2012 ASCO Annual Meeting: Immediate Impact on Clinical Practices. Non-Small Cell Lung Cancer (NSCLC) & Renal Cell Carcinoma (RCC)

Introduction:

In an effort to provide you with timely market feedback from ASCO 2012, OBR and MDOutlook Oncology Intelligence are pleased to share results from MDOutlook’s 5th Annual post-ASCO survey fielded among its global network of more than 62,000 cancer providers.

This second Quick-Poll to be published in the OBR blog explores Non-Small Cell Lung Cancer (NSCLC) & Renal Cell Carcinoma (RCC), and stay tuned to our blog in the coming weeks as we publish QuickPolls on the other tumor types as well.

Quick Poll Methodology and Respondents’ Geographic Distribution

  • Primary research phase involved a global survey to medical oncologists and multi-disciplinary physicians with an identified clinical interest in lung cancer and / or renal cell carcinoma utilizing targeting parameters within the proprietary MDOUTLOOK global cancer treater database
  • Timing: June 2012. One week after 2012 American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago, IL., May 31-June 4, 2012
  • Fielding via <10 minute long interactive internet survey utilizing proven effective methodology via the MDOUTLOOK survey tool
  • Survey closed 4 days after fielding
  • Reponse:102 on June 18th
  • No financial incentives provided for participation

Attendance at 2012 ASCO Annual Meeting

Key Conclusions:

  • ~Just over half of all survey respondents attended this year’s ASCO annual meeting
  • US had slightly more attendees than Ex-US physicians

NSCLC Survey Results:

1) Crizotinib Will Be the Standard Treatment Approach for NSCLC with ROS1 Gene Rearrangements

Key Conclusions:

  • Lung cancer treaters rate highly the findings that crizotinib has significant clinical activity in NSCLC patients with a ROS1 rearrangement
    • Over 80% rate it as very important or important
    • Only 4% rate it as not very important or not at all important
    • Little to no difference in responses between US and Ex-US oncologists (data not shown)

2) Testing for ROS1 Gene Rearrangements Will Become Standard Diagnostic Procedures in US for NSCLC

Key Conclusions:

  • Testing for ROS1 rearrangements in NSCLC are expected to increase 6-8 fold in the next year
    • Up from only 6-12% of patients in past year
    • Higher usage of testing by US oncologists (77% vs. 50%)
    • Sequential testing of ROS1 after ALK will be preferred diagnostic algorithm
      • In 1/5 – 1/3 of cases, diagnostic assays will be run at the same time

3) Awareness of PD-1 Blockade Strategy for NSCLC is Mixed;
Consistent Inside and Outside of the US

  • Awareness about PD-1 blockade strategy for the treatment of NSCLC is consistent across geographies
  • 1/3 of physicians who treat NSCLC reported high level of awareness of PD-1 blockade strategies for NSCLC
  • Almost 1/2 of NSCLC treaters reported little to no awareness of PD-1 blockade strategies for NSCLC

4) Majority of NSCLC Treaters Anticipate PD-1 Blockades Will Have an  Impact on Clinical Treatment  Practices for NSCLC

  • Majority of NSCLC treaters expect PD-1 blockade strategies will play some future role in their treatment armamentarium
    • Nearly1/3 expect this approach will play a large or very large role in the treatment algorithm
    • About 40% believe it will have some impact on their treatment practices
    • Less than a third of respondents believe it will have little or no success in its clinical development

Renal Cell Carcinoma (RCC) Survey Results:

1) Tivozanib Will Be a Widely-Used Therapeutic Agent for the Initial Treatment of Good and Intermediate Risk RCC

  • Physicians expect to use tivozanib as front-line treatment for ~1/3 of their RCC patients
    • Slightly more usage in patients with intermediate risk disease over those with good risk RCC
    • Slightly higher levels of usage outside rather than inside of the US
    • Very few individuals expect to use tivozanib in all of these patients or expect not to use it at all (data not shown)

2) Usage of Pazopanib as Front-Line Therapy for RCC Will Increase Due to the Results of the PISCES Trial

  • Due to the patients’ reported preference for pazopanib over sunitinib as a treatment for RCC, its usage as 1st line therapy will increase dramatically
    • Most of its increased usage will come at the expense of sunitinib
  • For only ~ 1/4 of RCC treaters did these results not change their opinion of these agents
  • Little to no difference among US and Ex-US respondents (not shown)

3) The Results from Non-Efficacy Clinical Trials Are Integrated Into the Clinical Decision Process

  • Results from non-efficacy clinical trials play some role in a physicians decision on the treatment of choice
    • Somewhat more important to US oncologists than to those outside of the US
  • For 25-30% of oncologists, these results play a large role (rated 8 or higher) in their decisions
    • For only ~10% do these types of studies offer little to no help

4) Awareness of PD-1 Blockade Strategy for mRCC is Slightly Higher Outside of the US

  • Ex-US RCC treaters reported higher awareness of PD-1 blockade strategies than US counterparts
    • 70% of Ex-US treaters reported Some or Large/very large awareness compared to 50% of US treaters
  • 1/2 of US treaters have no to little awareness of PD-1 blockade strategies
  • 1/3 of Ex-US treaters reported having no to little awareness

5) Most Treaters of mRCC Anticipate PD-1 Blockades To Have a Positive  Impact on Treatment of mRCC

  • Majority of RCC treaters expect PD-1 blockade strategies will play an important future role in the treatment of metastatic RCC
    • Nearly half expect this approach will play a large or very large role in the treatment algorithm
    • Only 20-30% of respondents believe it will have no to little impact on the treatment of mRCC
    • Overall, relatively equal levels of enthusiasm for this treatment inside and outside of the US

Conclusions from the ASCO 2012 Quick Poll on Non-Small Cell Lung Cancer and Renal Cell Carcinoma

  • For NSCLC, the usage of crizotinib for patients with ROS1 gene rearrangements represents a significant clinical development for the global oncology community
  • Correspondingly, there will be a large increase in the amount of diagnostic testing for ROS1 rearrangements in NSCLC samples
    • In most cases, testing of ROS1 will be done for those patients with a normal ALK gene
  • These patients would otherwise be considered non-candidates for treatment with crizotinib
    • Concurrent testing of ALK and ROS1 genes at same time will also be used in up to a third of patients
  • Additional work is needed to understand the rationale behind sequential vs. concurrent testing
  • In RCC, tivozanib will be a commonly used 1st line treatment for both good and intermediate risk disease by US and Ex-US physicians
  • Pazopanib will likely see an increase in its usage as front-line therapy for RCC, largely at sunitinib’s expense, due to the reported patient’s preference for it in the PISCES trial
    • Results from clinical trials with non-efficacy endpoints, such as the PISCES trial, do play an important role in the physicians treatment decision process
      • Slightly higher level of importance for those in the US
  • Both NSCLC treaters and RCC treaters expect PD-1 blockade to have an important impact in the future treatment of these cancers
    • Relatively low amount of awareness for this approach in either disease at the present time

Final Thoughts

Quick polls are a fast way of measuring expected acceptance of clinical data post major medical meetings, and perhaps can be used to make some assumptions about adoption amongst providers. In today’s information hungry environment, the speed at which these polls can be conducted and analyzed can be advantageous for market planning and “pressure testing” acceptance of data amongst key stakeholders.

Submitted by Jan Heybroek, President and Robert Stephan, Sr. Director Medical Services, The Arcas Group

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