The ninth Annual Meeting of the International Society of Gastrointestinal Oncology was held from September 13–15, 2012 in Arlington, VA. The agenda provided a broad canvas on which to highlight advances in managing the diverse spectrum of gastrointestinal malignancies. Presentations by international experts of proffered papers, case reviews, oral abstracts, and poster presentations were complimented by lively panel discussions. Attendees commented on the quality and comprehensive nature of the educational program.
A popular feature of the ISGIO meetings is the ability of audience members to interact directly with faculty members. Attendees were able to lend their own voices and professional opinions to select program segments by responding to polls and questions posed during case presentations, question and answer sessions, and panel discussions. An important, forward-looking educational initiative of the Annual Meetings is the engagement of younger faculty from academic institutions throughout the United States and worldwide. In case presentations, panel discussions, and presentation of award-winning abstract submissions of novel research, fellows in training and young faculty members presented research abstracts and patient cases. This led to interactive debates between the faculty panel and audience. The responsibility of overseeing an educational session provided a unique learning experience for young faculty, expanding the interaction with colleagues possessing a broad range of academic and clinical experience.
The meetings began with a spirited debate about the role of radiation therapy in the adjuvant management of esophageal and gastric cancer. The argument for combined chemoradiotherapy in esophageal cancer was made by Dr. David Ilson, and the argument for chemotherapy alone was made by Dr. Hope Uronis. The role of radiation therapy in patients with gastric cancer after D2 resection was called into question by Dr. Mitchell Posner. In Asian studies, where D2 resection is mandatory, patients achieve a survival benefit from adjuvant chemotherapy alone without radiotherapy. Although American data indicate a potential role for radiotherapy to reduce local gastric cancer recurrence, as reviewed by Dr. Brian Czito, this is in the setting of suboptimal surgery in which only 10% of patients undergo D2 resection. Completed and ongoing trials of second-line therapy in advanced gastric cancer in Japan were also reviewed, including recent studies firmly establishing a benefit for second-line chemotherapy in advanced disease. The role of targeted agents, including HER2 targeted therapy and the ongoing investigation of anti angiogenic agents was also reviewed.
A multidisciplinary approach was the focus of presentations and discussion of pancreatic cancer. A panel of surgeons, medical, and radiation oncologists debated the criteria for borderline resectable pancreatic cancer and the relative merits of preoperative chemotherapy and chemoradiotherapy. Despite the validation of adjuvant chemotherapy in resected pancreatic cancer, as reviewed by Dr. Robert Mayer, the benefits achieved have been modest and ongoing evaluation of targeted agents and more novel multiagent chemotherapy await validation in clinical trials.
The debate in colorectal cancer focused both on the optimal use first line of targeted therapies, and new approaches studying targeted agents as potential maintenance therapy in advanced disease were presented and discussed by Drs. Axel Grothey, Howard Hochster, Kohei Shitara, and Johanna Bendell. The theme of the value of continued VEGF suppression throughout the treatment of metastatic colorectal was underscored by recent positive trials for the continuation of agents like bevacizumab into second-line chemotherapy, and the validation of the VEGF ligand-targeted agent Ziv-Aflibercept as an active agent in combination with chemotherapy in second-line treatment. The Japanese perspective on adjuvant therapy in colon cancer was discussed by Dr. Nizomu Fuse.
The session dedicated to Hot Topics always draws a great deal of attention, and this year was no exception. This year's talks included a presentation by Dr. Adam Bass, who presented provocative data from the TCGA project, which aspires to obtain total genomic sequencing in a range of gastrointestinal cancers. The emergence of new and previously unappreciated tumor promoting pathways, as well as the apparently even greater complexity of the esophagogastric cancer genome compared to colorectal cancer, sparked enthusiastic discussion and questions from the panel and audience. The role of the microbiome and its role in cancer development and tumorigenesis were reviewed by Dr. Juanita Merchant, as was potentially enhanced screening techniques for colorectal cancer screening employing fecal DNA testing by David Ahlquist. Dr. Al Benson reviewed the ongoing evolution of the cooperative group mechanism to facilitate and accelerate clinical trial progress by the encouragement of greater intergroup collaboration and coordination of more directed research trials.
The emergence of novel targeted therapies as viable treatment options in neuroendocrine cancers was reviewed by Dr. Jonathan Strosberg. The pathology and nuances of diagnosis of neuroendocrine cancers was discussed by Dr. David Klimstra. A panel discussion of the multidisciplinary management of neuroendocrine cancers, including ablative strategies and the evolution of novel systemic therapies, followed these presentations. The meeting ended with an extended session on the management of hepatocellular cancer. This session was highlighted by the review of new drug therapies by Drs. Rebecca Miksad and Ghassan Abou-Alfa, and an update on diagnostic and therapeutic interventions in biliary cancer by Dr. Stanley Branch. The session and meeting culminated with case reviews and presentations of the management of hepatocellular cancer, which included discussion by Drs. Weijing Sun and Davendra Sohal.
The informal consensus among faculty and symposium participants indicates that the 2012 Annual Meeting was a complete success, adding to a series of recently successful and well received international meetings and programs offered by ISGIO. I wholeheartedly agree and anticipate equal success for the Tenth Annual ISGIO meeting, which will take place October 17-19, 2013, at the Hilton Crystal City in Arlington, VA. Please mark your calendars today.