Journal Spotlight
PARP Inhibitors in Maintenance Treatment for Advanced Ovarian Cancer
David M. O’Malley, MD, and Antonio Castaneda, MD
Based on multiple phase III prospective trials, there is evidence that both PARP inhibitors and antiangiogenic therapies such as bevacizumab provide benefit when utilized in a maintenance strategy in the first-line treatment of advanced epithelial ovarian cancer (GOG 218, ICON7, SOLO-1, PRIMA, VELIA...
Intestinal Microbiota and Mortality in Recipients of Allogeneic Hematopoietic Cell Transplantation
Matthew Stenger
In a study reported in The New England Journal of Medicine, Jonathan U. Peled, MD, PhD, of the Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center (MSK), New York, and colleagues found that intestinal microbiota from patients undergoing allogeneic hematopoietic cell tra...
Enzalutamide Improves Survival vs Standard First-Line Treatment in Hormone-Sensitive Metastatic Prostate Cancer
Matthew Stenger
As reported in The New England Journal of Medicine by Ian D. Davis, MBBS, PhD, FRACP, FAChPM, of Monash University and Eastern Health in Melbourne, and colleagues, the phase III ENZAMET trial has shown that the androgen receptor inhibitor enzalutamide improved progression-free and overall survival...
Enzalutamide Prolongs Metastasis-Free Survival in Patients With Nonmetastatic, Castration-Resistant Prostate Cancer
Matthew Stenger
AS REPORTED in The New England Journal of Medicine by Maha Hussain, MD, of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, and colleagues, the phase III PROSPER trial has shown a 71% reduction in the risk of metastasis or death with enzalutamide (Xtandi) vs placebo in men...
FALCON Trial Informs the Evolving Role of Fulvestrant in Advanced Hormone Receptor–Positive Breast Cancer
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 procedure utilization begin to decr...
Similar 10-Year Survival With Active Monitoring, Surgery, or Radiotherapy for PSA-Detected Clinically Localized Prostate Cancer
Matthew Stenger
In the UK ProtecT trial reported in The New England Journal of Medicine, Freddie C. Hamdy, FRCS, FMedSci, of the University of Oxford, and colleagues found no significant differences in prostate cancer–specific or overall mortality among men with clinically localized prostate cancer dete...
First-Line Nivolumab Alone and Combined With Platinum-Based Chemotherapy in Advanced NSCLC
Matthew Stenger
The phase I CheckMate 012 study examined the effects of nivolumab (Opdivo) monotherapy and nivolumab combined with platinum-based doublets as first-line treatments in patients with advanced non–small cell lung cancer (NSCLC). Encouraging efficacy and safety findings were reported in the Journal ...
European Studies Compare Conventional vs Hypofractionated Radiotherapy for Localized Prostate Cancer
Matthew Stenger
Two recent European phase III trials with different study designs focused on hypofractionated vs conventional radiotherapy in localized prostate cancer. Investigators in the CHHiP trial1 showed that the hypofractionated approach is noninferior to standard fractionation, with no increase ...
Atezolizumab Improves Survival vs Docetaxel in Previously Treated NSCLC: Increased Benefit With Increased PD-L1 Expression
Matthew Stenger
In the phase II POPLAR trial reported in The Lancet, Louis Fehrenbacher, MD, of Kaiser Permanente Medical Center, and colleagues found that the investigational anti–programmed cell death ligand 1 (PD-L1) antibody atezolizumab improved overall survival vs docetaxel in patients with non–small cell l...
First-Line Ibrutinib Improves Progression-Free and Overall Survival vs Chlorambucil in Older Patients With Chronic Lymphocytic Leukemia
Matthew Stenger
As reported in The New England Journal of Medicine and at the 2015 American Society of Hematology Annual Meeting, Jan A. Burger, MD, PhD, and colleagues found that first-line treatment with the oral Bruton’s tyrosine kinase inhibitor ibrutinib (Imbruvica) improved progression-free and overall surviv...
