On 16 to 18th of March 2023 was the Annual Meeting of the Japanese Society of Medical Oncology known as JSMO 2023. This is one of the big oncology meetings in Asia with lots of representatives from Asian countries. This year our Regulatory and Study Start Up Manager, Galina Fujimori Petrikova, had the pleasure of attending the meeting and she shared with us her experience of attending JSMO 2023.
1. What was your first impression when you saw the program for the event?
Galina: Since it was for me first opportunity in attending such a big conference, I felt a bit overwhelmed with the program involving lots of different talks, running at three different building locations. There were some presentations that simply only one could be chosen since they run in parallel at the same time. My very first impression was rather ‘WOW’, it was like visiting a small town of scientists for the time being. Overall, a thrilling experience.
2. What was your impression of the venue and the organisation on arrival?
Galina: The whole event was impressively well organised (directions, provided materials, small meals, interpreters including digital equipment, etc.). Although there were small areas where it was not clear what to expect but that is purely by cultural change rather than lack of staff or organisational failure. If I was missing something, it was the opportunity for more interactive sessions or similar type of exposure.
Also, I think there could have been more handy transport, like buses to centre of town as the distance was still pretty substantial for walking. Most of the staff assistance was in Japanese, but there were some English-speaking personnel among them, just not always obvious who is the best one to ask. I can speak some Japanese so no worries for me but can be tricky for exclusively English speakers. The English-speaking staff could be made visible a bit better. Roughly speaking there were about 3-5% of non-Asian attendees assumingly speaking English only.
3. What kinds of attendees JSMO 2023 attracted?
Galina: The highest number of attendees were clearly medical doctors, including junior ones and some academia representatives including students, some basic science researchers, mainly from Japan, but also from some other Asian countries like Taiwan, Singapore, South Korea, Thailand, Indonesia. Sadly, not many from mainland China. I got feeling there is very little collaboration with China, which is bit disappointing, especially for area like science.
4. What were the most interesting topics for you that you managed to attend?
Galina: Lots of talks were focused on Asian / Japanese greater prevalence of cancers, particularly gastric and lung cancers, which tend to dominate in Japan and some other Asian countries. One of the reasons is lifestyle; smoking, high salt diet and eating hot (in temperature) food.
There was a guest from the UK, Prof. Ian Chau from Royal Marsden Hospital, but the most interesting talk focused on Gastric Cancer was by fairly young consultant Dr. Yelena Janjigian, chief of GI in Memorial Sloan Kettering Cancer Center in New York City, US. She had not only good presentation skills, but great passion and knowledge.
Unresectable gastric cancer has often poor prognosis with life expectancy less than a year. 20% of the cancers have overexpression of human epidermal growth factor (HER2) of gastric and gastro -oesophageal junction adenocarcinomas. It was emphasised how important is to perform serum level of HER2 biomarker in gastric cancer determining a patient’s overall survival, treatment outcomes by addressing different monoclonal antibodies treatments and their resistance within strong tumour heterogeneity; particularly addressing Trastuzumab as first line treatment, combined with chemotherapy. The most recent gastric cancer drug catalogue is Nivolumab, Pembrolizumab and Trastuzumab. Trastuzumab has proven to be effective in HER2 positive breast cancer but not as much in HER2 positive gastric cancer as initially expected knowing these two cancers have overlapping molecular entity within the mutational subtype. Moving forward how currently we view future cancer treatments looking into personal approach; this has been disturbing element, mainly due to heterogeneity of the disease.
Adding Trastuzumab, there has not been much of an increased incidence of adverse events once combined with chemotherapy, which was perceived positively. Hence patients with intestinal type tend to have overall better prognosis versus diffuse type.
There was mentioned primary and secondary resistance to HER-2 targeted therapy that need to be still addressed. Comparing these two clinical indications treatment strategies looking into greater molecular level was quite interesting. There was also emphasis how important is to check ctDNA which is critical tool to test for possible re-occurrence.
There is current development of novel agents such as HER2 antibody-drug conjugates and bispecific antibodies, and the strategies with antitumor activity are rather ongoing.
My other stronger form of interest was visiting one of the sarcoma lectures, with my interest in gastrointestinal stromal tumour (GIST), which is the most common GI sarcoma. It was interesting to learn that this disease is handled by GI team rather than Sarcoma. In many ways it has overlapping entity. There was introduced to me 4th line of antigenetic type of therapy Pimitespib which most likely is new or recent. GIST is one of the Sarcoma diseases being treated using targeted (molecular) approach, as there are number of GISTs resistant to first line Imatinib, which is still a gold standard to treat majority of GIST conditions including adjuvant and neoadjuvant setting.
