Op-Ed
For the Impoverished, Health Care Is a Luxury
Chandrakanth Are, MBBS, MBA, FRCS, FACS
Cancer is the second leading cause of death worldwide, and the global burden is on an inexorably upward trajectory. For the year 2012, there were 14.1 million new cancer cases and 8.2 million cancer-related deaths worldwide.1 It is predicted that by the year 2035, there will be 23.9 million new canc...
Long-Term Follow-up of PIVOT Argues for Immediate Treatment of Men With Unfavorable-Risk and Possibly High-Volume, Low-Risk Prostate Cancer
Anthony V. D’Amico, MD, PhD
The updated results of the PIVOT1 study—reported in The New England Journal of Medicine by Wilt et al and reviewed in this issue of The ASCO Post (page 20)—did not show a statistically significant difference between treatment and observation for the initial management approach to men with newly diag...
Fighting Misinformation in HPV-Related Cancer Prevention
Lois Ramondetta, MD
Lois Ramondetta, MD FAKE NEWS, junk science, and alternative facts seem pervasive in our current culture, to the detriment of important, verified scientific advancements. One area where this is quite evident is the vaccine against human papillomavirus (HPV). Although we have had a safe, eff...
Tissue Specimens in Clinical Trials: A Double-Edged Sword
Apar Kishor Ganti, MD, MS, FACP
Apar Kishor Ganti, MD, MS, FACP AN INCREASING number of clinical trials require the submission of tissue specimens, either from archived specimens or increasingly from fresh biopsies taken after enrollment into the trial. These specimens can be either mandatory, required to determine whethe...
One Size May Not Fit All: Thoughts on the New Adjuvant Bisphosphonate Guideline for Early-Stage Breast Cancer
Ruth M. O’Regan, MD, and Amye J. Tevaarwerk, MD
Ruth M. O’Regan, MD Amye J. Tevaarwerk, MD The oncology community has now conducted several prospectively designed, hypothesis-driven randomized clinical trials among women with breast cancer to address this question: Do adjuvant bisphosphonates decrease the risk of breast cancer b...
Maintaining Predictable Increases in NIH Funding for Cancer Research
Richard L. Schilsky, MD, FACP, FASCO
Richard L. Schilsky, MD, FACP, FASCO CONGRESS RECENTLY passed its fiscal year (FY) 2017 spending bill, which contains an additional $2 billion for the National Institutes of Health (NIH). This marks the first time in more than a dozen years that Congress funded back-to-back increases for th...
Adding Pravastatin to Chemotherapy in Small Cell Lung Cancer
Rowan T. Chlebowski, MD, PhD, FASCO
Following early reports associating favorable outcomes in cancer patients with the use of statins,1,2 further observational studies in this area have provided mixed findings.3 As recently reported in the Journal of Clinical Oncology, and reviewed in this issue of The ASCO Post, Seckl and colleagues ...
The Emperor’s New Clothes: Biosimilars and Cost in Oncology
Kevin Knopf, MD, MPH, and Charles Bennett, MD, PhD, MPP
Kevin Knopf, MD, MPH Charles L. Bennett, MD, PhD, MPP Biosimilars are biologic products similar to the parent (branded) molecule in structure and function—such as erythropoietin and filgrastim (Neupogen).1 To truly bend the cost curve, we want to see a dramatic economic savings ach...
Neoadjuvant Studies of Endocrine Approaches in Breast Cancer Mandated Before Embarking on Large Adjuvant Studies
Matthew J. Ellis, MB, BChir, BSc, PhD, FRCP
Largely based on studies demonstrating that letrozole can suppress plasma estradiol levels to a greater extent than anastrozole,1 the adjuvant activity of these endocrine agents were compared in 4,136 patients with node-positive breast cancer in the FACE trial. As reviewed in this issue of The ASCO ...
Idelalisib in Resistant CLL: Benefit Shown, Questions Remain
Leo I. Gordon, MD, FACP
As reported in The Lancet Oncology by Dr. Andrew Zelenetz and colleagues and reviewed in this issue of The ASCO Post, an international phase III trial in 416 patients with refractory or recurrent chronic lymphocytic leukemia (CLL) addressed the benefit of adding the first-in-class phosphoinositide 3...
Scalp Cooling to Prevent Chemotherapy-Induced Alopecia: Is It Now Ready for Prime Time?
Julie Nangia, MD
In oncology, sometimes we forget about the small, everyday things that can significantly impact a patient’s life. When patients are explained the side effects of chemotherapy and chemotherapy-induced alopecia, most women will cry or become visibly upset. When a woman loses her hair, it represents so...
High-Risk Mutations Predict Poor Outcomes for Patients With Myelodysplastic Syndromes Undergoing Transplantation
Kamal Menghrajani, MD, and Martin S. Tallman, MD
Kamal Menghrajani, MD Martin S. Tallman, MD Although several treatment options are available for patients with myelodysplastic syndromes (MDS), hematopoietic stem cell transplantation (HSCT) remains the only curative therapy.1 The risks of complications and death from transplantati...
Will the UK’s Departure From the EU Impact Oncology in Europe?
John F. Smyth, MD
“No man is an island entire of itself; any man’s death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee.” —John Donne (1624) This statement is almost certainly true—and sadly in a negative way not just for the UK but for ...
Incorporating the ‘Goals of Medicine’ With the ‘Goals of Care’
Bates D. Moses, MD
Bates D. Moses, MD In both inpatient and outpatient medical settings, the physician-patient communication process can become more difficult as a disease progresses. Conflicts due to a misunderstanding of therapeutic goals and/or a patient’s values can slowly arise over time among patients, ...
Making American Research Great Again
Ronald A. DePinho, MD
Ronald A. DePinho, MD In the past 10 years, we have made remarkable advances in how we fight cancer. One of the most powerful new tools in our arsenal is cancer immunotherapy, which reawakens our own immune system to produce stunning results for many suffering from advanced cancer. Immunot...
Autologous Transplantation for Myeloma: Don’t Change the Winning Team
Parameswaran N. Hari, MD, MRCP, and Luciano J. Costa, MD, PhD
Parameswaran N. Hari, MD, MRCP Luciano J. Costa, MD, PhD Over the past 20 years, the Intergroupe Francophone du Myelome (IFM) and Dr. Michel Attal have pioneered the use of autologous hematopoietic cell transplantation (AHCT) for multiple myeloma in a series of randomized studies. ...
Atezolizumab: Another Therapeutic Option for Patients With Previously Treated Non–Small Cell Lung Cancer
Bruce E. Johnson, MD
The OAK study—recently reported by Rittmeyer and colleagues and reviewed in this issue of The ASCO Post—is the first study to show patients with previously treated non–small cell lung cancer (NSCLC) treated with a humanized antibody (atezolizumab, Tecentriq) directed against the programmed cell deat...
Androgen Blockade and Salvage Radiation Therapy in Prostate Cancer: Cautious Optimism Amid Unanswered Questions
Philip W. Kantoff, MD; Daniel E. Spratt, MD; and Edoardo Francini, MD
Philip W. Kantoff, MD Daniel E. Spratt, MD Edoardo Francini, MD The recent report of results of RTOG 9601 by Shipley et al in The New England Journal of Medicine1—reviewed in this issue of The ASCO Post—strongly supports the variably used practice of adding “androgen block...
My Year of Living Wonderfully: 12 Months as ASCO President
Daniel F. Hayes, MD, FACP, FASCO
At the heart of every ASCO committee, department, task force, policy statement, clinical guideline, thematic meeting, and Annual Meeting lies one issue and only one issue: ‘Does this represent what is best for our patients? — Daniel F. Hayes, MD, FACP, FASCO EACH YEAR, th...
Ensuring Equitable Cancer Care for All Patients
Sanjeev Arora, MD, MACP, FACG, and Ernest Hawk, MD, MPH
Sanjeev Arora, MD, MACP, FACG (left) Ernest Hawk, MD, MPH Cancer is the second-leading cause of death across the globe. Significant efforts, such as the National Cancer Moonshot Initiative and The University of Texas MD Anderson Cancer Center’s Moon Shots Program, will drive advanc...
Neoadjuvant Immunotherapy in High-Risk Melanoma: A New Approach
E. George Elias, MD, PhD
Neoadjuvant immunotherapy can induce very effective autoimmunization specific to each patient’s melanoma and result in tumor ablation. It is nontoxic, safe, well tolerated, and relatively less expensive than any other adjuvant approach. — E. George Elias, MD, PhD Melanoma...
Next-Generation Genitourinary Oncology: Keeping One’s Powder Dry
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
The critical issue is that we need to be more cognizant of the value proposition than in past eras, and genitourinary oncologists must come to grips with the idea that finances for health care are becoming much more restricted. — Derek Raghavan MD, PhD, FACP, FRACP, FASCO...
Trastuzumab Biosimilar Could Lead to Lower Health-Care Costs and Greater Drug Access for Patients With Metastatic Breast Cancer
Chau T. Dang, MD
The importance of these findings cannot be underscored sufficiently. The development of a biosimilar for treatment in this setting could mean not only lower health-care costs for society overall, but also greater access to an important life-saving or life-extending drug for a lar...
The Mystery of Grace
Jennifer Lycette, MD
In oncology, we encounter myriads of moments of grace in our practices every day, and they don’t leave us unchanged. — Jennifer Lycette, MD The day after I told Nell she had seven metastases to her brain, she sent me flowers. She was my patient; I was her oncologist. I h...
The Path Forward for Clinical Pathways in Oncology
Robin T. Zon, MD, FACP, FASCO
ASCO’s recommendations and criteria to improve the development and implementation of oncology pathways serve as a first step in this path forward, leaving us filled with optimism for 2017 and beyond. — Robin T. Zon, MD, FACP, FASCO The year 2016 was a memorable one for on...
New First-Line Options for ALK-Positive Lung Cancer on the Horizon
Alice T. Shaw, MD, PhD
The prolonged front-line progression-free survival seen with second-generation inhibitors, coupled with rationally developed second-line options, should ultimately translate to longer overall survival [in ALK-positive NSCLC]. — Alice T. Shaw, MD, PhD Anaplastic lymphoma k...
Implications of SWOG S0777 and the Future of Combination Treatments for Multiple Myeloma
Tanya M. Spektor, PhD, and James R. Berenson, MD
The ability to more rapidly assess changes in clinical status will allow us to be more conservative in our approach to treatment in many patients, since failures of treatments can quickly be remedied with the addition of other agents or changes in the treatment altogether. &m...
FALCON Trial Informs the Evolving Role of Fulvestrant in Advanced Hormone Receptor–Positive Breast Cancer
Aman U. Buzdar, MD, FACP
Aman U. Buzdar, MD, FACP Endocrine therapy for breast cancer has evolved over the years. Initial endocrine therapies consisted of ablative procedures (oophorectomy, adrenalectomy, and hypophysectomy). With the availability of pharmaceutical estrogens, progestins, and androgens, ablative pro...
Make Vaccination Great Again
Erich M. Sturgis, MD, MPH
Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. It affects 80% of individuals, with the initial infection usually occurring between the ages of 15 and 24. Persistent infection with oncogenic HPV genotypes, primarily 16 and 18, is the cause of virtually all cer...
Timing Is Everything
Daniel F. Hayes, MD, FACP, FASCO
I look forward to a time when it doesn’t matter when or where a patient is diagnosed and when every patient has a 100% chance of being cured of his or her cancer…. This is ASCO’s vision and mission—and mine. — Daniel F. Hayes, MD, FACP, FASCO In 1959, my 5-year-old cousin...
The Cost of a Patient’s Last Ride
Chandrakanth Are, MBBS, MBA, FRCS, FACS
Chandrakanth Are, MBBS, MBA, FRCS, FACS It was a call from a referring physician who wanted the patient to be transferred to our major academic center. The patient had a history of a lethal malignancy in a very advanced stage. The patient was already outside the bell curve, for she had surv...
What Precisely Is Precision Oncology—and Will It Work?
Vinay Prasad, MD, MPH, and Robert Peter Gale, MD, PhD, DSc(hc), FACP, FRSM
We know from chaos theory that even if you had a perfect model of the world, you’d need infinite precision in order to predict future events. —Nassim Nicholas Taleb The term “precision oncology” is used to describe diverse strategies in cancer medicine ranging from the use of targeted therapies ge...
As We Strive for a Cancer Cure, We Must Not Forget the Survivors
Janet Snapp, MSN, RN, FPCN, and Dori Klemanski, DNP, CNP, RN
With a truly national survivorship infrastructure, as the fear of cancer begins to fade, so too will the burdens faced by survivors. — (Left) Janet Snapp, MSN, RN, FPCN, and Dori Klemanski, DNP, CNP, RN Although a cure for cancer remains elusive, there are many promisi...
Confirmation or Transformation? The Case of Palbociclib in Hormone Receptor–Positive Metastatic Breast Cancer
Massimo Cristofanilli, MD, FACP
Women with hormone receptor–positive metastatic breast cancer are witnessing an unprecedented time of success in the battle against their disease. Just in the past 12 months, a number of prospective, randomized, phase III studies were reported, with positive results indicating the value of fulvestra...
Mutational Characteristics of Chemotherapy-Treated Bladder Urothelial Neoplasms
Juan J. Chipollini, MD, and Philippe E. Spiess, MD
Radical cystectomy with urinary diversion is the standard of care for muscle invasive bladder cancer.1 Meta-analyses of prospective data have shown a 5% overall survival benefit at 5 years for those receiving neoadjuvant systemic chemotherapy prior to cystectomy.2,3 We currently know of two distinct...
Medicare Access and CHIP Reauthorization Act: The Final Rule
Philip J. Stella, MD
The Medicare Access and CHIP Reauthorization Act represents the biggest change in medicine that I’ve witnessed in my career…. We should seize the opportunity to transform how care is provided from a system we know is broken to one that truly represents quality and value. It’s too g...
Recent Progress and Concepts in Pancreatic Cancer
Robert Peter Gale, MD, PhD, DSc(hc), FACP, FRSM
We are unlikely to manage this disorder with one or even several drugs in the way tyrosine kinase inhibitors have cured some people with CML. Different people are likely to need different therapies or combinations of therapies, which will need to be proved effective in controlled c...
Pembrolizumab as First-Line Therapy in Metastatic NSCLC: Practice-Changing Implications of KEYNOTE-024 Trial
Deborah B. Doroshow, MD, PhD, and Roy S. Herbst, MD, PhD
Deborah B. Doroshow, MD, PhD Roy S. Herbst, MD, PhD We are in the midst of a paradigm shift in lung cancer. In the past 2 years, the anti–programmed cell death protein 1 (anti–PD-1) inhibitors nivolumab (Opdivo) and pembrolizumab (Keytruda) were found to improve overall survival in...
