Perspectives
Reflecting on My First National Presentation
Larry Leichman, MD
I gave my first national presentation of my original clinical research on a topic that was to become a professional obsession: finding a cure for esophageal cancer. (Spoiler, I failed.) It was late May 1982. Writing about this now is undoubtedly predicated on my recent retirement, my desire to loo...
Younger, Fit Patients With CLL: Goal Remains Undetectable Minimal Residual Disease and Time-Limited Therapy
Jennifer R. Brown, MD, PhD
As reviewed in this issue of The ASCO Post, Shanafelt and colleagues recently published the interim analysis of E1912, a U.S. Intergroup–led randomized phase III trial comparing ibrutinib/rituximab, followed by ibrutinib to disease progression vs 6 months of fludarabine, cyclophosphamide, and rituxi...
Multimodal Therapy for High-Risk or Locally Advanced Endometrial Cancer: Is It Any Clearer in 2019?
Maureen E. Roberts, MD, and Christina S. Chu, MD
Endometrial cancer remains the most common gynecologic malignancy affecting women in the United States. There are over 60,000 new cases diagnosed and more than 12,000 deaths annually. Traditional management includes surgical staging, with optimal disease cytoreduction as able, and adjuvant thera...
Targeting an Important Tumor Vulnerability With Maintenance Olaparib in Germline BRCA-Mutated Pancreatic Cancer
Brian M. Wolpin, MD, MPH
In the POLO trial, which is discussed in this issue of The ASCO Post, Golan and colleagues evaluated the potential benefit of maintenance olaparib after disease stability or response to a minimum of 4 months of platinum-based chemotherapy in patients with metastatic pancreatic cancer and a pathogeni...
The Fight Against Breast Cancer Illustrates the Health-Care Challenges of Women in Poverty
Quyen D. Chu, MD, MBA, FACS
"Of all the forms of inequality, injustice in health is the most shocking and the most inhumane….” —Dr. Martin Luther King, Jr Progress has been made in expanding access to health care for low-income populations, but the quality of care still lags behind and can result in less successful outcomes ...
Hey Siri, Should I Get a Medical Degree?
Timothy D. Murtha, MD, MHS, and Nita Ahuja, MD, MBA
I received a coffee mug from a physician colleague some years ago with the tag line: “Please do not confuse your Google search with my Medical Degree.” Physicians of all stripes and colors can relate to the agony of debunking a “Dr. Google” diagnosis. However, in a fast-evolving health-care land...
Many Choices Now for Men With Metastatic Hormone-Sensitive Prostate Cancer: How to Decide?
Andrew J. Armstrong, MD, SCM, FACP
Based on the recently published ENZAMET, ARCHES, and TITAN trials,1-3 we now have several choices of systemic combination therapies for men with metastatic hormone-sensitive prostate cancer; the ENZAMET trial is reviewed in this issue of The ASCO Post. In 2019, men are now faced with decisions of ...
TITAN Trial: Apalutamide Adds to Options for Men With Metastatic Hormone-Sensitive Prostate Cancer
Fred Saad, MD, FRCS
Androgen-deprivation therapy has been, and remains, the standard of care for patients with metastatic prostate cancer. Patients are often surprised to know that was all we would do to control their disease and sometimes asked why they would not get chemotherapy, as for other cancers. I would take th...
All Oncologists Are Geriatric Oncologists...They Just Don’t Know It Yet
Stuart Lichtman, MD
You don’t have to be a geriatrician to properly evaluate and manage older patients with cancer. The wave of older patients with cancer predicted over 30 years ago is now fully upon us. The oncology community finds itself ill-prepared to manage the increased number of older patients. It is not just t...
Gender Equity
Stephanie Graff, MD
Diversity, inclusion, and gender equality were prevalent themes for 2019 that ran throughout the ASCO Annual Meeting. From the first year that featured free onsite child care for attendees, to a session on “Establishing a Mutually Respectful Environment in the Workplace,” as well as a Plenary Sess...
No Man Is an Island: Reflections From an ASCO IDEA Recipient
Frederic Ivan Leong Ting, MD
IT WAS a chilly Chicago morning, and I was sitting at the lobby of my hotel when I saw a smiling gentleman cheerfully waving at me from his car. It was Lawrence H. Einhorn, MD, picking me up for our drive to Indiana. I was one of the recipients of the ASCO International Development and Education Awa...
Physicians and the Threat of Nuclear War
Robert Peter Gale, MD, PhD, DSc(hc), FACP, FRCP, FRCPI(hon), FRSM, and David G. Nathan, MD
The Hippocratic Oath calls on physicians to “use treatment to help the sick according to my ability and judgment,” but not all versions of the oath call on us to prevent disease. Here we urge our colleagues to acknowledge that additional mandate and renew their commitment to preventing what coul...
Winning the Lottery
Sir Murray F. Brennan, MD
I was born at the beginning of World War II in a country half way around the world from the fighting. As a child, I was immune to the carnage. My father was too old to be included, although his elder brother had been killed in World War I. Thousands of families in many countries lost a father, a b...
An ASCO Survey, Hope, and Conventional Therapies
Wendy S. Harpham, MD, FACP
HOW DO YOU respond when patients with a good prognosis want to delay chemotherapy to try an anticancer diet for a few months or visit an unregulated clinic for unproven therapies? I’m asking because of an alarming finding of ASCO’s 2018 National Cancer Opinion Survey: “Nearly 4 in 10 Americans bel...
Accelerated Approval Program: For the Benefit of Patients
Ellen V. Sigal, PhD
A DIAGNOSIS of any life-threatening cancer or other serious illness has always been a world-shaking event for those touched by significant disease, and most of us have known—or will know—the frustration, helplessness, and desperate sense of urgency provoked by the words, “The disease is worsening, a...
Darolutamide in Nonmetastatic Castration-Resistant Prostate Cancer: Delaying Overt Metastatic Disease Is a Major Advance
Michael T. Schweizer, MD, and Daniel W. Lin, MD
Nonmetastatic (M0) castration-resistant prostate cancer arises in the subset of men with biochemically recurrent disease (ie, rising prostate-specific antigen [PSA] level after definitive therapy in the absence of metastases) who develop PSA progression after chronic exposure to androgen-depriva...
What We Remember: From D-Day to Cancer Care
Jonathan Lewis, MD, PhD
I RECENTLY returned from Normandy, France, where my wife and I attended events honoring the 75th Anniversary of D-Day and the millions, including close friends and family, who fought and died in the Second World War. My wife and a journalist from Los Angeles laid a wreath on Omaha Beach in honor of ...
How Have We Got It So Wrong?
John F. Smyth, MD
The past 20 years have seen an unprecedented increase in the development of effective drugs for the management of cancer. The advent of immunotherapy offers even the promise of cure for some previously highly resistant diseases. The science is brilliant, the need is ever increasing—but the cost is...
Aspirin Use and Cancer Prevention: Long-Term Data Needed on Benefits and Risks
Ernest Hawk, MD, MPH, and Karen Colbert Maresso, MPH
In addition to its well-known cardioprotective benefits, aspirin has a substantial body of observational, preclinical, and clinical evidence supporting its efficacy in preventing cancer, most strongly for colorectal cancer.1 The strength of this evidence led the U.S. Preventive Services Task For...
Marking a Year of Learning From ASCO Members
Monica M. Bertagnolli, MD, FACS, FASCO
This past year, I have traveled thousands of miles across the United States meeting with ASCO members and their patients, focusing on members who care for patients in particularly challenging settings. While I am not surprised by the extraordinary work our members are doing in every region of the ...
Trastuzumab Emtansine in Treatment of Residual Breast Cancer After Neoadjuvant Therapy: Who Will Benefit?
Chau T. Dang, MD, Pedram Razavi, MD, PhD, Sarat Chandarlapaty, MD, PhD, and Shanu Modi, MD
The discovery of trastuzumab has been revolutionary in the treatment of HER2-positive breast cancer, both in the metastatic and early-stage settings.1-6 This cannot be disputed. In the early-stage setting, the addition of trastuzumab to standard chemotherapy has led to a 50% gain in disease-...
Combination Immunotherapy With Lenalidomide Plus Rituximab in Indolent NHL: Time to Replace Rituximab Monotherapy?
Franck Morschhauser, MD, PhD
With increasing knowledge on the key role of the tumor microenvironment in lymphomagenesis, treatments for indolent B-cell lymphoma, especially follicular lymphoma, are mechanistically moving toward a more immunomodulatory approach. Chemotherapy-free regimens are an attractive alternative to convent...
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...
Harnessing the Power of Twitter for Clinical Trial Enrollment and Success
Miriam A. Knoll, MD
CLINICAL TRIALS are vital for advancing cancer care for our patients. Each trial represents an unanswered problem for which researchers are committed to solving. Designing, funding, recruiting, and completing a trial are tremendous undertakings for each researcher, physician, patient, and organizati...
Physician Identity and Physician Wellness Are Inextricably Linked
Chandrakanth Are, MBBS, MBA, FRCS, FACS
Imagine a 70-year-old patient who is scheduled for a pancreaticoduodenectomy. On the morning of surgery, the patient is checked in at the front desk by the “data-entry provider.” The patient is taken to the preoperative area, where the appropriate formalities are completed by multiple “bedside-care ...
Psychosocial Care Is a Critical Component of Value-Based Oncology
Ellen Miller-Sonet, JD, MBA
The ongoing dialogue regarding health-care payment reform that attempts to incentivize high-value care by linking reimbursement to quality rather than quantity has largely ignored the ultimate consumer/buyer—the patient. Yet, in the minds of clinicians, policymakers, and the public at large, patient...
Shared Decision-Making in Lung Cancer Screening: Whence? Whither?
Frederic W. Grannis, Jr, MD, and Sheila Ross
We read with interest a recent article published on ASCOPost.com, which summarized a paper on the role of shared decision-making in lung cancer screening.1,2 The summary and original report highlight a mandate by the Centers for Medicare & Medicaid Services (CMS) that bears careful considera...
Ramucirumab After Sorafenib in Advanced Hepatocellular Carcinoma: An Efficacious Therapy With Applicability Challenges
Thomas A. Abrams, MD
In the 2 years since the U.S. Food and Drug Administration’s (FDA) approval of regorafenib in the treatment of patients with sorafenib-refractory advanced hepatocellular carcinoma, we oncologists have witnessed a veritable avalanche of newly approved medicines for the treatment of advanced hepatoc...
Fine-Tuning an ‘Airport Diagnosis’
Maxwell M. Krem, MD, PhD
HIS HEAD WAS DIFFERENT from those of the other people in line. He bore a matrix of white rows of circular patches on his shaved scalp like a wig. The patches were electrodes, connected by cords to a power supply in a satchel around his shoulder. I was able to make an instant and unfortunate “airport...
Caring: Isn’t That Why We Went to Medical School?
Sir Murray F. Brennan, MD
YOU CANNOT write about caring; you must practice it. None of us went to medical school thinking we would be an oncologist or a neurosurgeon or a stem cell biologist. But we did have vague aspirations of wanting to help others: to be involved in other lives. It was an altruistic avocation; how coul...
Prostatectomy vs Watchful Waiting: Clinical Dilemma Centers on Aggressive vs Indolent Disease
Hind Rafei, MD, and Brian F. Chapin, MD
THE MANAGEMENT of localized prostate cancer remains controversial. Although the widespread use of prostate-specific antigen (PSA) testing has resulted in a dramatic increase in the diagnosis and treatment of prostate cancer, many men do not benefit from intervention because the disease is either...
CAR T-Cell Therapy for DLBCL: At the Crossroads of Hype and Reality
Parameswaran Hari, MD, MRCP
In the 20-plus years I have spent in hematologic oncology, I have been fortunate to have a ringside seat to watch “game-changing” advances come into our field—all-trans retinoic acid for acute promyelocytic leukemia, tyrosine kinase inhibitors starting with imatinib for chronic myeloid leukemia, the...
10 Patient-Centered Principles for More Conservative Cancer Diagnosis
Andrea J. Lim; Sumit Agarwal, MD; Sedan M. Dulgarian; Lynn A. Volk, MHS; and Gordon D. Schiff, MD
Although diagnostic errors date back to antiquity, in recent years, they have begun to receive attention as an important patient safety issue. This culminated in the National Academy of Medicine’s 2015 landmark report, which concluded that most people in the United States would experience ...
National Consensus Project Clinical Practice Guidelines: Improving Education on the Tenets of Palliative Care
Cardinale B. Smith, MD, PhD
The provision of palliative care (primary or specialty) is paramount to providing excellent quality care to all patients with cancer. Palliative care is associated with improving the quality of life, mood, and survival in patients with cancer. In fact, ASCO guidelines recommend that patients with ad...
Reshaping the Treatment Landscape in Refractory Multiple Myeloma
Shaji K. Kumar, MD
THE TREATMENT approaches for multiple myeloma, both newly diagnosed and relapsed disease, continue to undergo major transformation as new agents and combinations are being introduced.1 This change has been driven by the introduction of novel drug classes such as monoclonal antibodies, as well as n...
A Peaceful Transformation: The Origin of the Frederick National Laboratory
Ethan Dmitrovsky, MD; Douglas R. Lowy, MD; and Norman E. Sharpless, MD
JUST 2 MONTHS before Congress passed what to this day is America’s most sweeping anticancer legislation, President Richard Nixon came to Fort Detrick in Frederick, Maryland, to declare his administration’s historic commitment to the fight. “I have come here today for the purpose of making an announ...
Conference Highlights From the 2018 American Society of Hematology Annual Meeting & Exposition
Krishna Gundabolu, MBBS
In sunny San Diego, the 2018 American Society of Hematology (ASH) Annual Meeting & Exposition welcomed nearly 30,000 attendees who were eager to present, learn, network, and cheer the joint achievements of many researchers. The packed meeting was filled with important information from thousand...
‘Curve 2’ and Oncology: What Those in Charge Don’t Understand … or Ignore
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, FAAAS
THERE IS little doubt that the U.S. health-care system is under assault from many directions.1 It is clear that the costs of health management are no longer sustainable, and the United States has one of the highest per capita health costs among the 36 member nations of the Organisation for Economi...
Physician Wellness: Time to Heal the Healer
Chandrakanth Are, MBBS, MBA, FRCS, FACS
Physician wellness is emblazoned upfront in the news with attention-seeking headlines on a daily basis. The fact that one or two physicians commit suicide every day in this country sometimes elicits more of a sympathetic acknowledgment than a committed call to address it. Moreover, these sobering ...
Progress With ALK Inhibitors: When Will We Consider ALK-Positive Lung Cancer a ‘Chronic Disease’?
Fred R. Hirsch, MD, PhD
As reported by Solomon et al in The Lancet Oncology1 and reviewed in this issue of The ASCO Post, results from a global phase II study of the third-generation ALK inhibitor lorlatinib showed a high overall response rate and high intracranial response rate for patients with advanced ALK-positive no...
Essential Elements of an Effective Clinical Trials System: Business and Mission
Thomas E. Witzig, MD
Clinical trials aimed to improve health and quality of life are the cornerstone of progress in medicine. Support comes from academic medical centers, philanthropy, the National Institutes of Health (NIH), industry, or combinations thereof. Clinical trials need to be hypothesis-driven and address a...
Breast Cancer Surgical Terminology Should Be Updated to Reflect Modern Medical Practice
Damien Hansra, MD
BREAST CANCER is a microscopic disease, with most patients presenting with “localized” stage I to III disease, for which they are offered curative-intent surgery often accompanied by radiation therapy, chemotherapy, and hormonal therapy. More accurately, we now know that patients with localized br...
How to Save Billions on Cancer Care Costs: The Potential of Value-Based Prescribing in Oncology
Allen S. Lichter, MD, FASCO, and Mark J. Ratain, MD
IT IS TIME for value-based prescribing—the reduction of prescribing costs using basic pharmacologic principles—to be tested and deployed in oncology. The savings are real and there for the taking. If you are concerned about the high costs in cancer care, here is a chance to get maximum value for...
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...
IMpassion130 Trial: Changing the Treatment Landscape in Metastatic Triple-Negative Breast Cancer
Kevin Kalinsky, MD, MS, and Dawn Hershman, MD, MS
THE IMPASSION130 trial—reported in The New England Journal of Medicine by Schmid et al1 and reviewed in this issue of The ASCO Post—was an eagerly awaited study in newly diagnosed metastatic triple-negative breast cancer. To briefly review, 902 patients were randomly assigned in a 1:1 fashion to...
Will the Trump Administration’s Plan to Reduce Cancer Drug Prices Work?
Hagop M. Kantarjian, MD
High drug prices are the number one health-care concern of many Americans. The average price of a cancer drug rose from less than $10,000/yr before 2000 to more than $170,000/yr in 2017.1-3 Between 1995 and 2013, the launch price of cancer drugs increased by 10% to 12% every year, and the average ...
