Moderator: On behalf of the American Society of Clinical Oncology (ASCO), welcome to the Cancer.Net Ask the ASCO Expert chat on Top Advances in Cancer Research: News From ASCO's Annual Meeting, a live question-and-answer session hosted by Roy Herbst, MD, PhD.

During this hour, Dr. Herbst will answer as many questions as possible. Due to an increasing number of chat participants and number of questions submitted for each chat event, time simply does not allow us to address all of your questions, and we encourage you to consult your doctor and cancer care team.

Some questions may be adapted so that Dr. Herbst's answers can help as many people as possible.

Dr. Herbst will take questions from 1:00 - 2:00 PM ET. As you prepare your questions, please keep in mind that Dr. Herbst is unable to give individual medical advice in this setting, nor is he able to address questions that include information specific to one person's medical profile.

The information presented here is for informational and educational purposes only and is not intended to substitute the professional medical advice or treatment recommendations provided by your doctor.

This forum is neither intended nor appropriate to serve as a means of obtaining a second opinion on cancer diagnosis or treatment. In response to questions about specific drugs, Dr. Herbst's comments will focus only on the state of current research and clinical trials.

It is advised that you do not delay seeking professional medical advice based on any information received during this chat event.

The chat is governed by all terms and conditions of the Cancer.Net website. Participation in this chat event means that you fully understand and agree to abide by the terms and conditions of the Cancer.Net website.

Good afternoon and welcome. Thank you for joining us. Dr. Herbst will now begin taking questions.

Roy Herbst, MD, PhD, is a Professor and Chief of the Section of Thoracic Medical Oncology in the Department of Thoracic/Head and Neck Medical Oncology and Department of Cancer Biology at the University of Texas M. D. Anderson Cancer Center.

Dr. Herbst is Chair of the American Society of Clinical Oncology (ASCO) Cancer Communications Committee and has published numerous studies in peer-reviewed publications.

Dr. Herbst, thank you for taking the time to join us today.

Sara: My dad has stage IIa non-small cell lung cancer and we are trying to figure out treatment options. He is 66. Is chemotherapy an option? I hear mixed views on whether this is an acceptable treatment.

Dr. Herbst: My recommendation would be is, if his functional status is good, he consider chemotherapy in this situation. Data over the last few years presented at ASCO and compiled this year in a summary of all studies, would suggest that chemotherapy can reduce the chance of recurrent disease by upward of 10%.

You might have heard that a study reported at this year's meeting in earlier disease, that being stage IB, is now less positive than it was a few years ago. However, this was a small study, and I think the preponderance of evidence is that one should certainly talk with their physician about adjuvant chemotherapy.

Guest5: I am confused by all the information coming out of the STAR trial. Is raloxifene (Evista) better than tamoxifen (Nolvadex)? What do I talk about with my doctor?

Dr. Herbst: I share your view. As a physician, this ASCO meeting was the very first time the patients, the public, and the physicians saw the entire data from this trial. I think the jury is still not in regarding these two agents. But my sense is that like many things in medicine, there are pros and cons to each alternative.

While the raloxifene did have fewer incidents of side effects, there were an increased number of noninvasive cancers detected. I think the good news is now is that women have two alternatives which clearly seem to reduce the risk of breast cancer, and a choice you should certainly discuss with your treating physician.

Guest36: What are biomarkers? How are they used to treat cancer?

Dr. Herbst: Very often, to be most effective, we would like to treat cancer before it can be physically detected. That's because once we can see cancer on an x-ray, it has likely spread or metastasized, which of course, is a difficult situation to deal with. Therefore, we look to measure something in the blood or in the tumor tissue that can give us some inkling regarding the aggressiveness of the cancer.

For example, in prostate cancer, we might measure prostate specific antigen (PSA). Or in breast cancer, we might look for evidence in a breast tumor removed from a patient that a drug has had an effect on the tumor cells. Basically, with so many agents under study right now, it is going to be important to develop some sort of assay that can be used in the blood, urine, tissue, that will help us to gain early insights into the utility of the treatment.

TBM2: I'm excited to hear about the new drug for breast cancer (for women who can no longer take trastuzumab [Herceptin]). Do you think this will be a new treatment for breast cancer? Is it being tested on other cancers?

Dr. Herbst: Lapatinib (Tykerb) is an oral agent that blocks a receptor on breast cancer cells called HER-2, which is similar to the activity of trastuzumab. However, this molecule also blocks other receptors, including the HER-1 receptor. Why is this possibly important? At this meeting, we saw data showing that lapatinib plus chemotherapy is significantly more effective than chemotherapy alone for women whose cancer no longer responds to trastuzumab. This suggests that the next generation of targeted agents for treating breast cancer is here and now, I suspect this agent will be looked at, in fact it's already is being looked at, as an alternative to trastuzumab as the first therapy, and in several other trials in patients who have failed trastuzumab. In my opinion, this was a very important result from the Atlanta ASCO meeting.

Charles88: What are the new lung cancer developments?

