publication date: May. 1, 2020
Conversation with The Cancer Letter
With 61,000 people registered, first-ever virtual AACR annual meeting “enthusiastically received”
Antoni Ribas, MD, PhD
Professor of medicine, professor of surgery, professor of molecular and medical pharmacology, University of California Los Angeles;
Director, Tumor Immunology Program, Jonsson Comprehensive Cancer Center;
Chair, Melanoma Committee, SWOG
This story is part of The Cancer Letter’s ongoing coverage of COVID-19’s impact on oncology. A full list of our coverage, as well as the latest meeting cancellations, is available here.
Nobody knew how to even begin to predict the number of people who would register for the first-ever virtual annual meeting of the American Association for Cancer Research.
There was no registration fee, no travel, no need for hotels—but also no revenues for the professional society.
When over 61,000 people registered online from 140 counties—nearly three times the number who usually come to the in-person Annual Meeting—Antoni Ribas, MD, PhD, Program Chair for the AACR Annual Meeting 2020 and AACR President-Elect., was immensely excited that the this first virtual meeting was so enthusiastically received by the global cancer community.
“An AACR Annual Meeting usually draws an attendance of nearly 23,000 scientists and clinicians in all subdisciplines of cancer research. This one had over 61,000 registrants, and at peak sessions, there were about 24,000 people viewing the talks at the same time,” Ribas, a professor of medicine, professor of surgery, and professor of molecular and medical pharmacology at the University of California Los Angeles, director of the Tumor Immunology Program at the Jonsson Comprehensive Cancer Center, and chair of the Melanoma Committee at SWOG, said to The Cancer Letter.
“This is unprecedented. I could not have predicted that this would happen,” Ribas said. “We were just trying to make sure that important clinical and scientific information was rapidly disseminated and find the best platform for it to release data that could not wait for a later replacement meeting. It was all done in a short period of time and we were thrilled that the platform held up.”
AACR didn’t charge for registration this year. Because of financial and other challenges being faced by cancer researchers dealing with the COVID-19 crisis, AACR felt that offering the annual meeting free to registrants was an important decision, Ribas said.
According to tax documents, conferences and workshops were the highest source of revenue for the association, contributing $25.6 million to AACR’s $60.3 million gross reciepts in 2018, the most recent year for which a filing is available. This figure includes all conferences and workshops and doesn’t include the cost of these events.
The virtual meeting marks the beginning of a transition for oncology conferences from in-person to online—only one change among many that have been made in light of the COVID-19 pandemic. Ribas is expected to be named president of AACR within the next week, and will face the task of leading the organization in a time when the future of clinical trials, drug approvals, and even the number of people in the field are in question.
In July, AACR plans to hold a COVID-19 and Cancer virtual meeting.
“We’re going to emerge out of this, and it’s going to be the same principles that we’ve had so far, where science and knowledge will allow us to move forward, and it will be applied to the pandemic, it will be applied to cancer research and to cancer treatment,” Ribas said.
Ribas spoke with Alexandria Carolan, a reporter with The Cancer Letter.
Based on the meeting this week, what do you think the future of oncology meetings will look like?
This was an unexpected success in regard to the number of registrants. There was no way I could have predicted this huge number if you had asked me a month ago.
This was the first-of-its-kind virtual meeting where AACR was presenting mostly clinical research that needed to be released without delay.
It’s usually an important part of the program, and it was exciting to have these top clinical trials presented along with the science behind them for the community to enjoy.
For example, we saw the pembrolizumab every six weeks [regimen] approved by the FDA Tuesday, right after it was presented at the AACR virtual meeting.
There are clinical trials that, once presented, lead to next steps, with people saying that “that’s the way to go” or “no, that’s not the way to go.”
So, we couldn’t just sit on these important data. That’s why we imposed on ourselves to create something that hasn’t been done before, and make it freely available to everyone.