How to Build a Clinical Trial Infrastructure in the Community Oncology Setting
Mehmet Sitki Copur, MD, FACP
HISTORICALLY, CLINICAL research has been viewed as an entity belonging to academic settings alone. With the advent of the Community Clinical Oncology Program (CCOP) in the 1980s and later with the Cancer Trials Support Unit, cancer clinical trials have begun to emerge in the community setting. Pro...
Should Oncologists Recommend Cannabis?
Donald I. Abrams, MD
A RECENT survey of 400 clinical oncologists found that 80% discuss the use of medical cannabis with their patients, and although nearly 50% recommend it, fewer than 30% consider themselves knowledgeable enough to make such recommendations.1 Oncologists are perhaps among the most evidence-demanding...
Encorafenib and Binimetinib: A New Benchmark in Metastatic Melanoma Therapy?
William H. Sharfman, MD
IN JULY 2018, the U.S. Food and Drug Administration (FDA) approved the combination of the oral BRAF inhibitor encorafenib (Braftovi) and the oral MEK inhibitor binimetinib (Mektovi) for BRAF V600E– or V600K– positive metastatic melanoma. The FDA approval was based on the results of the COLUMBUS tr...
Dealing With the Challenges Presented by the Parenteral Opioid Shortage
Amitabh Gulati, MD
The opioid drug problem in the United States is a crisis, with unprecedented numbers of overdose deaths. The reaction to this has resulted in new federal laws and regulations aimed at restricting overuse and overprescribing of opioids. However, these well-intentioned actions, along with other atte...
Duvelisib in Resistant Chronic Lymphocytic Leukemia: Expanding the Treatment Armamentarium
Catherine C. Coombs, MD, and Anthony R. Mato, MD, MSCE
The phase III DUO trial, reported by Flinn et al and reviewed in this issue of The ASCO Post, has led to the U.S. Food and Drug Administration (FDA) approval of a novel B-cell receptor (BCR) kinase inhibitor, duvelisib (Copiktra), which targets phosphoinositide 3-kinase (PI3K)-δ/γ in patients wi...
Electronic ‘Datarrhea’ and Wellness
Chandrakanth Are, MBBS, MBA, FRCS, FACS
THE INTRODUCTION of the electronic health record (EHR) was supposed to lead us to a utopian world for health-care delivery in America. The Patient Protection and Affordable Care Act, signed into law on March 23, 2010, promoted its implementation by providing financial incentives.1 The Centers for ...
Cancer Taught Me to Help Patients Find Healing Hope
Wendy S. Harpham, MD, FACP
AS AN INTERNIST, I strived to give patients hope by prescribing therapies that increased their chance—their hope—of the best outcome and by encouraging them with hopeful words. My own hope was to care for patients until I was old. Just weeks after celebrating my 36th birthday, I was diagnosed wit...
Cancer Care in the Palestinian Territories
Robert Peter Gale, MD, PhD, DSc(hc), and Khalid Halahleh, MD
The global burden of cancer is huge and growing. In 2018, there will be > 18 million new cancer cases and 9.6 million deaths.1,2 Although several recent articles have reviewed cancer in developing countries, few have focused on the Palestinian territories. There are several reasons for that, ...
Cabozantinib in Advanced Hepatocellular Cancer: Call for Revision of Practice Standards
Amit Mahipal, MBBS, and Lewis R. Roberts, MB, ChB, PhD
As reported in The New England Journal of Medicine by Ghassan K. Abou-Alfa, MD, and colleagues, and reviewed in this issue of The ASCO Post, the phase III CELESTIAL trial has demonstrated that cabozantinib (Cabometyx) improved the median overall survival to 10.2 months in comparison to 8 months ...
The Relevance of the RELEVANCE Trial in Follicular Lymphoma
Jonathan W. Friedberg, MD, MMSc
We have seen remarkable progress in the outcomes of patients with advanced-stage follicular lymphoma over the past 2 decades.1 Recent manuscripts and presentations describing long-term follow-up of randomized trials comparing various chemotherapy platforms (all combined with anti-CD20 antibodies) ...
Wear That White Coat—With Pride
Chandrakanth Are, MBBS, MBA, FRCS, FACS
These days it can be hard for physicians. Many in the physician workforce wonder whatever happened to the ideals and expectations that drew them to this noble profession. The genuine passion to heal the sick and infirm and in turn improve the health of the entire society The ability to touch hum...
Targeting CCR4 in Cutaneous T-Cell Lymphoma: The MAVORIC Trial
Christiane Querfeld, MD, PhD
The C-C chemokine receptor 4 (CCR4) is predominantly expressed in type 2 helper T (Th2) cells and regulatory T (Treg) cells.1 Under physiologic conditions and in response to its ligands, CCL17 (TARC) and CCL22 (MDC), CCR4 promotes T-cell migration to the skin.2 Of note, CCR4 is highly expressed in m...
More to Learn About Using PARP Inhibitors for Advanced Breast Cancer With Germline BRCA Mutation
Leisha A. Emens, MD, PhD
Germline mutations in the breast cancer–susceptibility genes 1 and 2 (BRCA1/2) increase the risk for cancer due to an inability to repair DNA double-strand breaks, and about 5% of patients with unselected breast cancer carry a germline BRCA mutation.1 These DNA repair–deficient tumors are dependen...
Treatment of Triple-Negative Breast Cancer With BRCA1/2 Mutations: More to Learn From Ongoing Trials
William J. Gradishar, MD, FASCO, FACP
The treatment of triple-negative breast cancer remains a clinical challenge with no single validated target, though numerous pathways are druggable and are being investigated. In the subset of BRCA-mutated triple-negative breast cancer, the approval of the first poly (ADP-ribose) polymerase (PARP) i...
An Invitation to Be Quiet No Longer
Stephanie L. Graff, MD
My male colleagues sometimes broach the topic of #MeToo or sexual harassment in medicine by saying how uncomfortable it makes them. Ah, yes. How uncomfortable the sexual harassment I have faced for years makes you. I casually bring up microaggressions—subtle verbal or nonverbal slights against an...
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...
If It Isn’t Documented, Does It Count?
Rebecca Roy Thomas, MD, MHS
“The quality of mercy is not strained. It droppeth as the gentle rain from heaven Upon the place beneath.” —William Shakespeare THESE LINES from The Merchant of Venice suggest that mercy should be freely given. However, the metrics of quality is strained, pouring like a thunderous storm obscuring ...
Chemotherapy for Acute Myeloid Leukemia: Where Should It Be Given?
Elihu H. Estey, MD
USING THE National Cancer Database, Bhatt et al1 recently reported that of the 61,775 adults with acute myeloid leukemia (AML), those who received chemotherapy from 2003 to 2011 lived longer than those who, in those same years, did not; the study is reviewed in this issue of The ASCO Post. Althoug...
Love in the Time of Cancer
Lawrence H. Einhorn, MD
The ASCO Post is pleased to reproduce installments of the Art of Oncology as published previously in the Journal of Clinical Oncology. These articles focus on the experience of suffering from cancer or of caring for people diagnosed with cancer, and they include narratives, topical essays, histori...
Medical Marijuana: Research Not Anecdotes
Richard J. Boxer, MD
For patients with cancer, marijuana may be valuable in controlling pain and chemotherapy-induced nausea and vomiting. Furthermore, it may have efficacy as an appetite stimulant. No randomized clinical trial has investigated the utility of whole-plant medical marijuana to alleviate these symptoms in ...
On Not Being Ready
Laura Rooms, MD
The ASCO Post is pleased to reproduce installments of the Art of Oncology as published previously in the Journal of Clinical Oncology. These articles focus on the experience of suffering from cancer or of caring for people diagnosed with cancer, and they include narratives, topical essays, historica...
Why Oncologists Should Decline to Participate in the Right to Try Act
Thaddeus Mason Pope, JD, PhD
ON MAY 30, 2018, President Donald J. Trump signed into law the Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017.1 This law creates an additional and alternative pathway for patients with a “life-threatening disease or condition” to access investigational...
8-Year Update of SOFT and TEXT Trials: Positive but Not Definitive
Steven E. Vogl, MD
At the 2017 San Antonio Breast Cancer Symposium (SABCS), the International Breast Cancer Study Group (IBCSG) and its collaborators presented the 8-year updates of the key modern trials of ovarian function suppression after local treatment for young women with resected breast cancer.1 These updates o...
When Can Patients With Gleason 6 Prostate Cancer Safely Undergo Active Surveillance?
Prior to ASCO’s 2016 endorsement of the Cancer Care Ontario (CCO) guideline on active surveillance in the management of localized prostate cancer,1 most men—over 90%—diagnosed with low-risk localized disease were treated with active therapy.2 Today, about 50% of American men with low-risk disease ...
With Compassion Toward None, With Technology for All?
Chandrakanth Are, MBBS, MBA, FRCS, FACS
Imagine health care in the not too distant future… JOHN IS GOING about his usual Saturday at home, when his health-care–enabled smart watch alerts him to a sudden rise in his heart rate. As he is wondering about the reason, he feels a sharp pain in his left lower quadrant. The tachycardia cros...
Treatment Beyond Disease Progression in Melanoma: Challenge Centers on Knowing Who May Benefit
Sarah A. Weiss, MD, and Mario Sznol, MD
Dr. Weiss is Assistant Professor (Medical Oncology), Developmental Therapeutics, Melanoma Program, Yale Cancer Center. Dr. Sznol is Professor of Medicine (Medical Oncology); Co-Director, Cancer Immunology Program, Yale Cancer Center Co-Director, Yale SPORE in Skin Cancer, New Haven, Connecticut. ...
The Raven
David P. Steensma, MD
The call from the dermatologist came at noon on Good Friday, just after my wife left with our two young daughters for a week on her family’s tree farm in Northern Michigan. I was on call for the hospital inpatient leukemia service, so I could not join them. When the dermatologist solemnly began, “...
De Novo Metastatic Prostate Cancer: Positive Recent News, Many Open Questions
Karim Fizazi, MD, PhD
After about 70 years with no significant progress, the landscape for men with de novo metastatic prostate cancer has changed dramatically in the past 4 years, with statistically significant and highly clinically meaningful survival improvement reported from multiple phase III trials when abiraterone...
Prostate Cancer Therapy in Evolution: Time to Rethink and Redirect?
Christopher Logothetis, MD and Eleni Efstathiou, MD, PhD
The ASCO updated guidelines on the treatment of metastatic non-castrate prostate cancer penned by Morris and his colleagues1 provide valuable information annotated to the strengths of evidence in recently reported prostate cancer studies. CHAARTED, GETUG-AFU 15, LATITUDE, and STAMPEDE have colle...
Endangered Art of Medicine
Gabriele Roden, MD
I hold a cold, lifeless mouse instead of my patient’s heated hand, checking off the tiny box marked “Anxiety,” while she squirms under twisted blankets. I don’t remember when or how or why it happened, that the static screen wedged itself between my patients and me and compliance with the dig...
Adherence to Oral Anticancer Treatment: Priorities in Lymphoma and CLL
Michael E. Williams, MD, ScM, and Jonathan W. Friedberg, MD, MMSc
ADVANCES IN cancer treatment have been nothing short of breathtaking in recent years. Among the most important has been the advent of effective oral therapies, marking a significant change in the way many patients receive treatment and in the oversight required by the cancer care team. As with p...
‘Pearls of Wisdom’ for Leadership and Success in Academic Medicine Gathered Over a 35-Year Career
Daniel F. Hayes, MD, FACP, FASCO
Dr. Hayes, ASCO President 2016–2017, is Professor of Internal Medicine; Stuart B. Padnos Professor in Breast Cancer; and Clinical Director of the Breast Oncology Program at the University of Michigan Comprehensive Cancer Center, Ann Arbor. AS I COMPLETE my 3-year term as ASCO President, I am stim...
Nivolumab Plus Ipilimumab in Advanced Renal Cell Carcinoma: A Shift in the Treatment Paradigm
Rana R. McKay, MD
For over a decade, vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors have been the standard first-line agents in the management of patients with advanced or metastatic clear cell renal cell carcinoma.1-3 Historically, phase III trials of first-line VEGF therapies included interfer...
Serving as ASCO President Is One of the Best Jobs in the World
Bruce E. Johnson, MD, FASCO
The opportunity to serve as ASCO President is the greatest honor of my professional career. It has been a pleasure and a highly rewarding experience to interact with our members and members of ASCO’s Board, executive leadership, and professional staff during my tenure. The year has allowed me to wor...
ASCO Clinical Practice Guideline on Managing Immune-Related Adverse Events: Next Big Step for Immune Checkpoint Inhibitors
Jedd D. Wolchok, MD, PhD
The publication of the ASCO clinical practice guideline for the management of immune therapy–related adverse events—reviewed in this issue of The ASCO Post—represents an important next step in the incorporation of checkpoint blocking antibodies as standard cancer treatment modalities.1 The U.S. Foo...
Both Patients and Clinicians Face Challenges in Recognizing and Reporting Immune-Related Adverse Events
Keith T. Flaherty, MD and Padmanee Sharma, MD, PhD
The publication of ASCO’s toxicity management guidelines for immune checkpoint antibodies by Brahmer and colleagues,1 reviewed in this issue of The ASCO Post, has been long awaited, considering more than 15 distinct indications have been granted by the U.S. Food and Drug Administration (FDA). Th...
Role of MRI in Detection of Clinically Significant Prostate Cancer: ‘Practice-Affirming’ Results From The PRECISION Trial
Lucas W. Dean, MD and Karim Touijer, MD, MPH
Simultaneously presented at the 2018 European Association of Urology meeting and published in The New England Journal of Medicine, the PRECISION trial will go down as a landmark study for solidifying the role of magnetic resonance imaging (MRI) in prostate cancer diagnosis.1 This trial provides ...
How a Recent Study Heats up the Debate Over Intraperitoneal Chemotherapy in Newly Diagnosed Advanced Ovarian Cancer
Bradley J. Monk, MD, FACS, FACOG
Based on pharmacokinetic and preclinical data, there appears to be a biologic advantage to the use of intraperitoneal chemotherapy in treating some malignancies confined to the abdomen. Since most ovarian, fallopian tube, and peritoneal cancers present and recur in the peritoneal cavity,...
Molecular Minimal Residual Disease Detection Shows Further Promise in Acute Myeloid Leukemia
Andrew Dunbar, MD, and Martin Tallman, MD
Extended next-generation sequencing genomic profiling in acute myeloid leukemia (AML) has revealed remarkable heterogeneity and molecular complexity of the disease and provided critical insights into the genetic mechanisms underpinning of preleukemic and leukemic pathogenesis.1,2 Despite signifi...
Evolving Standards and Quality Metrics Ensure High-Quality Cancer Programs
Lawrence N. Shulman, MD
Dr. Shulman is Deputy Director, Clinical Services, and Director of the Center for Global Cancer Medicine, Abramson Cancer Center; and Professor of Medicine, Hospital of the University of Pennsylvania, Philadelphia. IN 2008, WHEN ALLEN LICHTER, MD, FASCO, then Chief Executive Officer of ASCO, call...
Updated ASCO/SSO Guideline on Sentinel Lymph Node Biopsy in Melanoma: Addressing Fundamental Clinical Questions
John F. Thompson, MD, FRACS, FACS
Dr. Thompson is Professor of Melanoma and Surgical Oncology, Sydney Medical School, The University of Sydney, and Senior Surgeon, Melanoma Institute Australia, Sydney. IN THE MID-1990s, the surgical management of patients presenting with primary cutaneous melanomas changed forever when the sentin...
Combined Immune Checkpoint and VEGF Inhibition: Exciting yet Challenging Time for Renal Cancer Therapeutics
Robert A. Figlin, MD, FACP
The treatment paradigm for metastatic clear cell renal cell carcinoma continues to evolve at a rapid pace. We have recently approved agents that target the vascular endothelial growth factor receptor (VEGFR) pathway in the front-line setting—such as the tyrosine kinase inhibitor cabozantinib (Cabome...
Promise and Challenges of CAR T-Cell Therapy for Diffuse Large B-Cell Lymphoma: ZUMA-1 Trial Results
Kieron Dunleavy, MD
Advancing therapeutics and augmenting curability in diffuse large B-cell lymphoma (DLBCL) have been very challenging. Although many novel approaches have offered promise and continue to be developed, we have not yet identified a clearly superior approach to R-CHOP (rituximab [Rituxan], cyclophospham...
Enormous Cost of Failure to Screen Heavy Smokers for Lung Nodules
Steven E. Vogl, MD
In 2011 the American College of Radiology Imaging Network (ACRIN) group published its publicly funded study of three annual screening chest computed tomography (CT) scans among heavy smokers aged 55 to 74.1 The results remain the first and only screening study for any cancer demonstrating a signif...
A Tribute to Two Amazing Scientists
Francis S. Collins, MD, PhD
Dr. Collins is Director of the National Institutes of Health. Originally posted on March 19, 2018, to the National Institutes of Health (NIH) Director’s Blog (https://directorsblog. nih.gov). OVER THE PAST couple of weeks, we’ve lost two legendary scientists who made major contributions to our w...