I was delighted to hear about one of the very important sarcoma (retroperitoneal) radiotherapy studies shared data, call STRASS (semi- academic), which was exploring effect of radiotherapy in adjuvant, post operative setting that turned to be not as effective as expected. It meant a lot to me since this is a study I used to be in charge of the set-up and project management in the UK. Now STRASS 2 – exploring rather neoadjuvant/preoperative RT is still ongoing. The study might deliver interesting outcome understanding how much these patients can benefit from radiotherapy in combination with or without surgery. In general, radiotherapy studies have been still challenging to run being under-regulated as they are of other entity as intervention study.
Also, one of the interesting talks was form me to hear on the subject of good clinical practice (GCP) and regulatory compliance in Japan focusing on global studies where some examples were brought demonstrating Japanese working group working towards the GCP, perceiving it as strict set of rules versus other international community seeing it more as a concept. There are two different regulatory working cultures facing the approach of compliance in two different ways occasionally crushing on their joint projects. Essentially, it makes Japanese group to overwork and limit in some areas of more flexible conduct where could be applicable. Japanese group, even as the society is very good, composed of responsible followers and often similar approach from other side is expected.
5. Was there a poster presentation session?
Galina: One of the posters that drew my attention was on working experience setting up Phase 1, multi-cantered Oncology studies in Japan via CRO. Particular survey was made looking into collaboration with IQVIA. It was noted that there are some difficulties in preparation period of Phase 1 trials compared to later phases. Delays in set-up are more concentrated in communication with CRO vs direct communication with a Sponsor. Sites feel they are lacking receiving important information and process is delayed than in oppose to Sponsor’s communications directly. IQVIA Japan prepared some templates in light of improving overall communication, the survey has shown only 20% of templates are being used and should be further promoted. They believe that current trend needs improvement focusing on better knowledge and more constructive form of communication. I thought this was interesting evidence since our company also works in similar environment and our aim is rather to enhance the communication on different studies set-ups. Equally, it was re-affirming that such challenges exist even at wider scope within international community of clinical research and only continuous collaboration and close communication would improve these outcomes.
The second poster that made impression on me was a poster on mapping efficacy of PD-1 blockade using soluble PD-1 and PD-L1 in advanced cancer patients treated with check-point inhibitors, was also very interesting as it showed to be a great biomarker. Before it was explored and believed being relevant only for non-small cell lung cancer (NSCLC) patients. Looking into multivariant analysis involving other cancer groups it was noted there is not apparent difference in sPD-1 and sPD-L1 levels across cancer types. Survival analysis showed that neither sPD-1 nor sPD-L1 are significantly associated with progression free survival (PFS) and overall survival (OS) in the PD-1 blockade therapy. Patients with low sPD-1 and high PD-L1 also had numerically lower PFS / overall treatment response rate compared with others. OS had similar tendency as PFS, which turned to be important predictive biomarker for anti-PD-1 antibody in cancer patients other than NSCLC.
Another interesting poster based on cross-sectional study of questionnaire-based survey was focusing on hospital sites conducting clinical trials demonstrating lack of some infrastructure in medical teams, targeting research nurses. Factors like: Ethical conflict, lack of confidence, working under pressure, team collaboration struggle were explored.
In conclusion nurses’ attitudes in oncology clinical trials are composed of two main factors. Job demand, which means psychological burden is connected to the above four factors. Nurses who feel less affected by ‘lack of self-confidence’ and ‘team collaboration difficulties’ have been receiving the training regarding the needs. In this particular cancer centre (National Cancer Center Hospital, Nursing Division) in Tokyo research nurses tend to work for more than one clinical research team which sounded like being under great demand and pressure. It was identified they need further support including structuring and internal training as great amount of them work under continuous physiological pressure not being sufficiently recognised. Speaking particularly to one of the nurses of this institute who was presenting the poster was for me quite interesting since myself I was closely working with the nurses and could relate to some of those undermined needs, job challenge and the struggle.
6. Would you recommend to others to attend JSMO?
Galina: Attending JSMO has been wonderful experience for me which allowed me to get some insight of different and wider forum than what I have experienced before in Europe like (British Sarcoma, EORTC events and investigator’s meetings).
I have enjoyed choosing the topics I am interested in, even just in English I still had to choose my stronger preference and sometimes unfortunately, there was more than one.
Because this forum was run in Japanese dominating society, more talks were concentrated on gastric, lung cancers but also basic science, how to continue applying the whole genome sequencing towards cancer genomic medicine. Some oncological areas were rather underrepresented. There were also interesting talks on Japanese national health system looking into off-label drugs which are commonly used in the US, but not in Japan (33%), compassionate use program, referring to ESMO guidelines, fewer talks on patients’ quality life, etc. Since Japanese cancer society is focused more on clinical science than social science; quality of life talks, ethical areas although more subjective, often require greater attention, especially in this country. Living here, also as a resident, there is a space for improvement where voice of patients should be more involved and recognised. It is very important part of the modern medicine and patients themselves can teach us a lot in light of improvements. This was rather less represented compared to Western / European forums.
However, this area is under development and in this conference, it has been covered more by an invite of international presenters (from Australia and EU).
Published on 12 April 2023
