The 2023 American Society of Clinical Oncology (ASCO) Breakthrough meeting will be held in person and online August 3 to 5 in Yokohama, Japan. This meeting shines a light on the cutting-edge advances that are transforming cancer care in Asia and beyond. Research highlighted at ASCO Breakthrough will explore how new technologies may intersect with clinical care today to improve patients’ lives and well-being.

You can learn more about research from this meeting by following the #ASCOBT23 hashtag on Twitter.

Below are summaries of 4 studies that will be presented at the meeting:

Stool DNA test accurately detects gastrointestinal cancers and identifies tumor location

Who does this study affect: People at risk for gastrointestinal cancers.

What did this study find: A study out of China found that a new, noninvasive multi-target stool DNA test was able to accurately detect gastrointestinal (GI) cancers and identify the location where the cancer started.

GI cancers are cancers that affect the body’s GI tract, which is the bodily system involved in swallowing and digesting food, absorbing nutrients, and removing waste from the body. These cancers include bile duct cancer, colorectal cancer, esophageal cancer, pancreatic cancer, and stomach cancer, among others. Overall, GI cancers make up one-fourth of cancer cases around the world, according to the World Health Organization.

While tests using either stool (feces) or blood have been approved by the U.S. Food and Drug Administration for the early detection of colorectal cancer, there are currently no similar tests approved for the early detection of other GI cancers. Stool tests are noninvasive, and most people can do the test at home. In this study, researchers wanted to learn whether using a new stool DNA test could detect and locate more GI cancers early.

The study included 124 Chinese people who had been diagnosed with GI cancer but had not received treatment, as well as 92 people who did not have cancer but received GI cancer-related examinations every 3 years.

The study showed that the test was able to accurately detect GI cancers and identify the location where the cancer started. Overall, of the patients who had cancer, 79% tested positive for cancer with the test, and of the patients who did not have cancer, 96% tested negative for cancer. Of the 4 participants who did not have cancer but received a positive result from the test, 3 were diagnosed with advanced adenomas, which are benign tumors that can become cancerous, and 1 person was pregnant.

For each of the specific GI cancer types included in the study, the test positively identified 71% of colorectal cancer cases, 83% of stomach cancer cases, 75% of esophageal cancer cases, 81% of pancreatic cancer cases, and 91% of ampullary cancer cases. Ampullary cancer is cancer of the ampulla of Vater, which is where the pancreatic duct and bile duct meet and empty into the first part of the small intestine.

The researchers also evaluated how effective the test was in identifying the type of GI cancer, which is called sensitivity. Sensitivity is the percentage of people with cancer who were correctly identified by the test as having cancer. The sensitivity of the test was 88% for colorectal cancer, 91% for stomach cancer, 88% for esophageal cancer, 90% for pancreatic cancer, and 95% for ampullary cancer.

What does this mean for patients: This noninvasive stool DNA test could help detect different GI cancers early and accurately, including the location where the cancer started.

Stool is a promising sample for GI cancer detection because it contains the host’s exfoliated cells and circulating-free DNA derived from GI cancer cells. Our study aims to develop a noninvasive, multi-target stool DNA methylation test for the early detection and localization of GI cancers.”

—      lead study author Li-Yue Sun, MD
Guangdong Second Provincial General Hospital
Guangzhou, China

Exercise helps improve sexual health for people with prostate cancer 

Who does this study affect: People with prostate cancer.

What did this study find: Results from a randomized, controlled clinical trial from Australia found that patients who followed a supervised exercise program had improved sexual health. Prostate cancer and its treatment can lead to problems with sexual health, including erectile dysfunction and a loss of sexual desire. These sexual side effects may be temporary, but some can last for a long time. Side effects that change sexual health can affect a person mentally, emotionally, and physically.

In this study, the researchers wanted to see whether supervised resistance and aerobic exercise given in the clinic would improve sexual health. Aerobic exercise is also known as cardio, and it is the type of exercise that raises your heart rate. Resistance exercise is also called strength training. The researchers also wanted to explore whether adding a type of counseling called psychosexual therapy would help.

The study included 112 men with prostate cancer who had or were receiving cancer treatment and who had concerns about problems with sexual health. This study was done at exercise clinics that were connected to universities between 2014 and 2018. The participants were divided into 3 study groups. Group 1 included 39 people who received 6 months of supervised resistance and aerobic exercise in a group setting for 3 days per week. The 36 patients in Group 2 received the same exercise program plus psychosexual therapy. The 37 patients in Group 3 received usual care for prostate cancer, which does not include supervised exercise instruction.

The researchers evaluated whether the participants in Groups 1 and 2 were more satisfied with their sexual function than those in Group 3. To do this, participants were asked to complete a questionnaire called the International Index of Erectile Function (IIEF), which scores a person’s sexual ability and satisfaction with sexual activity. Those who participated in the supervised exercise program had a 5.1-point increase in their ability to have an erection of the penis compared with a 1.0-point increase in those who received usual care. Those who received supervised exercise also were more satisfied with sexual intercourse. Their satisfaction with sex increased by 2.2 points, compared with 0.2 points for those who received usual care. The psychosexual therapy, which was self-managed, did not add any improvements for the participants.

What does this mean for patients? Supervised resistance and aerobic exercise improved ability to have an erection and satisfaction with sexual intercourse for patients with prostate cancer.

Nearly half of patients with prostate cancer report having unmet sexual health care needs, highlighting the lack of current health care services to adequately address the demand for management of sexual dysfunction after prostate cancer treatment. Our study shows that these patients can immediately benefit from supervised exercise interventions to improve their sexual health and that exercise should be considered as an integral part of treatment for prostate cancer.”  