Why Right-to-Try Laws Are Dangerous
Ellen V. Sigal, PhD
Why wouldn’t you support a patient with a terminal illness the “right to try” any therapy that may save his or her life? The answer to this question—one engulfed in a political debate in Congress—seems simple. It is not. [Editor’s Note: [Editor’s Note: On May 30, 2018, the President signed into la...
New Agents for Initial Treatment of Metastatic Prostate Cancer: A New Standard of Care?
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
FOR DECADES, the status of metastatic prostate cancer trials was not particularly exciting. With an absence of high-impact novel agents, the focus of cancer trial groups was on the improvement of standard care. Well-crafted, large trials of hormonal therapy demonstrated the utility of combined and...
Osimertinib: A New Standard of Care in Initial Treatment of EGFR-Mutant NSCLC
Suresh S. Ramalingam, MD
Dr. Ramalingam is Professor of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta. MUTATIONS IN the epidermal growth factor receptor (EGFR) gene were discovered in 2004. These mutations, localized most commonly to exon 19 or 21, vary in prevale...
It Starts With a Discussion: ASCO Guideline on Interventions to Address Sexual Problems in People With Cancer
Anne Katz, PhD, RN, FAAN
Dr. Katz is a certified sexuality counselor at CancerCare Manitoba, Canada. SEXUALITY AND SEXUAL functioning are important to cancer survivors, and considering the significant number of survivors, this is an issue that should not be ignored. In a survey of cancer survivors who had completed treatme...
Why Right-to-Try Laws Are Dangerous
Ellen V. Sigal, PhD
Why wouldn’t you support a patient with a terminal illness the “right to try” any therapy that may save his or her life? The answer to this question—one engulfed in a political debate in Congress—seems simple. It is not. [Editor’s Note: On May 30, 2018, the President signed into law the Trickett W...
Laryngeal Preservation: All Patients Need a Voice
Francis Paul Worden, MD
Following the publication of two landmark studies in the United States,1,2 laryngeal preservation with combined chemoradiotherapy has become standard practice as opposed to laryngectomy for patients with locally advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Gro...
Releasing Follicular Lymphoma From the Curse of Frankenstein
Bruce D. Cheson, MD, FACP, FAAAS, FASCO
In the December 10, 2017, issue of The ASCO Post, I authored an article in which I raised the possibility of curing follicular lymphoma without the dreaded chemotherapy. Clearly, no good deed goes unpunished: My good friend and The ASCO Post’s editor Jim Armitage, MD, challenged me to defend that ...
Changing Negative Perceptions on the Impact of Clinical Trials in Brazil
Vinicius Ernani, MD, and Carlos H. Barrios, MD
CLINICAL TRIALS are an essential research tool to advance medical knowledge and patient care. Traditionally, the majority of pharmaceutical-sponsored clinical trials have been implemented in Western Europe and North America. More recently, however, large pharmaceutical companies have increased t...
Bone-Modifying Agents in Metastatic Breast Cancer: Time to De-escalate Dosing Intervals
Julie R. Gralow, MD, FASCO
AS REVIEWED in this issue of The ASCO Post, ASCO and Cancer Care Ontario (CCO) have issued an updated guideline on the role of bone-modifying agents in metastatic breast cancer.1 The updated guideline supports a change in clinical practice for our patients with breast cancer and bone metastasis. A...
Avelumab in Advanced Urothelial Carcinoma: Further Study Needed to Clarify its Role
Aly-Khan A. Lalani, MD, FRCPC, and Toni K. Choueiri, MD
AS REVIEWED in this issue of The ASCO Post, Patel and colleagues have presented data from the phase I JAVELIN study evaluating avelumab (Bavencio) in platinum-refractory patients with advanced urothelial carcinoma.1 The drug is active with durable responses when compared with historical single-a...
ECHELON-1: A Commendable Study, but Questions Remain
Syed A. Abutalib, MD and James O. Armitage, MD, FASCO
“The important thing is not to stop questioning. Curiosity has its own reason for existing.” —Albert Einstein The phase III international ECHELON-1 study, designed to evaluate brentuximab vedotin (Adcetris) as part of a front-line chemotherapy regimen for previously untreated advanced classic H...
ASCO Endorsement of ASTRO Guideline on Stereotactic Body Radiotherapy for NSCLC Highlights Shared Patient Decision-Making
Megan E. Daly, MD
As reviewed in this issue of The ASCO Post, a recent ASCO panel, chaired by Bryan Schneider, MD, and Brendon Stiles, MD, has provided an endorsement of a recently published guideline on the use of stereotactic body radiotherapy for non–small cell lung cancer.1 The original guideline,2 developed and ...
Durvalumab Takes a Giant Leap Into Stage III NSCLC
Karen Kelly, MD
Immune checkpoint inhibitors have had a dramatic impact on survival for patients with stage IV non–small cell lung cancer (NSCLC), with whispers that a cure might be achieved in a subset of patients. In typical fashion, active new agents are evaluated in earlier stages of disease. Stage III NSCLC...
Alexander Fleming Would Have Loved Our Success With Cancer Immunotherapy
John F. Smyth, MD
THE UNIVERSITY of Edinburgh Medical School was established in 1726 during the Scottish Enlightenment. As one of the oldest medical schools in the English-speaking world, it is interesting to reflect on the seminal contributions made centuries ago by several alumni that are still relevant to the pr...
Bosutinib for First-Line Use in Chronic Myeloid Leukemia: Is Three a Crowd?
Ellin Berman, MD
BOSUTINIB ( BOSULIF) is the latest tyrosine kinase inhibitor that has shown a superior molecular response profile when compared with imatinib.1,2 An orally available dual SRC/ABL1 inhibitor, the drug was shown in preclinical studies to have a potent inhibitory activity against BCR-ABL1 and minimal...
Fiber Is Only One Component in Improving Outcomes in Cancer Survivors
Wendy Demark-Wahnefried, PhD, RD
SINCE 2003, every iteration of the American Cancer Society’s Nutrition Guidelines for Cancer Survivors has advocated for a plant-based diet with ample quantities of whole grains, as well as vegetables and fruits.1-3 This recommendation has been based primarily on data that such foods pla...
Another PI3K Inhibitor Welcome For Use in Indolent Lymphoma
Brad Kahl, MD
PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) signaling is important for the proliferation and survival of malignant B cells. Copanlisib (Aliqopa) is a novel pan-class PI3K inhibitor with predominant activity against PI3K-alpha and PI3K-delta isoforms. As reviewed in this issue of The ASCO Post, ...
Checkpoint Inhibition for Patients With Recurrent or Advanced Cervical Cancer: A Promising Strategy, but Which Patients Will Benefit the Most?
Julia Fehniger, MD and Franco Muggia, MD
For nearly 20 years, chemoradiation using single-agent platinum therapy has been the standard of care for advanced or recurrent cervical cancer.1 More recently, the Gynecologic Oncology Group (GOG) 240 trial tested the addition of bevacizumab (Avastin) to platinum-based chemotherapy, which confe...
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...
Assuming the Role of NCI Director: Working to Accelerate Progress
Norman E. Sharpless, MD
I’m not sure anything can prepare a person to become director of the National Cancer Institute (NCI), but I can honestly say that I am humbled to have been appointed to this position and am excited to have this unique opportunity. As many of you may know, I come to NCI from the University o...
Evidence-Based Support for Triplet Therapies in Multiple Myeloma
Muhamed Baljevic, MD and Sarah A. Holstein, MD, PhD
Over the past 15 years, multiple myeloma has garnered among the highest number of regulatory approvals by the U.S. Food and Drug Administration (FDA) for the management of all phases of the disease. This fast-expanding repertoire of treatment options has pushed the median survival of multiple my...
Follicular Lymphoma: Is the Road to Cure Paved With Gallium?
Bruce D. Cheson, MD, FACP, FAAAS, FASCO
The roadside along the path to curing follicular lymphoma is riddled with the debris of failed cytotoxic regimens. For decades, clinical trials unsuccessfully pitted various chemotherapy combinations against each other. It took but a single, noncytotoxic molecule, rituximab (Rituxan), to forever alt...
Immunotherapy Plus Chemotherapy in Non–Small Cell Lung Cancer: Despite the Failure of Ipilimumab, Guarded Optimism Persists
Tyler F. Stewart, MD and Sarah B. Goldberg, MD, MPH
Ipilimumab (Yervoy) is a fully human monoclonal antibody that inhibits cytotoxic T-lymphocyte–associated protein 4 (CTLA-4) and was the first checkpoint inhibitor approved after showing survival benefit in metastatic melanoma.1 Indeed, in the first-line setting for metastatic melanoma, ipilimuma...
Immunotherapy Has Indelibly Changed the Treatment Paradigm in Urothelial Carcinoma
Cora N. Sternberg, MD, FACP
Cisplatin-based combination chemotherapy is the preferred first-line therapy for metastatic urothelial cancer and the only treatment shown to improve survival in patients with previously untreated disease for many years. This chemotherapy also has proven to be beneficial in the neoadjuvant and adj...
PARP Inhibitors in BRCA-Related Ovarian Cancer—and Beyond!
Ursula A. Matulonis, MD
Poly (ADP ribose) polymerase (PARP) inhibitors are among the most exciting new classes of oncology drugs, and their development has coincided with the increasing recognition of the therapeutic vulnerability in targeting DNA damage response and DNA repair. The initial clinical testing of PARP inhibit...
Genomic Profiling With Multidisciplinary Collaboration: Improving Breast Cancer Outcomes Through Timely Chemotherapy Initiation
Alice Chung, MD and Armando Giuliano, MD
As reviewed in this issue of The ASCO Post, Losk and colleagues from Dana-Farber/Brigham and Women’s Cancer Center report their institution’s implementation of a protocol of surgeon-initiated genomic profiling of estrogen receptor–positive tumors in women with early breast cancer that resulted i...
Gene-Expression Assays in Early-Stage Breast Cancer: Who Should Order Them and When?
Cesar A. Santa-Maria, MD, MSCI, Ashley Cimino-Mathews, MD, and Antonio C. Wolff, MD, FACP, FASCO
A deeper understanding of biology has allowed significant advances in the treatment of breast cancer. In the early-stage setting, standard pathology measures can help identify which subset of patients with hormone receptor–positive breast cancers are more likely to experience benefit from adju...
ENDEAVOR Trial Endeavors to Make Case for Carfilzomib: Despite Survival Advantage, Should We Be Surprised?
Prashant Kapoor, MD and S. Vincent Rajkumar, MD
LOCATION! LOCATION! LOCATION! That’s what home buyers are frequently cautioned about before purchasing a property. For trialists, and more importantly, practicing oncologists, a study’s design, akin to a property’s location, must be taken into account prior to buying into the results and changin...
Balancing Immune-Related Adverse Events With Efficacy of Dual Checkpoint Inhibitor Therapy in Melanoma
Alexander N. Shoushtari, MD
MUCH PROGRESS has been made in the past decade in the treatment of patients with newly diagnosed metastatic melanoma. In the front-line setting, programmed cell death protein 1 (PD-1) monotherapy (nivolumab [Opdivo] and pembrolizumab [Keytruda]) and combined PD-1 plus cytotoxic T-lymphocyte–associ...
Smashing the Glass Ceiling in Medicine
Elizabeth L. Travis, PhD, FASTRO, and Ethan Dmitrovsky, MD
IT IS A SAD TRUTH that academic medicine, like many other professions, has a glass ceiling that hampers its ambitions. In medicine, this glass ceiling blocks women and minority faculty from reaching the highest ranks of leadership. Even if the root cause is not yet known, we want to eliminate th...
Expert Point of View: Alexander Eggermont, MD, PhD
Caroline Helwick
BASED ON THE RESULTS of COMBI-AD1 and CheckMate 238,2 invited discussant Alexander Eggermont, MD, PhD, Professor of Oncology at Gustave Roussy in Paris, commented: “It’s a good day for melanoma!” In COMBI-AD, treatment with the combination of dabrafenib (Tafinlar) and trametinib (Mekinist) signi...
Carfilzomib May Be a Strong Candidate for Salvage Therapy in Relapsed/Refractory Multiple Myeloma—but Questions Remain
George Somlo, MD
WITH THE INCLUSION of proteasome inhibitors and immunomodulatory agents first into salvage and then as components of first-line, consolidation, and maintenance regimens, response rates, depth of response, and median progression-free and overall survival have all improved for patients suf...
Can We Have a Successful Vaccine Against Cancer?
Electra D. Paskett, PhD
EARLY IN our careers, few of us imagined that a vaccine could one day prevent cancer. Now, there is a vaccine that keeps the risks from human papillomavirus (HPV) at bay, and yet universal adoption of the HPV vaccine has been incomplete. As a result of misinformation about the vaccine—and its admi...
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...
Immunotherapy for Metastatic Mismatch Repair–Deficient Colorectal Cancer: Game-Changer for Small Group of Patients
Karuna Ganesh, MD, PhD, and Luis A. Diaz, Jr, MD
PATIENTS WITH DNA mismatch repair–deficient (dMMR) metastatic colorectal cancer display a high level of microsatellite instability (MSI-H)1 and demonstrate poor chemosensitivity and shorter overall survival than patients with mismatch repair–proficient (pMMR) metastatic metastatic colorectal cancer....
Adoptive Cell Therapy—Act 1: The Beginning
Frederick R. Appelbaum, MD
ON AUGUST 30, 2017, the first genetically engineered T-cell therapy (tisagenlecleucel [Kymriah]) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of patients up to 25 years of age with B-cell precursor acute lymphoblastic leukemia that is refractory or in second or lat...
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—did not show a statistically significant difference between treatment and observation for the initial management approach to men with newly diagnosed pros...
Fighting Misinformation in HPV-Related Cancer Prevention
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, effective vaccine since 2006 t...
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...
Pursuing Combination Strategies With Checkpoint and Tyrosine Kinase Inhibitors in Hepatocellular Carcinoma
Josep M. Llovet, MD, PhD
PRIMARY LIVER CANCER is the second leading cause of cancer-related death worldwide. Hepatocellular carcinoma accounts for 90% of liver cancer, with around 800,000 new cases diagnosed globally each year.1 In contrast to the stable or declining trends observed for most neoplasms, the incid...
Brachytherapy for Prostate Cancer: An Old Form of Radiation Treatment That Is Still One of the Most Effective
Jordan A. Holmes, MD, MPH, and Ronald C. Chen, MD, MPH
BRACHYTHERAPY HAS a long track record in treating cancer, dating back to the first reported use of an implanted radioactive source in 1901, and brachytherapy for the treatment of prostate cancer dates back to 1914, when Pasteu and Degrais used a radium source inserted through a urethral catheter...
Sacituzumab Govitecan in Heavily Pretreated Metastatic Triple-Negative Breast Cancer: A Step in the Right Direction
Francisco J. Esteva, MD, PhD
IN A SINGLE-ARM multicenter trial reported by Bardia and colleagues1 and reviewed in this issue of The ASCO Post, the use of sacituzumab govitecan (IMMU-132) showed a response rate of 30% and a clinical benefit rate of 46% in heavily pretreated patients with metastatic triple-negative br...
Tissue Specimens in Clinical Trials: A Double-Edged Sword
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 whether a given patient has the required biom...
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...
Are Thyroid Cancer Incidence and Mortality Rates Truly Increasing in the United States?
Lori J. Wirth, MD, and Manisha H. Shah, MD
THYROID CANCER diagnoses are increasing at a rate faster than any other malignancy in the United States. In 2017, there will be 56,870 new cases, accounting for 3.4% of all cancers, and 2,010 people will die of thyroid cancer.1 This represents a more than 200% increase in incidence since the 197...
Alectinib: A New Standard for First-Line Therapy of ALK-Rearranged NSCLC?
Alex A. Adjei, MD, PhD, FACP
ANAPLASTIC LYMPHOMA KINASE (ALK) was first identified in anaplastic large cell lymphoma. The ALK gene itself is not oncogenic, but it can become oncogenic by at least three mechanisms: by forming a fusion gene with a number of other partner genes, by copy number gain, or by mutations in ...
Blinatumomab in Advanced Acute Lymphoblastic Leukemia: A Brighter Therapeutic Outlook
Richard M. Stone, MD
NEW DRUGS that will improve the outcome of adult patients who develop a deadly disease such as acute leukemia are badly needed; combinations of cytotoxic chemotherapeutic drugs may have reached an upper limit of utility. Agents that eradicate leukemia by alternative mechanisms would be o...
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
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 bone metastases and other recurrence? A meta-analysis1 by ...
Maintaining Predictable Increases in NIH Funding for Cancer Research
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 the NIH, demonstrating the bipartisan consensu...
Pembrolizumab in Second-Line Therapy for Advanced Urothelial Carcinoma
Jonathan E. Rosenberg, MD
THE TREATMENT OF metastatic urothelial carcinoma experienced a long period of stagnation until the recognition that targeting the programmed cell death protein 1 (PD-1) pathway could yield deep and durable responses.1-3 Cisplatin-based combination chemotherapy has been the reference standard for f...