Vaccine Therapy in Metastatic Renal Cell Carcinoma: Past, Present, and Future
Neeraj Agarwal, MD
If the ADAPT study replicates the results of the previous phase II study of AGS-003 plus sunitinib, this regimen will have the distinct advantage of being one of the most well-tolerated combinatorial regimens in the first-line setting for metastatic clear cell variant renal cell ca...
Putting Patients First: My Journey in Advocacy
Ellen V. Sigal, PhD
The most important lesson I have drawn in 2 decades is this: Although science remains the touchstone in our long fight together, each patient individually matters. — Ellen V. Sigal, PhD When I lost my only sister to breast cancer in 1986, patients like her had devastating...
‘Dear Presidential Candidates’: A Letter From an Oncologist
Jame Abraham, MD
Dear Presidential Candidates: Wouldn’t it be great if history’s Alexander the Great was actually Dr. Alexander Fleming, the doctor-scientist who saved millions of lives by discovering penicillin, rather than the other Alexander, who conquered and killed thousands of innocent people? Wouldn’t it be ...
Evaluating the FDA’s Approach to Cancer Clinical Trials
Richard Pazdur, MD
Given the recent advances in our understanding of cancer and our improved technologic capabilities, we are now placing an emphasis on evaluating how we design clinical trials to make the system more efficient, to more rapidly deliver safe and effective products for patients. &mda...
ASCO Applauds MACRA’s Focus on High-Quality, Patient-Centered Care
ASCO President Daniel F. Hayes, MD, FACP, FASCO
Editor’s note: As The ASCO Post went to press, the Department of Health & Human Services finalized a landmark new payment system for Medicare clinicians. The system, known as MACRA, (Medicare Access and CHIP Reauthorization Act of 2015), replaces the flawed Sustainable Growth Rate and will equip...
Why Curing Cancer Will Take Decades
I’m a realistic optimist—or an optimistic realist. There is tremendous opportunity to make progress—and ultimately to win. We just have to keep our goals both ambitious and realistic along the way. — Eric S. Lander, PhD This past summer, Eric S. Lander, PhD, President of ...
Reducing Drug Costs by Increasing Science-Driven Drug Discovery
Ronald A. DePinho, MD
Our ultimate success will be defined over the coming years, when we’ve produced transformative new medicines that can be delivered to patients more quickly and at a lower cost than the current paradigm. — Ronald A. DePinho, MD For several years now, the American health-ca...
Is Human Life Worth No More Than a Text Message?
Chandrakanth Are, MBBS, MBA, FRCS, FACS
Technology has a definite role in health care, but it needs to be harnessed appropriately. — Chandrakanth Are, MBBS, MBA, FRCS, FACS The words “cost control,” “value-based health care,” and similar iterations are floating around freely these days to make us aware of the u...
Have You Received Your Immune Checkpoint Inhibitor Yet?
Tony S.K. Mok, MD
Despite the issues in biomarker status, dosage, and cost-effectiveness, we cannot deny the fact that KEYNOTE-010 has established pembrolizumab as second- or third-line therapy for advanced-stage NSCLC. — Tony S.K. Mok, MD “Have you received your immune checkpoint inhibito...
GADOLIN and the Perplexing Role of Obinutuzumab in the Treatment of B-Cell Malignancies
Anas Younes, MD
Collectively, these data indicate that just because obinutuzumab-based chemotherapy in CLL was better than rituximab-based therapy, one should not extrapolate and substitute rituximab with obinutuzumab in other regimens and for other B-cell malignancies. — Anas Younes, MD ...
Moonshots and ‘Onco-nauts’
Daniel F. Hayes, MD, FASCO
We need to trade competition for collaboration, and we need to be sure we maintain a sustainable federal research-funding source that matches inflation. Doing so will ensure that our onco-nauts can continue to make progress in conquering cancer. — Daniel F. Hayes, MD, FASCO...
CMS Proposal for Part B Drug Payment: A Poorly Conceived Experiment
Blase N. Polite, MD, MPP
Blase N. Polite, MD, MPP On March 11, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule in the Federal Register to test a change in reimbursement for Part B drugs.1 The first phase involves changing the 6% add-on to the average sales price (ASP) used to mak...
The Age of the Atomic Hematologists/Oncologists
Robert Peter Gale, MD, PhD, DSc(hc), FACP, FRSM, and Dieter Hoelzer, MD, PhD
Our approach to radiation accident victims today is based largely on observations and contributions from these atomic hematologists and oncologists.… More importantly, readers surely know of the considerable supportive roles of erythropoietin, G-CSF, and hematopoietic cell transp...
Supporting Policy to Reduce Tobacco-Related Deaths
Ronald A. DePinho, MD
How could we, America’s health-care providers and knowledge experts, not do everything possible to protect our fellow citizens from a life ravaged by smoking? — Ronald A. DePinho, MD One billion lives. That is the estimated human death toll of tobacco use in the 21st century.1 To...
Moonshot Program for … Compassion
Chandrakanth Are, MBBS, MBA, FRCS, FACS
A 65-year-old patient with widely metastatic pancreatic cancer was emergently transferred to our facility in the early hours of the morning with free air suggestive of a perforated viscus. The patient is from a small town several hundred miles away from our academic center, which can be quite typica...
The ENDEAVOR Trial: A Case Study in the Interpretation of Modern Cancer Trials
S. Vincent Rajkumar, MD
It can be easy to miss the forest for the trees in the interpretation of clinical trials. In particular, trials for the treatment of cancer are exceedingly complex, with long lists of inclusion and exclusion criteria, designs with hidden biases, drugs with unpronounceable names (if not cumbersome al...
SIRIUS Trial Heralds a New Era of Promise in Treating Resistant Myeloma
Jacob P. Laubach, MD, MPP, and Paul G. Richardson, MD
The advent of daratumumab as an approved agent for the treatment of multiple myeloma provides a very exciting platform both now and for the future and heralds a new era of promise in the treatment of multiple myeloma. — Jacob P. Laubach, MD, MPP (left), and Paul G. Richa...
Moving the Needle on HPV Vaccination
Barbara K. Rimer, DrPH, Abby B. Sandler, PhD, and Owen N. Witte, MD
In 2012–2013, members of the President’s Cancer Panel (prescancerpanel.cancer.gov) focused their efforts on accelerating widespread acceptance of and use of approved human papillomavirus (HPV) vaccines to prevent cancer. The topic is important, because HPVs cause most cases of cervical cancer and la...
Combined-Modality Therapy for Low-Grade Gliomas: Balancing Toxicity, Delivery Logistics, and Survival Benefit
Low-grade gliomas account for 15% of all primary brain tumors and represent a heterogeneous group of glial neoplasms. Although these tumors have been termed low-grade, this is a misnomer, especially for some grade II gliomas, which may exhibit a more aggressive behavior and variable natural history....
The Arrival of Generic Imatinib Into the U.S. Market: An Educational Event
Hagop Kantarjian, MD
Hagop Kantarjian, MD Imatinib mesylate (Gleevec), a Bcr-Abl tyrosine kinase inhibitor, is approved therapy for chronic myeloid leukemia (CML) in the United States. Imatinib is a miraculous drug that results in a normal functional lifespan in most patients with CML who can afford and com...
Using Telemedicine to Reduce Wait Times for Veterans
Richard J. Boxer, MD
John Farrow, a 67-year-old Vietnam veteran, had not been able to sleep for days. A week ago, his primary care doctor at his local outpatient Veterans Administration (VA) clinic told him that his prostate-specific antigen (PSA) blood level was rapidly increasing, and his prostate was abnormal on exam...
Dethroning the Emperor of All Maladies
Ronald A. DePinho, MD
Deep knowledge of immunology, cancer biology, and disruptive technology in computational science and molecular profiling has positioned us to dethrone the emperor of all maladies. The cancer research community is prepared to fulfill President Barack Obama’s call for a national cancer moonshot aimed ...
Physicians as Champions for Quality Improvement
Joseph Jacobson, MD
Interest in quality measurement and improvement was once primarily a concern of regulators, insurers, and consumer advocates. Today, quality improvement is front and center in health care—a continuous mission requiring the efforts of everyone on the health-care team. At the recent ASCO Quality Care ...
Throwing Out the Baby With the Bathwater: A Critical Appraisal of the USPSTF Recommendation Against Screening for Prostate Cancer
Daniel A. Barocas, MD, MPH
In 2012, the U.S. Preventive Services Task Force (USPSTF) issued a recommendation against routine screening for prostate cancer.1,2 The grade D recommendation was considered controversial at the time, and remains so now, because many stakeholders have weighed the same body of evidence and come to di...
Computer-Assisted Decision Support in Medical Oncology: We Need It Now
Andrew D. Seidman, MD
Today’s medical oncologist is increasingly challenged to stay current with the latest developments in cancer treatment. I have been fortunate to speak with many oncologists over the past quarter-century on how professional life has evolved since the 1990s. These conversations have left me with a sen...
Regulators Embrace Immunotherapy
John F. Smyth, MD
The Cancer Drug Development Forum exists to provide, as the name implies, a meeting place to bring together academia, the pharmaceutical industry, and most important regulators for full and frank discussions to facilitate anticancer drug development. In the recent past, the Cancer Drug Development F...
Nuns Work Where None Work
Jame Abraham, MD
It was December 9, 1975—a cold morning in the tribal village in Mahuadanr in Bihar, India. The valley was filled with an eerie mist coming down from the hills surrounding the village. Champa, a 5-year-old malnourished girl with sunken eyes, an emaciated face, and a huge ascites, was carried by her m...
Cost in the Context of Value for Cancer Medicines
Mace L. Rothenberg, MD
Bringing new cancer therapies through the discovery and development process entails considerable risk and many years of study. It also requires substantial investment and incentives from the public and private sectors to fuel future investment and discovery. A system that rewards advances in cancer ...
'Doctor, We Prayed for You'
Chandrakanth Are, MBBS, MBA, FRCS, FACS
A 70-year-old female patient underwent a cardiac procedure to repair her mitral valve, and at the same time, she also underwent a coronary artery bypass grafting. She had an uneventful course for the first four postoperative days. On the sixth postoperative day, she started complaining of abdominal ...
The 340B Drug Pricing Program: Background, Concerns, and Solutions
Hagop Kantarjian, MD, and Robert Chapman, MD
The 340B Drug Pricing Program was created by Congress through the Veterans Health Care Act of 1992 to allow some health-care entities—including safety-net providers with large shares of uninsured and low-income patients and other “covered entities”—to obtain drugs at discounted prices.1,2 Congress g...
The Evolving Treatment Landscape of ALK-Positive NSCLC
Alice T. Shaw, MD, PhD
Since the initial discovery of ALK rearrangement in non–small cell lung cancer (NSCLC) in 2007,1 small molecule tyrosine kinase inhibitors of ALK have transformed the course of disease for those patients with ALK-rearranged (ie, ALK-positive) NSCLC. Crizotinib (Xalkori), a multitargeted tyrosine kin...
Winning the Battle at the Front Lines: Lenalidomide Plus Rituximab— A Promising Initial Treatment for Mantle Cell Lymphoma
Michael Wang, MD
Mantle cell lymphoma is a pernicious, incurable disease. Front-line therapies for this disease are not currently standardized; however, novel therapies for relapsed or refractory mantle cell lymphoma can ideally be translated into beneficial treatments for newly diagnosed patients, as clearly demons...
Ibrutinib in Relapsed Mantle Cell Lymphoma
Mitchell R. Smith, MD, PhD
Treatment of mantle cell lymphoma continues to evolve, both in the front-line and relapsed settings. Key advances include better use of established agents, such as the incorporation of high-dose cytarabine into initial induction regimens and application of rituximab (Rituxan) consolidation/maintenan...
A Shot to End Cancer: HPV Vaccination
Ronald A. DePinho, MD
As health-care providers, we have an obligation and a responsibility not only to care for our patients, but also to educate them—and the general public—about their cancer risk and ways to reduce or prevent it. We are living in the golden era of cancer prevention and treatment, made possible by inves...
Minimally Invasive Surgery for Rectal Cancer: An Evolving Issue
Steven Nurkin, MD, MS, FACS
Over 10 years ago, we welcomed a new approach to cancer surgery when the 2004 COST trial demonstrated the benefits of laparoscopic compared with open surgery for colon cancer. This randomized trial of 872 patients showed improved perioperative recovery with laparoscopic colectomy without compromisin...
Ductal Carcinoma in Situ and Relevant Endpoints for Omission of Standard Treatments: Are We There Yet?
Meena S. Moran, MD
The optimal management strategy for ductal carcinoma in situ has become increasingly controversial with respect to potential overdiagnosis and overtreatment. Much of the controversy for ductal carcinoma in situ stems from its exceptional breast cancer–specific survival, which approaches close to 100...
ASCO Endorsement of ACCP Guideline on Treating SCLC: Moving Forward to Better Outcomes in Oncology
Leena Gandhi, MD, PhD
In the current climate of rising health-care costs, particularly in the field of oncology, clinical guidelines provide a crucial tool to guide practitioners in evidence-based care and to improve the quality and consistency of care.1 The ASCO review and endorsement of the American College of Chest Ph...
Filial Gaze at Our Noble Profession
Chandrakanth Are, MBBS, MBA, FRCS, FACS
As we stood outside patient X’s room going over the vitals, from a distance, I saw the father of the patient by the side of her bed. I saw him standing there and looking down at his child conveying what I guess were words of reassurance and reinforcing the pillars of strength needed for her recovery...
ASCO Guideline on the Use of Biomarkers in Treatment Decisions in Metastatic Breast Cancer: Shedding Light on an Often Mysterious Art
Elizabeth Reed, MD
As summarized in this issue of The ASCO Post (see "ASCO Clinical Practice Guideline: Use of Biomarkers to Guide Systemic Therapy for Women With Metastatic Breast Cancer"), Van Poznak and colleagues recently presented an ASCO clinical practice guideline on the use of biomarkers for decisions regardin...
Molecularly Targeted Therapy Brings New Hope to Patients With Relapsed/Refractory Hairy Cell Leukemia
Philip A. Thompson, MBBS (Hons), and Farhad Ravandi, MD
The treatment of hairy cell leukemia is one of the great success stories in hematologic malignancies, with patients now having a survival that is only slightly inferior to an age-matched normal population. Purine analogs, such as cladribine, are the mainstay of first-line therapy, with approximately...
