ASCO 2024

The Annual Meeting of the American Society of Clinical Oncology (ASCO) is the world’s biggest cancer conference; this year, more than 40,000 clinicians, investors, pharma executives and other professionals involved in cancer research from all around the world met in Chicago on the shores of the majestic Lake Michigan.

There was a strong message in this year’s theme: “The art and science of cancer care: from comfort to cure”. This emphasises that the focus of the meeting was not only on innovative treatments, but also on palliative care and approaches to creating better lives for cancer patients.

We were there and here are our key highlights from the meeting:

1) Focus on AI

Strikingly, the first plenary presentation included a session on the implementation of AI technologies in clinical practice. In addition, all through the meeting we heard how AI technologies showed promise – from increasing colorectal cancer screening uptake among underserved populations, for example, to how a machine-learning model may predict the risk-benefit of immune checkpoint inhibitors (which help the body’s immune system fight cancer cells) and optimising drug dosing. Moreover, other AI technologies demonstrated their potential in genomics and biomarker discovery, clinical decision support and improving diagnostic accuracy. Particularly interesting was a session on breast cancer diagnostics, which highlighted an increasing number of AI-related tests coming to market, including AI-supported mammography, automatic scoring of breast cancer biomarkers, automatic detection of lymph-node metastasis, and clinical-decision support tools.

2) Liquid biopsy for breast cancer

Another interesting presentation regarded the use of liquid biopsies (which work by detecting cancer-specific biomarkers that are released in the blood) to predict breast cancer relapse. During the presentation, it was shown that in a 76-patient study, a new test called NeXT was able to correctly identify 10 women whose cancer relapsed long before the disease was visible on the scans, with no false-negative cases. This result further paves the way for the implementation of liquid biopsies in clinical practice.

3) Moderna/Merck cancer vaccine in melanoma

Moderna presented a three-year update of a Phase 2b randomised KEYNOTE-942/mRNA-4157-P201 study, a clinical trial evaluating mRNA-4157 (V940), an investigational individualised neoantigen therapy (INT), in combination with KEYTRUDA, Merck’s anti-PD-1 therapy (pembrolizumab), in patients with resected high-risk melanoma (stage III/IV) following complete resection (with a sample size of 157). The idea with this type of approach is to immunise the patient after tumour resection with tumour antigens which have been specifically based on the unique mutational signature of the DNA sequence of the patient’s tumour. It was impressive to see that the combination of vaccine plus pembrolizumab demonstrates a clinically meaningful and durable improvement in recurrence-free survival, the primary endpoint of the study, reducing the risk of recurrence or death by 49%. After three years, 75% of those who had the vaccine and pembrolizumab were still cancer-free, compared to 56% of people who only received pembrolizumab. This is quite significant and a landmark result in the cancer vaccines field.

4) Immunotherapy before surgery

In two landmark presentations, we saw the relevance of using immunotherapy approaches ahead of surgery (known as neoadjuvant immunotherapy) in some types of cancer. In the NICHE trial, a neoadjuvant combination of ipilimumab and two doses of nivolumab treatment in 20 patients with a high mutational load colorectal cancer resulted in a major pathological response in 19 out of the 20 patients. Moreover, Professor Christian Blank (of the Netherlands Cancer Institute) presented ground-breaking results from the NADINA trial, which examined the efficacy of neoadjuvant immunotherapy versus adjuvant immunotherapy (i.e. post-surgery) in treating stage III melanoma. The study involved 423 patients. The key findings highlight that the neoadjuvant approach greatly improves outcomes for patients, with a 68% reduction in risk of recurrence of the disease. For the patients with major responses, the results were particularly promising: a 95% event-free survival rate at 12 months. These results could redefine the treatment of stage III melanoma.

5) Use of GLP-1 receptor agonists to reduce cancer risk

Ozempic and Wegovy are the best-known examples of drugs called GLP-1 receptor agonists (GLP-1 RAs), which mimic the action of GLP-1, a hormone made by the small intestine. These drugs were originally used to treat type 2 diabetes, and recent landmark studies also support their use for weight loss. At ASCO, a retrospective study in patients with a body mass index of at least 35kg/m2 (i.e. severely obese) found that treatment with GLP-1 RAs appears to lower the risk of developing obesity-related cancer, with results similar to bariatric surgery. Specifically, when compared with those who received no treatment, the researchers discovered a 39% reduction in cancer risk for 13 types of such cancers.

6) Pharma industry progress

Key developments from the large healthcare firms included the promising results from the Novartis NATALEE trial for early-stage breast cancer, Verastem’s combination therapy in pancreatic cancer, and Novartis’s Scemblix treatment for chronic myeloid leukaemia. All showed improved patient outcomes and fewer side effects.

7) ADC still a key modality

As expected, Antibody-Drug Conjugates (ADCs) were in the spotlight as a modality with showcases of significant advancement in this area. ADCs are highly targeted treatments, which seek to deliver potent cancer-killing drugs directly to cancer cells without damaging surrounding tissue. Overall, this underscored the expanding role of ADCs in oncology, both in improving their safety profile and in achieving better efficacy in different types of cancer.

The 2024 ASCO Annual Meeting thus showed major advancements in oncology, driven by innovative research from all around the world, not least substantial contributions from China. From the potential paradigm shift in stage III melanoma treatment with neoadjuvant immunotherapy to significant results in personalised cancer care via AI integration, the conference highlighted a future where cancer treatment will be more tailored to patients.

As private-equity investors in many cutting-edge healthcare companies, we are tremendously excited by the breadth of the opportunity set – and this is just in oncology alone – and by the growth prospects of these pioneering businesses.