The Oncology Podcast

The Oncology Journal Club Episode 12: Climate Toxicity in Cancer Care PLUS Breast Cancer and Oestrogen, Advanced Melanoma, First Nations People with Cancer and much more

• The Oncology Network presents The Oncology Journal Club Podcast • Season 2 • Episode 12

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What if we told you that cancer care could be kinder to both the planet and the patient? Join us for another enlightening and educational conversation with Professor Craig Underhill, Dr. Kate Clarke and Professor Christopher Jackson.

Laugh along with Craig who, despite battling 'man flu,' sheds light on reducing the climate toxicity of cancer care. Meanwhile, Kate reassures listeners by debunking myths about the safety of oestrogens in hormone replacement therapy and IVF in patients with breast cancer, shifting focus to the real culprit—progesterone. CJ guides you through the intricacies of cross-trial comparisons in advanced melanoma, breaking down Professor Georgina Long's study on nivolumab-based therapies with a focus on the utility of propensity scores.

We also spotlight initiatives aimed at improving cancer outcomes for First Nations communities in Australia, such as the introduction of cancer navigators.

Dive into the latest episode of The Oncology Journal Club Podcast for a blend of humour, hope and hard-hitting discussions that promise to challenge and inspire.

For papers, bios and other links visit the Show Notes on our website.

For the latest oncology news visit www.oncologynews.com.au.

We invite healthcare professionals to join The Oncology Network for free - you'll also receive our free weekly publication The Oncology Newsletter.

The Oncology Podcast - An Australian Oncology Perspective

Speaker 1:

Welcome to the Oncology Journal Club podcast, a fun and educational oncology learning resource for medical professionals. I'm your producer, rachel Babin, from the Oncology podcast. I'm joined by our esteemed hosts Professor Craig Underhill, dr Kate Clark and Professor Christopher Jackson. Today's episode covers an eclectic mix of papers, quick bites and scientific meeting reviews. Craig talks us through how we can reduce the climate toxicity of cancer care. Kate reviews oestrogens and breast cancer. Kate reviews oestrogens and breast cancer and CJ analyzes a paper from Georgina Long comparing the Relativity 047 and the Checkmate 067 trial data. We have quick bites, a report from the recent COSA ASM and a report from the China Anti-Cancer Association meeting. For additional insights, links to the papers and bios of our hosts, visit the show notes on oncologynetworkcomau. The Oncology Journal Club podcast is produced with pride by the podcast team at the Oncology Network. Thanks for listening.

Speaker 2:

Kia ora, kia ora, g'day. It is OJC Trans-Tasman episode 12, years whizzing by, We've got a great lineup of papers to talk about today that I think will appeal to a wide number of our listeners. Thanks for those who've sent emails with some nice feedback in the last few weeks and please tag your friends. Share with your friends if you're enjoying the podcast. Kia ora, Dr Clark.

Speaker 3:

Kia ora Craig. How are you feeling?

Speaker 2:

Oh, I've got a man cold, so sorry about that everyone. If I sound a bit snuffly, I'll try not to have a coughing spasm. Non-covid. I heard a lot of people left COSA with COVID, but you know I will survive.

Speaker 4:

Craig, I certainly hope you make it to the end of the episode alive because we all know all us men know how serious man flu can be. I mean, I know that half our audience won't quite appreciate that, but you know, you really are very, very sick and probably some people in your condition would be in the HDU on IV antibiotics, pip tears, the works burger. Really, we're so pleased that you could make it through and I just hope you manage.

Speaker 2:

I know you know how sick I was and getting a bit better. I actually called my GP and had a telehealth appointment with my GP.

Speaker 4:

Oh really.

Speaker 2:

Man sees GP. That's like a headline.

Speaker 3:

Did they call an ambulance for you?

Speaker 4:

No A man-bulance.

Speaker 2:

No, all right, let's push on on that note. I'm glad you're all here and, kate, I think we're going to ask you to go first with your main paper today uh kia ora craig.