Trabectedin in Liposarcoma/Leiomyosarcoma: The Drug Is Approved, Now the Real Drug Development Begins!
Laurence H. Baker, DO
Led by George Demetri, MD, of Dana-Farber Cancer Institute, Boston, expert medical oncology investigators from leading academic sarcoma centers and Janssen Pharmaceuticals employees performed a phase III trial in order to provide evidence for the U.S. Food and Drug Administration (FDA) approval of t...
Reducing Racial Disparities in Breast Cancer Incidence and Mortality Trends to Improve Outcomes
Graham A. Colditz, MD, DrPH
A recent report by DeSantis and colleagues from the American Cancer Society, summarized in this issue of The ASCO Post, presented breast cancer incidence and mortality data from an extensive analysis of the U.S. system of state-based tumor registries.1 The data showed that the incidence of breast ca...
Closing the Racial Survival Disparity Gap in Breast Cancer: Models for Change From Chicago, New York, and Beyond
By Bobby Daly, MD, MBA, and Olufunmilayo I. Olopade, MD, FACP, OON
It has long been said that white women of European ancestry are more likely to be diagnosed with breast cancer, but African American women are more likely to die of it. This statement has introduced multiple articles on the topic of the racial survival disparity in breast cancer, including our own r...
Nodal Irradiation in Node-Positive Breast Cancer: It Is Not Time to Change Practice
Alice Chung, MD, and Armando E. Giuliano, MD
Management of the regional nodes in breast cancer has evolved from the era of the extended radical mastectomy to exclusion of axillary dissection in appropriately selected patients. Throughout this evolution, studies of nodal irradiation have been shown to improve locoregional control, usually witho...
Does Low-Dose Radiation Cause Leukemia?
Robert Peter Gale MD, PhD, DSc(hc), FACP, FRSM, and F. Owen Hoffman, PhD
Data from A-bomb survivors, persons with ankylosing spondylitis and neoplasms treated with radiation therapy, and many other sources show a strong association between exposure to ionizing radiation (particles or electromagnetic waves with sufficient energy to cause an ionization such as photons and ...
5-Year Results of GEC-ESTRO Trial of Accelerated Partial-Breast Irradiation vs Whole-Breast Irradiation: Is There Any Impact?
Jay R. Harris, MD
There is a strong rationale for the use of accelerated partial-breast irradiation: The large majority of in-breast recurrences are at or near the primary site, limiting the radiation dose to the primary site has the potential to decrease side effects, and treatment can be delivered over a shorter pe...
Getting the Content and the Message Right in Breast Cancer Screening Guidelines
Therese Bevers, MD, and Mark Helvie, MD
According to recent national headlines, the American Cancer Society (ACS) now recommends that women at average risk of breast cancer should “screen later and less often.”1 While the new ACS recommendations (summarized in this issue of The ASCO Post) might initially be taken as casting doubt on the v...
ACS Breast Cancer Screening Guidelines: Balancing the Benefits and Harms of Mammography
Ismail Jatoi, MD, PhD, FACS
For the past 30 years, mammography screening has been one of the most contentious issues in medicine. Controversy has generally centered on the age at which to begin mammography screening (40 vs 50 years) and also, to a lesser extent, on the age at which it should stop. The recent American Cancer So...
Updated Guidelines for Treating Stage IV NSCLC: Trying to Keep Up
Heather A. Wakelee, MD
In late August 2015, Gregory A. Masters, MD, and colleagues published an update to the ASCO guidelines for systemic therapy for stage IV non–small cell lung cancer (NSCLC), summarized in this issue of The ASCO Post.1 This builds on the full guidelines published in 20092 and the additional switch mai...
Changing Landscape in the Treatment of Metastatic Renal Cell Carcinoma: Findings With Nivolumab and Cabozantinib
Brian I. Rini, MD, FACP
In the October 25 issue of The ASCO Post, we presented two important studies in previously treated advanced renal cell carcinoma, including the paper by Motzer et al “Nivolumab versus everolimus in advanced renal-cell carcinoma” (CheckMate 025), published in The New England Journal of Medicine, Sept...
Diet and Cancer: How Will We Make Progress?
Clifford A. Hudis, MD
Not only is breast cancer among the most common cancers in women, but it is also one of the most common causes of premature death. Rates of death from the disease vary widely around the world, reflecting variations in risk, screening, and access to highest quality treatment. Although female gender ...
ASCO Recommendations for Use of White Blood Cell Growth Factors: What Remains the Same and What Has Been Modified
Gary H. Lyman, MD, MPH
Neutropenic complications remain the main dose-limiting toxicity of cancer chemotherapy treatment and are associated with considerable morbidity, mortality, and costs.1 Although patients who have experienced a prior neutropenic event are at increased risk of subsequent events, several studies have s...
Survival and Bevacizumab in Early Breast Cancer: Time to Reconsider?
Jens Huober, MD, and Beat Thürlimann, MD
In metastatic HER2-negative breast cancer, several trials have shown that the addition of the anti–vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab (Avastin) to different chemotherapy regimens significantly improved response rates and progression-free survival by various mag...
ASCO-Endorsed ASTRO Guidelines: Searching for Consensus on Radiotherapy for Endometrial Cancer
Ann H. Klopp, MD, PhD, Patricia J. Eifel, MD, and Akila Viswanathan, MD, MPH
Endometrial cancer is the most common gynecologic cancer, but there has been little consensus about the appropriate indications for adjuvant therapy. One reason for the lack of consensus is the absence of randomized studies in endometrial cancer that report an overall survival benefit. This may be a...
Discussing Financial Toxicity With Patients Who Have Cancer
Jonas A. de Souza, MD
Patient: “Doc, how much are these drugs going to cost me?” Physician: “They are expensive, and you can see our financial counselor to help you understand the costs.” Cancer care is not a black-and-white endeavor, and costs are considered a distasteful subject to be passed over in tactful silence...
Anti-EGFR Therapy in Squamous Cell Lung Carcinoma: Swimming With or Against the Tide?
Aline Fusco Fares, MD, Daniel Vilarim Araujo, MD, and Natasha B. Leighl, MD
Lung cancer is the most common, lethal, and costly cancer worldwide, accounting for at least 1.8 million new cases per year (12.9% of the total).1 Over the past decade, there has been a major shift in the treatment of non–small cell lung cancer (NSCLC), especially in adenocarcinoma, accompanied by a...
Bevacizumab in Ovarian Cancer: Results of ICON7
Maurie Markman, MD
Based on preclinical (in vitro and in vivo) data, there is a strong biologic rationale for the addition of an antiangiogenic drug strategy in the treatment of epithelial ovarian cancer.1 Single-agent trials have confirmed both the biologic and clinical activity of bevacizumab (Avastin) in the manage...
NCCN Turns 20: Value-Based Care Has Arrived
Charles L. Bennett, MD, PhD, MPP, and William S. Shimp, MD
Twenty years ago, the National Comprehensive Cancer Network (NCCN) began as a cooperative effort of 12 prestigious cancer centers, working to define and promote national guidelines for the care of patients with cancer. A major goal was to encourage uniformity in the management of malignant diseases,...
Ductal Carcinoma in Situ: Where We Have Been and Where We Can Be
Laura Esserman, MD, MBA, Jasmine M. Wong, MD, Cheryl Ewing, MD, and Michael Alvarado, MD
Ductal carcinoma in situ has been a recent topic of debate in the news because of a recent article by Narod et al1 and an accompanying editorial2 about the study in JAMA Oncology. This study, summarized in this issue of The ASCO Post, chronicled the long-term outcomes for women diagnosed with ductal...
Adjuvant Treatment of Early-Stage Breast Cancer: Meta-analyses Provide More Clarity
Aju Mathew, MD, MPhil, and Adam Brufsky, MD, PhD
The Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) continues its practice of being a lighthouse, shedding its beacon of light on the vast ocean of breast cancer research through the publication of two large, individual patient level–data meta-analyses on the management of women with ear...
Docetaxel Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer
Oscar B. Goodman, Jr, MD, PhD
Sweeney et al reported on the results of a seminal phase III trial (E3805) of chemohormonal therapy vs androgen-deprivation therapy in metastatic hormone-sensitive prostate cancer in a recent issue of The New England Journal of Medicine,1 and the study is summarized in this issue of The ASCO Post. ...
Older Patients With Cancer: A Growing Population in Need of Evidence-Based Care
Laura A. Levit, JD, and Arti Hurria, MD
The 2013 Institute of Medicine (IOM) report Delivering High Quality Cancer Care: Charting a New Course for a System in Crisis1 identified the dearth of evidence on older adults as a major quality-of-care issue. The U.S. population is aging at a rapid rate, and cancer is a disease that primarily affe...
Anti–PD-1 Superior to Chemotherapy in the KEYNOTE-002 Trial
Douglas B. Johnson, MD, MSCI
Immunotherapy, once considered a niche treatment for a few specific cancers, has rapidly emerged as an additional pillar of cancer therapeutics. With the proliferation of promising results, clinical trials, and new drug approvals, one cannot help but be amazed that only 3 years have elapsed since Dr...
Our Children’s Future Is Our Responsibility
Ronald A. DePinho, MD
Cancer prevention is a child-care issue. With many of cancer’s instigators planting their seeds during childhood, we—as a profession and as a nation—must seize this important window of opportunity to protect the health and well-being of future generations. Current estimates suggest that up to one-h...
Updated Analysis of Menopausal Hormone Therapy and Breast Cancer Risk
Kathleen I. Pritchard, MD, FRCPC
As reviewed in this issue of The ASCO Post, Chlebowski and colleagues1 reported differing patterns of breast cancer risk during or after hormonal therapy with estrogen plus progestin2 or estrogen alone,3 in an analysis of two Women’s Health Initiative (WHI) trials. This recent update on risk provide...
Our Patients Are the True Heroes of Cancer Research
Julie M. Vose, MD, MBA, FASCO
A few weeks ago, I read an op-ed1 in The New York Times written by Stan Collender, a patient with Merkel cell carcinoma, a rare and aggressive type of skin cancer. In his article, he described his participation in a clinical trial for a new drug he is hoping will stem progression of his cancer and t...
Immune Checkpoint Inhibitors: The Dawn of a New Era for Lung Cancer Therapy
Suresh S. Ramalingam, MD
The therapeutic paradigm for lung cancer has changed rapidly over the past few years toward individualized therapy. For certain subsets of patients, molecularly targeted agents have resulted in robust gains in overall survival and quality of life. However, for the majority of patients with nonsquamo...
Value: What Do We Mean, Who Should Decide?
John F. Smyth, MD
Oscar Wilde famously defined a cynic as “a man who knows the price of everything and the value of nothing.” I do not think that oncologists need to be as cynical as this, but it was very appropriate that a major theme of this year’s ASCO Annual Meeting was the concept of “value.” It is clear that th...
Cost vs Our Values in Cancer Care
Richard J. Boxer, MD, FACS
An 80-year-old patient with metastatic prostate cancer asked me to discontinue his treatments, which were costing him more than $1,000 every 3 months. Although he had Medicare, he did not have secondary insurance. I told him that I would seek compassionate-care payment from the pharmaceutical compan...
Collaborating Toward a Cure
We’ve seen how dramatically patients’ lives can change when they are matched with the right treatment at the right time in their disease course. Although this is still an exception and not the rule, we believe collaborative research approaches will make this kind of precision medicine a reality for ...
Progress in the Treatment of Patients With EGFR-Mutated NSCLC
Ramaswamy Govindan, MD
Approximately 10% to 15% of patients with advanced non–small cell lung (NSCLC) cancer have mutations in the epidermal growth factor receptor (EGFR) in tumor cells. Specific therapies to inhibit the activity of EGFR-mutated NSCLC have now been clearly shown to improve response rate and progression-fr...
Adjuvant Ipilimumab in High-Risk Stage III Melanoma: Encouraging Study Results Yet Questions Remain
Michael A. Postow, MD
Ipilimumab (Yervoy) is a fully human monoclonal antibody that blocks the negative T-cell regulator cytotoxic T-lymphocyte antigen 4 (CTLA-4) and has improved overall survival for patients with unresectable or metastatic melanoma in two phase III studies.1,2 Based upon these results, ipilimumab was t...
Biosimilars: Questions Remain
Richard J. Boxer, MD, FACS
Biosimilars are biologic drugs that are similar to an already established “reference” or “innovator” biologic drug product and can be manufactured when an original biologic drug product’s patent expires. Reference to the innovator product is an integral component of approval for a biosimilar. The U....
How CancerLinQ™ Can Benefit People Living With Cancer
As a regular readers of The ASCO Post know, ASCO is developing an exciting new health information learning system called CancerLinQ™, which will exponentially enlarge our understanding of cancer therapy far beyond what we’ve achieved with our system of clinical trials. Cancer clinical trials have le...
Predicting Recurrence After Surgery in Renal Cell Carcinoma: 16-Gene Assay Recurrence Score Ushers in New Era
Derek Raghavan, MD, PhD
In a study reported in The Lancet Oncology and reviewed in this issue of The ASCO Post, Brian Rini, MD, of the Cleveland Clinic Taussig Cancer Institute, and colleagues showed that a 16-gene assay recurrence score could predict postoperative outcome in patients with stage I to III clear cell renal c...
Pembrolizumab in Advanced NSCLC: The Promise of Immune Checkpoint Inhibitors
Vamsidhar Velcheti, MD, and Roy Herbst, MD, PhD
Drugs targeting the immune-checkpoint pathways have shown promising activity in non–small cell lung cancer (NSCLC). In a recent article in The New England Journal of Medicine, Garon and colleagues reported the results of the KEYNOTE-001 clinical trial evaluating single-agent pembrolizumab (Keytruda)...
Considering Clonality in Precision Medicine
Michael Green, PhD
Precision cancer medicine entails treating patients based upon the molecular characteristics of their tumor. One could argue that we have been tailoring therapeutic regimens based upon tumor characteristics for years, whether it be treating patients based upon disease subtypes determined by histolog...
Clinical Trials, Drug Costs, and Restoring the Primacy of the Patient Volunteer
Laurence H. Baker, DO
“What’s past is prologue.” —William Shakespeare Today, a cancer drug under study in a clinical trial is commonly provided for a finite period of time after the study closes to accrual. If that drug were not yet U.S. Food and Drug Administration (FDA)-approved when the study began, the complimentar...
What Is the Future of Intraperitoneal Treatment in Advanced Ovarian Cancer?