We were excited to provide a scientific program with many sessions but we knew it would be a big challenge to organize it in such a short period of time.
An AACR Annual Meeting usually draws an attendance of nearly 23,000 scientists and clinicians in all subdisciplines of cancer research. This one had over 61,000 registrants, and at peak sessions, there were about 24,000 people viewing the talks at the same time.
This is unprecedented. I could not have predicted that this would happen. We were just trying to make sure that important clinical and scientific information was rapidly disseminated and find the best platform for it to release data that could not wait for a later replacement meeting. It was all done in a short period of time and we were thrilled that the platform held up.
But overall, the platform held up to the massive audience.
We’re in an unprecedented pandemic, and AACR is facing much of the same challenges that the rest of the world is. What’s the biggest challenge you’ll have to face at AACR once you are president?
It’s clear that my term as president of AACR is going to be marked by how to respond to the COVID-19 pandemic.
There’s no way that we can go on with cancer research and develop new treatments if this pandemic is not under control. Clearly, cancer will not disappear while there’s a coronavirus pandemic, so we have to be able to keep our focus on both diseases.
I think the cancer research field has a lot to contribute to fighting the pandemic, and we need to do that so in order to get on with our mission and our goals.
In regards to cancer, we are suddenly seeing population-level disease drops in mortality, and the quality of drugs and treatment is improving. Will COVID-19 stop this, or slow it?
It will temporarily slow it. The majority of gains of the last several decades in fighting cancer have all been driven by science and applying scientific knowledge to patients, which is at the core of what our organization does.
Most research labs have been asked to stop what they’re doing, because we can’t have people working closely together, propagating a virus. It’s a logical thing to have social distancing and that we don’t continue to work the same way right now, because all we would be doing is feeding the virus as opposed to fighting cancer.
The temporary closing of research labs is a way to fight cancer, because we need to deal with the immediate problem—the pandemic—while at the same time working on cancer.
Labs have been shuttered, because they’re considered non-essential right now. What does this mean?
It means that we’re fighting in a different way. We have to adapt to this new reality. We cannot have people close together and allow the virus to go from one person to another, making some people really sick as we could then not be fighting cancer.
Meanwhile, patients with cancer continue to have cancer, and that’s where we’re really struggling to find the right balance between providing care and doing the things that patients need, or exposing them and others to the spread of this virus.
It’s a troubling time where patients are afraid to go to have their blood drawn, to go to the clinic to have infusion, to have the surgery that would benefit them in treating their cancer, to have chemotherapy or immunotherapy or radiation therapy. That gives options to the cancer that we would otherwise be treating.
It’s very difficult to find this balance, and we’re now acting with the idea of a short-term plan, but we don’t know what the future holds. If it’s going to be longer, then we’ll have to change many things that we have been doing.
At the same time, this virus has triggered a lot of innovation in a very short time. It’s amazing how we’ve gone from doing everything in person, face-to-face, having people coming in, flying from other places to just see the doctor—to now having telemedicine for the majority of patients.
I have clinic this afternoon, and the majority of my patient visits are on phone or video calls. We’re providing results this way. We’re discussing treatments this way. This will trigger more home care, and not having people go to the infusion room, but instead have the infusion brought to them. It’s allowing treatments to be given in a different way.
We’re decreasing the time that patients are going to see the doctors in person and getting infusions in order to try to decrease the pandemic, and that’s why telemedicine will be a lasting benefit from a terrible thing, which is this COVID-19 pandemic.
Do you see oncology being more inclusive with telemedicine in the future? How will this change how you treat patients?
That has two potential answers, because, yes, bringing care to people closer to home will make it more inclusive to more people, but then there are people who are at a disadvantage and more vulnerable with everything that’s happening because they do not have access to the internet and to telemedicine do not benefit.
Their care is being delayed until they go and see somebody in person, and these visits are delayed. This virus is disproportionately affecting people with low socioeconomic status and certain ethnicities.