Adding Elotuzumab to Lenalidomide Plus Dexamethasone Improves Progression-Free Survival in Refractory Multiple Myeloma
Matthew Stenger
In an interim analysis of the phase III ELOQUENT-2 trial reported in The New England Journal of Medicine, Sagar Lonial, MD, of Emory University School of Medicine, Meletios Dimopoulos, MD, of National and Kapodistrian University of Athens, and colleagues found that the addition of elotuzumab to lena...
Radiotherapy or Not in Older Women Receiving Breast-Conserving Surgery and Endocrine Treatment?
Matthew Stenger
In the phase III PRIME II trial, designed to assess whether whole-breast irradiation could be omitted in women aged ≥ 65 years with early-stage breast cancer undergoing breast-conserving surgery and receiving adjuvant endocrine treatment, Ian H. Kunkler, MB BChir, FRCR, of Western General Hospital, ...
ASCO Releases Guideline on Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers
Matthew Stenger
ASCO has released a clinical practice guideline on prevention and treatment of chemotherapy-induced peripheral neuropathy in adult cancer patients, published in the Journal of Clinical Oncology.1 The guidelines resulted from the efforts of an expert panel, with representation from the fields of med...
SSO-ASTRO Consensus Guideline on Margins for Breast-Conserving Surgery in Stage I/II Invasive Breast Cancer
Matthew Stenger
The Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO) formed a multidisciplinary expert panel in 2013 to examine the relationship between surgical margin width and ipsilateral breast tumor recurrence and develop guidelines on margins for breast-conserving surgery...
GeparTrio Long-Term Data Show Response-Guided Neoadjuvant Therapy for Breast Cancer Improves Survival
Matthew Stenger
In an exploratory analysis of long-term survival data from the GeparTrio trial reported in the Journal of Clinical Oncology, Gunter von Minckwitz, MD, PhD, of the German Breast Group in Neu-Isenburg and the University of Frankfurt, Germany, and colleagues found that response-guided neoadjuvant chemo...
Profound and Rapid Molecular Remission with CD19-targeted T Cells in Relapsed B-cell ALL
Matthew Stenger
As was recently reported in Science Translational Medicine, Renier J. Brentjens, MD, and colleagues at Memorial Sloan-Kettering Cancer Center, New York, found that profound molecular remission was rapidly induced in patients with relapsed B-cell acute lymphoblastic leukemia (ALL) using autologous T ...
Bone Marrow Transplants Reduce Risk of Graft-vs-Host Disease Compared to Peripheral Blood
Caroline McNeil
Patients who receive bone marrow transplants are significantly less likely to develop chronic graft-vs-host disease than those who receive peripheral blood stem cell transplants, according to a new, large randomized trial, the first of its kind with unrelated donors. Published recently in The New En...
No Advantage to Longer Adjuvant Chemotherapy in Women with Early Breast Cancer: CALGB 40101 Trial
Matthew Stenger
The ideal duration of adjuvant therapy for women with lower-risk primary breast cancer remains unknown. The National Surgical Adjuvant Breast and Bowel Project (NSABP) B-15 trial, reported more than 20 years ago, found no difference in outcomes between six cycles of cyclophosphamide, methotrexate, a...
Study Shows Routine CT Surveillance Overused in Pediatric Hodgkin Lymphoma
Matthew Stenger
The value of routine CT surveillance monitoring of pediatric patients for recurrence of Hodgkin lymphoma has been unclear. A study of CT surveillance recently reported by Stephan D. Voss, MD, PhD, and colleagues from the Children’s Oncology Group (COG) in the Journal of Clinical Oncology showed that...
ASCO Issues New Guideline on Chemotherapy Dosing for Obese Patients
In April, ASCO released a new clinical practice guideline on the appropriate dosing of chemotherapy drugs given to obese adult patients with cancer. The result of an analysis by a panel of experts assembled by ASCO, the guideline calls for the use of a patient's actual body weight when calculating c...
