At Microphone 1
Do Not Rush to High-Dose Twice-Daily Radiation for Limited Small Cell Lung Cancer
Steven E. Vogl, MD
Bjørn Henning Gronberg, MD, PhD, presented a paper at the ASCO20 Virtual Scientific Program reporting astounding positive results favoring higher-dose, twice-daily radiation therapy in limited-stage small cell lung cancer.1 This was a phase II study (large for phase II but small for phase III) condu...
Neoadjuvant Cisplatin for BRCA-Mutation Carriers: Pruning the Dead Branches
Steven E. Vogl, MD
At the 2019 San Antonio Breast Cancer Symposium, Nadine Tung, MD, of Beth Israel Deaconess Medical Center, presented a multisite study called INFORM, run by the Translational Breast Cancer Research Consortium.1 It compared single-agent cisplatin with a “classic” combination of doxorubicin and cycl...
Tumor Size and Grade Matter, and Ovarian Ablation by Chemotherapy May Explain Subgroup Anomaly in TAILORx
Steven E. Vogl, MD
At the 2019 ASCO Annual Meeting, and simultaneously in The New England Journal of Medicine, we heard the third paper reporting results from TAILORx.1,2 The first, in 2015,3 indicated that women with node-negative breast cancers with Oncotype DX recurrence scores less than 11 did extremely well wit...
Denosumab Prevents Neither Breast Cancer Relapse Nor Death
Steven E. Vogl, MD
The recently published report of Austrian Breast and Colorectal Cancer Study Group’s Study 18 (ABCSG-18)1 for the secondary endpoint of disease-free survival suggests that denosumab given in a low dose of 60 mg subcutaneously every 6 months during aromatase inhibitor adjuvant therapy is beneficial...
The Risks of Drug Approval Based on Shaky Evidence
Steven E. Vogl, MD
Two recent publications in The New England Journal of Medicine (NEJM), and the resulting drug approval applications that have already been filed, lead to concern that the basis of medical practice on valid evidence may be corrupted. Each involves statistically shaky analysis leading to a striking ...
Duration Studies in Oncology Have Often Been Poorly Designed and Analyzed
Steven E. Vogl, MD
The ASCO Post is pleased to introduce “At Microphone 1,” an occasional column written by Steven E. Vogl, MD, of Bronx, New York. When he’s not in his clinic, Dr. Vogl can generally be found at major oncology meetings, and often at the microphone where he stands ready with important questions for pre...
Adjuvant Pertuzumab in HER2-Positive Breast Cancer: Value Yet to Be Demonstrated
Steven E. Vogl, MD
The ASCO Post issue of June 25, 2017, did an excellent job of summarizing the results and controversy generated by the initial results of the APHINITY trial, reported at the 2017 ASCO Annual Meeting and published simultaneously online in The New England Journal of Medicine.1 With a median follow-up ...
Model Emphasizes Long-Term Risks of Ovarian Ablation Plus Aromatase Inhibitor
Steven E. Vogl, MD
“At Microphone 1” is an occasional column written by Steven E. Vogl, MD, of Bronx, New York. When he’s not in his clinic, Dr. Vogl can generally be found at major oncology meetings and often at the microphone, where he stands ready with critical questions for presenters of new data. Here Dr. Vogl ...
Neratinib Is Approved: Should We Reject It Anyway?
Steven Vogl, MD
The U.S. Food and Drug Administration (FDA) approved 1 year of extended adjuvant neratinib (Nerlynx) after chemotherapy and a year of trastuzumab (Herceptin) for HER2-positive breast cancer this summer on the basis of the ExteNET trial. Many were surprised at the approval, since the evidence of be...
WHAT SHOULD PUMA DO?
Steven Vogl, MD
Puma should invest in developing an escalating-dose schedule for neratinib (Nerlynx). If one plans on giving a drug for a year, and starts after finishing a year of effective adjuvant therapy, there is no hurry to begin at full, intolerable doses. Starting at a lower dose and escalating slowly as to...
Duration of Adjuvant Oxaliplatin-Based Therapy for Stage III Colon Cancer
Steven E. Vogl, MD
“At Microphone 1” is an occasional column written by Steven E. Vogl, MD, of the Bronx, New York. When he is not in his clinic, he can generally be found at major oncology meetings and often at the microphone, where he stands ready with critical questions for presenters of new data. The opinions expr...
Extended Duration of Aromatase Inhibitors Need Not Be Very Long
Steven E. Vogl, MD
At the 2017 San Antonio Breast Cancer Symposium (SABCS), Michael Gnant, MD, FACS, of the Medical University of Vienna presented the 9-year median follow-up of a trial looking at the length of extended aromatase inhibitor therapy. At least four other recently presented or published trials have addr...
Should We Treat Rising PSA in Men With Castrate Androgen Levels?
Steven E. Vogl, MD
In rapid succession, the SPARTAN study results were presented at the 2018 Genitourinary Cancers Symposium, the data were published in The New England Journal of Medicine,1 and the drug apalutamide -(Erleada) was approved by the U.S. Food and Drug Administration (FDA) for men with previously treate...
TAILORx: How to Apply This Landmark Study
Steven E. Vogl, MD
TAILORx changes the configuration of the ball field and the shape of the ball in deciding which women will be recommended chemotherapy after resection of node-negative, hormone receptor–positive breast cancer. TAILORx was presented by Joseph Sparano, MD, at the 2018 ASCO Plenary Session and simult...
The Persephone Trial Reconsidered
Steven E. Vogl, MD
The Persephone presentation by Helena Margaret Earl, MBBS, PhD, got a lot of publicity after a pre–ASCO Annual Meeting press release, suggesting that 6 months of adjuvant trastuzumab (Herceptin) is enough. The advice of experts has been that the evidence is inconclusive, but I have not heard a det...
The Persephone Trial Reconsidered
Steven E. Vogl, MD
Persephone is a 4,088-patient trial that Helena Margaret Earl, MBBS, PhD, reported at the 2018 ASCO Annual Meeting as establishing that 6 months of trastuzumab (Herceptin) is not inferior to 12 months in 4-year survival without invasive or local regional recurrence or distant metastases. Dr. Earl ...
Encourage Lung Cancer Screening to Prevent Early Deaths
Steven E. Vogl, MD
Discussions of benefits and harms from screening of high-risk populations for lung cancer have missed the point. The National Lung Screening Trial (NLST) showed an early and statistically significant major benefit in all-cause mortality from computed tomography (CT) screening.1 Those referred for ...