Pembrolizumab and Cetuximab-Treated Head and Neck Cancer: Activity Confirmed But No Surprises
Laura Q.M. Chow, MD
WITH THE RECENT efficacy findings, improvements in survival, and resultant U.S. Food and Drug Administration (FDA) approvals of programmed cell death protein 1 (PD-1) immune checkpoint inhibitors across multiple solid tumor indications, the publication of yet another positive trial adds to the lit...
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
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 achieved as oncology biosimilars for rituximab (Rituxan), trastuzumab (...
Encouraging Results With Pembrolizumab in Relapsed/Refractory Classical Hodgkin Lymphoma
Stephen M. Ansell, MD, PhD
AN EFFECTIVE antitumor immune response relies on cytotoxic T cells that are activated and able to target the malignant clone. As T cells become activated, they upregulate suppressive receptors including programmed cell death protein 1 (PD-1). Upregulation of inhibitory signals is importa...
Has a New Standard Really Been Established for the Adjuvant Treatment of Pancreatic Cancer?
Andrew H. Ko, MD
THE PAST YEAR has undoubtedly been a disappointing one as far as clinical advances in pancreatic cancer go. No fewer than five high-profile randomized phase II or III trials in this setting reported negative results in 2016, ranging from next-generation cytotoxic agents1 to novel immunot...
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
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 transplantation can be substantial. Determining which patients may bene...
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 ...
ASCP/CAP/AMP/ASCO Colorectal Cancer Biomarker Guideline: A Clinician's Perspective
Leonard Saltz, MD
The joint American Society for Clinical Pathology (ASCP), College of American Pathologists (CAP), Association for Molecular Pathology (AMP), and ASCO guideline reported by Sepulveda et al, and reviewed in this issue of The ASCO Post, represents a collaboration of three pathology societies and ASCO...
Major Breakthrough in Development of Systemic Targeted Therapy for Midgut Neuroendocrine Tumors
Allan V. Espinosa, MD, and Manisha H. Shah, MD
This issue of The ASCO Post discusses a recent trial reported by Strosberg et al in The New England Journal of Medicine that is the first phase III randomized international multicenter clinical trial evaluating lutetium Lu-177 dotatate as a peptide receptor radionuclide therapy in midgut neuroen...
Lessons Learned and to Be Learned: Reducing Risk of Subsequent Malignancies in Childhood Cancer Survivors
Lisa Diller, MD
I recently saw a patient in our survivorship clinic. She was treated at age 15 years for Hodgkin lymphoma and is now in her early 50s. During the prior 2 decades, she had developed both bilateral breast cancer and thyroid cancer, as well as multiple basal cell carcinomas, all occurring w...
Incorporating the ‘Goals of Medicine’ With the ‘Goals of Care’
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, their surrogates, and thei...
Making American Research Great Again
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. Immunotherapy saved President Jimmy ...
Autologous Transplantation for Myeloma: Don’t Change the Winning Team
Parameswaran N. Hari, MD, MRCP, and 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. Notable studies include comparisons of planned upfront AHCT vs nontrans...
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
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 blockade” to salvage radiation therapy in men with a rising prostate-specific antigen (PSA...
My Year of Living Wonderfully: 12 Months as ASCO President
Daniel F. Hayes, MD, FACP, FASCO
EACH YEAR, the ASCO President chooses a theme for his or her term, which is not a trivial pursuit. Trying to think up something novel and catchy, yet not schmaltzy, is quite a challenge. However, in my year as Chair of the Scientific Program Committee for the 2010 ASCO Annual Meeting, th...
Provision of Genetic Services to Women With Breast Cancer: We Must Do Much Better
Brittany L. Bychkovsky, MD, MSC, and Judy E. Garber, MD, MPH
Genetic testing for inherited cancer susceptibility is increasingly part of the care of cancer patients and their relatives. Early clinical guidelines recommended BRCA1/2 testing for women diagnosed with breast or ovarian cancer if they also have a significant family cancer history or Ashkenazi ...
Managing Small Renal Masses: A Point-by-Point Consideration of ASCO’s Clinical Practice Guideline
Jose A. Karam, MD, FACS
As reviewed in this issue of The ASCO Post, a recent issue of the Journal of Clinical Oncology featured an ASCO Clinical Practice Guideline on the management of small renal masses reported by Finelli and colleagues.1 This comprehensive guideline is written by a group of well-regarded and...
Optimizing Treatment for Elderly Patients With Glioblastoma
Isabel Arrellaga-Romany, MD, PhD, and Tracy T. Batchelor, MD, MPH
In 2005, Stupp and colleagues published their landmark paper demonstrating in a randomized phase III trial that the addition of temozolomide to radiation increased overall survival in patients with newly diagnosed glioblastoma. Notably, patients over age 70 years were excluded from thi...
Metastatic Urothelial Carcinoma: A Model Malignancy for Immune Checkpoint Blockade
Matthew D. Galsky, MD
Platinum-based combination chemotherapy became a mainstay of first-line treatment for metastatic urothelial cancer in the 1980s. With combination platinum-based regimens, 40% to 50% of patients achieve an objective response to treatment. However, aside from approximately 5% to 10% of pat...
Ensuring Equitable Cancer Care for All Patients
Sanjeev Arora, MD, MACP, FACG, and 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 advances in cancer prevention, screening, and treatment. However, right now, t...
On the Variance of Cancer Outcomes by Time and Geography
Otis W. Brawley, MD, MACP
A recent study by Mokdad and colleagues, reviewed in this issue of The ASCO Post, looks at cancer demographic data for 28 cancers and compares mortality rates in 1980 to results in 2014.1 Publishing mortality rates by geographic area and the observation of significant differences is not ...
Neoadjuvant Immunotherapy in High-Risk Melanoma: A New Approach
E. George Elias, MD, PhD
Melanoma is an immunogenic tumor, as it expresses various melanoma-specific antigens. However, it is both biologically and clinically heterogeneous. Biologically, it expresses different melanoma antigens and has diverse genetic profiles among different patients. Clinically, it varies in ...
Next-Generation Genitourinary Oncology: Keeping One’s Powder Dry
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
There is a new yin-yang of management in genitourinary oncology, with the balance of opposing power focused among cancer cells, kinase inhibition, and lymphocyte function, representing a shift in the fashions of treatment somewhat away from chemotherapy. This linear progress has been com...
Monoclonal Antibody Therapy With Daratumumab in Multiple Myeloma: Expanding Therapeutic Horizons
Paul G. Richardson, MD
The advent of successful monoclonal antibody therapy in the treatment of relapsed/refractory myeloma has dramatically improved the prognosis of patients for whom currently approved novel therapies have failed. In 2015, the approval of the combination of elotuzumab (Empliciti) with lenali...
Trastuzumab Biosimilar Could Lead to Lower Health-Care Costs and Greater Drug Access for Patients With Metastatic Breast Cancer
Chau T. Dang, MD
The human epidermal growth factor receptor (HER) family consists of four members—epidermal growth factor receptor (EGFR), HER2, HER3, and HER4—all transmembrane receptor tyrosine kinases, which regulate cell growth and survival, differentiation, and migration, as well as other cellular r...
The Path Forward for Clinical Pathways in Oncology
Robin T. Zon, MD, FACP, FASCO
The year 2016 was a memorable one for oncology. In January, President Barack Obama announced the launch of the National Cancer Moonshot initiative, spearheaded by Vice President Joe Biden, which aims to accelerate cancer research. And in December, through bipartisan Congressional support...
New First-Line Options for ALK-Positive Lung Cancer on the Horizon
Alice T. Shaw, MD, PhD
Anaplastic lymphoma kinase (ALK) rearrangements define a subset of non–small cell lung cancer (NSCLC) patients for whom ALK inhibitors are highly effective. In PROFILE 1014, the multitargeted ALK inhibitor crizotinib (Xalkori) was shown to be superior to platinum/pemetrexed (Alimta) chem...
Implications of SWOG S0777 and the Future of Combination Treatments for Multiple Myeloma
Tanya M. Spektor, PhD, and James R. Berenson, MD
The treatment of multiple myeloma is becoming increasingly complicated. This is not only because of the complexity of the disease, but also because of the increasing number of effective combination treatments and continuous development of new drugs. This has resulted in an ever-increasing numb...
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...
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
In 1959, my 5-year-old cousin, Kim, was diagnosed with acute lymphocytic leukemia (ALL). As an 8-year-old, I didn’t really understand what was happening to him, except that he had to go to the Riley Hospital for Children in Indianapolis, Indiana, for treatment. The haunting vision of his...
The Cost of a Patient’s Last Ride
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 survived far longer than expected for a malignancy ...
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...
Radiation Therapy for Glioblastoma: What Is New and What Is Missing in the ASCO-Endorsed ASTRO Guidelines
Walter J. Curran, Jr, MD
An ASCO Special Article in the Journal of Clinical Oncology by Sulman et al,1 reviewed in this issue of The ASCO Post, issued ASCO’s endorsement of the American Society for Radiation Oncology (ASTRO) guidelines on radiation therapy for adult patients diagnosed with glioblastoma. It is a ...
Nivolumab in Squamous Cell Carcinoma of the Head and Neck in CheckMate 141: Game Not Over
Lori J. Wirth, MD
Most patients with squamous cell carcinoma of the head and neck present with locally advanced disease. With combined-modality approaches, the chance of cure ranges from < 50% to up to 80%, depending on the site, stage, and other risk factors, such as human papillomavirus (HPV) status....
Diamonds Are Forever, Tyrosine Kinase Inhibitors Are Not?
Jorge Cortes, MD
Sir Donald Munger: “You have been on holiday, I understand. Relaxing, I hope?” James Bond: “Oh, hardly relaxing, but most satisfying.” (Diamonds Are Forever) As tyrosine kinase inhibitors became the mainstay of therapy for patients with chronic myeloid leukemia (CML), our assumption ha...
PARP Inhibitor Niraparib Yields ‘Unprecedented’ Results in Ovarian Cancer in Phase III Trial
Bradley J. Monk, MD, FACS, FACOG
The first phase III trial of an inhibitor of poly (ADP-ribose) polymerase (PARP) yielded unprecedented results in treating ovarian cancer. The trial was presented at the European Society for Medical Oncology (ESMO) in Copenhagen, Denmark, and electronically reported concurrently in The N...
As We Strive for a Cancer Cure, We Must Not Forget the Survivors
Janet Snapp, MSN, RN, FPCN, and Dori Klemanski, DNP, CNP, RN
Although a cure for cancer remains elusive, there are many promising ideas to eradicate this disease, including the Cancer Moonshot Initiative and an ever-increasing body of cancer research that continually drives innovative treatments in an effort to improve survival and, ultimately, find a c...
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
It is gratifying to see the Centers for Medicare & Medicaid Services (CMS) does listen to public comments regarding new proposals. Since CMS opened the comment period for its Quality Payment Program, which repeals the Sustainable Growth Rate Formula and was proposed to implement the ...
The FDA Ensures Quality and Safety of Generic Drugs in the United States
Kathleen Uhl, MD, John R. Peters, MD, and Howard Chazin, MD, MBA
The U.S. Food and Drug Administration’s (FDA) generic drug program has substantially increased the availability of affordable, high-quality drugs in the United States. It is arguably the only really effective health-care cost–containment program. The more than 10,000 generic drugs currently ...
Another Step Forward for Genomic Assays in Early-Stage Breast Cancer: Findings With MammaPrint in the MINDACT Trial
Harold J. Burstein, MD, PhD
Genomic assays have had a powerful influence on the management of early-stage breast cancer, particularly estrogen receptor–positive tumors. The mainstay of adjuvant treatment for early-stage, hormone receptor–positive breast cancer has been endocrine therapy, either with tamoxifen and a...
Recent Progress and Concepts in Pancreatic Cancer
Robert Peter Gale, MD, PhD, DSc(hc), FACP, FRSM
November is National Pancreatic Cancer Awareness Month, the impetus for this article. Pancreatic cancer is a huge health challenge. It's the eighth most common cancer in the United States and the fourth most common cause of cancer deaths but is expected to become the second most common c...
Adjuvant Sunitinib for Renal Cell Carcinoma: Not Ready for Prime Time
Sumanta Kumar Pal, MD
In renal cell carcinoma and other cancer types, a consistent paradigm in drug development exists: Observe efficacy of a drug in the metastatic setting and move quickly to explore the agent in the adjuvant setting. In the cytokine era, there were multiple efforts to characterize whether a...
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
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 the second-line setting compared with docetaxel for patients with...
Vaccine Therapy in Metastatic Renal Cell Carcinoma: Past, Present, and Future
Neeraj Agarwal, MD
As reviewed in this issue of The ASCO Post, Brian Rini, MD, and colleagues recently reported results from the phase III IMPRINT trial,1 which randomized HLA-A*02–positive patients with treatment-naive metastatic clear cell variant renal cell carcinoma, in favorable- and intermediate- ris...
Cautious Optimism About Olaratumab in Soft-Tissue Sarcoma
Margaret von Mehren, MD
The current plethora of drugs in development for oncology is leading to the testing of novel agents in common as well as rare diseases. Targeted therapies have been a focus of great interest in soft-tissue sarcomas, with testing of a variety of oral tyrosine kinase inhibitors leading to the approv...
The Future of Health Care in America: Which Corridor?
Chandrakanth Are, MBBS, MBA, FRCS, FACS
It was mid-morning, and I was walking along one of the long corridors in our hospital, attending to clinical duties. From a distance, I noticed this elderly couple walking in the opposite direction. As we got closer, it became obvious that the elderly gentleman appeared winded and was lo...
Putting Patients First: My Journey in Advocacy
Ellen V. Sigal, PhD
When I lost my only sister to breast cancer in 1986, patients like her had devastatingly few choices. Over the intervening decades, sustained commitment to biomedical research at the National Institutes of Health (NIH) and major technologic advances have led to transformative changes in ...
‘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 ...
What We Know and What We Need to Know About Neoadjuvant Chemotherapy in Advanced Ovarian Cancer
David M. Gershenson, MD
Ever since the landmark studies of Griffiths and colleagues in the 1970s,1 primary cytoreductive surgery followed by chemotherapy with the objective of achieving minimal residual disease has been the standard approach for women with advanced-stage epithelial ovarian cancer. However, what...
New SSO-ASTRO-ASCO Clinical Practice Guideline Clarifies the Question of Margins for Breast-Conserving Surgery in Ductal Carcinoma in Situ
Jay R. Harris, MD
In 2014, the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) published a “Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer.”1 A multidisciplinary expert guideline used a met...
Evaluating the FDA’s Approach to Cancer Clinical Trials
Richard Pazdur, MD
Since the announcement of the U.S. Food and Drug Administration (FDA) Oncology Center of Excellence (OCE) on June 29, 2016, as part of the White House’s Cancer Moonshot, we’ve been working to further the FDA’s efforts to get new oncology products into the hands of patients. We are commit...
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...
Risk of Metastasis With Active Monitoring in PSA-Detected Localized Prostate Cancer: The ProtectT Trial
Anthony V. D’Amico, MD, PhD
The ProtecT study findings1 are provocative. Despite having a control arm of active monitoring with serial prostate-specific antigen (PSA) testing, as compared with watchful waiting in the prior randomized trials (ie, SPCG-42 and PIVOT3), and also enrolling men with more favorable-risk d...
Surgery and Radiation ProtecT Against Progression/Metastasis vs Active Monitoring in Prostate Cancer, but at What Cost?
Andrew J. Armstrong, MD, ScM, FACP, W. Robert Lee, MD, and Judd Moul MD, FACS
The ProtecT trial showing similar 10-year survival with active monitoring, surgery, or radiotherapy for prostate-specific antigen (PSA)-detected localized prostate cancer but a greater risk of disease progression/metastasis with monitoring was recently reported by Hamdy and colleagues and is summa...
Why Curing Cancer Will Take Decades
This past summer, Eric S. Lander, PhD, President of the Broad Institute of the Massachusetts Institute of Technology and Harvard in Cambridge, Massachusetts, and Co-Chair of the President’s Council of Advisors on Science and Technology, raised a few eyebrows at the Aspen Ideas Festival w...
Daratumumab Plus Bortezomib/Dexamethasone: Changing the Treatment Paradigm in Relapsed or Refractory Myeloma
Kenneth C. Anderson, MD
The CD38 antigen was first recognized on normal and abnormal plasma cells over 3 decades ago. Indeed, this antigen was originally classified as T10, as it was the tenth antigen described on T cells. Its distribution of expression included activated B and T cells, natural killer cells, le...
Small Cell Lung Cancer and Immunotherapy: A Change Is Coming, Just Not Front Line (Yet!)
Jeffrey Crawford, MD
Ever since the immune checkpoint agents arrived, the pace of clinical investigation in oncology has continued to accelerate with an ever-increasing number of trials of single-agent and combination therapies with novel designs that are transforming our drug-development process. However, e...