Robert L. Coleman, MD
An analysis of Gynecologic Oncology Group (GOG) studies recently reported in the Journal of Clinical Oncology by Tewari and colleagues and reviewed in this issue of The ASCO Post showed a survival benefit of intraperitoneal chemotherapy vs intravenous chemotherapy over long-term follow-up in women w...
The Basket Trial: An Evolving Clinical Trial Design
Amanda J. Redig, MD, PhD, and Pasi A. Jänne, MD, PhD
The recently published results of the CUSTOM (Molecular Profiling and Targeted Therapies in Advanced Thoracic Malignancies) trial, reviewed in this issue of The ASCO Post, describe a basket trial focused on identifying molecular biomarkers in advanced non–small cell lung cancer (NSCLC), small cell...
The Promise of Immune Checkpoint Inhibition: Changing the Therapeutic Landscape for Melanoma and Other Malignancies
Kim A. Margolin, MD
The past 3 years have witnessed transformative changes in the way that solid tumors and hematologic malignancies are approached, in almost every instance now including consideration of some form of immunomodulation in the first- or later-line therapeutic setting. The greatest success has occurred wi...
Another Angiogenesis Inhibitor Shows Benefit in Metastatic Colorectal Cancer, but Where Do We Go Next?
Weijing Sun, MD, FACP
The phase III RAISE trial—reported by Tabernero and colleagues in The Lancet Oncology1 and reviewed in this issue of The ASCO Post—demonstrated that ramucirumab (Cyramza), a fully human IgG1 monoclonal antibody to the vascular endothelial growth factor receptor 2 (VEGFR2) extracellular domain, in c...
Illumination and Innovation: Transforming Data Into Learning
Peter Paul Yu, MD, FACP, FASCO
The ASCO Annual Meeting is our Society’s premier event and without a doubt one that is highly anticipated by the oncology world. The success of the meeting stems from the desire to share with each other our data and the knowledge we have gleaned from those data over the course of the past year. The ...
PARP Inhibitors: The First Potential Treatment of Hereditary Ovarian Cancers
Ursula A. Matulonis, MD
Poly(ADP-ribose) polymerase (PARP) inhibitors are one of the most exciting new classes of agents in development for the treatment of ovarian cancer. Olaparib (Lynparza), the lead oral PARP inhibitor, received accelerated approval by the U.S. Food and Drug Administration (FDA) for the treatment of re...
Prostate Cancer Survivorship: Identifying Opportunities for Improvement
Matthew J. Resnick, MD, MPH
Prostate cancer survivors currently approach 3 million in number and comprise 43% of all male cancer survivors in the United States.1 These men face myriad unique oncologic, functional, emotional, and psychological issues that require evaluation and management throughout the survivorship phase of th...
MAINSAIL Trial: Worse Outcomes With Addition of Lenalidomide to Docetaxel-Prednisone in Prostate Cancer
Robert J. Jones, MD
The combination of docetaxel plus prednisone has been a standard therapy in advanced prostate cancer since 2004.1 Since then, there have been multiple randomized phase III trials comparing this standard of care with additional drug therapy. None has demonstrated improvement in outcome. Lenalidomide...
Increased Risk of Secondary Bone Marrow Neoplasia After Adjuvant Breast Cancer Treatment: Risk/Benefit Analysis and Biologic Insights
Elizabeth A. Comen, MD, and Andrew D. Seidman, MD
Ever since the early application of adjuvant chemotherapy for breast cancer decades ago, it has been recognized that there is always a price to pay for its success in reducing breast cancer mortality. Most of that “cost” is commonly considered in terms of the potential morbid short- and long-term co...
Optimizing Treatment for Small, Lymph Node–Negative, HER2-Overexpressing Breast Cancers
Julie R. Gralow, MD
Large, randomized phase III clinical trials showed that the addition of HER2-targeted therapy to chemotherapy for patients with early-stage, HER2-overexpressing breast cancers substantially decreased the risk of recurrence and improved survival. The chemotherapy given in these trials varied, but it ...
A Closer Look at the Disparities in Breast Cancer Outcome by Race and Ethnicity
Melanie E. Royce, MD, PhD
The report from Dr. Steven Narod and colleagues recently published in JAMA1 and reviewed in this issue of The ASCO Post adds to the growing evidence regarding observed disparities in breast cancer outcomes by race and ethnicity among women in the United States. Since 1990, breast cancer death rates ...
Welcome to Multikinase Inhibitors in Radioiodine-Refractory Thyroid Cancer
Lori J. Wirth, MD
In the past 2 decades, the incidence of thyroid cancer has risen steeply, with rates now growing by 5.5% annually.1 In 2014, 62,980 new cases of thyroid cancer were diagnosed in the United States. The good news is that, overall, the prognosis of thyroid cancer remains excellent; 97.8% of patients wi...
Potential Power of Meaning-Centered Group Psychotherapy in Patients With Advanced Cancer
William Breitbart, MD
The recent publication of the results of our National Cancer Institute (NCI) RO1-funded randomized controlled trial of meaning-centered group psychotherapy for advanced cancer patients in the Journal of Clinical Oncology,1 and the accompanying summary published in this issue of The ASCO Post, repres...
Pembrolizumab vs Ipilimumab: Good vs Better
Douglas B. Johnson, MD, MSCI
The treatment landscape for metastatic melanoma has recently undergone a remarkable transformation. Prior to 2011, clinicians and patients were presented with difficult decisions between therapies without proven survival benefit. Now, similarly difficult but much more hopeful choices are posed among...
In Search of Meaning: A Personal Journey
William Breitbart, MD
A famous Talmudic question asks: “What is truer than the truth?” The answer: “The story.” This is the story of my personal journey in search of meaning and the development of an approach to care for patients with advanced cancer, which I came to call “meaning-centered psychotherapy.” In terms of th...
Unexpectedly Huge Survival Benefit With Pertuzumab and Trastuzumab in HER2-Positive Metastatic Breast Cancer
Javier Cortés, MD
In my opinion, the combination of pertuzumab (Perjeta) and trastuzumab (Herceptin) is one of the most important advances in the field of metastatic breast cancer in the past 10 years. As recently reported by Swain, my other colleagues, and me and reviewed in this issue of The ASCO Post, the CLEOPATR...
Creating a Collective Path Forward to Optimize Value in Cancer Care
Richard L. Schilsky, MD, FACP, FASCO
The Centers for Medicare and Medicaid Services projects that U.S. health-care spending will reach $4.3 trillion and account for 19.3% of the nation’s gross domestic product by 2019.1 Although cancer care represents a small fraction of overall health-care costs, the cost of cancer care is rapidly inc...
Brentuximab Vedotin After Autologous Stem Cell Transplantation in High-Risk Hodgkin Lymphoma: Implications of the AETHERA Trial
Stephen M. Ansell, MD, PhD
Hodgkin lymphoma is generally thought to be a malignancy with a favorable prognosis. Overall, approximately 80% of patients will have durable, long-term remissions with initial chemotherapy. Some patients, however, demonstrate evidence of disease progression, and these patients usually receive salva...
Informing Decision-Making About Mammography Screening
Ruth Etzioni, PhD
Overdiagnosis associated with breast cancer screening has been the subject of much attention in recent years. The notion that cancer screening—largely believed to be beneficial—could actually be harmful is simultaneously fascinating and difficult to believe. With the publication of multiple studies...
PRIME II and the Omission of Radiation Therapy in Low-Risk, Elderly Patients Undergoing Breast Conservation: The Time Has Come
Meena S. Moran, MD
Despite the high prevalence of breast cancer worldwide, it is important to recognize that > 40% of all cases occur in women aged 65 years or older in both the United States and the United Kingdom.1,2 Breast cancers in older patients are more often associated with indolent features and with overal...
Heal Thy Patient … Reflections on the Human Side of Medicine
Chandrakanth Are, MBBS, MBA, FRCS, FACS
The first time I met Mrs. X and her husband was to discuss the surgical treatment options for pancreatic cancer. She had just been diagnosed with pancreatic cancer at her local hospital and was being referred to a tertiary care center for operative management. Mrs. X and her husband were no differen...
Should We Be Worried If Patients Tolerate Endocrine Therapy Well?
N. Lynn Henry, MD, PhD
When meeting with patients to discuss adjuvant endocrine therapy for breast cancer, the question often arises, “How will I know that the treatment is working?” While the efficacy of these treatments has been demonstrated for the majority of patients in multiple large randomized clinical trials, they...
Breast Cancer Management in Review
Jame Abraham, MD, FACP
With the field of breast oncology as complex as ever, a brief update of the latest findings impacting breast cancer treatment seems timely. To that end, I have assembled highlights from a collection of newsworthy studies featured over the past year and into early 2015. Part 1 of this review, which ...
Aspirin as Adjuvant Therapy for Colon Cancer: Is the Time Right?
Alfred I. Neugut, MD, PhD
Aspirin has long proved to be a multipotent drug, with efficacy as a pain reliever, anti-inflammatory agent, antiplatelet agent, and cardioprotective agent. In the cancer world, a large literature has accumulated demonstrating its ability to prevent various epithelial malignancies, most notably colo...
In Search of ‘Just’ Prices: Questioning the High Cost of New Cancer Drugs
As the oncology community begins the slow and often difficult-to-define transition from volume to value in the delivery of cancer care, the relationship between the price and value of certain high-priced cancer drugs is getting more scrutiny. We generally correlate the efficacy of a new drug and its...
Clinical Trial Participation: ‘Is It All Worth It?’
Lee M. Krug, MD
Clinical trials have become increasingly complex over the past several years, and unfortunately, this has resulted in the typical scenario described below. We are fortunate that there are so many promising agents available for patients, and we want to encourage their participation in clinical trials...
Results of RTOG 0617 Reconsidered
Laurie E. Gaspar, MD, FASTRO, FACR, MBA
Radiation Therapy Oncology Group (RTOG) 0617 was a study initially designed to address an important issue in radiation oncology regarding the treatment of stage III non–small cell lung cancer (NSCLC): Are outcomes improved with high-dose as opposed to standard-dose thoracic radiation therapy? The ad...
Breast Cancer Management in Review
Jame Abraham, MD, FACP
Anyone who has attended the major oncology meetings knows that research from clinical trials in breast cancer often dominates the stage, with countless abstracts featuring new and updated results. To help the readers of The ASCO Post stay up to date with the latest discoveries and findings impacting...
Adjuvant Chemotherapy and Overall Survival in Muscle-Invasive Bladder Cancer: Still Climbing the Mountain
Maha Hussain, MD, FACP, FASCO
Muscle-invasive bladder cancer can be a lethal disease despite curative intent local therapy, with 5-year survival that can be as low as 30% based on the extent of T status and/or lymph node involvement. The use of neoadjuvant chemotherapy with MVAC (methotrexate, vinblastine, doxorubicin, and cispl...
The ASPIRE Trial of Carfilzomib in Relapsed Myeloma: A Major Step Forward
Sagar Lonial, MD
Currently in myeloma, there are at least five new agents that are either approved or in the late-stage of development with impending approval. Major questions in the field relate to how we, as clinicians, will use these new agents and where they will fit in the overall treatment schema. The phase I...
Refining the ‘Right Patient, Right Drug’ Pairing in Cancer Care: RAS Profiling in Metastatic Colorectal Cancer
Brandon G. Smaglo, MD
In an important post hoc analysis (reviewed in this issue of The ASCO Post), Van Cutsem and colleagues have further refined our knowledge of who are the “right” patients with metastatic colorectal cancer to receive treatment with cetuximab (Erbitux).1 This refinement was accomplished through the ret...
Shining a Spotlight on Epithelioid Hemangioendothelioma
Jane Gutkovich
In the winter of 2013, my son, Dmitriy, now 26, had a cough that wouldn’t go away. After several rounds of antibiotics failed to halt the persistent problem, a pulmonologist we consulted ordered a chest x-ray, which showed a large tumor lodged between Dmitriy’s lungs. Although the doctor said the tu...
Health-Care Fraud and Abuse: Implications for Oncology
Z. Kevin Lu, PhD, Brian Chen, JD, PhD, Zaina Qureshi, PhD, MPH, Oliver Sartor, MD, and Charles Bennett, MD, PhD, MPP
Health-care fraud is a long-standing problem in the United States, accounting for $75 billion in government expenses per year,1 while total spending on government health-care programs is over $1 trillion. Two decades ago, the Department of Justice increased its efforts to combat health-care fraud. T...
Increasing the Use of Hypofractionated Radiation in Early-Stage Breast Cancer: The Way Forward
Lori J. Pierce, MD
Bekelman and colleagues are to be congratulated on the publication of an important paper—reviewed in this issue of The ASCO Post—alerting us all to the underutilization of hypofractionated whole-breast irradiation in the treatment of early-stage breast cancer.1 As background, recent randomized radi...
SOFT Trial Results Inconclusive: Further Study Needed
Edith A. Perez, MD
The results of the SOFT trial—presented at the 2014 San Antonio Breast Cancer Symposium, reported recently by Francis et al in The New England Journal of Medicine,1 and reviewed in this issue of The ASCO Post—were not as conclusive as we had hoped. In essence, the study enrolled women with resected ...
Big Data and the Promise of Precision Medicine in Cancer
Peter Paul Yu, MD, FACP, FASCO
Precision medicine—and its promise to revolutionize how we understand disease and care for our patients—is a concept that oncology has understood and embraced for well over a decade. But millions of Americans recently heard about the concept for the first time when President Obama announced a high-p...
Nivolumab in Previously Treated Metastatic Renal Cell Cancer
Mario Sznol, MD
The approval of multiple inhibitors of either the VEGF or mTOR pathway provided an incremental advance in the treatment of metastatic clear cell renal cancer. However, the agents have several important limitations: For example, the optimal clinical effect appears to be dependent on chronic administr...
Crizotinib Crosses Another Finish Line in Lung Cancer
Justin F. Gainor, MD
Treatment of anaplastic lymphoma kinase (ALK)–positive lung cancer has been one of the great success stories in oncology in the past decade. First discovered in lung cancer in 2007, ALK rearrangements are found in 3% to 5% of patients and define a distinct molecular subgroup of the disease with char...
Aged to (Im)Perfection: Age-Related Clonal Hematopoiesis?
Michelle M. Le Beau, PhD
Five decades ago, the analysis of metaphase chromosomes in the hematologic malignancies provided our first broad glimpse into the genetic anatomy of a malignant cell. Today, the advent of high-throughput methods such as next-generation sequencing, capable of surveying the entire genome, provides an ...
The Search for Optimal Adjuvant Breast Cancer Chemotherapy: The End of an Era?
