Spotlight at major international cancer conference shines on Upstate faculty

Three Upstate Medical University professors—Jeffrey Ross, MD, Jeffrey Bogart, MD, and Gennady Bratslavsky, MD—were among the researchers presenting their work at the ESMO Congress 2019, the European Society of Medical Oncology, in Barcelona, Spain, Sept. 27 to Oct. 1.

The ESMO Congress is world’s second-largest cancer conference. This year the conference attracted more than 28,000 attendees.

Ross is making headlines for a study, in which he was a primary author. Ross’s research that was reported at the conference found that DNA profiling is revealing novel treatment choices for patients with cancer whose disease has spread by the time they are diagnosed and no primary tumor site of origin can be found—so-called carcinoma of unknown primary (CUP).

The research showed that approximately one in three patients with CUP may not be adequately treated with standard chemotherapy but may be suitable for matched targeted treatment or immunotherapy based on DNA changes in their tumor.

“Standard treatment for CUP has not changed in decades so, if we can change the outcome for the one in three patients with targetable mutations identified by DNA profiling, that could have an important impact on CUP therapy,” said Ross, a member of Upstate’s pathology faculty and one of the leaders of the molecular laboratory, located in the Central New York Biotech Accelerator.

CUP affects approximately one in 15 patients with cancer, despite investigations to try to identify the primary tumor from which the cancer has spread. They then receive anti-cancer treatment and/or palliative care to relieve symptoms arising from the spread of their cancer. However, only about one in 10 patients survive for one year.

“CUP is a bit of a pariah because people don’t understand it and assume that nothing can be done. We need to change that attitude and encourage clinicians to look for and treat the drivers of each patient’s disease as shown by DNA profiling,” urged Ross.

An analysis of 303 CUP tissue samples collected in 2018, reported at the ESMO Congress 2019, used cutting edge technology to search for DNA changes and revealed that 32% could have been targeted by the latest medicines. (1) The same technology is now being used in the ongoing prospective CUPISCO trial. This is randomizing patients with CUP to individualized targeted treatment or immunotherapy based on genetic alternations in their tumor, or to standard platinum-based chemotherapy. Initial results are expected within the next few years.

Bogart, chair of the Department of Radiology and interim director of the Upstate Cancer Center, presented his research on “interim toxicity analysis for patients with limited stage small cell lung cancer (LSCLC) treated on the experimental thoracic radiotherapy (TRT) arms of CALGB 30610 (Alliance.)”

Bogart said his research is based on a 10-year study of more than 700 patients throughout the country—including many treated at Upstate. The study involved varying radiation treatment plans for patients with small cell lung cancer.

“The trial is completed and we will have to follow up with these patients over the next several years,” Bogart said. “The final question is one we don’t have the answer to yet and that is the best way to give radiation, which will have a big impact for how patients are treated in the future.”

Bratslavsky, chair of Upstate’s Department of Urology, had an oral presentation on the genetic landscape of malignant pheochromocytomas and malignant paragangliomas. Bratslavsky presented a unique data that came from a database of more than 200,000 patients that contained more than 120 extremely rare cases of malignant pheochromocytomas and paragangliomas.  While these cases are notoriously challenging to treat and have very few options, the new research presented by Bratslavsky identified several new opportunities for therapy using already available and approved by the FDA drugs for other cancers. This oral presentation was well received and attended by physicians and scientists from every corner of the globe.

Faculty say Upstate’s involvement at an international conference like ESMO helps to further establish Upstate as a leader in cancer research.

“It’s exciting for Upstate Cancer Center to be a significant source of new information for cancer patients and to be on the cutting edge of this kind of cancer genomics research,” Ross said. “It’s hopefully going to make the breadth of cancer work done at Upstate more well known. We’re doing more than just treating cancer patients. We’re doing basic and clinical research trying to help patients not just in Syracuse but everywhere.”

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