A Helping Hand, Just in Time: The ASCO Guideline for Managing Chronic Pain in Adult Cancer Survivors
Rajiv Shah, MD, and Robert A. Swarm, MD
With impeccable timing, as well as considerable forethought and planning, Dr. Paice and colleagues have produced a superb evidence-based guideline on “Management of Chronic Pain in Survivors of Adult Cancers.”1 (See this issue of The ASCO Post.) This summary of well-informed and thoroughly doc...
Immune Checkpoint Inhibitors March to First-Line Treatment in Advanced NSCLC
Karen Kelly, MD
For the majority of patients who are diagnosed with advanced-stage non–small cell lung cancer (NSCLC), platinum-based doublets have been the standard of care for over 30 years. Recently, the immune checkpoint inhibitors nivolumab (Opdivo) and pembrolizumab (Keytruda) demonstrated superio...
Reducing Drug Costs by Increasing Science-Driven Drug Discovery
Ronald A. DePinho, MD
For several years now, the American health-care system has been undergoing a transformation. Innovative ideas are being explored, new systems continue to be created, and millions of lives have been impacted. As health-care providers and research engines, academic institutions have an opp...
Updated USPSTF Guidelines for Colorectal Cancer Screening: More Methods, More Challenges for Patients and Providers Alike
Alexander R. Ende, MD, and William M. Grady, MD
As reviewed in this issue of The ASCO Post, the U.S. Preventive Services Task Force (USPSTF) recently updated its guidelines for colorectal cancer screening1 from 2008 and has now included seven acceptable strategies, including direct-visualization modalities (ie, endoscopy and computed tomography [...
I-SPY 2: Separating Contenders From Pretenders in Breast Cancer
William M. Sikov, MD, FACP
With the expansion of our understanding of signaling pathways in normal cells and how they are co-opted or corrupted in malignancy, the number of potential antitumor agents to be tested has exploded, exposing the limitations of traditional antineoplastic drug development and challenging ...
Hypofractionated Radiotherapy for Localized Prostate Cancer: A New Standard of Care?
Talha Shaikh, MD, and Eric M. Horwitz, MD
For at least the past quarter of a century, radiobiologists and radiation oncologists have debated the role of hypofractionation (fewer total fractions with a higher dose per fraction) for prostate cancer. The debate stems from the unique radiobiology of prostate cancer and the best means to e...
Is Human Life Worth No More Than a Text Message?
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 unsustainable upward trajectory of health-care costs. We are reminded constantly about how health care in America currently costs more than $3.4 trill...
Interim PET-Adapted Treatment in Advanced Hodgkin Lymphoma
Richard I. Fisher, MD
The ability to cure a majority of patients with advanced Hodgkin lymphoma is one of the major milestones of success in the combination chemotherapy era. It has been over 40 years since Bonadonna and colleagues in Milan developed the ABVD regimen (doxorubicin, bleomycin, vinblastine, and ...
Nivolumab in Recurrent Classical Hodgkin Lymphoma: Refreshingly Supportive Data
Stephen M. Ansell, MD, PhD
It is commonly said that if something is too good to be true, it usually is. It is therefore quite refreshing when really good results are replicated in a subsequent study. As reported in The Lancet Oncology by Younes et al1 and reviewed in this issue of The ASCO Post, a phase II trial ...
Have You Received Your Immune Checkpoint Inhibitor Yet?
Tony S.K. Mok, MD
“Have you received your immune checkpoint inhibitor yet?” I suspect St. Peter may have started asking this question routinely at the Pearly Gates to Heaven. If St. Peter has not, I am sure most oncologists have. With extensive media coverage on the approval of nivolumab (Opdivo) and pe...
ASCO Guideline Addresses Controversial Areas in Adjuvant Therapy for Breast Cancer
Sara M. Tolaney, MD, MPH
ASCO has published an adaptation of the 2015 Cancer Care Ontario (CCO) clinical practice guideline on adjuvant chemotherapy for early-stage breast cancer.1 There were several areas of controversy that the guideline attempts to address. Should Anthracyclines Be Standard of Care? The gui...
Hypofractionated Radiotherapy: Balancing Benefits vs Risks in Men With Localized Prostate Cancer
Paul L. Nguyen, MD
Radiation for prostate cancer typically requires 40 to 45 daily treatments, given over 8 to 9 weeks. Long fractionation schemes are chosen for most cancers, because they allow for tumor killing while reducing the potential for injury to normal tissue. However, the radiobiology of prostat...
Six Perspectives on the Cancer Moonshot Goal of Making 10 Years of Progress in 5 Years
the National Coalition for Cancer Research, With Contributions by the panelists, as well as Ms. Wendy Selig, Ms. Alex Carney, and Mr. Mark Smith.
The Cancer Moonshot initiative is bringing together scientists, oncologists, patient advocates, and representatives of the biopharmaceutical industry with renewed collaborative focus and the ambitious objective of consolidating 10 years of cancer research in 5 years. Achieving this outcome will re...
GADOLIN and the Perplexing Role of Obinutuzumab in the Treatment of B-Cell Malignancies
Anas Younes, MD
After several dose-finding phase I and II studies in a variety of B-cell malignancies, the potential clinical role of the newer anti-CD20 monoclonal antibody obinutuzumab (Gazyva) remained unclear. These early trials tested low and high doses as well as weekly and every-3-week schedules ...
Moonshots and ‘Onco-nauts’
Daniel F. Hayes, MD, FASCO
Where were you on July 20, 1969? I certainly remember where I was—sitting in a mess hall at summer camp watching a grainy black-and-white TV as Neil Armstrong took “one small step for man, one giant leap for mankind.” I recall the sense of jubilation and accomplishment that all American ...
Effects of the Global Economic Crisis on Cancer Care
Kenneth L. Kehl, MD
The global economic crisis beginning in 2008 was associated with substantial public health effects, especially with respect to mental health.1–3 Nevertheless, there is also evidence of a paradoxical association between recessions and reduced all-cause mortality, in part because of reduct...
Is Post-Transplantation Cyclophosphamide Disruptive Technology?
Matt Kalaycio, MD, FACP
There was a time when transplantation across human leukocyte antigen (HLA) barriers was fraught with so much difficulty that many thought it was impossible and we should stop trying. However, most patients do not have an HLA-matched sibling donor, and death was therefore certain if they ...
CMS Proposal for Part B Drug Payment: A Poorly Conceived Experiment
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 make drug payments under Part B to ...
ASCO Guideline on Endocrine Therapy for Metastatic Breast Cancer: Reaffirming Principles for Making Treatment Decisions
William J. Gradishar, MD, FASCO, FACP
The role of endocrine therapy for hormone receptor–positive metastatic breast cancer is well established, and clinicians are strongly encouraged to consider one of several therapeutic options for the majority of patients who present with metastatic disease. The recent ASCO guideline on t...
ASCO 2016 Guidelines for the Treatment of Pancreatic Cancer: Why Another Guideline?
Ramesh K. Ramanathan, MD
The 5-year survival rate of those diagnosed with pancreatic cancer remains stubbornly fixed around 5%. Even in the 20% of cases in which surgical resection is undertaken for curative intent, the 5-year survival rate after surgery is 20% to 30%. As we make progress in other cancers with d...
The Age of the Atomic Hematologists/Oncologists
Robert Peter Gale, MD, PhD, DSc(hc), FACP, FRSM, and Dieter Hoelzer, MD, PhD
Every longstanding culture has ages: The Minoans were followed by the Mycenaeans and, later, the Hellenistic peoples. And so it is with hematology/oncology. A descriptive age dominated predominately by histopathologists was followed by an age of experimentalists. Development of the atomic bomb...
Supporting Policy to Reduce Tobacco-Related Deaths
Ronald A. DePinho, MD
One billion lives. That is the estimated human death toll of tobacco use in the 21st century.1 Tobacco use is the leading cause of preventable death worldwide—20% of all deaths and 30% of cancer deaths in the United States are linked to tobacco use.2,3 Impacting this preventable public health me...
Ixazomib: A Relevant Addition to Myeloma Therapy
S. Vincent Rajkumar, MD
In 2015, four new drugs were approved for the treatment of multiple myeloma by the U.S. Food and Drug Administration: panobinostat (Farydak), daratumumab (Darzalex), elotuzumab (Empliciti), and ixazomib (Ninlaro). Of them, the first three are drugs with unique new targets, whereas ixazomib is the th...
Anti–PD-1 Treatment With Pembrolizumab in Gastric/Gastroesophageal Junction Cancers: Who Is Likely to Respond?
David H. Ilson, MD, PhD
Immune checkpoint inhibitors have emerged as one of the most promising new areas of drug development in oncology. Broad activity has been observed for these agents across a spectrum of hematologic malignancies and solid tumors. As reviewed in this issue of The ASCO Post, Muro and colleagues now repo...
Pembrolizumab in Triple-Negative Breast Cancer: Emerging New Treatment Modality
Lajos Pusztai, MD, DPhil, Professor of Medicine, Chief of Breast Medical Oncology and Co-Director of Cancer Genetics Research Program at Yale Cancer Center, New Haven, Connecticut, commented on KEYNOTE-012. He remarked that the overall response rate of 18.5% to the single agent is similar to re...
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...
Ovarian Suppression in Premenopausal Women With Estrogen Receptor–Positive Breast Cancer
Katarzyna J. Jerzak, MD, FRCPC, and Kathleen I. Pritchard, MD, FRCPC
Oophorectomy was the first proposed form of endocrine therapy for women with breast cancer. Over 100 years ago, Thomas Nunn reported a relationship between menopause and regression of breast cancer.1 This incited interest in the induction of menopause as an anticancer therapy, and in 1986, a r...
Learning About Fertility Is Important to Young Patients With Cancer
Kathryn J. Ruddy, MD, MPH
It is more and more common for people to wait until their 30s or 40s to have children. Consequently, many young adults have not completed their desired childbearing when they are diagnosed with cancer. Cancer treatments can impair fertility directly (usually via gonadotoxicity from chemotherapy,...
PALOMA-3 Trial in HER2-Negative Metastatic Breast Cancer: Challenge of Moving Beyond Estrogen Receptor Positivity
Richard S. Finn, MD
Hormone receptor–positive breast cancer represents the largest therapeutic subgroup of the disease. The development of endocrine therapies has shaped the treatment paradigm for both advanced- and early-stage disease for decades.1 Still, despite their significant impact, advanced breast cancer re...
SIRIUS Trial Heralds a New Era of Promise in Treating Resistant Myeloma
Jacob P. Laubach, MD, MPP, and Paul G. Richardson, MD
Multiple myeloma cells uniformly overexpress CD38.1 Daratumumab (Darzalex), a CD38-targeting human IgG1 kappa monoclonal antibody, has been evaluated in a series of phase I/II trials involving patients with relapsed or relapsed and refractory myeloma who have received at least two or more prio...
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 Best HCAHPS Score: A Rodeo Invitation
Chandrakanth Are, MBBS, MBA, FRCS, FACS
An otherwise healthy, actively working, independent 60-year-old patient came to us with a several months’ history of abdominal pain. He had been seen by other physicians prior to coming to us for a second opinion. Our workup revealed a large cystic lesion emanating from the pancreas but involvin...
What ASCO Can Do for You—and for Our Patients
Daniel F. Hayes, MD, FASCO
This is an exciting time to be an oncologist. I often say I wish I were 30 again and just starting out in my oncology career. Never before have we had such sophisticated technology for evaluation of the tumor or such a potent arsenal of targeted and effective therapies to treat cancer. Further, the ...
ExteNET Trial of Neratinib: One Size Does Not Fit All in HER2-Positive Breast Cancer
Edward H. Romond, MD
Neratinib is an oral anti-HER2 tyrosine kinase inhibitor that has shown promising activity in the treatment of HER2-positive metastatic breast cancer.1 It differs from monoclonal antibodies such as trastuzumab (Herceptin) because, as a small molecule, neratinib blocks the ATP binding site on the int...
ASCO and European Association of Urology Agree on Bladder Cancer Guidelines
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
I like economies of scale, and thus it makes perfect sense that ASCO has set a formal process to allow potential endorsement of selected guidelines from other organizations, rather than redoing the whole process. Recently, we have seen the publication of a formal endorsement of the European Asso...
Curb Your Enthusiasm: No Benefit of Adjuvant Sorafenib or Sunitinib in Nonmetastatic Renal Cell Carcinoma
Cora N. Sternberg, MD, FACP
Renal cell carcinoma is the most common cancer of the kidneys. Up to 30% of patients present with advanced/metastatic disease, and recurrence can develop in patients at high risk treated by nephrectomy for localized tumors. Renal cell carcinoma is notoriously resistant to chemotherapy and hormon...
Atezolizumab in Previously Treated Advanced Urothelial Carcinoma
Nicholas J. Vogelzang, MD
The recent study by Rosenberg et al in The Lancet—summarized in this issue of The ASCO Post—is a very important paper in the field of bladder cancer therapy.1 It is the first phase II trial in metastatic transitional cell carcinoma that demonstrates the single-agent activity of the investigation...
Eribulin in Liposarcoma: A Closer Look at the Comparative Data
Margaret von Mehren, MD
Sarcoma therapy is a challenge for oncologists. Soft-tissue sarcomas encompass more than 50 different histologies, resulting in limited familiarity of management for many treating physicians. In addition, there have been few available effective therapies. The phase III trial of eribulin (Halavan...
The Arrival of Generic Imatinib Into the U.S. Market: An Educational Event
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 comply with the treatment and w...
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 ...
Moving Forward in Castration-Resistant Prostate Cancer: The TERRAIN and STRIVE Studies
E. David Crawford, MD
It was over 2 decades ago that my colleagues and I reported in The New England Journal of Medicine that a first-generation oral antiandrogen, flutamide, when added to a luteinizing hormone–releasing hormone (LHRH) agonist, improved survival by nearly 6 months compared to an LHRH agonist alone in men...
Shedding Light on a Cornucopia of Breast Tumor Biomarker Assays
Melanie Royce, MD, PhD
As our understanding of the complexities of breast cancer expands, so does our treatment armamentarium—and along with it the range of factors that must be included in our treatment decisions. Gone is the simple algorithm of adjuvant chemotherapy for almost every patient with a ≥ 2-cm tumor, except f...
‘So How Long Do I Have?’
Parvez Dara, MD, FACP, MBA
Imagine accidentally falling off an abyss. One simply cannot fully understand the gravity of the situation! You might skip a beat thinking about it while sitting in a chair in your living room, if you have tons of empathy, as you try to get into the shoes that are flailing for survival. But there h...
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 ...
CDX2 in Stage II Colon Cancer: Ready for Prime Time?
Kimmie Ng, MD, MPH
In a recent issue of The New England Journal of Medicine, Dalerba et al published an impressive article describing a novel bioinformatics approach to identifying new prognostic and predictive biomarkers in patients with stage II and III colon cancer (see summary in this issue of The ASCO Post).1 The...
Active Surveillance Has Become Standard Care for Men With Low-Risk Localized Prostate Cancer
Ethan Basch, MD
Active surveillance has been increasingly adopted as a standard approach for men with Gleason score ≤ 6 localized prostate cancer, with major guidelines and consensus statements encouraging this approach,1 including a recently published guideline from Cancer Care Ontario (CCO),2 and endorsement of t...
Praise for the ACS/ASCO Breast Cancer Survivorship Care Guideline
Ann H. Partridge, MD, MPH
The recent publication of the American Cancer Society (ACS)/ASCO breast cancer survivorship care guideline is a tremendous contribution to the literature and should provide a roadmap for providers who care for patients with a history of breast cancer for years to come.1,2 The guideline, reported by ...
The POPLAR Trial: PD-L1 Blockade With Atezolizumab in Second- or Third-Line Non–Small Cell Lung Cancer
Jean-Charles Soria, MD, PhD
The randomized phase II POPLAR trial—reported by Fehrenbacher and colleagues and reviewed in this issue of The ASCO Post—is another key piece of information for the medical community regarding the value of immune checkpoint blockers in second/third-line treatment of patients with non–small cell lun...
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...
Chronic Lymphocytic Leukemia: The Golden Drug Only for Golden Agers?
Stephan Stilgenbauer, MD, PhD
As reviewed in this issue of The ASCO Post, Burger and colleagues recently reported findings of the RESONATE-2 trial of ibrutinib (Imbruvica) vs chlorambucil (Leukeran) as initial therapy for elderly patients with chronic lymphocytic leukemia (CLL).1 The study met its primary endpoint of independent...
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...
Cancer Survivorship Research: Learning From the Past to Improve Future Outcomes
Lisa Diller, MD
Soon after effective therapies for some childhood malignancies were first identified, early leaders in our field had concerns about what would happen to surviving patients as they aged. In 1975, Giulio D’Angio, MD, one of the founders of modern pediatric radiation oncology, presciently called for th...
Introduction of New Diagnostic Devices in Oncology: New Is Not Necessarily Better
Daniel F. Hayes, MD, FASCO
“New!” “Improved!” “Throw out that old [fill in the blank] and go buy a new [fill in the blank]!” Sound familiar? The key to marketing is to convince customers that they need a product without which they had previously been quite happy. All too often, this strategy is accompanied by a caveat emptor ...