Dr. Herbst: We have seen at this meeting the emergence of several new small molecule angiogenesis inhibitors, which seem to have some reasonable activity in non-small cell lung cancer. These include ZD6474, sunitinib (Sutent), and sorafenib (Nexavar). In addition, we saw some very exciting new data that suggests that the drug bevacizumab (Avastin) can now add to chemotherapy in the second line setting of this disease.

While only a phase II randomized trial, we saw that the combination of bevacizumab with chemotherapy or the combination of bevacizumab with erlotinib (Tarceva) was an improvement over chemotherapy alone.

Importantly, the combination of bevacizumab plus erlotinib was found to be much better tolerated than any of the chemotherapy combinations, as one would expect. The one concern that remains, however, with using bevacizumab, is that there did appear to be the same risk of pulmonary bleeding that was seen in prior trials at around 2+%.

Guest218: There has been a lot of cancer news this week. How can I be sure my doctor knows the latest information on my type of cancer?

Dr. Herbst: The ASCO meeting is the largest meeting of its type in the world, and we had oncologists here from around the country and the world. Of course, not everyone can travel to Atlanta (someone has to mind the store), but the proceedings from this meeting are now available online and ASCO will be holding regional meetings to recap the most important highlights over the next few weeks.

In addition, many of these papers you've heard about will soon be published in medical journals and distributed that way. That said, you are your own best advocate, and certainly you should always feel free to ask your physician about things you have heard or read about cancer treatment.

I know that my patients frequently bring in articles or information from websites for discussion. The good news is that the field is moving forward so fast in a positive direction that it is important to get the best treatment possible at any given time.

JennaR: What is HPV, and what I should I do about this new vaccine I've read about? My mother had ovarian cancer and a complete hysterectomy seven years ago.

Dr. Herbst: HPV is a virus called human papillomavirus that is known to be a cause of cervical, vaginal, and vulvar cancers, among others. Cervical cancer, of course, is the reason why an annual Pap test is important.

One new approach for treating this disease, which worldwide, is a major health-care issue, was to develop a vaccine not against the cancer, but against the virus that causes the cancer. This is known as Gardasil.

Data presented show that the use of this vaccine can decrease 100% of HPV-related vaginal and vulvar precancers. This is an agent that has already been shown to prevent cervical cancer.

The idea is that when this vaccine is approved, it will most likely be for women, though specific recommendations will depend on the country.

CeliaF: Is the HPV vaccine for both men and women?

Dr. Herbst: Yes. The vaccine could be given to both men and women. This is a bit of a delicate issue, of course, since HPV is a sexually transmitted disease, so I expect that there will probably be a debate regarding whether only women, or women and men, should receive this vaccine. This virus puts women at risk for these gynecologic cancers. You can imagine that in countries or areas where medical care is not as strong as others, this type of primary prevention of this cancer could be much more effective than the Pap test, which only finds a cancer once it's developing. This will be a matter of discussion for public health authorities.

Moderator: Transcripts of today’s chat will be available June 7, 2006, on Cancer.Net by 12:00 PM ET. More information about receiving transcripts will be provided at the end of the chat.

Guest31: What are effective methods for managing the rash from EGFR drugs, specifically Panitumumab.

Dr. Herbst: The class of agents that blocks the EGFR receptor produces an acne-like skin rash. The only good news about this is that it would appear that in most situations, when analyzed, the rash appears to correlate with a better activity of the drug.

My advice regarding the rash to my patients is usually to begin with topical antibiotics, such as clindamycin gel (Cleocin T, Clinda-derm). If this does not work, often helpful is an oral antibiotic, such as minocycline or doxycycline. If that is not effective, one sometimes needs to reduce the dose of the drug.

Other approaches that have had mixed results include steroids, and in some cases, pimecrolimus (Elidel). However, if the rash begins to spread over the body or affect the face, I would suggest a consultation with a dermatologist. For more information, please see the new article on Cancer.Net on Skin Reactions of Targeted Therapies.

Kayla: I've noticed that much of the cancer news was from studies conducted during clinical trials. If there is a promising new treatment, how long does it take for the general patient population to benefit?

Dr. Herbst: That can vary. For example, the drug lapatinib, which worked in the women with trastuzumab-refractory breast cancer, is not yet available because it is not approved by the U.S. Food and Drug Administration (FDA). However, this drug is being tested in an ever-increasing number of clinical studies and one can certainly ask their physician about available clinical trial sites for enrollment in their area.

In some cases, data from the meeting incorporates existing drugs into new combinations, sequences, or uses, and often from the data from this meeting and public scrutiny from this meeting, physicians might incorporate these new practices in a rapid fashion.

Guest128: I read a disturbing report about doctors not always referring advanced cancer patients to specialists. My parents live in a rural area. Do you have suggestions to make sure I get them the right care?

Dr. Herbst: Yes, be their advocate. ASCO is working hard to educate all physicians regarding the advances in cancer treatment, through our meeting, publications, and websites, but there is no substitute for the informed patient or family member, and you need to bring your resources of their care to them, and this should be a fail-safe mechanism for any family situation.