Speaker 3:

So my main paper is a review. We love a review and it's a review on estrogens and their associations with breast cancer. It's very reassuring, I think. Those of us that treat breast cancer get a lot of queries from GPs about risk of breast cancer with HRT, risks of breast cancer with IVF, particularly and those are huge decisions for women, being at that time of my life myself.

Speaker 3:

The big hitters in this article are that estrogen is probably not the evil, progesterone seems to be. Are that estrogen is probably not the evil, progesterone seems to be. So those women who can be on HRT, estrogen patches and use a Mirena or something similar, an indwelling device, as uterine protection, or have had a hysterectomy and so don't need progesterones, are probably at no greater risk of breast cancer than those who don't. So that's fantastic. And IVF and the high estrogen load that is very temporary appears to be completely safe, even in those women with genetic mutations that would otherwise increase the risk of breast cancer. So very reassuring data for those of us that are A women and B those of us that treat them. So not really a long paper, but always a good review, and it's nice to have some actually written down evidence rather than just instinct.

Speaker 4:

Is there any activity of progesterone in men flu?

Speaker 3:

Might, ttfu. We call them concrete pills. If you've ever had to take them, stop it.

Speaker 4:

I was just wondering you know, progesterone being hormones which are obviously female hormones, and men flu being such a terrible disease affecting men if progesterone might therefore actually be active in hardening men up to help them combat this cold.

Speaker 3:

There are drugs that harden men up, but they start with V rather than B. Son.

Speaker 4:

Sounds like there's some therapeutic options there for you, professor Underhill, have you?

Speaker 2:

got any other important scientific points to make up in this paper.

Speaker 3:

No, no, I just recommend everybody read it. It's in Annals of Oncology, which is always a good read, and it is written by Drs Kim and Munster, so get on it.

Speaker 2:

Thank you very much, Professor Jackson. What have you got for us today?

Speaker 4:

Well, the paper I wanted to cover in detail today was a fantastic paper by, again, a wonderful Australian Professor, georgina Long. I've covered many of her papers before in this podcast because the work that she continues to do continues to define our field, and this is the nivolumab relactamab versus nivolumab ipilimumab paper at the Limimab paper. Now, one of the issues with medical oncology so often is that you end up with competing streams of development. So you get company A going in this direction and company B going in that direction. You often end up not directly comparing to active regimes and we're all told at conferences cross-trial comparisons are terrible, but we all do it anyway. The cross-trial comparisons are terrible, but we all do it anyway. The cross trial comparisons are always problematic because the study's baseline characteristics are often not the same. But there are mathematical ways you can get around that, principally by using a method called propensity score and this is complicated math which I don't understand very well but was used in this particular study and I'm going to go into that in some detail.

Speaker 4:

In advanced melanoma we've had the Relativity 047 study, which was a Phase 2-3 study of NEVO plus minus RelatLimib. The headline results were a median PFS of 4.6, improving to 10.1 months, with Relat Limit which was probably exaggerated due to the shape of the curves. Hazard ratio was 0.75. So an increment, but not at that. Esmo magnitude of benefit scale for Landmark 12-month overall survival was 36 months versus 47.7. And there were multiple grade still double the grade three adverse events of 9.7% to 18.9%. With the combination All groups seemed to benefit, but the comparator wasn't ipi-nevo, and ipi-nevo is the reference regime for advanced melanoma, particularly for the high impact groups, particularly those with LDH high and with heavy tumor burden. So there is no study of nevorella versus nevo-ippy, so doublet versus doublet, and so this was a mathematical comparison of these two. So they use something called the inverse probability of treatment weighting, which is a propensity score. Now propensity score is essentially a mathematical way of crunching populations which are disparate in trials to mold them to be similar in terms of their weighting for key factors. So if you've got a mismatch in BRAF or mismatch in LDH, then you can crunch them mathematically to consider if they were equal and then look at how that would play out if those populations were comparable and they use what's called weighted cohorts. They add a mathematical weighting to that. Now this group had access to the individual patient data, which is the best way of doing propensity scores rather than just doing a meta-analysis, which sometimes is just extracted from the tables and page. The outcomes in this study were PFS response rate, overall survival and melanoma-specific survival, as well as adverse events, which of course is of interest when you're looking at doublet regimes, and the results showed that overall survival and progression-free survival were similar between the doublet combos, except for the acral population, which seemed to favour epinevo.