Rowan T. Chlebowski, MD, PhD
Using a complex and innovative study design, Budd and colleagues from the Southwest Oncology Group (SWOG) addressed, in a randomized multicenter trial,1 an issue that has been under evaluation for over 40 years—namely, what are the optimal dose and schedule for adjuvant breast cancer chemotherapy? M...
For Hodgkin Lymphoma Patients, It Ain’t Over
Anas Younes, MD
With less than 10,000 patients diagnosed with Hodgkin lymphoma each year and a cure rate of approximately 75% to 80%, drug development for this disease was never a priority for pharmaceutical companies. So when the antibody-drug conjugate brentuximab vedotin (Adcetris) was approved by the U.S. Food ...
Translational Research: Under Assault From the Bottom Line
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
One of the disheartening aspects of becoming a senior medical administrator is that you have the opportunity to view the health-care system from two sides. From the Presidential suite, it is clear that there is increasing chaos in health care in the United States, characterized by blowouts of expen...
ASCO President on ABIM Decision
The ASCO Post
Peter Paul Yu, MD, FACP, FASCO, ASCO President, made the following remarks following ABIM’s recent announcement concerning maintenance of certification: “Last year, the American Board of Internal Medicine (ABIM) released a new process for maintenance of certification (MOC) that many physicians felt...
ASCO Endorsement of ESMO Guidelines on Hereditary Colorectal Cancer Syndromes
Patrick M. Lynch, JD, MD
In a recent issue of the Journal of Clinical Oncology,1 and as reviewed in this issue of The ASCO Post, an ASCO expert endorsement panel reviewed and endorsed, with minor qualifications, the European Society for Medical Oncology (ESMO) clinical practice guidelines for management of familial/genetic ...
Iniparib: The Fairy Tale Dream Comes to an End
Denise A. Yardley, MD
The first poly ADP ribose polymerase (PARP) inhibitor was developed in the early 1990s. Since then, the activity of PARP inhibitors has been explored in a variety of settings, including and perhaps most enthusiastically in the treatment of cancer. The greater dependence of several cancers on PARP, a...
Molecular Classification Predicts Postcystectomy Recurrence in High-Risk Bladder Cancer
Cora N. Sternberg, MD, FACP
Radical cystectomy is the standard therapeutic option for patients with muscle-invasive bladder cancer. However, 5-year overall survival for high-risk patients with pT3, pT4, pN-negative, and pN-positive M0 bladder cancer after radical cystectomy is only about 50% and ranges from 32% in patients wit...
What Is a Physician? Call a Spade a Spade
Chandrakanth Are, MBBS, MBA, FRCS, FACS
Anyone who has awoken from a decades-long amnestic spell can be forgiven for thinking that physicians cannot do anything right nowadays. Compared with decades ago, when physicians did mostly right, we now seem to be nowhere close to correctness. Nearly every malady that befalls the health-care envir...
Survival Benefits of Front-Line Treatment With Nivolumab for Advanced Melanoma Confirmed, Yet Questions Remain
Michael A. Postow, MD, and Jedd D. Wolchok, MD, PhD
As reported in this issue of The ASCO Post, Robert and colleagues recently published a phase III study comparing the anti–programmed death 1 (PD-1) antibody nivolumab with the standard melanoma chemotherapy dacarbazine in the front-line treatment of patients with advanced BRAF wild-type melanoma.1 I...
Crizotinib in ROS1-Positive NSCLC: A Next Step Forward
Jacek Jassem, MD, PhD, and Rafał Dziadziuszko, MD, PhD
Advances in the molecular characterization of non–small cell lung cancer (NSCLC) have led to the identification of molecularly defined distinct subsets of patients who derive benefit from targeted therapies. Currently, two such groups of agents have moved widely into clinical practice: epidermal gro...
Complexities of Targeting HER2 in Estrogen Receptor–Positive Breast Cancers
Ruth O’Regan, MD
The interactions between the estrogen receptor (ER) and HER2 pathways in breast cancers are clearly complex and remain incompletely understood. Historically, cancers that express both ER and HER2 were thought to be intrinsically resistant to endocrine therapy, likely due to HER2 being the dominant p...
The Long and Winding Road to Modern Integrative Oncology
Barrie R. Cassileth, MS, PhD
It has been a long road from the blind acceptance of unproven “alternative” remedies for the treatment of cancer to the development of rigorous guidelines for integrative care, which address symptom control. The recently released Society for Integrative Oncology (SIO) guidelines applicable to breast...
Transplants for AML in First Remission: A Great Leap Forward, Sideways, or Backward?
Robert Peter Gale, MD, PhD, DSc(hc), FACP, Hillard M. Lazarus, MD, FACP, and Peter H. Wiernik, MD, FACP, FASCO
“All great truths begin as blasphemies.” —George Bernard Shaw (Annajanksa, 1918) Until about 15 years ago, persons with acute myelogenous leukemia (AML) were considered candidates to receive a blood cell or bone marrow allotransplant in first remission only if they had had an HLA-identical sib...
ASCO Expert Statement on Cancer Survivorship Care Planning: Timing Is Everything
Mary McCabe, RN, MS
As the saying goes, “Timing is everything.” And so it is with the recently released ASCO Clinical Expert Statement on survivorship care planning.1 Although there has been extensive discussion and debate about the use of survivorship care plans since the publication of the 2005 Institute of Medicine ...
Moving a Mountain: Crizotinib in ROS1-Rearranged NSCLC
Tony S.K. Mok, MD
It was thousands of years ago in China. An elderly man was unhappy with the mountain that embraced his seaside village. He would need to walk for hours before he could reach the nearest town. So, as the old fable goes, he set his mind to move the mountain. Every day, he dug up basketfuls of rocks an...
Getting the Most Out of Ipilimumab in Melanoma
Sapna Pradyuman Patel, MD
Ipilimumab (Yervoy) was first approved by the U.S. Food and Drug Administration (FDA) in 2011 on the basis of an improvement in overall survival compared with gp100 vaccine in patients with advanced melanoma.1 Response rates with ipilimumab have been modest at best—10% to 15% using 3 mg/kg and 15% u...
Racing Against Acute Lymphoblastic Leukemia: CTL019 Is a Fast CAR With Sustained Endurance
L. Elizabeth Budde, MD, PhD, Samer K. Khaled, MD, and Stephen J. Forman, MD, FACP
The long-term outcome for patients with relapsed or refractory acute lymphoblastic leukemia (ALL) is poor, with 5-year overall survival from first relapse being only approximately 10%.1,2 Patients with disease relapse following allogeneic transplant have the worse prognosis and are typically exclude...
When Should We Stop Prescribing?
John F. Smyth, MD
This year’s European Society for Medical Oncology (ESMO) meeting held in Madrid was attended by 19,000 delegates, and it was encouraging to see among that number so many young oncologists being given time off for education and discussion. There has never before been a time when so much new informati...
CAR T-Cell Therapy in Cancer: Driving Toward the Clinic
Andrew Evens, DO, MSc
Chimeric antigen receptor (CAR) T-cell therapy represents a novel and promising therapeutic advance in cancer.1,2 It constitutes a form of personalized therapy that harnesses adoptive cell transfer through genetic engineering of autologous T cells. The initial step in this therapeutic paradigm invol...
Sigmoidoscopy or Colonoscopy for Colorectal Cancer Screening: Is It Still the Question?
Aline Charabaty, MD
Mortality from colorectal cancer remains a public-health concern, being the second leading cause of cancer-related death for men and women combined. The major preventive measure for colorectal cancer is to screen for and remove adenomatous polyps. Average-risk individuals (ie, those who do not have ...
From ‘Clinical Judgment’ to Evidence-Based Medicine: Thoughts on the ASCO/CCO Guideline in Metastatic Castration-Resistant Prostate Cancer
Maha Hussain, MD, FACP, FASCO
We are witnessing unprecedented progress in the development of therapy for patients with metastatic castration-resistant prostate cancer. The U.S. Food and Drug Administration (FDA) has issued 13 approvals since 1996 for agents that have demonstrated an impact on overall survival, pain, or skeletal-...
HDAC Inhibitors and Triple Therapy in Relapsed Myeloma
Sagar Lonial, MD
The use of histone deacetylase (HDAC) inhibitors as human cancer therapy has focused on the impact of these agents on epigenetic regulation and gene transcription. However, the use of HDAC inhibitors in myeloma may be working through a different mechanism. Specifically, HDAC6 is known to regulate th...
The Next-to-Last Frontier in Managing Acute Promyelocytic Leukemia
Martin S. Tallman, MD
The treatment of acute promyelocytic leukemia (APL) represents one of the major triumphs in the field of hematologic malignancies. With either the vitamin A derivative all-trans retinoic acid (ATRA) combined with anthracycline-based chemotherapy or ATRA plus arsenic trioxide (Trisenox), approximatel...
Why I Think Dr. Ezekiel Emanuel Is Wrong About Aging
Jimmie C. Holland, MD, as told to Jo Cavallo
The image of aging that Ezekiel Emanuel, MD, PhD, expresses in his essay, “Why I Hope to Die at 75,” in the October issue of The Atlantic,1 is bleak indeed and one that has contributed mightily to the negative views of aging imbedded in our society. But I refute his description of growing older as y...
Treatment of Newly Diagnosed Multiple Myeloma With Lenalidomide Plus Low-Dose Dexamethasone
S. Vincent Rajkumar, MD
The FIRST trial—reported by Benboubker and colleagues in The New England Journal of Medicine and summarized in this issue of The ASCO Post (page 93)—is a landmark study.1 It is one of the largest randomized trials in multiple myeloma ever conducted. More importantly, it is a well-designed trial that...
Complexity of the Contralateral Prophylactic Mastectomy Decision
Lisa A. Newman, MD, MPH, FACS, FASCO
The powerful and important study by Kurian et al,1 reviewed in this issue of The ASCO Post, adds vital information to the discussion regarding use of contralateral prophylactic mastectomy among patients with unilateral breast cancer in the United States.2,3 Based upon data from the California Cancer...
Maintenance Therapy in Ovarian Cancer: What’s at Stake?
Robert L. Coleman, MD
Maintenance therapy in ovarian cancer refers to a cohort of women achieving response to initial adjuvant chemotherapy who then go on to additional therapy in the hopes of extending time to recurrence or inducing a lasting remission. The concept is not new and retains its scientific and clinical rele...
High-Dose Melphalan, Early Stem Cell Transplant, and Lenalidomide Maintenance in Myeloma: One Size Still Does Not Fit All
Paul G. Richardson, MD
In an important recent study by Dr. Antonio Palumbo and colleagues,1 reviewed in this issue of The ASCO Post (page 128), 273 patients aged ≤ 65 years were randomly assigned to early transplant or consolidation therapy using MPR (melphalan, prednisone, and lenalidomide [Revlimid]) after successful in...
BRAF/MEK Inhibition in BRAF-Mutant Advanced Melanoma
Keith T. Flaherty, MD
Preliminary evidence of efficacy for BRAF inhibitors as monotherapy in advanced melanoma first emerged in 2009.1 Phase II and III trials rapidly ensued for vemurafenib (Zelboraf) and dabrafenib (Tafinlar), leading to U.S. Food and Drug Administration (FDA) approval in 2011. As a result of melanoma f...
The RAINBOW Trial: Dawn of a New Era in Upper Gastrointestinal Malignancies
Manish A. Shah, MD
As reviewed in this issue of The ASCO Post (page 155), the RAINBOW trial is an international phase III study demonstrating improved overall survival with ramucirumab (Cyramza) plus paclitaxel as second-line therapy for patients with advanced gastric/gastroesophageal junction adenocarcinoma over pacl...
From the Genome to the Bedside: New Treatment Options for Children and Young Adults With Philadelphia Chromosome–Like ALL
Kathryn G. Roberts, PhD
The outcome for adolescents and young adults with acute lymphoblastic leukemia (ALL) is inferior to that in children, and the outcome for children with ALL who experience relapse is dismal. Therefore, new therapeutic options are urgently needed to improve survival rates for this high-risk ALL popula...
ASCO Endorses CAP/IASLC/AMP Guidelines for Molecular Testing of Patients With Non–Small Cell Lung Cancer
Fred R. Hirsch, MD, PhD
Personalized medicine is an established treatment concept for patients with advanced non–small cell lung cancer (NSCLC), and molecular characterization of tumors is crucial for choice of (first-line) therapy. As of right now, we have U.S. Food and Drug Administration (FDA)-approved drugs for two mol...
Why Physician-Scientists Are Indispensable to Cancer Research
Lorraine W. Egan
This is an exciting time for cancer research. We are beginning to see breakthroughs for patients with advanced melanoma, leukemia, multiple myeloma, lung cancer, and many other forms of cancer. Even so, cancer is projected to increase by about 45% and to become the leading cause of death in America ...
Linking Biology and Therapy in Chronic Lymphocytic Leukemia
Stephan Stilgenbauer, MD
Recent discoveries in biology, therapy, and (most importantly) the interplay between these two have led to groundbreaking advances in chronic lymphocytic leukemia (CLL). These advances underline the impact of the “translational” approach to cancer management in general. Standard of Care Reconsidere...
Adding Cetuximab to Chemoradiation Did Not Benefit Patients With Advanced Head and Neck Cancer: What Were the Reasons?
Avraham Eisbruch, MD
Two landmark randomized studies demonstrated improved survival of patients with head and neck cancer receiving the epidermal growth factor receptor (EGFR) antibody cetuximab (Erbitux) concurrent with radiotherapy compared with radiotherapy alone,1 and similar improvement in patients with recurrent/m...
Relevance of the Hippocratic Oath in the 21st Century
Hagop Kantarjian, MD, and David P. Steensma, MD
On the face of it, the idea that a code of professional conduct dating to the ancient Iron Age could possibly retain any relevance in the current era of “Big Data,” religious and cultural pluralism, trillion-dollar government budgets, and nanotechnology seems preposterous. Yet the well-publicized ch...
REVEL: Winning a Questionable Race
D. Ross Camidge, MD, PhD
The investigators and sponsors of the phase III REVEL trial should be congratulated and probably commiserated. In this large study, reported by Garon and colleagues in The Lancet and reviewed in this issue of The ASCO Post, 1,253 patients with advanced non–small cell lung cancer (NSCLC) were randomi...
Guidelines and Care: What Comes Next?
Clifford A. Hudis, MD, FACP
The goal of clinical, translational, and basic research is, in the end, the betterment of life on earth. Advances in basic and clinical science ultimately should lead to information that, in turn, enables clinicians to make better treatment decisions for individual patients in order to improve their...
