improve diagnosis, prognosis and treatment.

“While there have been recent advances in the treatment of GI cancers, many GI cancers still have relatively poor outcomes,” said AGITG Fellow Joanna Lee.

“Predictive and prognostic tools are required to optimise treatment outcomes for patients with GI cancers.”

The Plenary was followed by an overview of AGITG trials in early and advanced colorectal cancer, with insight into how the AGITG trials portfolio fits into the international context and clinical areas of need. The trials cover a broad range of clinical situations, from first-line chemotherapy and maintenance systemic therapy to ablative treatments for oligometastatic disease.

One of the trials noted by Ms Zhou was GENESCREEN 5-FU. “5-FU is widely used in GI cancers and DPYD genotype is a well-known factor that can significantly affect dosing safety,” she said. “Though relatively affordable testing is available, this is not yet routine practice. If feasible this could be easily incorporated into routine clinical practice in the very short-term and reduce severe 5-FU toxicity.”

She also noted that as opting to ‘watch and wait’ following neoadjuvant treatment becomes increasingly acceptable, more research is needed in this area to assess its safety and outcomes.

The day came to a close with a multidisciplinary discussion by an exceptional panel about the nuances of selecting and sequencing radiotherapy, chemotherapy and surgery in the treatment of locally advanced rectal cancer.

Wednesday 16 November

The day began with the translational keynote breakfast session presented by Professor Håvard Danielsen and Professor Robert Coffey showcased how deep sequencing and big data has helped define the fundamental mechanisms of gastro–intestinal carcinogenesis, including the earliest stages of colorectal cancer.

Translational Research Symposium One

The first symposium displayed the depth of gastro–intestinal translational research. Dr Tan discussed how the analysis of single cell RNA sequencing has enabled further molecular subtype characterisation of colorectal cancer. The pancreatic intracellular and immune landscape was targeted in pancreatic research led by Associate Professor Marina Pajic. She presented on studies in which existing drugs, such as sulfasalazine, are being repurposed in new ways to overcome the stroma in pancreatic clinical trials.

“These studies demonstrate an innovative and more cost-effective way to approach clinical trial design and development,” said Ms Lee.

Dr John Lock presented on the field of systems microscopy where imaging-based, single-cell systems biology approaches are used for research and translational applications.

Translational Research Symposium Two

The second symposium focused on the translation of genomic discoveries and technology into the clinic, particularly how to ensure equity of access. Professor Christina Curtis, Director of Breast Cancer Translational Research and Co-Director of the Molecular Tumor Board at the Stanford Cancer Institute, discussed how she developed new paradigms to understand how tumour progress and metastases and provider further insight into gastrointestinal malignancy. Dr Carlos Cabalag presented his research on how circulating tumour DNA can be used as a promising biomarker in early oesophageal cancer in clinic.

“Dr Cabalag’s research shows how ctDNA can be practically applied to the clinic – whether it be as a diagnostic tool, a tool to measure minimal residual disease and as well as it being used to determine risk stratification and prognosis,” said Ms Lee.

The symposium ended with a panel discussion on molecular test methodology and implications for pancreatic cancer, colorectal cancer and cholangiocarcinoma. The discourse highlighted differences in equity and access to somatic testing in Australia and New Zealand.

“It highlighted the need to do better for our patients,” said Ms Zhou.

“In Australia, somatic testing for pancreatic, colorectal and cholangiocarcinoma is limited by MSAC funding. As a result, patients are not able to access specific drugs targeting specific genetic alterations which may be available in other countries. There is also a discrepancy in what is funded in New Zealand in terms of somatic testing and available drugs.”

New Concept Symposium, Best of the Best Posters and Fast Forward

The New Concept Symposium this year saw three concepts being presented and reviewed:

• Dr Laura Tam presented BIL-PPP, a concept addressing unresectable locally advanced or metastatic biliary tract cancer
• Dr Sonia Gill presented Dr Helen Mohan’s concept COALA, addressing quality of life for rectal cancer patients
• Dr Anshini Jain presented PredictOrg, a concept proposing personalised chemotherapy for resectable colorectal cancer.

The Symposium was followed by the Best of the Best Posters and Fast Forward sessions.