Speaker 4:

When you think about subgroups of interest, we know that checkpoint inhibitors don't work as well in patients with liver metastases. So what about the liver metastasis subgroup? Was one a lot better than the other? Well, it seems that the patients with liver mets seem to do a fraction better with relactamib, nivolumab rather than ipinevo. So that does hold out. And those without liver metastases did better with ipinevo.

Speaker 4:

In terms of toxicity, relactacnib and Nivolumab had far fewer adverse events, which grade 3-4 was 23% versus 61% with ipinivo, and the adverse events causing discontinuation was 17% with rilanevo compared to 41% with ipinivo.

Speaker 4:

But this is ipi 3 rather than ipi 1, and we know that ipi 1 is better tolerated. So it's still not completely conclusive on whether the flipped dose, ipi or Flippi, is better than relanevo, but it does give some indication that they're at least comparable and maybe worth considering the nivolumab-relatinib combination and preference in those with lymphometastases. So in terms of other subgroups, slightly better overall response rate with apinevo and rafmutants, acryl and mucosal and those with high LDH, but otherwise they were overall pretty comparable. So another really good study giving confidence to select either for perhaps some populations going one way or the other with relaprimib and nivolumab compared to apinevo in the advanced melanoma population. So again, great trial, great study, done by a fantastic group, using individual patient data and making gains and saying that no one's ever going to do that head-to-head comparison. So let's do it mathematically and there's a very, very good study and that probably will be the best combination we're going to get of doublet versus doublet.

Speaker 2:

Oh, that's some controversial comments there. Professor Jackson, why would you think that this comparison will never be made? You don't think a property group would do that?

Speaker 4:

I think it's very unlikely, Craig. I think it's very unlikely that you'll see a heady comparison of those two. I think people are going to be more interested in novel checkpoint targets than comparing doublet with doublet.

Speaker 2:

The authors themselves, though the last line of the abstract is results should be interpreted with caution. So do you really think this is robust enough to be starting to select out subpopulations of patients to favour one treatment over the other? I would think that that might be fraught with a little bit of caution.

Speaker 4:

Well, I think you've got a hierarchy of evidence. I think you've got you know, the randomized controlled trial is clearly the pinnacle. When you don't have the randomized controlled trial, what do you do? I mean, most of the time, what we do when we don't have a randomized controlled trial is you just look at the two trials and you compare them in your head and you look at them and you make some assumptions. And what this has done is it's actually done that cross-trial comparison in a much more formalized way. And so, for those who are considering which of the two doublets you might choose for populations, particularly around toxicity, I think it gives you more information than we had before. So that's why I think it's an advance.

Speaker 2:

Sure.

Speaker 4:

So in terms of a comparison, it's much more robust than we've ever had before, and there are certainly people who would consider relanevo as a combination on the basis of the toxicity alone. So should that be enough to tip you one way or the other? When you go well, the toxicity is lower. Are they the same? I look pretty comparable, but maybe you want to consider those patients who need a higher response rate or the liver mets population, which is why I think it's a helpful study.

Speaker 2:

I agree. I think it's very interesting provocative data that it maybe is effective and have less toxicity. I'm just making the point, as I hope that there will be a randomized comparison and I just think, trying to select out subgroups liver mets, acromelanoma that's fraught with more danger in this kind of study, I would think. But good paper, great discussion, and I'd be interested to see if people do start selecting treatment based on this and subject obviously to the availability of the treatment.

Speaker 4:

Does Relictum have funded in Australia, Craig?

Speaker 2:

It is, but no, I don't think in the first line setting it's funded second line or as a default, if patients can't have EP, same company makes all three and I would have thought EP's coming off patent, so there'd be a motivation for the company to do a comparison.

