My brain is about to explode

Ahh, the joys of going to a big meeting. I heard the rumor that the prediction was that this year's ASCO has 33,000 attendees. There is something moving about that many people cominng together in the name of fighting cancer. My brain is about to explode: a combination of information overload and caffeine withdrawal (why is it so hard to find simple tea or Diet Coke at events like this?).

ASCO has been exciting in some ways, disappointing in others. I came to my current position the long way: taking a decade foray into basic science and research before pursuing medicine full time. Sometimes, listening to talks, I feel frustrated by how much we don't know...why has it taken so long....but then I hear something where it does seem like we are beginning to molecularly characterize tumors so that, hopefully, some day, we can tailor therapy (and dare we dream, also avoid toxicity?).

I am currently in full canine withdrawal. For some reason, I was coming back to my hotel room on the 15th floor, I thought that there would be a dog...but of course, not. No dog. Lousy conference. Even the security dogs have seemed to be on the scarce side. Used to be I saw the dogs every day.....but, no...they have HUNDREDS of security people to keep the oncologists in line -- no standing at the back of a room during a conference (why do we have to sit?? My sitter is sat out!), no stopping in a hallway. This meeting is regimented.

Chicago is nice, but there are far too many people. I don't see how people live here (not to mention, far too few dogs).

I did find this nice cow....I guess they try to make even people like me, yearning for the ranch fell at home. Somehow, a brass cow just isn't as nice as a real cow. I hate that I won't have much time with my dogs before having to rush to work, but it will be good to see all those brown eyes and brown noses.

So, what is cool about the meeting?

I attended a session about non-small cell lung cancer in the non-smoker. It was a tad on the disappointing side, but it did confirm what I had already suspected -- that they are finding non-smokers tend to live longer, even when they present with metastatic disease than do the smokers. There is likely a molecular basis for that-- in general, non-smokers more commonly present with adenocarcinomas (a flavor of lung cancer), and more commonly have mutations in the EGF receptor (allowing higher response rates to a certain class of drugs). Of course, I wanted to hear that there was a cure for that da** disease, but -- not yet.

I attended a few of the breast cancer sessions. I find it interesting. When I was in training, women with Her2neu amplified breast cancer were considered to have a poorer prognosis. Now, because of targeted therapies (Herceptin and Tykerb) those women have a BETTER prognosis when presenting with metastatic disease -- at least for the first two year. It's nice when the science really impacts the clinic.

Finally, my old friend Ras seemed to be the star of the meeting (slide stolen from the plenary session on KRAS and colon cancer):
Way back when I was an impressionable mind, I became interested in cancer while reading a Newsweek article about oncogenes. They had discovered c-myc and the ras (Kirsten/Harvey mutations) oncogenes and it was thought that the cure for cancer would follow in about 10 years. Unfortunately, regulation of the cell cycle has proven to be much more complex than 2 or 20 or 100 oncogenes....they are multiple pathways with multiple interactors that can all go awry during the process of turning a cell into a cell out of control. However, recently it has been discovered that in colon cancer, mutations in KRAS will confer resistance to EGF-receptor mediated drugs (like Erbitux). It is a small but important step -- this will help us to avoid treating patients with drug that they don't need to see as they won't help them. Hopefully, we will determine more of these cause/effect relationships between tumor gene expression and response to therapy.