Minimal Residual Disease in AML: Worth Looking?
Selina M. Luger, MD, and Marlise R. Luskin, MD, MSCE
As summarized in this issue of The ASCO Post, Ivey and colleagues demonstrated that assessing for NPM1-mutated gene transcripts by reverse-transcriptase quantitative polymerase chain reaction assay is a feasible approach for measuring minimal residual disease after acute myeloid leukemia (AML) induc...
Biomarkers in Prostate Cancer: PARP Inhibitors and Defects in DNA Repair
Oliver Sartor, MD
New data on molecular biomarkers in advanced prostate cancer are accumulating at a fast pace. The studies in this area can now be broadly grouped in two distinct areas—those that broadly relate to androgen signaling and those that relate to DNA-repair pathways. The Androgen-Signaling Pathway With ...
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...
Adding Targeted Therapy to Chemoimmunotherapy in Patients With Chronic Lymphocytic Leukemia: Questions as to Optimal Strategy Remain
Jennifer Woyach, MD
The HELIOS study is an international phase III trial of bendamustine (Treanda) plus rituximab (Rituxan) in combination with ibrutinib (Imbruvica) vs placebo in patients with previously treated chronic lymphocytic leukemia. As reported by Chanan-Khan in The Lancet Oncology1 and reviewed in this issue...
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 ...
For Postmenopausal Women With Ductal Carcinoma in Situ: NSABP B-35 and IBIS-II DCIS Trials Offer a Choice of Endocrine Therapy
Seema A. Khan, MD
The past year has produced an embarrassment of riches regarding the value of aromatase inhibitors for women with ductal carcinoma in situ of the breast. The long-awaited NSABP B-35 study matured and was reported by Margolese and colleagues at the 2015 ASCO Annual Meeting this past summer, followed b...
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 ...
Is Health Care in the United States a Basic Human Right or an Entitlement?
Gregory H. Jones, BS, and Hagop Kantarjian, MD
Mercy Killers is a one-man show that details the consequences of a medical health-care catastrophe (breast cancer) in a family.1 This disturbing fictional account is actually a daily event in cancer centers: losing insurance for technicalities, losing a home because of an inability to pay the mortga...
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 silenc...
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...
Elotuzumab Ushers in a New Era in Myeloma Therapy
S. Vincent Rajkumar, MD
The long wait for monoclonal antibodies for the treatment of multiple myeloma is over. In the landmark ELOQUENT-2 study, reviewed in this issue of The ASCO Post, Lonial and colleagues convincingly demonstrate the effectiveness of elotuzumab, a monoclonal antibody directed against SLAMF7, in the trea...
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...
COMBI-d Trial and the Need to Guide Progress in Melanoma Treatment
Michael S. Sabel, MD, FACS
As reviewed in this issue of The ASCO Post, Long et al1 have reported the final overall survival analysis of the COMBI-d phase III trial comparing combination therapy with the BRAF inhibitor dabrafenib (Tafinlar) and the MEK inhibitor trametinib (Mekinist) to monotherapy with dabrafenib alone, confi...
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...
Learning to Refine the Use of Regorafenib to Best Advantage in Advanced Colorectal Cancer
Richard Goldberg, MD
In patients with advanced colorectal cancer who have been heavily treated with a sequence of chemotherapy regimens and/or targeted therapies, the goals of treatment on or off a clinical trial are readily definable. These patients and their managing teams are striving to extend the length of lives, m...
The Conundrum of Estrogen-Receptor Signaling in HER2-Positive Breast Cancer
Ruth O’Regan, MD
BOLERO-1—reviewed in this issue of The ASCO Post—is the next installment in a series of randomized trials evaluating the addition of everolimus (Afinitor) to standard therapy in metastatic breast cancer.1 The initial evaluation of everolimus in the HER2-positive metastatic setting looked extremely p...
Improved Understanding of Glioma Tumor Biology
Mark R. Gilbert, MD
The management of patients with lower-grade gliomas is evolving. As evidenced by two recent publications in The New England Journal of Medicine,1,2 reviewed in this issue of The ASCO Post, there has been a substantial increase in our knowledge of the molecular characteristics of these neoplasms. Thi...
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...
Magnetic Resonance Imaging/Ultrasound Fusion: A Promising Technology for Image-Guided Prostate Biopsy
Richard G. Abramson, MD and Sandeep S. Arora, MBBS
An elegant study by Siddiqui et al1—reviewed in this issue of The ASCO Post—offers compelling evidence for the diagnostic utility of “targeted” prostate biopsy using multiparametric magnetic resonance imaging (MRI) data fused with ultrasound images. The technique involves first performing a dedicate...
Comparing Regimens Guides Therapeutic Decisions in Previously Treated Advanced Breast Cancer
Linda T. Vahdat, MD
Kaufman and colleagues recently reported findings of a phase III trial comparing eribulin (Halaven) vs capecitabine in patients with advanced breast cancer who had previously received anthracycline and taxane therapy,1 and a review of their study appears in this issue of The ASCO Post. Although thi...
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 ...
ASTRO Guidelines on Radiotherapy in Locally Advanced NSCLC: A Good Place to Start
Andreas Rimner, MD
ASCO’s endorsement of the American Society for Radiation Oncology (ASTRO) guidelines on the role of radiotherapy in locally advanced non–small cell lung cancer (NSCLC) is an important summary of the best evidence on the appropriate role and techniques for radiotherapy in this disease.1 These guideli...
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...
Hormonal Therapy and Risk of Ovarian Cancer
Ana I. Tergas, MD, MPH
Ovarian cancer is the second most common gynecologic malignancy in the United States, with an estimated 21,290 new cases expected this year. Ovarian cancer causes 5% of all cancer deaths in women, making it responsible for the highest number of gynecologic cancer deaths.1 Age, family history, and in...
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...
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...
Understanding the Role of Immune Function in the Treatment of HER2-Positive Breast Cancer
Randy F. Sweis, MD, and Olufunmilayo I. Olopade, MD
The addition of trastuzumab (Herceptin) to adjuvant chemotherapy undoubtedly transformed HER2-positive breast cancer from one of the most deadly subtypes to a highly treatable disease. Randomized phase III trials established adjuvant trastuzumab as standard of care in HER2-positive breast cancer.1,2...
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 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...
Cancer Genetics: Looking Back, Looking Ahead
The ASCO Post
At the 2014 San Antonio Breast Cancer Symposium, The ASCO Post sat down with geneticist Mary-Claire King, PhD, for some personal musings about her career and how she might guide young researchers who want to follow in her footsteps. Dr. King is known for a variety of accomplishments in genetics, inc...
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...
Striving for Quality, Not Quantity, of Life
Jo Cavallo
Advances in science and medicine have led to humans living longer than at any other time in history. According to a new report1 on mortality from the Centers for Disease Control and Prevention’s National Center for Health Statistics, life expectancy in the United States is at an all-time high of 78....
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...
Clinically Relevant Survival Benefit Seen for Everolimus in Pancreatic Neuroendocrine Tumors
Alice Goodman
Final results from the RADIANT-3 trial showed a 6-month difference in overall survival favoring everolimus (Afinitor) plus best supportive care over placebo plus best supportive care in patients with well-differentiated advanced and progressive pancreatic neuroendocrine tumors.1 Although the differe...
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 ...
The Power of Laughter
Julie Vose, MD, MBA, FASCO
The following essay by Julie Vose, MD, MBA, FASCO, is adapted from The Big Casino: America’s Best Cancer Doctors Share Their Most Powerful Stories (May 2014), coedited by Stan Winokur, MD, and Vincent Coppola. The book is available on Amazon.com and thebigcasino.org. When I met Cindy, she was ve...
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...
Does the United States Have the Best Health-Care System in the World?
Hagop Kantarjian, MD
Many concerns were raised and dire speculations predicted during the further implementation of the Affordable Care Act this year. So far, the trickling news is good: An estimated total of 20 million people gained coverage under the new law as of May 1,1 about 6 million enrolled in the law’s Medicaid...
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...
Facing Cancer Together
Dan Shapiro, PhD
David sits at his desk, tapping angrily. He’s tired of his abusive, ignorant boss, the VP for regional sales. The man’s sales targets are absurdly high, he’s impossible to reach on the phone, his “motivational” speeches evoke the stress of Glengarry Glen Ross, and even his fake all-light-brown hair ...
Michael Douglas Shares His Experience With Stage IV Oropharyngeal Cancer
Academy Award winning actor and producer Michael Douglas was the guest of honor at the opening day of the International Federation of Head and Neck Oncologic Societies (IFHNOS) 5th World Congress on July 27 in New York (see page 22 for more on the World Congress). He came not to plug the release of ...
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...
Do We Need So Much Emphasis on ‘Quality Care’?
James R. Gould, MD
Unfortunately, when I see The ASCO Post, my first impression is that you enable a group of researchers (part-time clinicians) to pontificate about their own agendas. The agenda that seems to be missing is the presentation of information that either supports or refutes the freight train of “quality c...
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...
A New Era in the Management of Advanced HER2-Positive Breast Cancer
Karen Lisa Smith, MD, MPH, and Vered Stearns, MD
Approximately 20% of all breast cancers are human epidermal growth factor receptor 2 (HER2)-positive. Prior to the era of HER2-targeted therapy, HER2-positive breast cancer was characterized by a poor prognosis.1,2 The development of the first HER2-targeted therapy, trastuzumab (Herceptin), led to d...
Colon Cancer Prevention: It’s All About Mindset and Minute Details
G.S. Raju, MD, FACG, FASGE
I would like to congratulate Corley and his colleagues for their seminal work on the association between adenoma detection rate and risk of colorectal cancer, advanced colorectal cancer, and colorectal cancer mortality. The impact of their findings—reported in The New England Journal of Medicine1 an...
Genomic Confidence and Competence
Patrick M. Boland, MD, and Michael J. Hall, MD, MS
As reported in the Journal of Clinical Oncology and reviewed in this issue of The ASCO Post, Stacy W. Gray, MD, AM, a medical oncologist at Dana-Farber Cancer Institute, Boston, and colleagues presented one of the first studies evaluating how academic oncologists perceive the incorporation of a nove...
Sharing 50 Years of Christmas: A Quality Metric?
Chandrakanth Are, MBBS, MBA, FRCS, FACS
A very pleasant 68-year-old woman was referred to my clinic with biopsy-proven liver metastasis from primary colon cancer. She was initially diagnosed with colon cancer, which was resected, and she then received chemotherapy. A suspicious liver lesion was biopsied in the adjuvant setting, which conf...
'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...
ASCO Guideline Update Extends Sentinel Node Biopsy Indications in Breast Cancer
Armando E. Giuliano, MD
The American Society of Clinical Oncology (ASCO) published its first guideline for sentinel lymph node biopsy in 2005.1 Since that time, many new randomized and cohort studies have been published investigating the indications and outcomes of the procedure. The updated 2014 guideline, recently publis...
Should Breast Cancer Patients With One to Three Positive Nodes Routinely Receive Postmastectomy Radiation?
Bruce G. Haffty, MD
The Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) continues to provide valuable clinically relevant and practice-influencing information garnered from individual patient-level data from numerous randomized trials in breast cancer. The large numbers of patients and long-term follow-up i...
Margin Reassessment in Breast-Conservation Therapy
Thomas A. Buchholz, MD, FACR, FASTRO
Significant progress has been made in local-regional and systemic treatments of breast cancer. Most patients currently diagnosed with breast cancer in the United States are diagnosed with early-stage disease and achieve excellent outcomes with breast-conservation therapy. Indeed, outcomes have sign...
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...
Cancer Has Robbed Me of My Physical Beauty but Not My Inner Strength
Mandy McCown, as told to Jo Cavallo
I’ve been plagued with various ailments all my life. Physically and emotionally abused by my stepfather as a child, over the years I’ve developed severe psychological issues including depression and anxiety disorder. I am also in constant physical pain from cervical degenerative disc disease, osteoa...
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...
Andrew D. Zelenetz, MD, PhD, on Treating the Elderly Lymphoma Patient With Elevated Bilirubin
Caroline Helwick
At the 19th Annual Conference of the National Comprehensive Cancer Network (NCCN), lymphoma expert and NCCN Panel Chair on Lymphoma, Andrew D. Zelenetz, MD, PhD, fielded questions from oncologists. The ASCO Post was there to capture his recommendations for a common clinical scenario—treating the eld...
Beyond the Cystoscope: Thinkers and Technicians
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
I have spent my career working with urologists. Over a long period of time, I have concluded that they are fine and interesting people who work hard, live well, support interesting hobbies, generally take good care of their families, and are very enjoyable company at parties. The recent discussion ...
Getting It Right in the End: Individualization of Care for Patients With Rectal Cancer
Leonard Saltz, MD
Data from trials conducted mostly in the 1970s and 1980s established the paradigm that optimal treatment of rectal cancer requires a combination of radiation therapy, chemotherapy, and surgery.1 Virtually all of these trials, however, demonstrated that radiotherapy added only to the local control ra...
The Role of Psychosocial Supportive Services in Palliative Care
More than 2 decades ago, Deane L. Wolcott, MD, helped develop comprehensive patient-centered psycho-oncology care in cancer centers across the country. Today, many aspects of that patient-centered care, including psychiatric, dietary, pain management, cancer rehabilitation medicine, survivorship, an...
Thirty Years of Effort Has Led to the Mainstreaming of Integrative Medicine in Oncology Care
When Barrie R. Cassileth, MS, PhD, began researching complementary medicine and its potential for use in oncology care over 30 years ago, not much was known about the importance of complementary therapies for the well-being of patients with cancer. She chose to conduct her doctoral dissertation rese...
A Vision of Independent Clinical Research in South America
Eduardo Cazap, MD, PhD, FASCO
Clinical research is vital for the development and improvement of methods designed to prevent and treat cancer. The majority of clinical trials take place in the developed world through sponsored pharmaceutical research companies.1 The corresponding lack of research in developing countries results i...
An Oncologic Surgeon Discusses the Pros and Cons of Pursuing a Business Degree
Is pursuing a Master of Business Administration (MBA) degree a good idea for ambitious surgical oncologists who want to advance their careers? The ASCO Post recently spoke with Martin J. Heslin, MD, MSHA, Chief, Section of Surgical Oncology, University of Alabama at Birmingham (UAB) Medical Center, ...
Learning to Live in the Moment
Laurie MacCaskill, as told to Jo Cavallo
I’ve been health conscious all my life. I have never smoked, I eat a healthy diet, and I have maintained a near-daily exercise routine since I was 20. I’m also steadfast about keeping yearly medical checkups and screenings. So when I felt a sharp, lightning-bolt of pain that went from the top of my ...
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...
Flaws in CNBSS Are Vast, Impact on Screening Recommendations Is Nil
Therese B. Bevers, MD
The recent report from the Canadian National Breast Screening Study (CNBSS)—published in BMJ and reviewed in this issue of The ASCO Post—concluded that annual mammography in women aged 40 to 59 does not result in a reduction in mortality from breast cancer beyond that of physical examination alone o...
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 ...
Will Colorectal Cancer Surveillance Change Based on the Results of the FACS Trial?
Cathy Eng, MD, FACP
Colorectal cancer is a common malignancy that will impact 1.4 million individuals globally each year.1 Approximately 70% to 75% of patients will present with locally advanced disease. For patients with stage III colon cancer, adjuvant chemotherapy is commonly offered, whereas chemotherapy for those ...
Prostatectomy vs Radiotherapy: A Study for Cautious Interpretation
Ronald C. Chen, MD, MPH, and Anthony L. Zietman, MD
Men with newly diagnosed localized prostate cancer face a decision between prostatectomy and radiotherapy, treatments deemed similarly effective but with well-established trade-offs in terms of treatment-related morbidity. Numerous clinical trials and other prospective studies, from both academic an...
Long-Term Complications of Prostate Cancer Treatment May Have Been Underappreciated
Kyle O. Rove, MD, Ty T. Higuchi, MD, PhD, and E. David Crawford, MD
The recent study by Nam et al in The Lancet Oncology—reviewed in this issue of The ASCO Post—provides a fresh perspective on complications other than incontinence or erectile dysfunction that commonly arise after primary treatment of localized prostate cancer.1 The authors conducted a population-bas...
‘How Am I Doing, Doc?’
Victor G. Vogel, MD, MHS
The goal of effective adjuvant therapy is to increase overall survival. It has been suggested cynically that all we need to accomplish, actually, is to delay recurrence until after the time the patients die from another cause. However, patients want to hear from us that “it’s never coming back,” and...
Transition From Busy Oncologist to Retiree: Challenges and Opportunities
Oncology is a demanding field that requires special qualities to care for very sick patients, many of whom will die prematurely of their disease. Research indicates that years of facing life-and-death decisions in the clinic can be associated with oncology burnout syndrome, which effects physician q...
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...
Expert Point of View: James Gulley, MD, PhD
Alice Goodman
“The key thing about this trial is that while the overall study was negative, subset analysis suggests that the patients who appear to benefit from ipilimumab have better prognostic factors, including no visceral disease, lower alkaline phosphatase, and elevated hemoglobin,” commented James Gulley,...