Guest41: Can you outline the new research findings on kidney cancer?

Dr. Herbst: Kidney cancer research made up almost half of the plenary session at the meeting because the results were quite significant. The multi-targeted, anti-vascular agent sunitnib was shown to improve survival in patients with advanced kidney cancer over the standard of care.

In addition, a new agent known as temsirolimus (CCI-779), which targets signaling pathways in the cell, also showed activity in this area. This is in addition to data on sorafenib, which we heard about at last year's meeting. Both sorafenib and sunitinib are approved by the FDA for this indication.

Clearly, progress is being made in this important area.

Guest227: Which of the biologic agents, besides cetuximab (Erbitux), are the most promising for head and neck cancers? Which chemotherapies are best to combine them with?

Dr. Herbst: We heard actually, in the very last session of the meeting, about some early indications that drugs such as erlotinib have early signs of activity in head and neck cancer in combination with chemotherapy.

We also learned that the anti-angiogenesis agent bevacizumab, combined with radiation and chemotherapy in a safe way, suggests that this might be a therapy in the future. It was intriguing to learn that in thyroid cancer, which is a different type of head/neck malignancy, that some of the newer drugs that target angiogenesis and tumor growth, such as ZD6474 and axitinib, have some effect.

Guest31: What is the future direction for tumor necrosis factor drugs, particularly Apo2L/TRAIL, when used in combination with other drugs?

Dr. Herbst: Apo2L/TRAIL is a novel agent that targets death receptors on tumors. Basically, the reason why chemotherapy and radiation therapy often fail is that cancer cells do not die because the mechanisms for cell suicide have been corrupted. The TRAIL works by taking the dying cell and finishing it off by giving it that extra "pop" necessary for its elimination.

The results presented at this meeting remain quite preliminary, but suggest that the drug is sufficiently safe with hints of early activity that should now go forward in combination studies for numerous cancers.

Guest24: I heard about yoga helping people with breast cancer. Do you think other types of exercises could be helpful for people recovering from cancer?

Dr. Herbst: It is important when we treat cancer that we focus on the patient's entire physical and emotional well-being. It was reassuring to see that such integrative health-care methods like yoga did seem to improve the qualitative outcome for patients with breast cancer.

One does not know if other forms of exercise would provide the same result, though it is my strong feeling that all forms of supportive physical and emotional therapy during cancer treatment cannot be a bad thing. For more information, please see Cancer.Net.

Lara: I heard the report this week about how older patients are getting aggressive treatments just before they die. My mother has stage IV breast cancer. Any suggestions or resources for us (so we can know our options if the time comes)? I don't want her to die in the ICU.

Dr. Herbst: I think it is very, very important that you talk honestly with your mother and discuss these issues with her. Then, the two of you and any other family members you feel should be there, need to go speak with her physician about her current status, future treatment plans (if any), and get from the doctor an assessment of her disease progress.

I think the news out of ASCO can help you since at least now you are more aware of the hospice and supportive care systems available, but it is only through this type of discussion that you will be able to truly decide with your mother what the best course of therapy for her is. My take from this paper is that this discussion should happen more often.

Guest396: What do you think is the most promising data that was presented at the 2006 Annual Meeting?

Dr. Herbst: This meeting was one of the largest ASCO meetings ever, and we saw advances in cancer therapy, cancer prevention, and cancer survivorship. I was personally struck by a number of major themes, including the fact that not only is targeted therapy for cancer a reality, but the next generation of agents have emerged that can target those patients who have become resistant to the first-line drugs.

In addition, our increased availability of agents now enables us to consider combining multiple agents, and we saw many presentations at this meeting better defining the factors that cause cancer to grow, which I expect will very soon allow to use the proper agents early on to better target and/or prevent the growth of different types of cancer.

Without question, progress is being made and the enthusiasm to continue with clinical studies and to translate these findings into daily practice is very real.

Moderator: The chat is now ending. Thank you for your thoughtful questions.

We hope this discussion has been valuable, and we regret not being able to answer every question.

We want to thank Dr. Herbst for lending us his time and expertise.

TRANSCRIPTS: The full text of today's chat will be available on Cancer.Net (www.cancer.net) June 7, 2006, by 12:00 PM ET. To receive a copy of the transcript by e-mail, please send a message to contactus@cancer.net.

June Q&A: In June 2006, visit Cancer.Net for a question-and-answer (Q&A) forum on How to Cope with Common Side Effects of Cancer Treatment. The featured experts are Jamie Von Roenn, MD, of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University; Thomas Smith, MD, of Virginia Commonwealth University Health System; Charles Loprinzi, MD, of the Mayo Clinic; and Georgia Decker, MS, RN, CS-ANP, of Integrative Care and the Oncology Nursing Society.

The chat room is now closed. Thanks again for joining us.

More Information

Cancer Advances: News From the 2006 ASCO Annual Meeting