Incorporating Immunotherapy Into Treatment of Early-Stage NSCLC
Neal Ready, MD, PhD
There is a strong rationale for incorporating immunotherapy into the treatment of early-stage non–small cell lung cancer (NSCLC), given the breakthrough results with PD-1 checkpoint inhibitors as monotherapy, combined with immunotherapy, or combined with chemotherapy in advanced-stage NSCLC. As revi...
Gut Bacterial Diversity: A Marker or Driver of Outcomes After Hematopoietic Cell Transplantation?
David N. Fredricks, MD
Previous single-center studies have linked the gut microbiota (via stool sample analysis) to outcomes after hematopoietic cell transplantation (HCT), such as overall mortality, transplant-related mortality, graft-vs-host disease, and graft-vs-host–related mortality.1-4 Although intriguing, these stu...
Front-Line Therapy in Advanced Renal Cell Carcinoma: Developing a New Standard
Rana R. McKay, MD
THE FRONT-LINE systemic treatment landscape for metastatic renal cell carcinoma has undergone tremendous movement over the past several years. A better understanding of the current management paradigm for therapy-naive patients warrants a reflection of historic landmark clinical trials that have c...
Treating Nonmetastatic Castration-Resistant Prostate Cancer: Implications of the PROSPER Trial
Konrad H. Stopsack, MD, MPH, and Philip Kantoff, MD
A MAN in his early 70s sits in our office. His general health is good, and he is feeling well. Yet he is deeply worried. Four years ago, when his prostate-specific antigen (PSA) level rapidly increased after radical prostatectomy and subsequent radiation therapy, he was started on androgen-depri...
Encorafenib Plus Binimetinib Improves Progression-Free Survival vs Vemurafenib in Advanced BRAF-Mutant Melanoma
Matthew Stenger
IN THE PHASE III COLUMBUS trial reported in The Lancet Oncology, Reinhard Dummer, MD, of University Hospital Zurich, and colleagues found that the combination of the BRAF inhibitor encorafenib and the MEK inhibitor binimetinib improved progression-free survival vs vemurafenib (Zelboraf) in patient...
ASCO Issues Statement on Alcohol Consumption and Cancer Risk
Matthew Stenger
As reported in the Journal of Clinical Oncology by Noelle K. LoConte, MD, of the University of Wisconsin, Madison, and colleagues, ASCO has issued a statement on the association of alcohol consumption with cancer risk that outlines proposals for promoting awareness of the association, supporting r...
A New Triumvirate in Estrogen Receptor–Positive Metastatic Breast Cancer
Neil Vasan, MD, PhD, and Maura N. Dickler, MD
THE BODY OF EVIDENCE supporting the use of cell-cycle inhibitors in combination with endocrine therapy for estrogen receptor–positive metastatic breast cancer now has another agent in the spotlight. The phase III MONARCH 2 trial—reported at the 2017 ASCO Annual Meeting and by Sledge et al in the...
Proof of Principle for Adoptive T-cell Therapy in Cancer
Matthew Stenger
In a recently published study, Memorial Sloan-Kettering Cancer Center investigators demonstrated the considerable antitumor efficacy of 19-28z chimeric antigen receptor (CAR)-modified T cells in patients with relapsed/refractory B-cell acute lymphoblastic leukemia (ALL). The ASCO Post asked lead aut...
New Guideline on Systemic Therapy for Melanoma Tackles Rapid Developments in Treatment Options
Geraldine Carroll
Systemic treatment of melanoma has changed rapidly since the introduction of ipilimumab in 2011. Newer therapies approved for melanoma since that time include immunotherapy, targeted therapy for mutation-bearing tumors, and injectional therapy for cutaneous or palpable lesions. ASCO has released the...
ASCO Releases Resource-Stratified Guideline on the Treatment of Late-Stage Colorectal Cancer
Leah Lawrence
ASCO has released a new guideline for clinicians and policymakers in resource-constrained settings on treating patients with late-stage colorectal cancer.1 “Around the world, there is a huge variation in resources, and what is available to clinicians may change week to week,” said Mary D. Chamber...