Expert Point of View: Thomas W. Flaig, MD
Alice Goodman
This study has the potential to expand the number of patients who can benefit from organ-sparing therapy,” said Thomas W. Flaig, MD, Associate Professor in the Division of Medical Oncology at the University of Colorado Denver, commenting on the pooled analysis of RTOG 9906 and 0233 presented at the ...
Expert Point of View: Neal J. Meropol, MD
Caroline Helwick
Neal J. Meropol, MD, Chief of Hematology and Oncology at University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, discussed the study by Kothari et al presented at the Gastrointestinal Cancers Symposium. He noted that complex interactions exist between PIK3CA and o...
Expert Point of View: Neal J. Meropol, MD
Caroline Helwick
Neal J. Meropol, MD, Chief of Hematology and Oncology at University Hospitals Case Medical Center at Case Western Reserve University, Cleveland, discussed the various findings in RAS mutations at the Gastrointestinal Cancers Symposium. “RAS mutations beyond exon 2 are common, occurring in about 15%...
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 Future of Biomedical Research
In January, Congress approved a $1 trillion appropriations bill for the rest of fiscal year 2014. While the new bill includes $29.9 billion for the National Institutes of Health (NIH)—$1 billion above FY2013 levels after sequestration—including $4.9 billion for the National Cancer Institute (NCI), i...
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...
Kava
Jyothirmai Gubili, MS
Kava Scientific Name: Piper methysticum Common Names: Kava-kava, kawa, kavain, rauschpfeffer, intoxicating long pepper, tonga, yagona, and yaqona. Overview Kava, a perennial shrub indigenous to the Hawaiian Islands and the Pacific Rim, is known for its relaxant effects and used for social and rec...
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 ...
An Overview of the REGAL Trial and Anti-VEGF Therapies in Recurrent Glioblastoma
Annick Desjardins, MD, FRCPC
As published in the Journal of Clinical Oncology by Batchelor and colleagues1 and reviewed in a recent issue of The ASCO Post (November 15, 2013, page 106), the REGAL trial was a randomized, phase III, placebo-controlled, partially blinded trial evaluating the efficacy of cediranib, an investigation...
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...
Molecularly Targeted Therapy for Lung Cancer
The ASCO Post
INSIDE THE BLACK BOX is an occasional column offering insight into the FDA and its policies and procedures. This installment addresses a changing paradigm in the treatment of lung cancer, exemplified by concurrent approval of a companion diagnostic with each of several new targeted agents or new dru...
Adjuvant Gefitinib in Patients With NSCLC: Bad Idea or Wrong Patient Selection?
Daniel Morgensztern, MD, and Roy S. Herbst, MD, PhD
Despite optimal surgical resection and adjuvant chemotherapy with cisplatin-based doublets, the 5-year overall survival for patients with early-stage non–small cell lung cancer (NSCLC) remains suboptimal. In the International Association for the Study of Lung Cancer (IASLC) staging project, the 5-ye...
Diagnosing and Treating Chronic Mucocutaneous Graft-vs-Host Disease
Jonathan A. Cotliar, MD
Chronic graft-vs-host disease is a major cause of late, nonrelapse death following allogeneic hematopoietic stem cell transplantation. In addition, chronic graft-vs-host disease results in significant functional impairment and decreased quality of life for long-term survivors of stem cell transplant...
Stress and Tumor Biology: Insights Into Managing Stress to Help Improve Cancer Care
By Lorenzo Cohen, PhD, Anil K. Sood, MD, PhD, Sarah Prinsloo, PhD, and Alejandro Chaoul, PhD, The University of Texas MD Anderson Cancer Center, Houston
Stress is ubiquitous in our society, especially for people diagnosed with a life-threatening illness. There is a common misconception that stress is derived from a particular negative event. However, the event itself (the stressors, such as cancer diagnoses and treatment) does not causes stress. Rat...
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...
S9704 Trial: Autologous Transplantation as Consolidation in Aggressive Lymphoma
Richard I. Fisher, MD
Autologous bone marrow or stem cell transplantation has had an important role in the treatment of aggressive lymphoma for several decades. The important results of the PARMA study1 demonstrated that patients in first relapse who remained chemosensitive had improved progression-free and overall survi...
Transplant Now or Later for High-Risk Aggressive Non-Hodgkin Lymphoma?
Julie M. Vose, MD, MBA
The use of high-dose chemotherapy and autologous hematopoietic blood or marrow transplantation for high-risk aggressive non-Hodgkin lymphoma has been extensively evaluated over the past few decades. This treatment was originally used only for patients with relapsed aggressive lymphoma. However, as t...
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...
Correctly Assessing Pain Progression and Quality-of-Life Deterioration in Metastatic Castration-Resistant Prostate Cancer
Howard I. Scher, MD
The therapeutic landscape for the treatment of castration-resistant prostate cancer has changed dramatically in the past 4 years, as five new agents affecting different aspects of the malignant process were proven to prolong life. The results are a great benefit to patients, but at the same time mak...
Valganciclovir in Glioblastoma, Selection Bias, and Flawed Conclusions
William T. Curry, MD
As reviewed in this issue of The ASCO Post, Söderberg-Nauclér et al from the Karolinska Institute have written a provocative letter to The New England Journal of Medicine suggesting that long-term administration of valganciclovir (Valcyte), a drug that targets cytomegalovirus (CMV), improves overall...
How to Measure the Impact of Dermatologic and Mucosal Adverse Events on Symptom Burden and Quality of Life
Christine B. Boers-Doets, RN, MSc
Targeted anticancer therapies like epidermal growth factor receptor (EGFR) inhibitors, multitargeted tyrosine kinase inhibitors (mTKIs), and mammalian target of rapamycin (mTOR) inhibitors frequently result in dermatologic adverse events and mucosal adverse events, or, taken together, mucocutaneous ...
Response-Guided Neoadjuvant Therapy for Breast Cancer: A Promising Model Warranting Additional Investigation
Roisin M. Connolly, MB, BCh, and Vered Stearns, MD
GeparTrio was an innovative phase III trial conducted by the German Breast Group, enrolling over 2,000 women with early breast cancer who were candidates for neoadjuvant chemotherapy. Patients with evidence of early response, defined as reduction in clinical tumor size by 50% or more, following two ...
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...
Long-Term CONKO-001 Results: Adjuvant Therapy Improves Survival
Eileen M. O’Reilly, MD
From 12% to 15% of the approximately 45,000 patients diagnosed with pancreas adenocarcinoma undergo a potentially curative resection each year in North America, translating into roughly 5,000 to 7,000 patients who are candidates for adjuvant therapy. About 80% of these patients will relapse and succ...
Has a New Standard of Care for Metastatic Pancreatic Cancer Been Established?
Andrew H. Ko, MD
For a number of years following the approval of gemcitabine for advanced pancreatic cancer, one phase III clinical trial after the next failed to demonstrate a survival benefit of combination chemotherapy compared to gemcitabine alone. Even the one positive study from the mid-2000s—the PA.3 trial le...
Gastric Cancer: Time to Revisit Angiogenesis
David H. Ilson, MD, PhD
Progress in the treatment of gastric cancer has lagged behind advances in other solid tumor malignancies. A modest but clear survival benefit with the use of adjuvant therapy combined with surgery has been achieved, including the use of postoperative adjuvant chemotherapy as shown in large-scale tri...
German Analysis in Diffuse Large B-Cell Lymphoma: Hypothesis-Generating Rather Than Definitive?
Brad Kahl, MD
In their retrospective analysis of German High-Grade Non-Hodgkin Lymphoma Study Group trials reported in the Journal of Clinical Oncology and reviewed in this issue of The ASCO Post, Held and colleagues assessed the effects of rituximab (Rituxan) and radiotherapy in patients with aggressive B-cell l...
Where Is Adjuvant Bisphosphonate Therapy Now?
Debu Tripathy, MD
The adjuvant use of bisphosphonates in breast cancer continues to yield seemingly contradictory data despite a sound biologic basis and smaller pilot studies suggesting that dampening bone turnover with bisphosphonates can lessen the bone reservoir of micrometastases.1,2 Early adjuvant trials with t...
Evaluation of Breast Cancer MRI Screening Strategies
Rinaa S. Punglia, MD, MPH, and Natasha K. Stout, PhD
Recent years have witnessed much heated debate about the benefits of breast cancer screening and optimal screening strategies. Unlike with mammography, no randomized data are available to determine whether screening with magnetic resonance imaging (MRI) reduces mortality from breast cancer. Therefor...
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...
In Mismatch Repair–Deficient Colon Cancer, Side Matters
Leonard B. Saltz, MD
In general, we have come to think of mismatch repair–deficient colon cancer as having a more favorable prognosis, being less likely to metastasize to regional nodes or distant sites, and being resistant to fluoropyrimidines. Much of our data, however, come from trials combining stage II and III pati...
Brivanib Fails to Live Up to the Promise of Early Studies
Laura Williams Goff, MD, MS
Hepatocellular carcinoma is a devastating disease worldwide. Although advances in liver transplantation, surgery, and locoregional therapies have made tumor control or even cure possible for a minority of patients, the majority of patients diagnosed with hepatocellular carcinoma will develop advance...
Finasteride for Prostate Cancer Prevention: Long-Term Results Disappointing but Reassuring
Michael L. LeFevre, MD, MSPH
All medical care should seek to achieve one or more of three goals: to relieve suffering, to prevent future suffering, or to prolong life. Care for cancer is no exception, and minimizing suffering from cancer and prolonging life has primarily resulted from advances in treatment. Although there are a...
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...
Two Patients in One, Mom and Baby: Managing Coincident Pregnancy and Lymphoma
Joseph M. Connors, MD
The news that she is both pregnant and has been found to have a potentially lethal malignancy is one of the most emotionally wrenching events any young woman ever faces. Understandably, the patient, her partner, their families, and even their caregivers find this experience fraught with anxiety and ...
High-Dose Spinal Stereotactic Body Radiotherapy Associated With Increased Risk of Vertebral Compression Fracture
Eric Lis, MD
As reviewed in this issue of The ASCO Post, Sahgal et al reported a multi-institutional analysis aimed at clarifying the risk of developing either new or progressive vertebral body compression fractures following high-dose spinal stereotactic body radiation therapy. In the period studied, they encou...
Evidence-Based Opportunity to Personalize Breast Cancer Risk: The Data Are Building
Victor G. Vogel, MD, MHS
The worldwide data from prospective studies of the relationship between levels of endogenous sex hormones and breast cancer risk in postmenopausal women show multiple and complex relationships.1 Nine prospective studies (different from those reported here) of women not taking exogenous sex hormones ...
The Power of Human Attachment
David Kissane, MD
For those patients with cancer who may be single, widowed, separated, or divorced, those for whom a natural social support system may be weak, the role of the cancer support group should not be overlooked. In leading a previous trial of supportive-expressive group therapy as a key pathway to foster ...
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...
The AVEX Trial
Stuart M. Lichtman, MD, FACP
As reported in The Lancet Oncology by Cunningham and colleagues and reviewed in this issue of The ASCO Post, the AVEX trial was an open-label randomized phase III trial limited to patients over the age of 70 years with previously untreated, unresectable metastatic colorectal cancer who were not deem...
Cardiovascular Risk Factors in Cancer Survivors
Smita Bhatia, MD, MPH
Armstrong et al evaluated the prevalence of self-reported hypertension, diabetes mellitus, dyslipidemia, and obesity and the incidence of self-reported major cardiac events such as coronary artery disease, heart failure, valvular disease, and arrhythmias in adult survivors of childhood cancer in the...
Cabozantinib in Medullary Thyroid Cancer: A Landscape-Shaping New Treatment
Mingzhao Xing, MD, PhD
Medullary thyroid cancer is derived from parafollicular C cells in the thyroid gland. The disease is sporadic in about 75% of cases and hereditary in the remaining 25%.1 Oncogenic mutations in the gene for tyrosine kinase receptor rearranged during transfection (RET) are driver genetic alterations o...
Lung Cancer Screening: Actionable Evidence
James L. Mulshine, MD
This recent paper in The New England Journal of Medicine outlines the details of the clinical outcomes with two incidence screens that were conducted as part of the National Lung Screening Trial (NLST).1 In the wake of the positive review of the U.S. Preventive Services Task Force (USPSTF) draft rec...
Trying to Improve Value in Cancer Care: An Experiment
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
One of the more significant problems in modern oncology practice is to provide increased value at a time when costs are spiraling upward, and new parameters of “success” are being introduced into the equation—most visibly, inside the Beltway in Washington, DC. Thus, oncologists will need to address ...
Psychosocial Health in Long-Term Survivors of Childhood Cancer
Kevin R. Krull, PhD
The study by Lund and colleagues discussed in this issue of The ASCO Post reinforces concerns about psychosocial health in long-term survivors of childhood cancer. Taking advantage of national registries, these investigators demonstrated that, when compared to the general population, survivors are a...
Germline Mutations and Breast Cancer Prognosis: Does the Cause Matter?
Mark Robson, MD
Since the discovery of BRCA1 and BRCA2, investigators have sought to determine whether the presence of a germline mutation independently influences the outcome of a breast cancer diagnosed in a woman with an inherited mutation. The question is highly relevant to an unaffected woman with a mutation, ...
Pazopanib vs Sunitinib in Metastatic Renal Cell Carcinoma: How Do We Choose?
Brian I. Rini, MD
Over the past decade, the field of metastatic renal cell carcinoma therapy has witnessed the development of multiple drugs targeting the vascular endothelial growth factor (VEGF) pathway, based on the underlying biology of renal cell carcinoma that leads to reliance on angiogenic signaling. The init...
Alcohol Consumption Between Menarche and Pregnancy and Breast Cancer Risk: Factors in Risk Accumulation
Graham A. Colditz, MD, DrPH
In a study recently published in the Journal of the National Cancer Institute and summarized in this issue of The ASCO Post, we found a relationship between alcohol intake between menarche and first pregnancy and risk for breast cancer. Placing this study in context can help us interpret the data an...
Radium-223 and Beyond in Metastatic Castration-Resistant Prostate Cancer
Maha Hussain, MD, FACP, FASCO
Metastasis to bone is the hallmark of prostate cancer and a major source of disease-related morbidity and mortality. In addition to prostate cancer cells, other major players in the vicious interactive cycle of prostate cancer bone metastasis are osteoblasts, osteoclasts, and mineralized bone matrix...
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...
Treatment of Relapse of Acute Leukemia Post-Transplant: Still Hope for Patients With Chemosensitive Disease
Richard Champlin, MD
Disease recurrence is a devastating event after allogeneic hematopoietic stem cell transplantation as treatment for acute myeloid leukemia (AML). Median time to relapse is approximately 4 months and the majority of relapses occur within 2 years after transplant. The prognosis is usually poor. Overal...
Tamoxifen in Women With BRCA1 and BRCA2 Mutations: Another Option?
Rowan T. Chlebowski, MD, PhD
In analyses of pooled information from cohorts of women with BRCA1 and BRCA2 mutations who have had a prior breast cancer diagnosis, Phillips and colleagues examined the association between tamoxifen use compared to nonuse on contralateral breast cancer risk.1 Tamoxifen use was associated with lower...
Pretreatment Lymph Node Dissection May Improve Survival in Advanced Cervical Cancer, But for Too Few?
Kathleen Moore, MD
Women with cervical cancer metastasized to para-aortic lymph nodes have historically had a poor prognosis, with 3-year overall survival rates of 25% to 40%.1-3 This has been attributed to the presence of occult systemic disease at the time of presentation and a high rate of distant recurrences follo...
Timely Findings From the Ovarian Tumor Tissue Analysis Consortium
Krishnansu S. Tewari, MD
In the Ovarian Tumor Tissue Analysis Consortium Study recently published by Sieh et al,1 tissue microarrays from 2,933 cases of epithelial ovarian carcinoma demonstrated that progesterone receptor (PR) expression and estrogen receptor (ER) expression were associated with significantly improved dise...
The BEATRICE Study: Where Does Targeting Breast Cancer Vasculature Stand in 2013?
Lisa A. Carey, MD
Antiangiogenic strategies using the anti–vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab (Avastin) gained traction in breast cancer with the publication of the Eastern Cooperative Oncology Group (ECOG) 2100 trial in 2007. That study demonstrated a progression-free survival ...
Sitimagene Ceradenovec/IV Ganciclovir in Glioblastoma: Legitimizing the Gene Therapy Approach for Brain Tumors
William T. Curry, MD
The ASPECT study,1 a randomized, open-label, phase III trial examining adenovirus-mediated gene therapy with sitimagene ceradenovec followed by IV ganciclovir for patients with operable high-grade glioma, is an important achievement for both neuro-oncology and gene therapy. As vector engineering bec...
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...
Molecular Profiling Improves Classification of Nodal Peripheral T-Cell Lymphomas
Steven M. Horwitz, MD
One of the primary obstacles we face in caring for patients with peripheral T-cell lymphomas is a too often inadequate response to chemotherapy with low rates of progression-free and overall survival.1 And while more intensive treatment programs and the availability of novel agents give a greater ho...
