Editor’s Note
	Figuring it out

The recent ASCO meeting in Orlando was unlike any I have attended in the last 30 years. While there were many new clinically relevant data sets presented in a variety of cancers, the real revelation occurred at the May 16th “education session” on monoclonal antibody therapy for breast cancer chaired by George Sledge, in which groundbreaking data were presented on the use of bevacizumab in metastatic disease and trastuzumab as adjuvant therapy.

Three days later, I found myself at a previously planned Meet The Professors recording session in Los Angeles. This turned out to be a fascinating opportunity to observe how clinical research findings are made available to medical oncologists in practice. Most striking was that only a couple of these community physicians had actually attended ASCO, and as a result, at the beginning of this MTP recording session, the level of information in the room about these groundbreaking data sets was minimal.

The discussions that took place over the day were riveting. As we sifted through a series of actual cases from the practices of these clinicians, it was fascinating to observe how the new information on bevacizumab and trastuzumab was being processed. It was also interesting to see a number of other recent and obvious shifts in standard care.

Many of the cases presented to our faculty of Steve Jones, Chuck Vogel, Peter Ravdin and Bill Gradishar related to the use of aromatase inhibitors in the adjuvant setting, and it is clear that oncologic practice has made a dramatic shift from an emphasis on cytotoxic agents to targeted biologic therapy.

As I moderated the discussion that day, and observed the uncertainty surrounding the implications of the new bev/trastuzumab data, my thoughts went back to December 2001 and the confusion generated by Mike Baum’s first presentation of the ATAC data demonstrating an advantage for anastrozole over tamoxifen as adjuvant therapy for postmenopausal women with early breast cancer.

For the next year, our CME group observed a rather slow uptake of this new treatment strategy, and it took perhaps another two or three years for aromatase inhibitors to be routinely incorporated into the management of early disease.

In retrospect, it is apparent that thousands of unnecessary relapses, endometrial cancers and deep vein thromboses occurred in postmenopausal patients continuing to receive tamoxifen as clinical investigators and oncologists in practice pondered the ATAC results.

Perhaps it was important to allow the data to mature, and additional data sets from similar trials to be presented to provide the necessary justification for this approach, but in 2001, there were also many researchers like Aman Buzdar who immediately concluded that the first ATAC data set warranted a change in clinical practice.

As I began the process of selecting cases from this most recent MTP recording session to include in our final edited audio program, a compelling dilemma quickly appeared: Namely, there was way too much good stuff to squeeze onto two audio CDs. We therefore decided to cut back on the print monograph supporting the discussion and expand the program to three audio CDs.

The enclosed discussion represents one of the first attempts to distill the clinical relevance of the May 16^th ASCO session, and it will be interesting to go back a few years from now and see how accurately these initial reactions predict the long-term response of academic and community-based oncologists to perhaps the most important new data set in breast cancer in 30 years.

—Neil Love, MD
NLove@ResearchToPractice.net