On 11-14 September 2016, the 13th Asian Society for Neuro-Oncology (ASNO) Annual Meeting and the 9th Co-operative Trials Group for Neuro-Oncology (COGNO) Annual Scientific Meeting were held in Sydney, Australia. The theme of this joint conference was “Neuro-Oncology: is the landscape changing?” With over 250 delegates from 20 countries attending, this was the largest neuro-oncology meeting ever held in Australia.
The ASNO-COGNO meeting is an exciting prospect for health professionals and researchers in the Asia Pacific region because many cannot afford the time or expense to travel to the large neuro-oncology conferences in Europe or the United States. The four day scientific programme offered delegates the opportunity to engage with the impressive international faculty1 assembled by the ASNO-COGNO meeting organisers, and the chance to be updated on the latest in brain tumour research and to learn from, and exchange ideas with, some of the best and brightest in the field of neuro-oncology.
ASNO-COGNO 2016 Summary
Workshops and Symposiums
Education was a strong focus of this conference, beginning on the first day with two workshops: SRS Workshop (stereotactic radiosurgery) and the Glioma Master Class. The Glioma Master Class featured presentations from invited overseas speakers: Professor Mitch Berger (USA); Professor Rakesh Jalali (India); and Professor Susan Chang (USA) as well as a list of prominent Australian clinicians2. Both workshops proved popular and received excellent feedback.
An interesting addition to the education programme was a lunchtime symposium titled “Difficult Dialogues” run by a professional communicator. This session featured oncologists Dr Fran Boyle, Dr Elizabeth Hovey, Dr Tony Dowling (all Australia) and Professor Susan Chang (USA) interacting with a professional actor, navigating difficult situations such as conveying a diagnosis and discussing treatment options. Further symposiums and satellite meetings included: a CNS Lymphoma Symposium; the GBM AGILE Meeting; the COGNO 2016 AGM; and the Brain Tumour Alliance Australia (BTAA) Annual Summit.
A focus on clinical trials
This was the first time the ASNO annual meeting had been held in Australia, and as it was combined with the COGNO annual scientific meeting, clinical trials were a continuing theme throughout the programme. At the COGNO Scientific Advisory Committee (SAC) meeting, proposers of new clinical trials were offered the rare opportunity to have their trial concepts critiqued by the international faculty, while COGNO members were updated on the status of existing trials currently underway or in development.
Australia, along with China and the USA, is one of the cornerstone countries involved in the GBM AGILE3 clinical trial platform initiative. GBM AGILE is an innovative but complex adaptive clinical trial platform which differs substantially from the way clinical trials are currently undertaken. It offers the opportunity to: offer multiple trial arms, including combinations of drugs, randomised against a single control arm; match the patient’s biomarker signature with the most appropriate trial arm; and quickly stop ineffective arms so that the more effective drugs are promoted faster. It will be open to both newly diagnosed and recurrent GBM patients and will use overall survival as the primary endpoint. One of the project initiators, Professor Al Yung (USA) said: “GBM AGILE will raise the bar for all clinical trials”.
The GBM AGILE protocol is currently awaiting approval from the US FDA, after which the initial drug targets and biomarkers will be selected. In an exciting development, there is also a proposal to include a registration component into the trial protocol, which would make the platform very attractive to pharmaceutical companies.
ASNO Country Updates
The Asia Pacific region offers some unique challenges in the field of neuro-oncology. The region offers a huge range of economic and cultural diversity and there can be wide discrepancies in both systems and standards of healthcare from country to country. This situation was highlighted in the Day 2 opening session on Country Updates, where speakers from Thailand, Indonesia, Malaysia and the Philippines outlined the challenges faced by doctors and brain tumour patients in their respective countries. A shortage of oncologists; high cost of treatment; access to basic chemotherapy drugs, such as temozolomide and PCV; and a lack of patient support groups were some of the many issues raised.
COGNO is largely an Australian organisation but this year they commenced an international outreach programme aimed at strengthening relationships and collaboration within the Asian region. COGNO chairman, Professor Mark Rosenthal noted that not only was Australia now very much a part of the Asian region, but an increasing number of Australian brain tumour patients were of Asian ethnicity. As part of this new outreach programme, travel scholarships were awarded to four young oncologists from Cambodia, Myanmar (two) and Vietnam to attend this year’s conference.
The ASNO-COGNO scientific programme was broken into nine sessions:
Session 1: ASNO Country Updates
Session 2: New Molecular Classification of Glioma
Session 3: Managing Imaging and Recurrence
Session 4: Next Generation Clinical Trials
Session 5: Translational Research
Session 6: Quality of Life: The Digital Era
Session 7: All Things Allied Health
Session 8: Technology Advances on the Horizon
Session 9: State of the Art
Unlike some of the larger neuro-oncology conferences, there were no concurrent sessions, which gave delegates the opportunity to attend every presentation. This was important for many of the doctors from smaller countries who do not specialise in any one area of oncology and need a broad overview of all disciplines.