Therefore, the disparities in care are now even more extreme, because the virus is affecting everybody—but the more vulnerable are affected more, because they have less access to care and less ability to do social distancing and to benefit from telemedicine.
We have to be very proactive about this. This is a major problem that all of us are facing in the field. AACR is working on a report about disparities in cancer and health care. A new chapter is going to be added to cover disparities in COVID-19 infections and cancer.
Obviously, these disparities will likely be demonstrated in cancer down the line. What will this look like?
People with comorbid conditions, hypertension, diabetes—especially if not well-controlled—with less access to care are at high risk for complications. It’s all these issues that make the vulnerable more vulnerable, especially now.
Let’s talk about the research. We’ve seen growth in cancer care and research, and you said how COVID-19 might slow this. What can AACR do to help?
If we think about this virus and we think about cancer, there are a lot of similarities.
Cancer is a disease of dysfunctional proteins that are doing something that’s bad for the body. That’s also what the SARS-CoV-2 virus does. It has a series of proteins that infect cells, it starts making dysfunctional proteins that are allowing the virus to expand, and the virus interplays with the inflammatory response and the immune system, the same as cancer cells.
The same principles that have been used to advance treatment of cancer are being used to address the COVID-19 pandemic.
Using drugs that inhibit proteins of the virus is the same concept as a targeted drug for a mutation in cancer, where there’s one protein that has certain functions that need to be stopped. Chemists make drugs that specifically block the function of that protein—whether it’s a virus protein or a mutated protein—and then it is developed clinically, in clinical trials.
The virus induces inflammatory processes that are leading to worse complications, the respiratory distress syndrome and others.
Those inflammatory processes are the same that cancer cells use to feed themselves to grow within a tumor microenvironment. Then the immune system, the immune cells, the T cells and the B cells, the ones we have learned to unleash to fight cancer, are also the ones that protect us from viral infections.
Sequencing genomes has been mostly applied to cancer, and we’re now seeing information about how to use those same sequencing methods to track the virus that also changes over time, as cancer does. I’m sure this sequencing knowledge will help us make better tests that can be done more in parallel, with genetic barcodes, so we can test more people faster, as opposed to looking for parts of the virus with a PCR or an antibody test.
The diagnostics field of cancer can provide a lot of knowledge about how to do these tests in a completely different way that I hope will allow universal testing in the near future.
And what do you expect from NCI during the COVID-19 crisis? How should they respond?
Dr. Dinah Singer, deputy director for scientific strategy and development, gave an address at the end of the AACR virtual meeting, where she assured the attendees that the NCI is very aware of the critical needs that are happening now, where research labs are being closed and people are sent home without active hands-on research.
But there are other ways that they are contributing to all of this. It was clear that the NCI has decided that they do not want to dismantle the cancer research workforce.
The personal costs would be terrible if the cancer research workforce would be abandoned, just because temporarily cancer scientists cannot show up in person to do what—to hold a pipette? But we continue doing research in different ways during this lockdown.
The National Cancer Institute has made it clear that grants will continue, that they will adapt the timelines, and that the expectations for research results will be adjusted—giving assurances that we’re fighting the virus and continuing to fight cancer in the same way by putting a hold on in-campus, hands-on research.
With regard to cancer research, obviously cancer isn’t going to stop for COVID-19. Patients are still receiving treatment, and their disease still takes priority. But is oncology going to lose trainees to other specialties now that COVID-19 is in play? Is this an issue?
I’m hopeful that this is going to be a period a time—albeit, a painful, very painful one, after which we’ll go back to some form of normality whenever we have better testing, vaccines, and treatment for COVID-19.
Once we do that, then I hope that the federal government and everyone in academia and industry will think about what happened and work to prevent another pandemic.
But the value of the things we were doing before the pandemic will not have gone away, and one of the top ones will continue to be fighting cancer. So, I don’t think this is going to take people away from careers in cancer research and treatment.