Colonoscopic Polypectomy and Predicting Cancer Risk: A Work in Progress
Srinadh Komanduri, MD, and Al B. Benson III, MD, FACP, FASCO
Colon cancer screening using colonoscopy has significantly decreased the incidence and mortality of colorectal cancer in the United States. In the National Polyp Study (NPS), colorectal cancer was prevented by removal of adenomatous polyps.1 A more recent study looking at long-term follow-up from th...
ECOG E4402/RESORT Trial: When ‘Black and White’ Results Are Actually Gray
Richard I. Fisher, MD
The results of the ECOG E4402/RESORT trial recently reported by Kahl and colleagues,1 and reviewed in this issue of The ASCO Post, provide interesting new information on the use of maintenance rituximab (Rituxan) vs retreatment with rituximab at progression in patients with low–tumor burden indolent...
Failure of Cilengitide in Newly Diagnosed Glioblastoma With Methylated MGMT Promoter
Elizabeth R. Gerstner, MD
Temozolomide in combination with radiation for newly diagnosed glioblastoma was approved by the U.S. Food and Drug Administration in 2005—almost 10 years ago—but we have unfortunately made little progress in improving survival for this incurable brain tumor. Despite recent completion of three large,...
Improving Treatment of Depression in Patients With Cancer: The SMaRT Oncology-2 Trial
William Breitbart, MD, and Yesne Alici, MD
Clinical depression is highly prevalent, associated with significant morbidity, often underrecognized, and inadequately treated in cancer patients. Professor Michael Sharpe and Jane Walker, PhD, and their colleagues’ seminal work on enhancing treatment of depression in cancer patients using a colla...
Will Oncologists Be the First to Cure Heart Disease?
Robert Peter Gale, MD, PhD, DSc(hc), FACP
Oncologists love jargon—a language peculiar to a particular trade, profession, or group that facilitates communication among members. Our day-to-day communications, medical notes, and journal reports are filled with this type of jargon. Other definitions of jargon are less flattering, including unin...
PSA—It Just Keeps Getting Better, So Why Should It Stand Alone?
Anthony V. D’Amico, MD, PhD
The updated results of the European Randomised Study of Screening for Prostate Cancer (ERSPC)—reported in The Lancet by Fritz H. Schröder, MD, of Erasmus University Medical Center, and colleagues1 and reviewed in this issue of The ASCO Post—show a continued decline, as predicted,2 in the number invi...
Angiogenesis in Ovarian Cancer: Are We Missing the Clinical Target?
Michael A. Bookman, MD
Production of vascular endothelial growth factor (VEGF) is increased during normal ovulation, and can account for much of the reversible toxicity associated with ovarian hyperstimulation.1,2 We also have compelling data from multiple clinical trials to validate the importance of tumor-associated ang...
PALB2 Study: Researchers and Patients Must 'Pal' for Progress
Judy E. Garber, MD, MPH
The recent publication by Antoniou et al on risk of breast cancer in PALB2 carriers,1 reviewed in this issue of The ASCO Post (page 47), is a contribution to the interesting history of the PALB2 gene, and an important milestone in the expansion of hereditary cancer susceptibility testing in the post...
Complications No Different Between Open and Robot-Assisted Radical Cystectomy When Open Urinary Diversion Performed
Piyush K. Agarwal, MD, Mani Menon, MD, and Adam R. Metwalli, MD
We read the letter to the editor in the July 24, 2014, issue of The New England Journal of Medicine entitled, “A Randomized Trial of Robot-Assisted Laparoscopic Radical Cystectomy,” with great interest.1 Provocative Results In the letter, reviewed in this issue of The ASCO Post, Bochner and collea...
Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography
Gary J. Whitman, MD
In a study reported in JAMA and reviewed in this issue of The ASCO Post, Friedewald and colleagues1 showed that the addition of tomosynthesis to digital mammography2 resulted in a decrease in the screening recall rate3 and an increase in the cancer detection rate.4,5 This retrospective analysis of s...
Sequencing Analysis of Tumor DNA: Is It All in the Plasma?
Britta Weigelt, PhD, and Jorge S. Reis-Filho, MD, PhD, FRCPath
Massively parallel sequencing analyses have demonstrated that most of the common malignancies display relatively complex repertoires of somatic genetic alterations, that the number of highly recurrent mutations is limited, and that a large number of genes is mutated in a small minority of tumors fro...
My Priorities for the Year Ahead
Peter P. Yu, MD, FASCO, as told to Jo Cavallo
I am honored and privileged to lead ASCO during its 51st year, a year that promises to bring both challenges and opportunities to our members and our patients. As the theme for my Presidential term, I’ve chosen Illumination and Innovation: Transforming Data Into Learning, because we are positioned t...
Failure of IGF-1R Inhibitor Figitumumab in Advanced Nonadenocarcinoma Non–Small Cell Lung Cancer
Jacek Jassem, MD, PhD
The vast majority of non–small cell lung cancer (NSCLC) patients present with advanced disease, and many will develop metastases after primary curative therapy. Until recently, despite its low efficacy, chemotherapy remained the only treatment modality in metastatic NSCLC. Within the past decade, th...
Precision Medicine: Precisely Where Are We Really?
John F. Smyth, MD
Having attended ASCO Annual Meetings for almost 40 years, I believe that this year’s 50th anniversary celebration was one of the best ever. In many of the presentations and discussions, I experienced a sense of reality about the true state of cancer management that in previous years has sometimes be...
EGFR as a Therapeutic Target for Gastroesophageal Cancer—or Is It Really?
Elena Elimova, MD, Shumei Song, MD, PhD, and Jaffer A. Ajani, MD
The epidermal growth factor receptor (EGFR) gene is often amplified and its protein overexpressed in upper gastrointestinal cancers—and overexpression has prognostic value. With the advent of monoclonal antibodies and tyrosine kinase inhibitors against EGFR, we have witnessed a rash of randomized cl...
Enzalutamide and the Landscape of Castration-Resistant Prostate Cancer: Integrating New Indications With Existing Agents
Daniel P. Petrylak, MD
The androgen receptor axis is a validated target for the treatment of castration-resistant prostate cancer. Several perturbations in this pathway are postulated to lead to androgen-independent growth, including androgen receptor mutation and amplification as well as the autocrine production of testo...
Patience Remains a Virtue: The Ongoing Quest to Optimize Adjuvant Endocrine Therapy in Breast Cancer
Kathy D. Miller, MD
The most recent ASCO Clinical Practice Guideline update—summarized in this issue of The ASCO Post—represents the latest chapter in the ongoing evolution of adjuvant endocrine therapy for hormone-sensitive breast cancer.1 Rather than including a comprehensive review of the 2010 guidelines, this updat...
Circulating Tumor Cells in Metastatic Breast Cancer: Are We Afraid of the Truth?
Massimo Cristofanilli, MD, FACP
All truths are easy to understand once they are discovered; the point is to discover them.” —Galileo Galilei There are several “truths” in breast oncology that have been discovered over the years, become widely understood, and changed the way we practice. Prospective randomized studies have s...
Active Surveillance in Low-Risk Prostate Cancer: When Will We Pay It More Than Just Lip Service?
Anthony L. Zietman, MD
Active surveillance is well established as an appropriate management option for men with low-risk prostate cancer and particularly for those over 65 years of age. Its legitimacy is now enshrined within National Comprehensive Cancer Network guidelines, in the American Society for Radiation Oncology C...
Low-Risk Prostate Cancer and Principles of Active Surveillance
John A. Fracchia, MD, FACS
For specific diseases, many physicians tend to recommend interventions and therapies with which they are most comfortable and familiar. It is not surprising that urologists and radiation oncologists did so in the study reported by Hoffman and colleagues in JAMA Internal Medicine and reviewed in this...
Take-Home Messages From ASCO's Immediate Past President
The ASCO Post recently spoke with ASCO Immediate Past President Clifford A. Hudis, MD, FACP, about his term as ASCO President. Dr. Hudis discussed his thoughts on ASCO today and shared his perspective on a number of important issues in oncology, including value in cancer care, big data, and more. R...
Progress in Differentiated Thyroid Cancer
Maria E. Cabanillas, MD, FACE
Treatment of differentiated thyroid cancer has been slow to advance. Three decades lapsed between the description of the first differentiated thyroid cancer patient being cured by radioactive iodine in the 1940s1 and the report of the study that led to the approval of doxorubicin in the 1970s.2 The ...
Swiss Medical Board Recommendation to End Mammography Screening: A Disturbing Proposal
Carol H. Lee, MD, FACR
Despite evidence from a number of prospective, randomized controlled trials showing that screening mammography reduces breast cancer mortality, screening mammography has been the subject of continual debate, controversy, and conflicting guidelines. Recently, the Swiss Medical Board, tasked with revi...
Prostate Cancer Biomarkers: Improvement in Predicting Clinically Significant Disease
Richard J. Boxer, MD, FACS
Prostate cancer will be diagnosed in 233,000 American men in 2014. It is one of the leading causes of death by a cancer (killing ~29,500 men annually).1 Hundreds of thousands of men undergo prostate biopsies each year, most for either benign disease or for a cancer that will never lead to their deat...
The More Things Change, the More They Stay the Same
Jimmie C. Holland, MD, and James F. Holland, MD
The ASCO Annual Meeting in June confirmed—and expanded—the excitement of the oncology community about molecular medicine and its future. The complex molecular pathways were pictured in living color on many slides in many large auditoriums. Newspapers across the country were equally enthusiastic as t...
Ado-Trastuzumab Emtansine as a Late Treatment for HER2-Positive Metastatic Breast Cancer—Better and Less Toxic Than Physician’s Choice
Lisa A. Carey, MD
TH3RESA is a randomized phase III open-label study, reported in The Lancet Oncology and summarized in this issue of The ASCO Post, which examined the activity of ado-trastuzumab emtansine (Kadcyla) in heavily pretreated HER2-positive metastatic breast cancer.1 Formerly known as T-DM1, ado-trastuzuma...
ASCO Guideline for Management of Brain Metastases From HER2-Positive Breast Cancer: An Important Framework
Priscilla K. Brastianos, MD, and Daniel P. Cahill, MD, PhD
Brain metastases are a devastating complication of cancer, and occur in up to 50% of patients with advanced human epidermal growth factor 2 (HER2)-positive breast cancer. Management of brain metastases requires individualized coordination between the traditional treatment modalities for intracranial...
Time to Move Forward With Lung Screening
James L. Mulshine, MD
Start with the most lethal cancer globally—lung cancer—for which standard approaches result in a modest 5-year survival. Then consider the results from the National Lung Screening Trial (NLST), suggesting in a well done randomized study that significant mortality reduction does occur with low-dose c...
'Small Practices Like Mine'
Carolyn B. Hendricks, MD
Recently, I participated in ASCO’s Congressional news briefing in Washington, DC, following the release of its report, The State of Cancer Care in America: 2014. During my presentation I talked about the workforce shortage of approximately 1,500 medical oncologists that is predicted by 2025. A numbe...
A Proposal for Patient-Selected Controlled Trials: Good Science and Good Medicine
Jim Omel, MD, and Karl Schwartz, MFA
The Clinical Trials and Translational Research Advisory Committee (CTAC) of the National Cancer Institute (NCI) met for the 22nd time on March 12, 2014, in their ongoing effort to improve efficiency and effectiveness of cancer clinical trials. A significant portion of the meeting addressed lagging p...
Reflecting on the Past Year and Looking Ahead to the Next
Clifford A. Hudis, MD, FACP
On assuming the Presidency of ASCO a year ago, I recognized that one of our greatest challenges as a professional society is helping the American public understand the value of cancer research, especially now, when scientific advances are accelerating but resources are contracting. This is partly wh...
Maintenance Therapy in Multiple Myeloma
S. Vincent Rajkumar, MD
In 2012, three randomized placebo-controlled trials reported a significant prolongation of progression-free survival with lenalidomide (Revlimid) as maintenance therapy for multiple myeloma.1-3 Two of these trials tested lenalidomide maintenance after stem cell transplantation, and one investigated ...
ASCO CEO Allen S. Lichter, MD, on Data Issue
"While there is no question that transparency about health-care costs is a good thing, the new database is already doing more to disrupt good care than shed light on bad care. “The Centers for Medicare and Medicaid Services has a responsibility to educate the public about the data they are releasi...
SSO-ASTRO Margin Guideline: Why Now and What Does It Mean?
Monica Morrow, MD
Although breast-conserving therapy has been a standard practice for more than 20 years, controversy still exists over what constitutes the appropriate margin of normal breast tissue around a tumor that minimizes local recurrence while maintaining a good cosmetic outcome. Surveys of surgeons1 and rad...
I Refuse to Capitulate to Cancer
Paul Kalanithi, MD, as told to Jo Cavallo
Early last year, just as I returned to my residency in neurologic surgery at Stanford University after completing 2 years of my postdoctoral fellowship in a laboratory developing optogenetic techniques, I started losing weight—dropping from 180 lb to 160 lb in just 6 months—and I was having fairly s...
Impact of Delayed Initiation of Adjuvant Chemotherapy for Breast Cancer Varies by Tumor Subtype
Karen Lisa Smith, MD, MPH, and Vered Stearns, MD
The optimal time interval between surgery and initiation of adjuvant chemotherapy for early-stage breast cancer is not well established. Although most physicians aim to initiate adjuvant chemotherapy within a few weeks of surgery, clinical factors may cause delay. The influence of delay on relapse a...
The Canadian National Breast Screening Trial Had So Many Flaws That Its Results Should Not Be Used to Guide Screening Recommendations
Daniel B. Kopans, MD, FACR
If a randomized, controlled trial of therapy for breast cancer was submitted for publication in which 1. The drug being tested was old and ineffective, and 2. prior to randomization, the women underwent a clinical breast examination and the study coordinators knew who had the largest cancers, and ...
Overdiagnosis of Breast Cancer: New Research Directions
Sudhir Srivastava, PhD, MPH, and Barnett S. Kramer, MD, MPH
Currently, one of the most challenging problems in oncology is to accurately predict whether neoplastic lesions detected by screening tests will progress. The focus on developing ever-more sensitive cancer screening tests has produced the clinical dilemma of overdiagnosis. Overdiagnosis occurs when ...
ASCO's Education and Professional Development Services
Jo Cavallo
Last September, Jamie H. Von Roenn, MD, left her position as Professor of Medicine at the Northwestern University Feinberg School of Medicine in Chicago to join ASCO as its Senior Director of Education, Science and Professional Development. In her new position, Dr. Von Roenn will provide strategic v...