Ramucirumab Plus Erlotinib Improves Progression-Free Survival in Previously Untreated EGFR-Mutated Advanced NSCLC
Matthew Stenger
As reported in The Lancet Oncology by Kazuhiko Nakagawa, MD, of the Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, and colleagues, the phase III RELAY trial has shown that the addition of the VEGFR2 inhibitor ramucirumab to the EGFR inhibitor erlotinib improved progres...
Bosutinib Improves Response Rate vs Imatinib as First-Line Treatment of Chronic Myeloid Leukemia
Matthew Stenger
IN THE PHASE III BFORE trial reported in the Journal of Clinical Oncology by Jorge E. Cortes, MD, of The University of Texas MD Anderson Cancer Center, and colleagues, the SRC/ABL kinase inhibitor bosutinib (Bosulif) improved response rates vs imatinib in the first-line treatment of patients with ...
Deep Androgen Suppression Plus Abiraterone and Prednisone: Effective Strategy for Hormone-Naive Prostate Cancer
Anis Hamid, MBBS, and Christopher J. Sweeney, MBBS
ANTAGONISM OF THE ANDROGEN AXIS remains a cornerstone of systemic therapy for high-risk localized and metastatic prostate cancer, reflecting the central role of androgen-dependent biologic mechanisms in hormone-naive disease. Despite the use of standard androgen-deprivation therapy, men with met...
ASCO and AACI Initiative to Reduce Administrative and Regulatory Burden in Cancer Clinical Trials
Matthew Stenger
As reported in the Journal of Clinical Oncology, Julie M. Vose, MD, MBA, FASCO, of the University of Nebraska Medical Center, Omaha, and colleagues have provided a summary of the groundwork of an initiative by ASCO and the Association of American Cancer Institutes (AACI) to identify and ...
Immune Gene Profile Strongly Associated With Benefit of Adjuvant Trastuzumab in HER2-Positive Breast Cancer
Matthew Stenger
In a study reported in the Journal of Clinical Oncology, Edith A. Perez, MD, of the Mayo Clinic, Jacksonville, and colleagues found that an immune function gene profile was associated with significantly improved relapse-free survival among patients with early-stage HER2-positive breast cancer who ha...
Oncology Practice: What Are the Factors Driving Change?
Caroline McNeil
Clinical practice changes in response to new medical evidence, but not always immediately or all at once. So what else determines whether and how quickly practice changes in response to evidence, for instance, that a widely used drug is effective only in patients with a certain biomarker? In a new ...
Sharing Treatment Decision-Making With Patients: Where’s the Evidence of Value?
Caroline Helwick
Though certainly not new to oncologists, “shared decision-making” between doctors and patients is receiving increased attention in the medical community today. While it’s an idea with merit, Steven J. Katz, MD, MPH, a specialist in quality care issues, maintains that expectations about the potential...
One Cancer Center's Approach to Death with Dignity
Frederick R. Appelbaum, MD
In November 2008, the Washington State legislature passed the Washington Death with Dignity Act allowing patients with a terminal diagnosis and less than 6 months to live to request and self-administer lethal medication. After considerable internal debate, our cancer center elected to develop a Deat...
Study Finds Young Cancer Survivors Often Skip Checkups
Athough the majority of the more than 69,000 adolescents and young adults (AYAs) diagnosed with cancer each year will survive their disease, many of them will experience interruptions in their education and a derailment in their career tract, curtailing their lifetime earning potential and reducing ...
Patient Expectations of Benefit in Early-phase Trials: Ethics Issues in Informed Consent
Matthew Stenger
It has been found that many patients in early-phase oncology trials believe their chance of benefit to be much higher than estimates derived from historical data.1-3 In a recently reported study in Journal of Clinical Oncology, Kevin P. Weinfurt, PhD, of Duke Clinical Research Institute, and colleag...