It will just make it difficult for a period of time, the same way our lives have been disrupted in so many other things that we were doing.
How are you and your institution navigating COVID-19? What changes have you made?
We immediately made changes. We tried to have fewer people together and make sure that we safeguard our patients and try to avoid any exposure of patients to a potential infection, and also the other way around, to protect health care workers from potential infections.
It’s now harder to enroll patients in clinical trials, because we have less support staff on site, and we’re less able to do tests and scans, biopsies, and infusions. All of this is a detriment to patients whose best option was to be in a clinical trial, and who could benefit in the treatment of the disease.
That is a difficult thing that we’re going through. We have not completely closed clinical research; we’re maintaining it in a scaled-down process. Within our research groups, we’ve decided which are the top-priority clinical trials, and what staff was needed to keep them open, and still put patients on studies.
In some places, they’ve had to completely stop this approach. The peak in Los Angeles and California has not been as bad as in the East Coast, because of early implementation of social distancing—also because our geographical environment and weather allow more social distancing, just naturally.
So, we’re not seeing this big influx of patients with COVID-19 infections that could have happened if nothing had been done.
We touched on the labs issue earlier, but have labs at UCLA been shuttered because they’re considered non-essential?
Yes. That was the right thing to do. Within a period of three or four days we were asked to close all research labs for non-essential work. If we kept any projects ongoing, we had to justify it and request special permission from our departments and our dean’s office.
But we all made a plan on how to continue the essential research and not start new research. We made contingency plans to make sure that people came in sequentially, not in groups, that several people were not in the same room, and that all communications were done electronically by phone, by internet, by email, by Zoom meetings.
All of that has avoided outbreaks in the research labs, which, if that had happened, would have been worse and caused further delay in cancer research.
That’s a good point. Could you describe what’s going on in clinical trials in the cancer world?
There are different directives that different drug companies have given on how to proceed with their clinical trials.
Most have sent notifications saying, “we understand what you’re going through, we understand that it’s hard to follow the protocol as it was written at this time.”
Not having access to certain things done for research as opposed to strictly patient care, there are going to be deviations to protocols—something we always want to avoid, but now they’re really necessary.
There have been organizations that have been even more proactive, like the NCI-funded cooperative groups, the one I know is SWOG, which has provided general directives of what to do during the pandemic.
How patients benefit should be above the protocols to be flexible with skipping visits, sending drugs to the patients’ homes, which used to be prohibited. Patients had to come and they had to get their bottle of pills that we had counted. Now we can send them to their homes.
Doing telemedicine visits, as opposed to having people coming to the office, giving infusions of treatments taking into consideration the risk and the benefit based on whether the physician and the patient agree to what is best, which is allowed during this period of time, and the patient will be able to continue the clinical trial and not be kicked out because they missed that time point and then cannot do the next one.
So, all of this evolved very rapidly. What we needed to do was to avoid the propagation of the virus so we could, short-term and long-term, do better for everyone.
And what’s happening with drug approvals in oncology?
I assume it’s going to be harder to provide the data on clinical trials. The analysis of the data will be harder or delayed.
All the clinical data have to be looked at carefully to be sure that there are no errors and that there’s no wrong information being entered—so, you need monitors going to the sites, rolling up their sleeves, and looking at all the source documents. That will not happen for a while.
So, I would assume that some of the clinical trials and approvals may be delayed, but meanwhile, the data that have been generated before can be worked on and analyzed better during this period of time where you’re not piling on more information.
I think in the short-term, it should not have an impact on new drug approvals. In the mid-term, we may see a gap and delay in some of the approvals.
Tuesday’s session at AACR on COVID-19 and cancer was really interesting because it brought together the perspective of all of these different countries, and how they have been dealing with the virus in regards to cancer. What do the data from yesterday tell us about COVID-19 disease and cancer?
