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Soft Tissue Sarcoma: Looking Ahead

Panelists:William D. Tap, MD, Memorial Sloan Kettering Cancer Center; Mark Agulnik, MD, Feinberg School of Medicine;George D. Demetri, MD, Dana-Farber Cancer Center;Martee L. Hensley, MD, Memorial Sloan Kettering Cancer Center; Shreyaskumar Patel, MD, The University of Texas MD Anderson Cancer Center;Damon Reed, MD, Moffitt Cancer Center
Published Online: Thursday, Sep 29, 2016



Transcript:

Shreyaskumar Patel, MD:
I just wanted to make the comment about the possibility of maintenance therapy. These biologics that are non-toxic, you could continue them for a little bit longer and that might change the microenvironment enough, whether it’s inhibiting, invasion, migration, maybe those floating tumor cells. Microscopic tumor cells remain floating, don’t get to lodge anywhere in an organ, and don’t ever make it to a metastasis, for example.

William D. Tap, MD: In some of the pediatric diseases where they’re metastatic on presentation, osteosarcoma, these may be important things to really look at. Well, this has been extremely informative, and I think we’ve discussed several important scenarios in the management of soft-tissue sarcomas. But, before we end the discussion, I’d really like to get final thoughts from each of our panelists. So, just give some advice. Mark, we’ll start with you and go down the line.

Mark Agulnik, MD: It’s a complete honor to be sitting here with such great colleagues, and really had we been here a year ago, it would have been a very different discussion. If we’re here again next year, it’s going to be a different discussion. It’s a great time to be doing this. I hope what comes out of this is our passion for these patients and our passions for the disease. Often you come to ASCO and you come to meetings, and you say you treat sarcoma. People look at you a little strange. It’s a phenomenal disease to treat. It’s an honor to be here.

William D. Tap, MD: Thank you, Mark. Shreyas?

Shreyaskumar Patel, MD: I think if nothing else, we have emphasized to our audience that this is a very rare and a very complex group of tumors. There are a lot of nuances. This is not a resistant disease. There are lots of options. Please feel free to engage your local sarcoma consultant for the best care for your patient.

William D. Tap, MD: I agree. Damon?

Damon Reed, MD: I hope we’ve also conveyed to the audience that there are standards in sarcoma. There does seem to be a lot of head nodding and a lot of people that are doing the same thing. I think we’ve also shown that there’s a great collegiality. We are nuts to go into this field maybe, it is hard. But, we do hope that maybe something that works on a mesenchymal tumor will help EMT and other things. We hope that we will be pioneers in the oncology community. I think we are already pioneers of caring for people from their birth to their 90s, and we do collaborate across age ranges better than any other single discipline. And so, I hope we’ve communicated that there is hope, that there are options, that there are standards, that there is collegiality, and that it can be better than what you Google.

William D. Tap, MD: Martee?

Martee L. Hensley, MD: I would say that we almost don’t realize how many times we use the words “data” and “clinical trials”. Almost everything that we’ve spoken about is data-driven decision making, and those data come from clinical trials that involve hundreds of human beings who are personally facing the challenges of sarcoma. We are indebted to all of those patients, and the doctors who help design those studies and enroll patients on a study. But, the exciting thing is that the clinical trials worked in that we get information from them. That’s why we can sit down for 90 minutes and really talk about what to do in a way that’s not just spouting off answers that seem plausible, but rather are really data-driven choices. So, I think it’s really exciting.

William D. Tap, MD: Yes, thank you. George?

George D. Demetri, MD: I think, in 2016, we have to talk about where’s immunotherapy in sarcomas. Let me just summarize that because at ASCO 2016, I think we’re going to hear some pretty negative messages about the fact that it’s not a home run yet the way it is in Merkel cell, the way it is in melanoma, and the way it looks in bladder. That, to me, is not a bad thing. That just means we have much more work to do, and then sarcoma becomes a testing ground to make all immuno-oncology approaches better. We’re going to need combinations. We may need new targets, but our field has struggled with that for a while, and all the drugs we’ve talked about are the product of that kind of research. Just like everybody said, our community is incredibly collaborative with each other. I think our patients are also quite collaborative with each other, and it makes for the ripe environment to have a lot more progress happen in the future. Thanks for moderating today and inviting me.