Decoding the Genetic Blueprint of Cancer Cells: Findings in Multiple Myeloma and Breast Cancer
Advances in next-generation DNA sequencing technologies are allowing scientists to decipher the whole genome or whole exome (ie, the coding region of the genome) of cancer specimens more quickly and inexpensively than ever before. And the results are revealing genes that had not previously been asso...
No Biochemical Progression-Free Survival Benefit With Adjuvant vs Salvage Radiotherapy After Radical Prostatectomy for Prostate Cancer
Matthew Stenger
As reported in The Lancet by Christopher C. Parker, MD, of Royal Marsden NHS Foundation Trust, Sutton, United Kingdom, and colleagues, initial findings in the phase III RADICALS-RT trial have shown no biochemical progression-free survival benefit with adjuvant radiotherapy vs a policy of salvage rad...
IMbrave150 Trial: Atezolizumab Plus Bevacizumab Improves Survival in Unresectable Hepatocellular Carcinoma
Matthew Stenger
As reported in The New England Journal of Medicine by Richard S. Finn, MD, of Jonsson Comprehensive Cancer Center, Geffen School of Medicine at the University of California, Los Angeles, and colleagues, the phase III IMbrave150 trial has shown that anti–programmed cell death ligand 1 (PD-L1) plus an...
POLO Trial: Maintenance Olaparib in Germline BRCA-Mutated Metastatic Pancreatic Cancer
Matthew Stenger
As reported in The New England Journal of Medicine by Talia Golan, MD, of Sheba Medical Center, Tel Aviv University, and colleagues, the phase III POLO trial showed that maintenance treatment with the poly (ADP ribose) polymerase (PARP) inhibitor olaparib improved progression-free survival vs placeb...
PACIFIC Trial of Durvalumab Sets Standard in Stage III Unresectable NSCLC
Karen L. Reckamp, MD, MS
IMMUNOTHERAPY HAS revolutionized the treatment of lung cancer over the past several years. Although lung cancer is associated with immunosuppression at baseline for most patients, the addition of immune checkpoint inhibitors can overcome that suppression and lead to antitumor immune responses. Ant...
MSLT-II Completion Lymph Node Dissection Trial: Practice Changing but Not Likely Practice Abandoning
Merrick I. Ross, MD
PROBABLY THE MOST IMPORTANT advance in the treatment of newly diagnosed primary melanoma has been the incorporation of sentinel lymph node biopsy as part of initial surgical management. The routine use of sentinel lymph node biopsy, often termed “sentinel lymphadenectomy,” in appropriately selecte...
ASCO Releases 2015 Report on The State of Cancer Care in America
In March, ASCO published its second annual report, The State of Cancer Care in America: 2015.1 Its findings show a mixed landscape, on the one hand, spotlighting advances in therapy and improving survival rates, but on the other, describing a cancer care system under stress from increasing demand fo...
Presurgical Gemcitabine/Cisplatin Improves Survival in Lung Cancer
Charlotte Bath
Preoperative gemcitabine plus cisplatin had a statistically significant impact on outcomes among patients with stage IIB/IIIA non–small-cell lung cancer in a phase III randomized study comparing surgery alone or surgery plus preoperative chemotherapy. The 3-year progression-free survival rates were ...
Neratinib in Previously TreatedHER2-Positive Metastatic Breast Cancer: Point of View From the NALA Trial
Kimberley T. Lee, MD, MHS, and Cesar A. Santa-Maria, MD, MSCI
Neratinib is an oral pan-HER tyrosine kinase inhibitor that is approved by the U.S. Food and Drug Administration (FDA) for two indications. The first is as adjuvant treatment of early-stage HER2-positive breast cancer following adjuvant trastuzumab therapy. The second is in combination with cape...
Front-Line Therapy in Advanced Renal Cell Carcinoma: Developing a New Standard
Rana R. McKay, MD
THE FRONT-LINE systemic treatment landscape for metastatic renal cell carcinoma has undergone tremendous movement over the past several years. A better understanding of the current management paradigm for therapy-naive patients warrants a reflection of historic landmark clinical trials that have c...