FDA Programs to Expedite Drug and Biologic Product Development
Paul Kluetz, MD, and Martha Donoghue, MD
With the advent of Breakthrough Therapy designation, there are now four FDA programs to expedite the development of promising new agents: Fast Track, Breakthrough Therapy, Priority Review, and Accelerated Approval (Table 1). These programs complement one another and serve a common goal: to speed the...
Cancer Genes, Promiscuity, and the National Debt
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
There is no doubt that this is a halcyon period in oncology. The unraveling of the genome has been tremendously important, and finally has helped us to move treatment selection from an era of rational empiricism to one of refined, molecular prognostication. In the care of breast cancer, the impact ...
ASCO's 50th Anniversary and the Road Ahead
Allen S. Lichter, MD, FASCO
As the American Society of Clinical Oncology celebrates its 50th anniversary, ASCO’s Chief Executive Officer Allen S. Lichter, MD, FASCO, recently talked with The ASCO Post about the Society’s past, present, and future. Important Milestone What are your thoughts about ASCO’s origins and its 50th a...
Consent Is Informed and Shared, But Is It Compassionate?
Chandrakanth Are, MBBS, FRCS, FACS
A 72-year-old, obese male patient and a poor operative candidate is diagnosed with esophageal carcinoma. He has multiple comorbidities and a past history of colon carcinoma. His staging workup, which included a colonoscopy, revealed recurrent colon carcinoma. Thus, we have a patient who we initially...
Adjuvant Trastuzumab Duration: When Is Enough, Enough?
Andrew D. Seidman, MD
The duration of adjuvant systemic chemotherapy for breast cancer has been a subject of investigation, scrutiny, and meta-analysis.1,2 With the appreciation that prolonged regimens of cytotoxic chemotherapy of, for example, 1 to 2 years in duration were not superior in reducing breast cancer recurren...
What Does ‘Myeloma’ Mean?
Sagar Lonial, MD
Over the centuries it has become clear that, as physicians, what we say and how we say it can have a major impact on those who seek our help. Our pronouncement that a patient is in remission or harbors a serious illness carries with it a large number of spoken and unspoken implications. So when we s...
Standardizing the Interpretation of PET Scans: An INR Equivalent
Matthew Lunning, DO, and James O. Armitage, MD
Since its introduction, the positron-emission tomography (PET) scan has shown great potential to improve our ability to care for patients with lymphoma. By demonstrating which masses seen on a computed tomography (CT) scan represent viable tumor, and by identifying viable tumor in places that were n...
Illness Is Personal!
Ira Byock, MD
For clinicians and health service researchers striving to improve care for people living with life-threatening conditions, September was a sobering month. The Dartmouth Atlas group released a brief report on Trends in Cancer Care Near the End of Life1 showing that while the proportion of patients wi...
The Devastating Impact of Sequestration on Medical Research
Richard J. Boxer, MD, FACS
The primacy of science and the overwhelming belief in medical research by the American people has sustained the research community and improved quality of life roughly since the turn of the 20th century. Almost without exception, the American people have voted for politicians who promise improved qu...
A Great Privilege to Die Beneath an Open Sky
Chandrakanth Are, MBBS, FRCS, FACS
It was 1:00 AM, and my beeping pager awakened me. When you’re a surgical oncologist, you know that a page from your chief resident at this hour of the morning usually means someone may need to go to the operating room. And, yes, it was the chief resident about a patient in crisis. Except in this cas...
Will Funding for Lung Cancer Ever Improve?
Apar Kishor Ganti, MD, MS, FACP
Lung cancer is the most common cause of cancer-related death in the world. In the United States alone, an estimated 228,190 new cases of lung cancer and 159,480 deaths from lung cancer will occur in 2013. These are alarming statistics when compared to the next four common causes of cancer-related de...
Role of Erlotinib in EGFR Wild-Type Lung Cancer
Pasi A. Jänne, MD, PhD
I welcomed Matthew Stenger’s Journal Spotlight on the TAILOR trial in the August 15 issue of The ASCO Post (“Docetaxel Superior to Erlotinib in Second-Line Treatment of Advanced Non–Small Cell Lung Cancer With Wild-Type EGFR”). The trial was recently published online in Lancet Oncology,1 and address...
Molecular Tests and Precision Medicine: Not So Fast Now!
William T. McGivney, PhD
The era of the application of genomic, proteomic, and a host of other “omic” analyses to guide decision-making in the therapeutic selection of drugs and biologics is now a key part of cancer care. Medical practice is working to keep up with the scientific advances, evaluate them, and add a variety o...
Where Are We with ALK Inhibition in Lung Cancer?
Fred R. Hirsch, MD, PhD
The prospective phase III PROFILE 1007 study compared the ALK inhibitor crizotinib (Xalkori) to chemotherapy in patients with advanced non–small cell lung cancer (NSCLC) with ALK gene–rearranged tumors refractory to previous chemotherapy. The study showed a clear superiority for crizotinib in terms ...
Evolving Issues in Low-dose CT Lung Cancer Screening
James L. Mulshine, MD, and Jeffrey Schneider, MD
Over a decade has passed since the start of the National Lung Cancer Screening Trial and more than 2 years since the first report indicating that this randomized study had demonstrated a significant reduction in lung cancer mortality with low-dose computed tomography (CT) screening.1 That favorable ...
Targeted Suppression of a Reactivated Developmental Pathway in Hepatocellular Cancer
James L. Abbruzzese, MD
This issue of The ASCO Post summarizes the results of an important study recently published in The New England Journal of Medicine by Yong and colleagues. As outlined, investigators from the National University of Singapore Yong Loo Lin School of Medicine have identified re-expression of SALL4 as a ...
Further Support for Front-line Targeted EGFR Therapy
Melissa L. Johnson, MD
LUX-Lung 3 is the sixth, and largest, prospective, randomized trial to evaluate targeted EGFR inhibition vs front-line platinum doublet chemotherapy for patients with EGFR mutations. LUX-Lung 3 distinguishes itself from the previous trials (see Table 1) by using afatinib (Gilotrif), a second-generat...
Is Age Truly Relative in HER2-positive Breast Cancer?
Carey K. Anders, MD
Breast cancer arising in younger women has increasingly become the subject of intense study, and often debate, over the past decade. Retrospective studies have illustrated that breast cancer in young women is more commonly an aggressive subtype (ie, triple-negative/basal-like, HER2-enriched), higher...
Why Is Stem Cell Transplant So Underused in Follicular Lymphoma?
Timothy S. Fenske, MD
Follicular lymphoma is the second most common subtype of non-Hodgkin lymphoma (NHL) in the United States. Of the nearly 70,000 new cases of NHL anticipated in 2013,1 approximately 7,000 to 13,000 (10%–19%) will be follicular lymphoma, by recent estimates.2-5 For many years, the median overall surviv...
Venous Thromboembolism in Patients with Cancer: Real-world Challenges for the Practicing Oncologist
Gary H. Lyman MD, MPH
The close association between cancer and thrombosis has been recognized now for more than 150 years.1 Not only is it now known that patients with cancer are at substantially increased risk of developing venous thromboembolism, even prior to the diagnosis of cancer, but the association between coagul...
Molecular Landscaping of Acute Myeloid Leukemia: Are We Relearning the Past or Informing the Future?
Guido Marcucci, MD, and Clara D. Bloomfield, MD
Acute myeloid leukemia (AML) is a clinically and molecularly heterogeneous disease.1 This concept has been supported by more than 4 decades of studies showing distinct outcomes of subsets of patients that differ in age, disease type (primary vs secondary vs therapy-related), and cytogenetic and mole...
Learning to Negotiate the Genomic Complexities of Cancer
Joyce F. Liu, MD, MPH
The Cancer Genome Atlas (TCGA) Research Network recently reported the results of an integrated analysis of the genomic features of 373 endometrial carcinomas.1 This report joins previously published results of similar analyses in ovarian, breast, and colorectal cancers, squamous cell carcinoma of th...
Results of AXIS Trial Indicate a Significant Improvement over Historical Survival Data in Renal Cell Carcinoma
Janice Dutcher, MD
The phase III open-label AXIS trial comparing axitinib (Inlyta) vs sorafenib (Nexavar) as second-line treatment for metastatic renal cell carcinoma has shown a significant difference in median progression-free survival (8.3 months in the axitinib group vs 5.7 months in the sorafenib group; hazard ra...
Financial Revamping of Medical Education
Richard J. Boxer, MD, FACS
The American medical education system was in a state of crisis in 1910 when Abraham Flexner published his treatise, Report on Medical Education in the United States and Canada (Carnegie Foundation Bulletin Number Four).1 A century later, we face another crisis in medical education—not in terms of it...
It’s Déjà Vu All Over Again
Joseph M. Connors, MD
Yogi Berra offered the comment “It’s déjà vu all over again” when he witnessed Mickey Mantle and Roger Maris repeatedly hitting back-to-back home runs in the early 1960s. His pithy remark neatly summarizes my reaction when I read the article, “Dose-Adjusted EPOCH-Rituximab Therapy in Primary Mediast...
On the Potential for Conflicts of Interest
Laurence H. Baker, DO
In a recent issue of The ASCO Post, I counted 14 expert commentaries where the authority who wrote or was interviewed for the piece reported “no potential conflicts of interest.” I wondered how likely that was. We need to be clearer on the meaning of potential conflicts of interest. How often have ...
Drug Approvals in Acute Myeloid Leukemia: Can We Do Better?
Hagop Kantarjian, MD, and Elihu Estey, MD
Forty years ago, President Richard Nixon announced a “war on cancer.” Some of that war’s first battles were won in the field of acute myeloid leukemia (AML) with two agents, cytarabine and daunorubicin, receiving U.S. Food and Drug Administration (FDA) approval based on their ability to produce typi...
Symptom Management with Complementary Therapies for Patients Receiving Radiation Therapy
Stephen M. Sagar, MD, FRCPC
The supportive care of patients with cancer receiving radiotherapy is an important responsibility for the radiation oncologist, and complementary therapies are an integral component of many patients’ treatment strategy.A recent prospective study suggests that 54% of patients with breast cancer recei...
Ibrutinib CLL Trial: Where Is the Equipoise?
Susan O’Brien, MD
The RESONATE trial is randomly assigning patients with refractory or relapsed CLL to either ofatumumab (Arzerra) or the investigational oral agent ibrutinib. Ofatumumab is an anti-CD20 monoclonal antibody like rituximab (Rituxan), but is more potent as a single agent. It was approved for refractory ...
Homoharringtonine/Omacetaxine: The Little Drug that Could
Hagop Kantarjian, MD, Susan O’Brien, MD, and Jorge Cortes, MD
First, a clarification: Homoharringtonine is a natural plant alkaloid derived from Cephalotaxus fortunei; from the 1970s until the present, it was the subject of intensive research efforts by Chinese investigators to clarify its role as an antileukemic agent.1-3 Omacetaxine mepesuccinate (Synribo) i...
SIDEBAR: Two Caveats on the PCOS Follow-up
Anthony V. D’Amico, MD, PhD
Dr. Resnick and colleagues are to be congratulated for following men on the PCOS study out to 15 years. The main result—“At 15 years, no significant relative differences in disease-specific functional outcomes were observed among men undergoing prostatectomy or radiotherapy”—should be interpreted wi...
SIDEBAR: CT Colonography Reconsidered
David H. Kim, MD
The parallel SIGGAR trials recently published in Lancet add to the growing body of literature regarding the utility of computed tomographic (CT) colonography in the detection of colorectal polyps and cancers. These papers reinforce the results seen in other large multicenter trials1-3 and echo the p...
The Future of Clinical Guidelines in Oncology
William T. McGivney, PhD
Clinical guidelines, like those of ASCO and the National Comprehensive Cancer Network (NCCN), clearly have represented the standard of care and, to a large extent, the basis for coverage policy, especially in the area of medical oncology. However, guidelines increasingly seem to be in the shadow of ...
Expert Point of View: Lorenzo Cohen, PhD
Lorenzo Cohen, PhD
It is clear from our study, and other studies examining mind-body interventions in patients with cancer, that it is important for patients to consider participating in some kind of program to manage their stress and improve their quality of life. This is particularly true for patients who are vulner...
SIDEBAR: Further Reflections on a Successful Trial
Stacey Berg, MD
The authors are to be congratulated for successfully conducting a randomized study of FLAG (fludarabine, cytarabine, and granulocyte colony-stimulating factor [Neupogen]) vs FLAG plus liposomal daunorubicin (DaunoXome) in relapsed pediatric acute myeloid leukemia (AML). The difficulty in conducting ...
On Radiation and Cancer Risk
Robert Peter Gale, MD, PhD, Eric Lax, and F. Owen Hoffman
We owe our life to radiation. The universe was created in a thermonuclear explosion, and continued existence of life on Earth depends on plants using chlorophyll to capture light energy emitted by the sun (and exploding supernovas) and converting it into chemical energy, with the subsequent conversi...
SIDEBAR: Beta-adrenergic Signaling Pathway
Zhongxing Liao, MD, and Daniel R. Gomez, MD
The take-home message from this study is that in this large group of patients, we have found that beta-blocker intake during radiation therapy for non–small cell lung cancer (NSCLC) is associated with improved survival and reduced rates of tumor spread, even when controlling for a large number of ot...
We Need Gemtuzumab Available Again to Treat AML
Farhad Ravandi, MD, Jorge Cortes, MD, and Hagop Kantarjian, MD
The word “revival” signifies a renewed use or acceptance after a period of inactivity; similarly, the word “resurrection” refers to the concept of an entity coming back to life after death. In the past year, these terms have been used frequently by us (and others) in articles calling for the return ...
Expert Point of View: Kevin P. Weinfurt, PhD
Kevin P. Weinfurt, PhD
Our work suggests three specific recommendations for researchers and care providers who are discussing with patients the possibility of enrolling in a phase I clinical trial. First, we should always communicate the likelihood of benefit in terms of the number of participants expected to derive bene...
Expert Point of View: Neal J. Meropol, MD
Neal J. Meropol, MD
A critical component of informed consent is an understanding of the potential risks and benefits of investigational treatments. In the context of early-phase oncology trials, concern has been raised about whether this understanding is adequate, since patients tend to express high expectations about ...
Cost of Cancer Drugs: What Price for What Benefit?
Hagop M. Kantarjian, MD, and Leonard Zwelling, MD, MBA
In 2011, national health-care spending in the United States was about $2.7 trillion, larger than the entire French national budget.1 U.S. national health-care spending is about 17% of the national gross domestic product. Total Medicare expenditures in 2011 were $549 million.2 In the debate about hea...