Speaker 4:

Interesting speculation. I mean, I think there's a lot of novel agents in melanoma still being tested and that's what investigative energy is at the moment, rather than comparing existing regimes. But you know that's speculative and until that time the trial's done, I think that does take us further forward than the you know rough. This paper says this. This paper says that what are you doing between time and doing those propensity score analyses? Does give it a little bit more rigor when you're doing those comparisons.

Speaker 2:

Yeah, okay. So I'm going to change tack completely and talk about climate change. So I found this really interesting paper called why we Should and how we Can Reduce the Climate Toxicity of Cancer Care. So this came out in the Journal of Oncology Practice published on the 1st of November 2024. First author, ema Lynch and the senior author was Seamus O'Reilly. So this is from a group of investigators in Ireland and the Netherlands who published this paper and they're really wanting to answer.

Speaker 2:

The question is how can we reconcile our duty of care to patients with our duty of care to patients, with our duty of care to the planet, and what would that reconciliation look like? Would our efforts make a difference? So it's a brief discussion paper. They point out that ASCO's Climate Change Task Force I didn't know that existed, but it does. They have previously published about how healthcare has quite a significant climate impact. It's a major polluter. About 5% of all global emissions are responsible as a result of healthcare, accounting for also 4.4% of greenhouse gases. And globally 2% of plastics are used in healthcare and that rate's rising by 6% a year. So it's potentially quite a big problem and they talk about we've seen quite transformational positive changes in cancer care that we would have thought inconceivable previously, previously as a result of individual and collective action. What can we do to try and reduce climate change impacts of cancer care?

Speaker 2:

One of the most significant touch points for us as medical oncologists is prescribing systemic anti-cancer therapy, and drug wastage is a big problem. Drug wastage is a big problem. About 4% to 18% of all cancer drugs, of all spending in the US, is due to cancer drugs Patients who receive oral anticancer therapy. Drug waste is experienced by 25% to 41% of patients and those who discontinue treatment about 46% to 85% have leftover drug doses which at the moment which is a legal requirement pharmaceutical regulations certainly in Australia you can't reuse those drugs. A lot of the suggestions on how should we tackle this problem is around reducing usage in the first place, and they suggest that the European Society of Medical Oncology, esmo, magnitude of Clinical Benefit Scale is a framework that could be utilized more broadly and only selecting clinically meaningful benefit treatments in the first place.

Speaker 2:

So it's about reducing unnecessary care, switching to oral pre-medication. So when you use IV there's a lot more wastage. So using oral when you can, using telemedicine when you can. So they refer to a study that showed that using decentralized digital trial or teletrial can reduce the carbon footprint of the clinical trial by up to 90%. So that's quite impressive. Considering oral hydration alternatives rather than IV. De-escalating therapy. De-prescribing using subcut if it's equivalent rather than IV again, less wastage. Changing regulations to enable vial sharing dose banding I had to look up what that was. Do you know what dose banding is, chris?

Speaker 4:

Yeah, we do it for kept cytobine.

Speaker 3:

We do it for IV drugs as well Dose banding and vial sharing. That has been a standard thing in New Zealand fume hoods for decades.

Speaker 2:

Quite some time. We have vial sharing as well, because a lot of our drugs are compounded in manufacturing facilities and the reimbursements now by the milligram rather than a vial, so that encouraged that. But I had to look up what dose banding was. I hadn't heard of that and I see there's a push out of the NHS and that's pre-mixing up rounded doses and people using rounded doses rather than having to make up an individual dose for a patient, so that reduces the wastage considerably and extending treatment intervals if necessary.

Speaker 2:

And here's a good one coordinating diagnostic tests with other visits, so scheduling tests on the same day rather than patients needing to use multiple trips, which uses up carbon. So anyway, it's a very interesting paper. I urge people to have a quick read it's not a very long paper and think about that idea of individual and collective action, and so I think this is sort of ripe for one of our national international groups to also write some frameworks or guidances on how we may be able to tackle this. And at a state and national level in Australia we may have to look at some of the regulations, for example, that prevent re-prescribing expensive oral drugs that are in blister packs and can't be re-dispensed to another patient.