This is something where I pushed for with my colleagues at the AACR. I thought we had to do something like this.
We had to go to the people who have been at the front lines of this problem and who have gathered information, so I contacted colleagues I know and asked to let me know who the best speakers are on various important topics.
I consider all of the people who talked in this session to be true heroes of cancer research. They were risking their lives taking care of patients before they knew what this virus was about, especially the ones from Wuhan and Northern Italy.
Not only did they do this, but they took care to collect information about what was happening to their patients. This all has its benefits and its limitations, because the information cannot be comprehensive at this juncture.
It has the biases of how those patients got to them, what they did or did not collect, and what are potential outcomes of the patients who didn’t get to them, which leads to different views that are probably related to how the data have been available to these investigators.
My general view—and I tried to bring it up in the discussion—was that we have two different messages: the one from the two presenters from Wuhan saying that patients with cancer do worse with COVID-19 infections.
That contrasts with the data that were provided from Italy, from France, and from Spain—where a cancer diagnosis was not an adverse prognostic factor for having a bad outcome with the COVID-19 infection.
It was patients who had comorbid conditions—in particular in the lungs, patients who have chronic lung inflammatory disease are also more likely to have lung cancer, both linked to cigarette smoking. Comorbid conditions like hypertension and obesity also led to higher risk of cancer, and those are also bad risk factors for COVID-19 outcomes.
And then the risk factors that were cancer-specific, like having received chemotherapy within a short period of time, as well as hematological malignancies which commonly receive frequent chemotherapy that leads to decreased white blood cell counts, decreased lymphocytes, that may make it difficult to control virus spread.
I’m going through this long explanation to say that the different information from China and from Europe may be based on referral patterns, type of disease, and comorbid conditions.
In the European series, the patients who had a prior cancer but are not being actively treated for it, did not do worse than the patients who were actively treated unless they had a very recent chemotherapy or a hematologic cancer.
You talked about how you pushed for this session yesterday to bring all these different perspectives together, and as you mentioned, some of them had different conclusions. What does this say about the role AACR meetings have during this pandemic?
I think one of our roles is to disseminate knowledge and provide the forum for reliable information, and that’s why we didn’t want to have just one presentation from one place.
We wanted to have a balance of all information by going to the people who would more likely have information that could be presented.
We’ll have another “COVID-19 and Cancer” session in the June AACR Virtual Meeting, and we’re planning a dedicated “COVID-19 and Cancer” conference in July—where we’re going to issues a call for abstracts that will be peer-reviewed in the same way that AACR has always done it.
The current information is mostly hypothesis-generating, but it’s also providing information on what’s happening, so people can incorporate that information and then make prospective plans that will really generate robust new information and help in management and treatment decisions.
Based on the meeting this week, what do you think the future of oncology meetings will look like?
It turns out that people really wanted to get information, and most of it about cancer research and trials results, with a limited set of basic and translational science sessions.
The June 22-24 AACR Virtual Annual Meeting II will be ten times bigger than this one. What will happen next year?
Well, I do not think that in-person meetings will disappear, because there’s a lot of other things that go on at an in-person meeting: the networking; the trainees getting to show their data in poster and oral sessions to develop their careers and network with senior investigators; the interactions that occur between industry colleagues and academics, as well as between companies that have a drug or a pathway or a diagnostic because they see each other’s data.
That needs to be able to happen, because that has helped the field, so I think there’s going to be a hybrid between virtual and in-person meetings, and we’ll have to see what’s the right balance.
Great. Is there anything else you’d like to add?
We’re going to emerge out of this and it’s going to be the same principles that we’ve had so far where science and knowledge will allow us to move forward.
It will be applied to the COVID-19 pandemic, and it will be applied to cancer research and cancer treatment.
Well, thank you so much for taking the time to speak with me, Dr. Ribas.
Thanks for your interest in the AACR and our AACR Virtual Annual Meeting.