Expert Point of View: Eduardo Bruera, MD, FAAHPM
Eduardo Bruera, MD, FAAHPM
The study by Weeks and colleagues is an important one that shows quite unexpected results. There are three main possible reasons for the very low rate of accurate reporting by the patients: (1) Physicians are not communicating prognosis adequately. (2) Patients are unable to understand the informati...
Are We Winning the War on Cancer?
Franco Cavalli, MD, FRCP
On December 23, 1971, President Richard Nixon signed the U.S. National Cancer Act. This date is widely considered to mark the beginning of the so-called “War on Cancer,” although that phrase was introduced only later on. Over recent decades, journalists have from time to time questioned whether we a...
Screening for Ovarian Cancer: A Gynecologic Oncologist’s Perspective
M. Steven Piver, MD
The recent U.S. Preventive Services Task Force (USPSTF) Reaffirmation Recommendation Statement concluded that in the population of asymptomatic women without known genetic mutations that increase risk for ovarian cancer, clinicians should not screen for ovarian cancer using transvaginal ultrasound a...
Who Should Receive First-line BEACOPP Therapy for Hodgkin Lymphoma?
Andreas Engert, MD
At the Pan Pacific Lymphoma Conference, held this year in Maui, Hawaii, Andreas Engert, MD, Chairman of the German Hodgkin Study Group, University Hospital of Cologne, Germany, led off the Hodgkin lymphoma section of the conference with a presentation on optimizing the use of BEACOPP (bleomycin, eto...
Explaining Research to Patients
John F. Smyth, MD
Everyone understands the need for medical research, especially regarding cancer. However, only a minority of the public understand what is actually involved in taking part in a clinical trial. As professionals, we are responsible for designing relevant studies, for their conduct and analysis, and as...
The Nuts and Bolts of Getting into an Oncology Fellowship
Bishoy Faltas, MD
Oncology continues to be one of the most sought-after specialties. Because of a shortage of oncologists and the accelerating pace of developments in the diagnosis and treatment of cancer, oncology has become an increasingly competitive field. Accreditation Council for Graduate Medical Education (ACG...
On Mentoring: Looking Back with Gratitude and Paying It Forward
Richard J. Boxer, MD, FACS
Upon graduation from medical school, doctors are given a gift that lasts a lifetime—the gift of respect. That respect needs to be re-earned every day, but it is accompanied by other rewards that come with caring for people: the ability to gain another’s trust, to reverse illness that alters the pati...
Cognitive Impairment in Patients with Cancer
Jorg Dietrich, MD, PhD
Cancer therapy, including radiation and chemotherapy, can be harmful to multiple organ systems. The central nervous system (CNS) has generally been considered less vulnerable to the toxic effects of cancer therapy. However, the use of more aggressive treatment modalities combined with prolonged pati...
On Mentoring: Looking Back with Gratitude and Paying It Forward
Richard J. Boxer, MD, FACS
Upon graduation from medical school, doctors are given a gift that lasts a lifetime—the gift of respect. That respect needs to be re-earned every day, but it is accompanied by other rewards that come with caring for people: the ability to gain another’s trust, to reverse illness that alters the pati...
The Problem of Monitoring Remission
John F. Smyth, MD
How wonderful it is that we now have to concern ourselves with survivorship issues! The ever-increasing success of cancer therapy means that more and more patients can look to a life beyond cancer diagnosis and treatment. But living with cancer creates its own problems. While treatment often may be ...
Maintenance of Certification: One Size Should Not Fit All
Andrew D. Seidman, MD
After a conference call and having returned several phone calls, I again opened my ASCO Medical Oncology Self Evaluation Program (SEP) book hoping to steal an hour to reread the chapter on multiple myeloma, and begin digging deeper into head and neck cancer. It was March 2011, and my Maintenance of ...
Breast Cancer and Noncommunicable Diseases: Where in the World Do We Start?
Benjamin O. Anderson, MD, FACS
As the world’s most common cancer among women, and the most likely reason around the globe that a woman will die of cancer, breast cancer affects countries at all economic levels. Despite the common misconception that breast cancer is primarily a problem of high-income countries, the majority of the...
To Scan or Not to Scan for Colon Cancer Recurrence?
Richard M. Goldberg, MD, and David P. Ryan, MD
Over the past 2 decades, we have seen a substantial increase in the 5-year survival of patients with stage II and III colon cancer, marking an evolving oncologic success story. However, in the postoperative setting, the value of regular CT screening to monitor for recurrence has been greeted with ...
Radiotherapy in Early-stage Hodgkin Lymphoma
Andreas Engert, MD
The treatment of patients with Hodgkin lymphoma is one of the major success stories in medical oncology. Depending on clinical stage, clinical risk factors, and the treatment given, 60% to 90% of all patients can be cured of their malignancy long-term. Hodgkin lymphoma survivors represent one of the...
Maintenance of Certification in Medical Oncology
James A. Stewart, MD, FACP
It is said that time is perhaps the most treasured asset we have. If you are a practicing oncologist, everyone wants more and more of your time, and I’m not referring to patients. Rather, there is an increasing proliferation of folks who want to make sure we’re doing a good job, and they are imposin...
Caveat Oncologist: Counterfeit Pharmaceuticals
Charles L. Bennett, MD, PhD, MPP, Zaina P. Qureshi, PhD, MPH, and Oliver Sartor, MD
In 2002, Tim F., a 17-year-old liver transplant patient, received 40,000 units of erythropoietin weekly, beginning immediately after his transplantation procedure.1 His family had purchased the product from the local CVS Pharmacy, upon his discharge from a Manhattan hospital. After each injection, T...
Clinical Findings and Consequences of Distributing Counterfeit Drugs for Hematology and Oncology
Charles L. Bennett, MD, PhD, MPP, Zaina P. Qureshi, PhD, MPH, and Oliver Sartor, MD
As introduced in our report on page 1 of this issue, counterfeit pharmaceuticals are an increasingly important safety concern, and three of the most prominent drug-counterfeiting episodes in recent years have involved hematology/oncology products. Counterfeit Erythropoietin Helen B., a 61-year-old...
Our Patients, Our Teachers
Richard J. Boxer, MD, FACS
There is no greater professional satisfaction than the knowledge that you have cared for a patient and the care brought an improvement in the patient's health. Regardless of the level of appreciation, whether the patient is cured or not, and even if the patient's sense of well-being may be psycholo...
Treating Acute Promyelocytic Leukemia without Chemotherapy
Farhad Ravandi, MD
Throughout the course of medical history, we have witnessed innovations that have initially been met with skepticism but have later revolutionized our management of patients with specific disorders. The recent history of oncology drug development is full of instances where a drug that was effectivel...
Moving the Field of Geriatric Oncology Forward
Stuart M. Lichtman, MD
With the aging of the population, virtually all of the subspecialties of oncology will soon be concerned primarily with the care of older patients. While there is not one precise definition of the age of “geriatric” patients, it is clear that the aging of our society has necessitated a focus on the ...
Autologous Hematopoietic Cell Transplantation for Adult Acute Myeloid Leukemia: A Question That Doesn’t Go Away
Frederick R. Appelbaum, MD
More than 3 decades ago, the first trials of autologous hematopoietic cell transplantation as consolidation therapy for acute myeloid leukemia (AML) in first remission were conducted. The initial results were inconclusive; most patients survived the procedure, but post-transplant relapse was common ...
Favorable Early-stage Hodgkin Lymphoma and HD.6: The Take-Home and Don’t–Take-Home Messages
Joachim Yahalom, MD
The Canadian HD.6 randomized study in patients with nonbulky early-stage Hodgkin lymphoma is mostly of historic interest.1,2 It has little relevance to current treatment standards or questions, and the risk for its inappropriate interpretation is of great concern. Radical Radiation Approach Long Ab...
Sentinel Lymph Node Biopsy for Thin Melanomas?
Michael S. Sabel, MD
When sentinel lymph node biopsy for the regional staging of melanoma was first introduced, it was recommended for any patient with a melanoma 1.0 mm in Breslow thickness or greater. Patients with thin melanomas were not thought to have a sufficiently high risk to warrant the additional cost and morb...
Ruxolitinib for Myelofibrosis Therapy: A Good Start but a Long Road Ahead
Animesh Pardanani, MBBS, PhD
Following a priority review process for orphan diseases, ruxolitinb (Jakafi) recently became the first drug to receive FDA approval for the treatment of intermediate- and high-risk myelofibrosis. Discovery in 2004 of the JAK2V617F mutation in a significant proportion of patients with BCR-ABL1–nega...
Integrative Oncology: Essential to Cancer Care
Barrie R. Cassileth, PhD
During the 1960s and 1970s, the concept of an expanded approach to oncologic treatment encompassing “body, mind, and spirit” grew in patient popularity and morphed into two basic categories: “alternative” and “complementary” therapies. Together, these later became known by the acronym CAM, for compl...
Gastric Cancer Is on the Rise: Screening and Education Are Vital
Libia F. Scheller, PhD
Gastric cancer is diagnosed in nearly 1 million people globally each year and is responsible for 740,000 deaths, making it the second leading cause of cancer death in the world. According to the American Cancer Society, more than 21,000 people in the United States were diagnosed with gastric cance...
Prostate Cancer Screening Reconsidered
Joshua Spendlove, MD, and E. David Crawford, MD
Prostate cancer is the most prevalent nonskin cancer in men. An estimated 16% of men are diagnosed with prostate cancer, yet only 3% of men die from it.1 Unlike other cancers, prostate cancer is associated with a prolonged lead-time, meaning it can take anywhere from 5 to 12 years to become apparent...
Reflections from The ASCO Post
The ASCO Post
The editors gratefully acknowledge all contributors to The ASCO Post and thank the columnists who contributed to Volume 2, January–December 2011: Al B. Benson III, MD, FACP Richard Boxer, MD, FACS Carlton G. Brown, RN, PhD, AOCN Barrie R. Cassileth, PhD E. David Crawford, MD Emil J. Freireic...
The Art and Grace of Just Letting Go
Richard Boxer, MD, FACS
Like a breeze rippling across a lake, the end of your career is approaching and you cannot escape its path. You can see it coming, and before you know it the inexorable movement will rush past you. You have two choices: Build a sail so that you can capture the energy and move with it, or remain unpr...
Chemotherapy Drug Shortages: A Preventable Human Disaster
Hagop M. Kantarjian, MD
The issue of chemotherapy drug shortages continues with no end in sight. Many heartfelt human interest stories have been told on television, in newspapers, and even to Congress, but the bottom line is that little, if any, action has been taken. Uniquely American Problem News of the generic chemoth...
Helping Cancer Survivors Return to Work
Mary S. McCabe, RN, MA
For many of the 12 million cancer survivors throughout the United States, remaining in the workforce is an important expectation that requires the support and attention of the oncology community. And while continuing employment can be critically important for economic reasons (especially in the curr...
Health-care Policy: A Three-act Play
Richard Boxer, MD, FACS
The health of Americans, the economy, the debt crisis, and the action or inaction in Washington are all seriously interrelated. Decades ago, the bank robber Willie Sutton was asked why he robs banks. His famous answer, “Because that’s where the money is,” succinctly describes the approach that Washi...
Important Benefit for Small Population Is a Major Milestone in Lymphoma
Anas Younes, MD
The approval of brentuximab vedotin (Adcetris) is a major milestone for the treatment of patients with relapsed Hodgkin lymphoma and anaplastic large cell lymphoma. It represents an excellent example of personalized cancer therapy. Patients are preselected based on a predictive biomarker that is exp...
We Can Conduct Clinical Trials of Protons
Theodore S. Lawrence, MD, PhD
A great deal has been written about proton therapy, with a good deal of heat and only a modest amount of light. I would like to comment on an aspect of the proton vs photon controversy that I believe has not been adequately addressed: Should we run clinical trials that would allow us to prove that p...
Conflicts of Interest in Health-care Reform?
Nora Janjan, MD, MPSA, MBA, and John Goodman, PhD
Last year’s health-care reform legislation, the Patient Protection and Affordable Care Act, was designed to incrementally roll out major new bureaucratic entities, oversight, and mandates for the practice of medicine between its enactment and 2013, after the next presidential election. A new lexicon...
My First of Many ASCO Meetings
Richard J. Boxer, MD
In June, I attended my first ASCO Annual Meeting. Although I have been practicing and teaching urology for 35 years with a specific interest in genitourinary oncology and I have attended dozens of national meetings, the ASCO Annual Meetings were not on my radar. Focus on the Patient The opportuni...
Fixing the Drug Shortage: It’s About Time
Derek Raghavan, MD, PhD
I have spent the past 30 years trying to improve the results of treatment for advanced cancer. I had the privilege of working with Sir Michael Peckham when the late Professor Tim McElwain and he were evolving variants of the PVB (cisplatin, vinblastine, bleomycin) and PEB (cisplatin, etoposide, bleo...
Opinion: The FDA–Pharmaceutical Industry Complex
Emil J. Freireich, MD, DSc (Hon)
On January 17, 1961, President Dwight D. Eisenhower, in his farewell address to the nation, coined the term “the military-industrial complex.” His purpose was to warn of the inefficiencies that could result from such a relationship, which would imperil the strength of our military and the safety of ...
Planning Survivorship Programs: An International Endeavor
Mary S. McCabe, RN, MA
The March 11th report by the U.S. Centers for Disease Control and Prevention highlighted once again the growing number of cancer survivors—now approximately 12 million. This good news serves as a reminder to the oncology community of the need for formal care for this increasingly large group of indi...
A Clinician Weighs In on the National Lung Screening Trial
Ramaswamy Govindan, MD
The results of the National Lung Screening Trial (NLST) will have important implications for practicing oncologists if low-dose helical CT screening is used routinely in the clinic. First, we will begin to find many more small tumors than we do now. This will pose new sets of questions for research...
Despite Advances, Little Overall Improvement Seen in Treatment of Older Adults with AML
Charles A. Schiffer, MD
The outcome of treatment of older adults with acute myeloid leukemia (AML) remains unsatisfactory, although certainly not a totally futile exercise. Patients satisfying the entry criteria for cooperative group clinical trials can be expected to have complete remission rates of 50% to 55%, with remis...
Conventional Induction Chemotherapy Beneficial in Only a Subset of Older Adults with AML
Farhad Ravandi, MD
Over the past several decades, progress in the treatment of acute myeloid leukemia (AML) in the older population (generally considered to be older than 60 years) has been limited (Fig. 1). In particular, the outcome of patients over age 70 has been poor, with few long-term survivors. Although AML ...
David A. Tuveson, MD, PhD, on Progress in Pancreatic Cancer: Expert Perspective