Speaker 4:

Yeah, I mean, I think that selling drugs in packs of 28 days only is a pretty mean commercial trick really, and they could certainly do weekly dispensing, for example, which would make a difference too, wouldn't it? And of course, you've got drugs which are temperature sensitive, which you can't actually guarantee they've been kept appropriately, etc. So that is a problem. But I think there was a recent article I can't remember if it was in JCO or not, craig, you may have seen it which showed that if you did allow returns of medications, it did reduce waste, which is quite considerably maybe 30 odd percent, something like that.

Speaker 4:

Just a couple other comments on climate change stuff, though. I mean, of course, all of that was around the wastage and oncology that contribute to climate waste. There's other issues with climate, of course you know air pollution being a major carcinogen in the first instance, the wildfires being a major problem in terms of carcinogenicity, and climate change causing extreme weather events, which has impacts on access to care as well, which is clearly a major problem worldwide too. There's actually this group, which I've only heard about recently, which is called Oncology Advocates for Climate Change, and they can be found at ouchforclimateorg O-U-C-H for climate, f-o-r climateorg, which is an international oncology advocates association for people who are interested in both cancer and climate, two of the most pressing issues facing high-income countries at the moment.

Speaker 2:

Thanks, Chris Benny. The focus of this paper, though, is what we could do as medical oncologists in terms of prescribing 100% to try and reduce waste, not just the global need to minimise the impacts of climate change and advocating for that, Kate.

Speaker 3:

Well, I think this is somewhere where those of us who claim to live in the developed world could perhaps listen to what people in the developing world have developed in order to get more value and out of resources, and also how they adapt to not having as much. When you don't have a lot, you don't waste a lot. So this is where we can listen to other people, other communities and probably learn some really useful ways to get around things that we haven't perhaps thought of.

Speaker 2:

I totally agree. You know, this is all about eliminating low-value healthcare and reducing unnecessary treatments as much as you know, changing the packaging. So that's you know. All of that has a collective impact.

Speaker 4:

And also reframing the issue in terms of focusing on climate justice rather than just reducing costs. So perhaps it's adding a different motivational button as well.

Speaker 2:

Yeah, that's right. I mean, that's the motivation is climate impact, but a lot of it is about reduce. It will reduce costs as well. All right, so anyway, I thought that was an interesting paper and it'd be interesting to hear any discussion on social media and what other people think about this issue as well. All righty, quick bites, chris. Do you want to go first?

Speaker 4:

The JCO 27th of September 2024 had a quick look at the evaluation of number of trial participants in pharmaceutical versus federally sponsored studies, and this is interesting to see what our recruitment patterns are to clinical trials and who's recruiting patients to what kind of trials. This was a review of studies registered on clinicaltrialsgov from 2008 to 2022, and it tried to identify the sponsor and categorized it if it was either industry-funded or federally-sponsored studies, so government or academic sponsorship. They found 26,080 studies conducted during that time. It's quite a large sample size and what they found was for adult oncology studies, for every one patient enrolled in a federally sponsored study, nih sponsored study, eight were recruited to a pharma study. So eight patients going into pharma studies for every one into a government funded study, which just gives you some perception of the extents to which the pharmaceutical companies are currently dominating the research landscape and the extent to which they're dominating the recruitment there.

Speaker 2:

Or the extent to which governments are not funding clinical trials.

Speaker 4:

Yes, yes, now that was my final point, craig. Oh sorry. And how that's changed over time is interesting. So over the time of that study 2008 to 2022, that went from 4.8 to 1 up to 9.6 to 1. So the proportion of patients going into pharmaceutical trials is going up and up and up. And the same is happening in childhood cancers, but perhaps to a lesser extent.