Can Obinutuzumab Benefit Patients With Rituximab-Refractory Non-Hodgkin Lymphoma?
Julie M. Vose, MD
Obinutuzumab is a glycoengineered type II antibody that differs from type I anti-CD20 antibodies by being associated with actin reorganization and adhesion followed by direct cell death.1 Obinutuzumab has been glycoengineered by reduction in fucose content of the Fc region, which increases its affin...
Ongoing Progress in Treatment of Medulloblastoma
Karen J. Marcus, MD
Brain tumors are the second most frequent pediatric malignancy. Medulloblastoma, a primitive cerebellar tumor of neuroectodermal origin, is the second most common brain tumor, accounting for 20% of childhood tumors of the central nervous system. Craniospinal radiotherapy has been the main curative m...
Pemetrexed Maintenance in PARAMOUNT: Continuation Proves to Be a Strong Option for Advanced NSCLC, Although Not a Mandate
H. Jack West, MD
The PARAMOUNT trial1 represents an important landmark study of continuation maintenance therapy with pemetrexed (Alimta). While maintenance therapy gained a toehold in routine management of advanced non–small cell lung cancer (NSCLC) several years ago, the first trials that demonstrated a significan...
Non–Small Cell Lung Cancer Maintenance Therapy: None, Single Agent, Multiple Agents?
Philip D. Bonomi, MD
Barlesi et al have reported results of a randomized trial comparing bevacizumab (Avastin) vs pemetrexed (Alimta)/bevacizumab as maintenance therapy in patients with stage IV nonsquamous cell non–small cell lung cancer (NSCLC). It is important to consider their observations in relation to data from o...
Ginseng in the Spotlight
Ollie Minton, MB, BS, PhD, FRCP
I read the study by Barton and colleagues in Journal of the National Cancer Institute with great interest. Ginseng seems potentially to be one treatment for cancer-related fatigue, a poorly understood but debilitating symptom that patients experience during and after treatment.1 I am impressed that...
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...
Oncologists Speak Out Against the High Cost of Cancer Drugs
That the United States spends twice as much on health care than other industrialized countries—about $2.8 trillion in 2012—without reaping appreciably better outcomes1 is not news. The topic has been dissected on the front pages of leading newspapers for years and was the subject of the entire featu...
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...
Looking for Drivers in the Rearview Mirror
John L. Marshall, MD
The latest clinical trial looking at combining vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) inhibition in metastatic colorectal cancer adds little to our overall understanding of the mechanisms for optimizing selection of patients to receive such therapies. W...
Just Say 'Know'
Jeffrey S. Groeger, MD, and Kathleen N. Cathcart, MD
In 1989, Denardo and associates reported the results of intensive care unit (ICU) therapy in a series of patients who developed acute respiratory failure and required mechanical ventilation after bone marrow transplantation. Of those on mechanical ventilatory support longer than 4 days, not one surv...
Bevacizumab in Glioblastoma: Another Perspective
Roger Henriksson, MD, Warren Mason, MD, FRCPC, Olivier Chinot, MD, and Wolfgang Wick, MD, on behalf of the AVAglio Steering Committee
Given the results of the AVAglio trial, we feel that a more balanced discussion about the role of bevacizumab (Avastin) in patients with newly diagnosed glioblastoma is in order. The accompanying article in The ASCO Post suggests that bevacizumab has no benefit in newly diagnosed glioblastoma; data ...
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...
Mitigating the Anxiety over Tumor Heterogeneity
Jean-Charles Soria, MD, PhD
This collaborative study with Foundation Medicine (Cambridge, Massachusetts), using very sensitive deep sequencing, partially mitigates some of the anxiety generated by the identification of tumor heterogeneity. While our data in lung cancer confirm that such heterogeneity exists, they also indicate...
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...
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 ...
The Tissue Is the Issue: Choosing Therapy for Lung Cancer
Fred R. Hirsch, MD, PhD
The new guidelines from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology (CAP/IASLC/AMP) are a significant step toward personalized therapy of patients with lung cancer. More than 226,000 new patients per year are d...
Role of Stem Cell Transplantation in Follicular Lymphoma
James O. Armitage, MD
The place of either autologous or allogeneic hematopoietic stem cell transplantation in the care of patients with follicular lymphoma has been a point of controversy. However, for patients in whom an effective chemotherapy or chemoimmunotherapy regimen for low-grade follicular lymphoma fails, I beli...
Lessons of 2 Decades' Experience with CHESS
David H. Gustafson, PhD
Our work on an Internet-based intervention for lung cancer confirmed what many other studies have shown about technologic interventions for health-care consumers—that such interventions can improve quality of life for caregivers and patients.1 We expected this result in part because of the clinician...
Emerging Prognostic Markers in Colon Cancer
Richard L. Schilsky, MD, FASCO
Patients with stage II colon cancer generally have a favorable prognosis, with about 80% of patients surviving 5 years after surgery and the majority of these long-term survivors presumed to be cured. Clearly though, some patients are destined to recur after surgery, and there is an urgent need to d...
Lynch Syndrome: A Multitude of Predispositions
Carrie L. Snyder, MSN, and Henry T. Lynch, MD
The current uncertainty regarding the relative frequencies of cancers of various anatomic sites in Lynch syndrome poses a difficulty in commenting on the syndrome’s overall cancer spectrum. It is even more vexing to address the order in which these cancers are prone to occur. What we do know is that...
The Intriguing Potential of S-1 in Pancreatic Cancer
Eileen M. O’Reilly
The results of the GEST study by Ueno and colleagues add to the intriguing potential role of the oral fluoropyrimidine S-1 in the treatment of pancreas adenocarcinoma. S-1 is a three-component drug consisting of tegafur (a prodrug of fluorouracil), gimeracil (5-chloro-2,4 dihydropyridine, or CDHP, a...
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...
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...
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 ...
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...
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 ...
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...
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...
Accountable Care Organizations: The New Normal?
Richard J. Boxer, MD, FACS
The accountable care organization was introduced into our lexicon during a public meeting of the Medicare Payment Advisory Commission in 2006, and the term became ubiquitous when it was specified in the Patient Protection and Affordable Care Act of 2010. After the November 6 election, accountable ca...
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...
Expert Point of View: John L. Marshall, MD
John L. Marshall, MD
The pendulum continues to swing in the treatment of stage II and III colon cancer. Not 5 years ago, our party line was that essentially all patients should receive 6 months of adjuvant FOLFOX (leucovorin, fluorouracil [5-FU], oxaliplatin): patients with stage II or III disease, whether rectal or col...
Expert Point of View: Fausto Roila, MD
Fausto Roila, MD
Thromboprophylaxis for patients with a central venous catheter is at present not recommended by the international oncologic associations. This is based on the results of four recent randomized controlled trials, three of them double-blind, in which there was no statistically significant difference b...
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...
Ignoring Level 1 Evidence in Invasive Bladder Cancer: Is Ignorance Bliss?
Derek Raghavan, MD, PhD
I’ve been part of the uro-oncology community for more than 30 years and have been proud to be involved in a good number of well-powered, enthusiastically subscribed randomized clinical trials. These have dated back to a time before randomization was necessarily the fashion. I have had the pleasure ...
SIDEBAR: Dacomitinib: Better in Whom? Better in What?
Tony Mok, MD
Drug development is a highly competitive business. A new drug must be proven to be better than the standard one before it can be registered for public use. Starting with preclinical data, there should be evidence of lower 50% inhibitory concentrations in selective cell lines or a broader spectrum of...
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...
Expert Point of View: Dan L. Longo, MD
Dan L. Longo, MD
The term “abscopal” is from Greek roots that mean “away from the target.” Coined by R.H. Mole in 1953, it was used to label observed effects of radiation at a distance from the volume irradiated. Mounting evidence suggests an immunologic basis for the effect, but it should also be remembered that bl...
Expert Point of View: Timothy Wilt, MD, MPH
Timothy Wilt, MD, MPH
PIVOT is the largest and longest randomized trial conducted in men with early-stage prostate cancer detected during the era of widespread PSA testing. The trial enrolled 731 men and followed them for up to 15 years after randomization. PIVOT results demonstrate that compared to observation, radical ...
Expert Point of View: Fritz H. Schröder, MD
Fritz H. Schröder, MD
I am happy to accept the invitation by The ASCO Post to comment on the recent, long-awaited publication of the PIVOT study (Wilt et al: N Engl J Med 367:203-213, 2012) and the accompanying editorial by Thompson and Tangen (N Engl J Med 367:270-271, 2012). The editorial both points out weaknesses of ...
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 ...
Three Experts Weigh In on the Health-care Reform Legislation
In light of the Supreme Court ruling, The ASCO Post asked three nationally regarded experts about how the Affordable Care Act will affect the practice of oncology. Ezekiel J. Emanuel, MD, PhD, Professor and Vice Provost for Global Initiatives, University of Pennsylvania: This is an overwhelmingly p...
Reflections from the Old World
John F. Smyth, MD
A few years ago, I was a key witness for a patent dispute at a trial in Delaware. Acting for the complainant, I was briefed that the opening gambit of the opposition lawyer would be to discredit my CV and, therefore, the value of my testimony. “So you are a full Professor at the University of Edinbu...
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...
Expert Point of View: Study Shows Continued Benefit of PSA Screening in Reducing Prostate Cancer Mortality
Fritz H. Schröder, MD
Many of the almost 100 reports in various journals and newspapers refer to the lack of effect on overall mortality with screening in ERSPC in a very critical fashion. Clarification is necessary. Our trial did not intend to and is not powered to study the effect of screening on overall mortality. Mor...
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 ...
Inefficient Markets Impede Cancer Pain Relief
Meg O’Brien, PhD
The potent analgesic property of morphine was first isolated in 1804, and after more than 2 centuries morphine is still the gold standard for moderate to severe pain. It is relatively easy to produce, and compared to most pharmaceuticals, morphine is dirt-cheap. Therein lies the cruel conundrum: Mor...
What Were the Take-home Messages from the 2012 Gastrointestinal Cancers Symposium?
Richard M. Goldberg, MD
Richard M. Goldberg, MD, of The Ohio State University Medical Center, chaired the steering committee of the 2012 Gastrointestinal Cancers Symposium in San Francisco, which attracted approximately 4,000 registrants who viewed data from some 700 scientific abstracts. The ASCO Post asked Dr. Goldberg t...
Cost of Care: A Multidisciplinary Responsibility
Daniel A. Vorobiof, MD
I read the interview with Dr. Ezekiel Emanuel (The ASCO Post, December 15, 2011) with much interest, as the health-care policy problems that America is currently experiencing have plagued other countries for some time. Despite proactive measures and attempts to amend those situations elsewhere, litt...
JAK2 and MPL Mutation Screening: What Are the Indications and How to Interpret the Results
Ayalew Tefferi, MD
The World Health Organization system organizes myeloid malignancies into five major categories, which are subsequently further subclassified using a combination of bone marrow morphology and cytogenetic/molecular information (Table 1).1 JAK2 and MPL mutations are not disease-specific and occur acros...
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...
Expert Point of View: Therapy for Hodgkin Lymphoma in the Elderly Remains Undefined
Andrew M. Evens, DO, MSc
Elderly Hodgkin lymphoma, typically defined as affecting individuals ≥ 60 years of age, remains a disease for which no standard treatment recommendation exists. This population is underrepresented in clinical studies, and survival rates in older patients with Hodgkin lymphoma are significantly and...
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...
Lessons from a Northern Neighbor: A Conversation with Joseph M. Connors, MD
Ronald Piana
Policy analysts searching for a better understanding of health-care models often compare the cancer delivery systems of Canada and the United States. The ASCO Post recently spoke with Joseph M. Connors, MD, Clinical Professor and Director of the BC Cancer Agency’s Centre for Lymphoid Cancer, Vancouv...
Improving Quality and Safety with Health Information Technology
Ronald Piana
A well-documented flaw in paper-based health care is the propensity for medical errors. According to Blackford Middleton, MD, MPH, MSc, implementing clinical decision support software can decrease medical error, improve outcomes, and lower the costs of care. Presenting a session titled “Improving Qu...
Oncologists Need Hands-on Approach in Developing Next Generation of EHRs
Ronald Piana
The electronic health record system offered by vendors is more like a filing cabinet, not the sophisticated, interactive database needed by busy oncologists, according to Kevin S. Hughes, MD, FACS, Co-Director, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, who presente...
Need for Data Capture Crucial, Now and After ‘Meaningful Use’
Cindy Chavez
It’s never enough. Whether it is the Centers for Medicare & Medicaid Services (CMS), other payers, pharmaceutical manufacturers, or specialty companies, one can never provide enough data. When will it all end? The problem, or the opportunity for many, is that it won’t end. The need for discrete ...
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...
Medicare Reimbursement to Physicians: Déjà Vu All Over Again
Nora Janjan, MD, MPSA, MBA, and John Goodman, PhD
In February 2011, The ASCO Post published an opinion piece (“Congress and the ‘Doctor Fix’: Looking Back, Looking Ahead”) about the ping-pong of legislative continuing resolutions to avert a 21.3% cut in physician reimbursement. These continuing resolutions were necessary because the Affordable Care...
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...
Expert Point of View: Chemotherapy Generally Safe in Pregnancy
Caroline Helwick
Chemotherapy delivered in the first trimester is associated with a 10% to 30% risk of abortion and 10% to 25% risk of malformations. Therefore, it should be postponed until the second or third trimester, when most regimens appear to be safe, according to Nicholas Pavlidis, MD, of the University of I...
Expert Point of View: Lessening Patients’ Suffering at the End of Life
Diane Meier, MD, FACP, Director, Center to Advance Palliative Care and Hertzberg Palliative Care Institute Mount Sinai School of Medicine, New York
In her interview with The ASCO Post, Judith Redwing Keyssar, RN, sheds light on easing the suffering of patients facing the end of life. Although what she says is appropriate for patients who are clearly dying, I would emphasize that palliative care is also pertinent to patients who are not terminal...
Do We Need the USPSTF?
Derek Raghavan, MD, PhD
Like most of the folks reading this commentary, I’m a taxpayer. Although I sometimes become impatient with the strategic games on Capitol Hill, I basically appreciate that government helps many things to work, and some of them even work well. However, there are aspects of government function that d...
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...
Integrative Medicine Offers Added Value for Patients with Cancer
Carolyn M. Matthews, MD
Addressing a patient’s physical, emotional, and spiritual needs during the cancer journey, integrative medicine combines such time-honored therapies as nutrition, exercise, and meditation alongside allopathic approaches to cancer care, with the ultimate goal of improving survival rates and reducing ...
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...
SIDEBAR: The March of Progress in Lung Cancer Treatment
Christopher G. Azzoli, MD
Before the discovery of predictive molecular tests (eg, EGFR mutation and ALK rearrangement), each chemotherapy drug for stage IV non–small cell lung cancer had about the same chance of success. Progress was made as more drugs were discovered. Patients lived longer with second- and third-line therap...
Giving Women a Fighting Chance When They Have Breast Cancer
Congresswoman Debbie Wasserman Schultz
I knew there was a chance I could get breast cancer, I just never thought it would really happen to me. I am one of 2.5 million breast cancer survivors living in our country today. Just weeks after getting a clean mammogram and my 41st birthday, I felt a lump in my breast. As a young and otherwise ...
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...
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...
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...
Evaluating Risk for Suicide in People Diagnosed or Living with Cancer
Andrew J. Roth, MD
The challenges of life-threatening physical illness can sometimes lead to suicide. In fact, given the critical stressors that a person with cancer faces, we might expect suicide to be a more common reaction. Patients with cancer are at increased risk of completed suicide, though the prevalence of su...
Point of View: Should Patients Over 70 Receive Aggressive Therapy for Acute Myeloid Leukemia?
Charles A. Schiffer, MD, and Farhad Ravandi, MD
Despite Advances, Little Overall Improvement Seen in Treatment of Older Adults with AMLBy 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 criter...
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 ...
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...
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...
SIDEBAR: Nonrandomized Analysis Viewed with Skepticism
Lori J. Pierce, MD
The findings from Grumley et al contradict the results from randomized trials of lumpectomy vs lumpectomy and radiotherapy for ductal carcinoma in situ (DCIS) and highlight the potential pitfalls of retrospective analyses. The meta-analysis of the DCIS trials revealed a significant 54% reduction in ...
Maria Svensson, MD, PhD Candidate, on Esophageal and Gastric Cancers: Significance of PD-1 and PD-L1 Expression
Aleix Prat, MD, PhD, on a HER2-Positive Breast Cancer Biomarker: Results From the PAM50 Trial
Robert A. Figlin, MD, on RCC: Results From the ADAPT Trial
Arjun Vasant Balar, MD, on Urothelial Carcinoma: Analysis of the IMvigor210 Cohort 1
Ethan M. Basch, MD, on Symptom Monitoring: Findings on Overall Survival Rates