—lead study author Daniel Abido Galvao, PhD
Edith Cowan University
Perth, Australia 

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Artificial intelligence can accurately identify cervical precancerous lesions during colposcopy

Who does this study affect: People at increased risk for cervical cancer.

What did this study find: A study out of Japan found that a new artificial intelligence (AI)-based model can accurately identify cervical intraepithelial neoplasia (CIN) lesions from videos taken during colposcopy. CIN, which may also be called cervical dysplasia, is an abnormal growth of cells on the cervix, which is part of the female reproductive system. While some of these abnormal cells may go away without treatment, others may eventually become cervical cancer.

A colposcopy is a procedure used to find cancerous or abnormal cells in the cervix, vagina, or vulva. A colposcopy may be recommended for people who received abnormal results following a Pap test so the doctor can confirm and diagnose certain problems, including CIN. During a colposcopy, the doctor may also perform a biopsy, which is the removal of a small amount of tissue for examination under a microscope, to determine whether abnormal areas found during the colposcopy may be cancerous or precancerous.

Extensive colposcopy training is required to teach doctors how to accurately detect CIN and perform more precise biopsies of suspicious areas. In this study, researchers wanted to learn whether an AI-based model could be used to accurately identify precancerous lesions from colposcopy results and help guide where biopsies should be performed.

Researchers conducted an analysis using 8,341 videos recorded during colposcopies from 2013 to 2019. The videos included 7 early-stage cervical cancer cases, 203 CIN3 cases, 276 CIN2 cases, and 456 CIN1 cases. CIN1 lesions have the lowest risk of becoming cancer, while CIN3 lesions have the highest risk of becoming cancer.

Researchers then trained the AI-based lesion detection model by showing it videos of 60 cases of cervical cancer and CIN3. The AI-based model was then shown 150 cases to test how accurately it could diagnose CIN lesions and cervical cancer.

The study found that the AI-based model was able to identify cervical precancerous lesions with high accuracy. In identifying lesions, the model had:

  • A sensitivity of 85% for CIN3 lesions, 86% for CIN2 lesions, and 87% for CIN1 lesions. Sensitivity is the percentage of people with a lesion who were correctly identified by the model as having a lesion.

  • A specificity of 73% for CIN3 lesions, 67% for CIN2 lesions, and 70% for CIN1 lesions. Specificity is the percentage of people who did not have a lesion and were correctly identified by the model as not having a lesion.

  • An area under the curve of 89% for the lesion area for CIN3 lesions and of 81% for both CIN2 and CIN1 lesions. The area under the curve indicates the overall accuracy of the model.

  • An accuracy of 95% for the number of lesions identified among CIN3 lesions, 93% for CIN2 lesions, and 97% for CIN1 lesions.

The model was also able to display a heatmap of the affected area with the highest acetic acid intensity, indicating where it was most likely for abnormal cells to be found, that corresponded with the actual biopsy location.

What does this mean for patients: For people who require a colposcopy after receiving abnormal Pap test results, an AI-based model may be helpful in accurately identifying cervical precancerous lesions, thus improving early detection and likelihood of curative therapy. This model could be especially useful in places where there may be fewer doctors trained in reading colposcopy results.

“Currently, there is no certification system for performing colposcopies in Japan, and the quality and interpretation of these examinations varies. Our study aimed to develop an artificial intelligence (AI)-based tool that reproduced colposcopy examination techniques of specialists to be used as a diagnostic aid by accurately identifying CIN lesions and guiding tissue sampling locations.”

—      lead study author Akihiko Ueda, MD
Kyoto University
Kyoto, Japan

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Liquid biopsy may help find common cancers before symptoms develop

Who does this study affect: People who have a moderate to high risk of cancer but no symptoms.

What did this study find: Results from the K-DETEK clinical trial in Vietnam have shown that a type of liquid biopsy called SPOT-MAS (Screening for the Presence Of Tumor by Methylation And Size) may be useful for detecting certain common cancers in people with no symptoms. The SPOT-MAS only looks for the 5 most common cancers in Vietnam: liver, breast, colorectal, stomach, and lung cancer. It is a type of liquid biopsy called a multiple cancer early detection test or MCED.

The researchers in this study wanted to see if the SPOT-MAS test could be used to successfully find early cases of cancer among Vietnamese people. This study includes 10,000 people aged 40 years or older with no symptoms of cancer but moderate to high risk of developing cancer. It was conducted in 13 large hospitals and 1 research institute in Vietnam. The participants were observed at 6 and 12 months. When the researchers analyzed the data, they had completed analyses for 2,795 study participants.   They found that the SPOT-MAS correctly detected cancer in 60% of cases, meaning that for every 100 positive tests, 60 of them will actually have cancer. In addition, the test was able to correctly identify the tumor’s location in 83.3% of cases. If SPOT-MAS detected cancer, then a patient received additional testing by doctors to confirm whether they really had cancer and then guide treatment decisions.

Cancer screening tools, such as mammography and colonoscopy, usually only test for a single type of cancer and require separate appointments and procedures. In some parts of the world, this makes cancer screening difficult. Giving a single blood test to screen people for several common types of cancer may be a convenient way to find cancer in people before they develop symptoms.

What does this mean for patients? The SPOT-MAS may be a helpful tool for initially screening people for common types of cancer, particularly in lower- and middle-income countries.

Common screening methods are often invasive, inaccessible, and involve separate procedures to screen individual cancer types. Affordable, accessible, noninvasive multicancer screening tests are needed for early detection, especially in a lower-middle income country like Vietnam. Our study provides clinical evidence for the applicability of the SPOT-MAS circulating tumor DNA-based assay as a complementary method in early cancer detection.”  

—senior study author Le Son Tran, PhD
Medical Genetics Institute
Ho Chi Minh City, Vietnam 

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