Speaker 4:

And what that study also showed was the overall recruitment in federal studies was flat over that 14-year period and certainly cancer diagnoses were not flat over that period. So when you see a flat line in terms of trial recruitment, what that is saying Craig, you're quite right is the funding and investment. In terms of the absolute amounts of money given or the ability to recruit patients, the study says it's been flat, so it hasn't gone up proportionally as you would have hoped it would have done in terms of being in line by those cancer diagnoses. So certainly, in my opinion, it's a reminder that we need to continue to invest in academic and public good studies, that we need to ensure that we aren't drowned out by the agendas of pharmaceutical companies, which are often, but not always, completely aligned with the academic groups.

Speaker 2:

Hi Kate.

Speaker 3:

So I've got a sad one and a happier one. I've got a sad one and a happier one. So my sad one is the Impassioned 132. So women who had had completed their chemotherapy and surgery for breast cancer, for triple negative breast cancer, and had relapsed within 12 months of completing that. So heart sinks for those of us who look after them. They were offered chemotherapy plus or minus atezolizumab, and the two sad bits was that the atezolizumab arm did know better and the median overall survival is less than 12 months. So that is heartbreaking. So triple negative breast cancer is still those women that don't do well after neoadjuvant chemotherapy an incredibly upsetting disease and sadly it is a disease of young women. So that was my sad news.

Speaker 3:

My happy news was the Checkmate 040, nivolumab plus ipilimumab still very hard for me to say given to those with advanced hepatocellular carcinoma who had previously been treated with serafinib and the five-year results. The OS is like 29%, so that's pretty sexy. These people are supposed to die within eight months. So still fiendishly expensive, still difficult, still not appropriate for everybody. But that gives me hope, particularly as, sadly, hcc is only increasing and it is only going to get worse as we defund our public health systems and our public health departments.

Speaker 2:

Fantastic Thanks, kate. So click on the links, people, if you want to read a bit more about that, chris.

Speaker 4:

So, Craig, have you been to any Super Spritter conference events recently?

Speaker 2:

I have. That sounds like a nice segue into my. I've replaced my quick bite with a quick report from the COSA conference held in the Gold Coast recently. So that was a good meeting. You know, it's sort of in terms of it's not ASCO scientific meeting, it's been. Some of the scientific presentations in Australia now go to places like the AGITG or TOGA meetings or MOGA.

Speaker 2:

But it's a great multidisciplinary meeting and the sessions have been put, you know, not just for medical oncologists or other medical specialties, but great input from allied health and nursing and consumers. The equity was the theme, so specifically bridging gaps, building progress, breaking down disparities. Some of the highlights for me there was an interesting session called Removing Barriers of Access to Care with Technology and that included using telehealth in routine care and also teletrials, and Robin Zon, who's the current ASCO president, was talking in that session. She's the author of the ASCO Telehealth Guidelines which were written during the heights of the COVID pandemic and I will put a link into those. So they're a really nice summary of where ASCO thinks it's okay to use telehealth in routine care and also specifically talks about teletrials and heavily references the Australian Australasian psoriatic-cosid telribe model. There was a session on cancer-related malnutrition and sarcopenia, the position statement and implementation toolkit released by COSA and that provides some practical resources and guidance to support the implementation of the COSA position statement recommendations on cancer-related malnutrition into practice, and it talks about screening, assessment and then treatment. I know a lot of places, especially in regional or remote Australia, have a lack of ability to refer easily to dietetic services and the same in Metro. They're under capacity but this provides some guidance of how to prioritise screening and assessment and then referral of patients. So that was a really good toolkit that people can. We'll put a link to that in the notes as well. So congratulations to the COSA group that wrote that, led by a large number of nutritionists, dietitians and other allied health professionals.