The scientific programme commenced with the traditional Welcome to Country, delivered by Gadigal Elder Uncle Ray Davidson, representing the Aboriginal people of Australia. This was followed by the Conference Welcome and then the ASNO Country Updates, beginning with an address by ASNO 2016 president, Professor Mark Rosenthal (Australia).
Some of the featured presentations from the first day’s sessions were:
- “What’s in the new classification?” – Prof Paul Mischel (USA)
- “Does it impact surgery?” – Prof Mitch Berger (USA)
- “Molecular markers: when it matters for clinical decisions” – Prof Roger Stupp (Switzerland)
- “SRS for brain metastases in the targeted therapy era and challenges in clinical trial design” – Assoc Prof Arjun Sahgal (Canada)
- “Surgery for recurrent glioma and brain metastases” – Prof Mitch Berger (USA)
Day Two opened with the Clinical Trial session, which featured the following presentations:
- “Challenges in clinical trial design” – Prof Roger Stupp (Switzerland)
- “GBM AGILE: champion in innovation” – Prof Al Yung (USA)
- “Biomarkers, pathology, targets and agents” – Prof Paul Mischel (USA)
- “Results of the interim analysis of the EORTC phase III CATNON trial on concurrent and adjuvant temozolomide in anaplastic glioma without 1p/19q co-deletion” – Prof Anna Nowak (Australia)
- “The future of clinical trial design” – Prof Don Berry (USA)
Session 5 Translational Research featured two excellent presentations:
- “Repurposing promising therapies in malignant glioma” – Prof Gregory Riggins (USA)
- “Repurposing Ibudilast in combination with temozolomide for glioblastoma” – Dr Kerrie McDonald (Australia)
This was followed by the sessions on Quality of Life and Allied Health, which included the following presentations:
- “Changing landscape in QOL in brain tumour patients: an emerging country perspective” – Prof Rakesh Jalali (India)
- “I will survive” – Dr Danette Langbecker (Australia)
- “Caring for the patient: Patient Reported Outcomes” – Adjunct Prof Mary Lovely (USA)
- “Nuances of driving and air travel for patients with glioma or brain metastases” – Assoc Prof Andrew Cole (Australia)
- “The changing care needs of the patient and caregivers throughout the brain tumour journey” – Adjunct Prof Mary Lovely (USA).
The final day’s sessions appropriately looked towards the future, with updates on the latest technological advances and developments in the field of neuro-oncology. Highlights from these sessions included:
- “Hypofractionated SRS for brain metastases: what is the rationale?” – Assoc Prof Arjun Sahgal (Canada)
- “Immune checkpoint inhibitors in glioma” – Dr Mustafa Khasraw (Australia)
- “Synergy of radiation and PD-1 inhibition in high grade gliomas” – Assoc Prof Fabio Iwamoto (USA)
- “The future of immuno-oncology: the big picture” – Dr Anna Barker (USA)
The meeting abstracts are available for download at the ASNO-COGNO website4.
Patients and carers were not overlooked at the ASNO-COGNO meeting. A half day Brain Tumour Education Forum was organised by Brain Tumour Alliance Australia (BTAA) on the Tuesday morning, with excellent presentations from Professor Mitch Berger; Professor Paul Mischel (both USA) and Dr Elizabeth Hovey (Australia). The opportunity to ask questions and engage with these prominent brain tumour clinicians was very much appreciated by the patients and carers who attended.
The IBTA and BTAA were the only patient organisations exhibiting at ASNO-COGNO this year, however people from around the world were able to keep track of proceedings through social media. The IBTA (@theIBTA) was one of several Twitter users5 live-tweeting from the conference sessions using the hashtag #asnocogno2016.
The 14th ASNO Annual Scientific Meeting will convene in Osaka, Japan, on 29-31 October 2017.
- The international faculty for ASNO-COGNO included: Assoc Prof Brian Alexander (USA); Dr Anna Barker (USA); Prof Mitch Berger (USA); Dr Don Berry (USA); Prof Susan Chang (USA); Prof Tim Cloughesy (USA); Prof Rakesh Jalali (India); Adjunct Prof Mary Lovely (USA); Prof Paul Mischel (USA); Prof Gregory Riggins; Assoc Prof Arjun Sahgal (Canada); Prof Roger Stupp (Switzerland); Prof Al Yung (USA).
- Australian clinicians involved in the Glioma Master Class: Prof Mark Rosenthal; Dr Jonathon Parkinson; Prof Anna Nowak; Dr Eng-Siew Koh; Dr Elizabeth Hovey; Assoc Prof Andrew Cole; Ms Marcia Fleet; Dr Andrew Neal; Prof Meera Agar.
- GBM = Glioblastoma multiforme; AGILE = Adaptive Global Innovative Learning Environment
- Download link for Meeting Abstracts here
- Twitter coverage of ASNO-COGNO was provided by: @SassStem @meera_agar @perth_meso_dr @theIBTA @cogno_trials @zarnielwin @DHLangbecker @SydneyBrainSurg @hagsie @BrainTumourAA @DrCraigGedye