At the Best of the Best Posters session, the following four chosen presenters had seven minutes to present their poster, with three minutes for questions:

• Dr Iris Tung: Initial uptake and impact of immunotherapy in Australian patients with deficient mismatch repair metastatic colorectal cancer
• Dr Melanie McCoy: Local and systemic Programmed Death-1 (PD-1) pathway activity predicts complete response to chemoradiotherapy in locally advanced rectal cancer
• Dr Subotheni Thavaneswaran: Genomic targetability of cholangiocarcinomas and outcomes for Australian patients screened through the Molecular Screening and Therapeutics (MoST) program
• Dr Jane McKenzie: Left side, RAS wildtype metastatic colorectal cancer (mCRC) – examining real-world first line treatment strategies and outcomes for patients.

At the Fast Forward session, the following four chosen presenters had three minutes to present:

• Dr Matthew Loft: Initial Survival Estimates and Conditional Survival Estimates in Early Stage Colorectal Cancer
• Dr Sam Banks: Benefits of Neoadjuvant FOLFIRINOX over upfront resection in borderline resectable pancreatic cancer – an international, multicentre real-world data analysis
• Dr Belinda Lee: Therapy and molecular characterisation patterns across Australasia: Big data insights from the PURPLE Pancreatic Cancer platform
• Dr Rachel Purcell: Human Gene and Microbiome Contributions to Radiotherapy Response in Rectal Cancer.

Gala Dinner and the 2022 AGITG Awards

The Awards were presented at the Gala Dinner on Wednesday evening in recognition of excellent research and presentations.

For the first time this year, multiple categories were introduced for the Innovation Grant and the Outstanding Site Award. Also presented was the inaugural Early Career Researcher Award.

Congratulations to all winners – view the full list of the awards and winners for 2022 here.

Thursday 17 November

The final day started with concurrent breakfast sessions for medical oncology, radiation oncology, and surgery on upper GI cancers.

This was followed by an overview of AGITG upper GI trials portfolio, with a summary by International Invited Faculty Dr Lizzy Smyth, GI oncology consultant at Addenbrooke’s Hospital in London, on the clinical and international relevance.

Ms Lee found the ASCEND trial particularly notable. “It is taking a novel approach to using a pre-existing chemotherapy regimen and improving its delivery to the tumour without adding another active drug or modality,” she said.

Ms Lee and Ms Zhou also attended a special interest breakout session, which addressed the role of immunotherapy in first-line gastro–oesophageal cancer. The session summarised updates on first-line chemo-immunotherapy trials, including CHECKMATE 648, KEYNOTE590 and ATTRACTION 04. It also elaborated on the role of biomarkers such as MMR and PD-L1 in selecting patients more likely to benefit from immunotherapy.

“The use of MMR and other biomarkers to predict for immunotherapy response is not new. However, it is exciting to see increased utility of immunotherapy in upper gastro–intestinal cancers,” said Ms Lee.

“GI cancers have heretofore not benefited much from immunotherapy.”

This session was concluded with a case describing the clinical application of immunotherapy in gastro-oesophageal adenocarcinoma.

Closing Plenary

The Closing Plenary introduced the theme for the 2023 ASM: equity, diversity and inclusion in clinical trials.

Clinical trials offer an important opportunity for patients to access innovative and promising treatments; however, they are not accessible to all. A panel comprising Christie Ah-Fa, Mariam Hachem, Associate Professor Reema Harrison, Dr Narayan Karanth, Dr Abhijit Pal and Dr Sabe Sabesan discussed barriers to equitable access to clinical trials, including geographic and sociocultural barriers – particularly for First Nations patients. Strategies to improve equity were also discussed, such as the availability of telehealth and remote trials, as well as the implementation of cultural and linguistic resources.

“It was great to see that there are strategies to allow patients to access trials that are geographically remote for them,” said Ms Lee.

“This is a huge limiting factor and reduces the burden of travel, accommodation and time toxicity.”

The 24th AGITG Annual Scientific Meeting ended on a high note once more. Thank you to all, including the meeting organising committees, sponsors, chairs, Invited Faculty, delegates, as well as to our MC, Julie McCrossin, for contributing to its success.