Speaker 2:

There's another toolkit which was released and that was about the Care Plus implementation toolkit. So that's a toolkit for implementing a model for early referral to palliative care. So we saw in the ASCO plenary this year that the importance of early referral to palliative care. So we saw in the ASCO plenary this year that the importance of early referral to palliative care. It does improve outcomes, not only qualitative but also survival outcomes, and this has been a pilot done by Professor Jenny Phillips and her group at St Vincent's Hospital and University of Melbourne in Melbourne to develop this similar to what we saw at the ASCO plenary stepped care model. So patients are referred and after, if they're stable, they go back out of the palliative care system, back in if there's a significant event such as hospitalisation or progressive disease. So it's seen as a sort of cost-effective model. So this was the release of the implementation toolkit, again useful for healthcare providers in cancer and also health services in how to implement a model of early referral to palliative care. That was co-designed with consumers. So there's some consumer material there. Chris and Kate are writing notes so hopefully they're going to go and look up the Care Plus implementation toolkit.

Speaker 2:

There was a great session on ensuring equitable access for First Nations people with cancer, so I learned something. There was an Australian Institute of Health and Welfare report came out, I think in October. It actually showed that the gap has widened in cancer outcomes between the First Nations people and non-First Nations people. So what we've seen over the last 10, 15 years quite considerable improvement in outcomes in non-Indigenous populations amongst our First Nations populations. Their outcomes have worsened. So cancer has now become the leading cause of death. Lung cancer is the number one. So the outcomes have gone backwards, so the gap has widened considerably. One of the big focuses on the Australian Cancer Plan that was released last year is trying to address that gap. So one of the solutions that was featured in this session was two pilots of cancer navigators for Aboriginal and Torres Strait Islander people with cancer. So some community-based navigators that help assist Aboriginal and Torres Strait Islander people with cancer into and out of the mainstream cancer system at the time of suspected cancer or during their treatment or during survivorship. So pilot done in Melbourne, one done in Queensland and North Queensland and they were shown in that session. So I encourage people to click on the links that we'll put in the abstracts in the notes and have a look at that.

Speaker 2:

And then there was a plenary session on AI and the impact that might have. There was one talk on how it's having an impact in radiology and reading reports and also pathology, and I did come across an interesting paper. I was alerted to this on reading the Washington Post, but there's a paper published in JAMA Open Network on the 28th of October Large Language Model Influence on Diagnostic Reasoning a randomized clinical trial where 50 physicians were used standard means to come up with diagnosis, as in talking to the patient or using tools like up-to-date versus the same approach plus using a learning language model. And it actually showed there was no improvement in the diagnostic result as a result of using the LLM, but it was marginally quicker. So that was interesting and put a link to that paper as well. And I noted New England Journal has published an editorial saying we do need more randomized clinical trials in AI to properly assess its benefits or other impacts.

Speaker 2:

And then, of course, the best session of the conference was called Addressing Disparities in Cancer Outcomes in Regional Victoria through Regionally led telehealth-enabled health services research. This is a blow your own trumpet session. So Regional Trials Network Victoria is running the Revitalise MRFF grant and we had a symposium showing the outcomes to date of that health services research program at its midway point. So interesting meeting. And the great thing, apart from catching colds or COVID is that you get to network with people. So as soon as you walk in the door you know people are grabbing you and wanting to talk to you about this, that and the other. So that is the value of the face-to-face interactions is that ability to network during the meeting.

Speaker 4:

Yeah, which is really meaningful, isn't it? I also went to a meeting last week as well, craig, but mine wasn't COSA, it was another four-letter acronym, it was CACA, the Chinese Anti-Cancer Association, which was hosted in Xi'an, in the north of China. Now, the Chinese Anti-Cancer Association hosted this meeting in association with the Asian Oncology Society, and I actually hadn't really paid much attention to the Chinese Endocrine Cancer Association previously, but I certainly have now. Their meeting had 36,000 attendees, so it's getting up there towards ASCO size and 120,000 people online apparently. So really, really, really big meeting across the region. So a really, really, really big meeting across the region.