William D. Tap, MD: I agree. And I’d like to echo what Mark said, that I’m humbled to be among such distinguished colleagues and friends. You really dedicated your life to this rare and difficult disease, and you really are shaping care for these patients. I think we’re sitting up here discussing these options because of all of your hard work and dedication as well. Thank you very much. So, really, on behalf of our panel, we’d like to thank you for joining us, and we hope that you found this Peer Exchange discussion to be useful and informative. Thank you.

Transcript Edited for Clarity

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Transcript:

Shreyaskumar Patel, MD:
I just wanted to make the comment about the possibility of maintenance therapy. These biologics that are non-toxic, you could continue them for a little bit longer and that might change the microenvironment enough, whether it’s inhibiting, invasion, migration, maybe those floating tumor cells. Microscopic tumor cells remain floating, don’t get to lodge anywhere in an organ, and don’t ever make it to a metastasis, for example.

William D. Tap, MD: In some of the pediatric diseases where they’re metastatic on presentation, osteosarcoma, these may be important things to really look at. Well, this has been extremely informative, and I think we’ve discussed several important scenarios in the management of soft-tissue sarcomas. But, before we end the discussion, I’d really like to get final thoughts from each of our panelists. So, just give some advice. Mark, we’ll start with you and go down the line.

Mark Agulnik, MD: It’s a complete honor to be sitting here with such great colleagues, and really had we been here a year ago, it would have been a very different discussion. If we’re here again next year, it’s going to be a different discussion. It’s a great time to be doing this. I hope what comes out of this is our passion for these patients and our passions for the disease. Often you come to ASCO and you come to meetings, and you say you treat sarcoma. People look at you a little strange. It’s a phenomenal disease to treat. It’s an honor to be here.

William D. Tap, MD: Thank you, Mark. Shreyas?

Shreyaskumar Patel, MD: I think if nothing else, we have emphasized to our audience that this is a very rare and a very complex group of tumors. There are a lot of nuances. This is not a resistant disease. There are lots of options. Please feel free to engage your local sarcoma consultant for the best care for your patient.

William D. Tap, MD: I agree. Damon?

Damon Reed, MD: I hope we’ve also conveyed to the audience that there are standards in sarcoma. There does seem to be a lot of head nodding and a lot of people that are doing the same thing. I think we’ve also shown that there’s a great collegiality. We are nuts to go into this field maybe, it is hard. But, we do hope that maybe something that works on a mesenchymal tumor will help EMT and other things. We hope that we will be pioneers in the oncology community. I think we are already pioneers of caring for people from their birth to their 90s, and we do collaborate across age ranges better than any other single discipline. And so, I hope we’ve communicated that there is hope, that there are options, that there are standards, that there is collegiality, and that it can be better than what you Google.

William D. Tap, MD: Martee?

Martee L. Hensley, MD: I would say that we almost don’t realize how many times we use the words “data” and “clinical trials”. Almost everything that we’ve spoken about is data-driven decision making, and those data come from clinical trials that involve hundreds of human beings who are personally facing the challenges of sarcoma. We are indebted to all of those patients, and the doctors who help design those studies and enroll patients on a study. But, the exciting thing is that the clinical trials worked in that we get information from them. That’s why we can sit down for 90 minutes and really talk about what to do in a way that’s not just spouting off answers that seem plausible, but rather are really data-driven choices. So, I think it’s really exciting.

William D. Tap, MD: Yes, thank you. George?

George D. Demetri, MD: I think, in 2016, we have to talk about where’s immunotherapy in sarcomas. Let me just summarize that because at ASCO 2016, I think we’re going to hear some pretty negative messages about the fact that it’s not a home run yet the way it is in Merkel cell, the way it is in melanoma, and the way it looks in bladder. That, to me, is not a bad thing. That just means we have much more work to do, and then sarcoma becomes a testing ground to make all immuno-oncology approaches better. We’re going to need combinations. We may need new targets, but our field has struggled with that for a while, and all the drugs we’ve talked about are the product of that kind of research. Just like everybody said, our community is incredibly collaborative with each other. I think our patients are also quite collaborative with each other, and it makes for the ripe environment to have a lot more progress happen in the future. Thanks for moderating today and inviting me.

William D. Tap, MD: I agree. And I’d like to echo what Mark said, that I’m humbled to be among such distinguished colleagues and friends. You really dedicated your life to this rare and difficult disease, and you really are shaping care for these patients. I think we’re sitting up here discussing these options because of all of your hard work and dedication as well. Thank you very much. So, really, on behalf of our panel, we’d like to thank you for joining us, and we hope that you found this Peer Exchange discussion to be useful and informative. Thank you.

Transcript Edited for Clarity
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