Speaker 4:

And certainly what struck me was the way in which the Chinese Endocrine Association had deliberately and strategically formed partnerships with a number of global organizations, and so there were joint sessions with JAMA, nedgem, uicc, aacr, lancet and London Global Cancer Week, amongst many other joint sessions. So Keke were clearly partnering with these global organizations to try and foster partnerships. It was an extraordinary type of onco-hospitality that was extended to these organizations to build these linkages, and I think one of the things I took away from it is that there's certainly a global shift which is going on and we're currently hitting globally uncertain times. In particular, many of the US institutions could be considered potentially unlikely to improve, with the likes of RFK and Dr Oz at the helm. So there's a challenging time for US organizations and who knows what Elon Musk will do in terms of reducing the impact, the investment in government departments in the US, whether or not that's going to lead to more of a shift to China.

Speaker 4:

So certainly I think that for the Asia-Pacific, it's clear that the Chinese Cancer Association is forming strong partnerships with its regional neighbours and that that looks set to continue, and in fact the UICC annual meeting will next be held in Hong Kong. So again, there's a very strong link there. And the next Asian Oncology Society meeting is in the middle of next year, in July in Seoul, and I'm sure that will be a very, very well attended regional meeting as well. So fascinating times in terms of geopolitics a very well run meeting, a great host of the Chinese Endocrine Association, some really interesting local data there.

Speaker 2:

Whereabouts in China, was it, Chris? When you first mentioned this, I was thinking you got scanned, because I mean, how many emails a day do you get inviting you to submit a paper to a conference somewhere in an obscure location?

Speaker 4:

Yeah, that's right. It was in Xi'an, china, which is the home of the Terracotta Army, amongst many other, so that's, of course, the eighth wonder of the world. Allegedly, it's a UNESCO heritage site. You're quite right, craig. I mean you and I and Kate will all get these bogus scam emails, but when you're working on a committee together I'm working with someone from CACA on the London Global Cancer Week committee and, of course, once you've got a personal invitation from someone who you've been working with, it's clearly no longer a scam, is it, but a really, really big meeting there.

Speaker 2:

Yeah, I know that Dorothy O'Keefe went from Cancer Australia and I think it was seen as an important opportunity to engage China and other Asian partners and continue dialogue outside of the government and, you know, semi-government and, as you say, continue some links in the context of ever-shifting geopolitics. And I liked your, was that the diplomatic answer that it's likely that US institutions may not be any better?

Speaker 4:

It's certainly hard to see them improving in the course of the next couple of years, but I guess it's important for us to wait and see how that plays out.

Speaker 3:

I think you know there's already significant links between New Zealand, australia and China biotech in terms of the research that's being done by, you know, maligan here, beijing trials, etc. You know, I think, and there seems to be more appetite for Asian communities to want to spend time with New Zealand researchers, purely by geography. It's a growing country with a growing amount of research skill and what I find always very humbling is the skill not only in the science, but the skill in English, you know, to just flick it in and out of a language. It's mortifying when we go there and go oh hey, I know we're in China, but is this meeting English? Sweet yeah.

Speaker 2:

Yeah, all right. So we've touched on a wide range of topics yet again, so hopefully people have found that interesting. There's something of interest and if you are interested, click on the links to get some more information. And we'll see you all soon for our end of year special. So I'm going to say goodbye. I know Professor Jackson's heading to an airport, mā te wā Ka kite. And Rachel on the sound desk. Thank you again.

Speaker 1:

Pleasure, as always, thank you.

Speaker 2:

Thanks everybody, see you soon, ciao.

Speaker 1:

Thank you for tuning in to the Oncology Journal Club podcast, proudly brought to you by the Oncology Podcast. Part of the Oncology Network For healthcare professionals. Seeking regular news, updates and insightful discussions, we invite you to join our community at oncologynetworkcomau. Your free registration includes a complimentary subscription to our weekly publication, the Oncology Newsletter, a valuable resource to stay updated on the latest advancements in the field. We value your input and welcome your feedback and paper recommendations via our social media channels, email and website. Your insights help shape the conversation and drive the direction of future episodes. This is Rachel Babin signing off for the Oncology Journal Club podcast.