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health-care policy

Pediatric Oncology Groups Endorse Ethical Framework for Rationing Scarce Drugs

The Children’s Oncology Group (COG) and the American Society of Pediatric Hematology/Oncology (ASPHO) have endorsed formal clinical recommendations for rationing chemotherapy and supportive care agents during times of shortage. The guidance is needed because persistent shortages of many standard...

lung cancer
issues in oncology
gastroesophageal cancer

PET Scan Use in Follow-up Care for Lung and Esophageal Cancer Shows Wide Variation Between Hospitals, No Impact on Survival

A new study suggests that one approach to watching for a cancer's return is being inappropriately used at many hospitals and isn't helping patients survive longer. The findings are published by Healy et al in the Journal of the National Cancer Institute. The study looked at how often survivors ...

multiple myeloma

CAR-T Cell Therapy May Have Role in Treating Multiple Myeloma

Among the burgeoning options for treating multiple myeloma could be an approach that is proving to be exciting in leukemia: CAR-T (chimeric antigen receptor T cells) therapy. Preliminary results of the first-in-humans study in myeloma were presented as a late-breaking abstract at the 2015 ASH...

Expert Point of View: Daniel Hamstra, MD

Formal discussant of these trials Daniel Hamstra, MD, of Texas Center for Proton Therapy, Irving, offered his perspective. With increased doses of radiation using additional conventional fractions, tumor control is improved, but the risk of damage to normal tissue is increased. Hypofractionation is ...

colorectal cancer
issues in oncology

Half of Elderly Patients With Colorectal Cancer Receive Expensive Therapy With Little Survival Benefit

A study published by Bradley et al in Medical Care showed that over a recent 10-year period, the rate of metastatic colorectal cancer patients older than age 75 receiving three or more treatments increased from 2% to 53%. During this period, 1-year treatment costs increased 32% to reach an...

leukemia

Children With Leukemia From High-Poverty Areas More Likely to Suffer Early Relapse

Among children with acute lymphoblastic leukemia (ALL), the most common pediatric cancer, those who live in high-poverty areas are substantially more likely to suffer early relapse than other patients, despite having received the same treatment, according to new research from Dana-Farber/Boston...

prostate cancer

Hypofractionation Is Ready for Prime Time in Prostate Cancer, but Will It Be Adopted?

Separate phase III trials presented at the 2016 Genitourinary Cancers Symposium demonstrated that modest hypofractionated radiotherapy is noninferior to conventional radiotherapy for men with intermediate- and low-risk prostate cancer and should be considered a new standard of care.1,2 However, it...

Expert Point of View: Irvin M. Modlin, MD, Lisa Bodei, MD, and Eric Liu, MD

The ASCO Post interviewed Irvin M. Modlin, MD, Emeritus Professor of Gastroenterological Surgery, Yale University School of Medicine, regarding his thoughts on the NETTER-1 results and peptide receptor radionuclide therapies for neuroendocrine tumors. Dr. Modlin led the first study of a peptide...

gastrointestinal cancer

Radiolabeled Somatostatin Analog May Represent A Paradigm Change in the Treatment of Neuroendocrine Tumors

A radiolabeled somatostatin analog compound, 177Lu-DOTA0-Tyr3-Octreotate (Lu-177 dotatate), reduced the risk of disease progression or death by 79% in the international phase III NETTER-1 population of previously treated, advanced neuroendocrine tumors of midgut origin.1 Lu-177 dotatate belongs to...

Nuns Work Where None Work

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...

issues in oncology

ASCO Provides Support and Guidance for the White House Cancer Moonshot Initiative

Although President Richard Nixon signed the National Cancer Act in 1971, essentially declaring a war on cancer, the genesis of the idea had actually been born 2 years earlier, after the first landing on the moon set off a new era of scientific exploration and sparked a belief that any scientific...

Expert Point of View: Irvin M. Modlin, MD, and Eric Liu, MD

Two neuroendocrine tumor experts had slightly different reactions to the latest RADIANT-4 data. Irvin M. Modlin, MD, Emeritus Professor of Gastroenterological Surgery at Yale University School of Medicine, New Haven, Connecticut, said in an interview that he essentially restricts his use of...

neuroendocrine tumors

Everolimus Effective in Neuroendocrine Tumors of Gastrointestinal Origin

In a subgroup analysis of the phase III RADIANT-4 trial, focusing on neuroendocrine tumors of gastrointestinal origin, the mTOR inhibitor everolimus (Afinitor) essentially doubled the median progression-free survival time, compared with placebo, researchers reported at the 2016 Gastrointestinal...

colorectal cancer

Adding Immunotherapy to Radiofrequency Ablation in Colorectal Cancer With Liver Metastasis Shows Promise in Preclinical Models

In a retrospective case-controlled study conducted in patients with colorectal cancer who had received primary tumor resection with or without preoperative radiofrequency ablation for liver metastases, the electrical procedure was found to induce antitumor immune responses in the...

prostate cancer

Study Links Normal Stem Cells to Aggressive Prostate Cancer

A study that revealed new findings about prostate cells may point to future strategies for treating aggressive and therapy-resistant forms of prostate cancer. The study proved that the prostate basal cell layer contains adult stem cells, which possess a unique gene-expression profile resembling the ...

SSO 2016: Federal 'Moonshot' Fight Against Cancer Means More Resources for Surgical Oncology Professionals

The 69th Society of Surgical Oncology (SSO) Annual Cancer Symposium, being held March 2–5 in Boston, will include featured lecturers with ties to the recently announced White House “moonshot” initiative to cure cancer—a proposed $1 billion in spending on cancer research over ...

breast cancer

Breast Reconstruction Using Abdominal Tissue: Differences in Outcome With Four Techniques

In women undergoing breast reconstruction using autologous tissue, newer muscle-sparing abdominal flaps can reduce complications while improving some aspects of quality of life, according to a study by Macadem et al in Plastic and Reconstructive Surgery. Comparison of four types of abdominal flaps ...

supportive care

2016 Quality Care Symposium: New Triage System Decreases Emergency Room Visits by Oncology Patients in Florida

A quality improvement initiative to reduce patients’ reliance on emergency room (ER) visits to treat cancer treatment side effects has shown to be highly effective, according to early findings from a new study. The strategy, involving a telephone triage service coupled with patient education, ...

cost of care

2016 Quality Care Symposium: Online Tool Improves Access to Information on Cancer Treatment Costs

To facilitate doctor/patient conversations about costs of cancer care, researchers developed and piloted an online tool for oncologists. The innovative resource lists prices for the 50 most commonly prescribed cancer treatment regimens. A survey of the pilot users at four clinics in Washington...

breast cancer

2016 Quality Care Symposium: Study Suggests Many Women With Early Breast Cancer Receive Unnecessary Imaging Tests

A new study suggests that up to 60% of the computed tomography (CT) scans, bone scans, and positron-emission tomography (PET) scans performed for more than 29,000 Michigan women diagnosed with early breast cancer between 2008 and 2014 could not be medically justified based on retrospective record...

issues in oncology

Cancer Statistics for African Americans, 2016

A new report outlines substantial progress in reducing the mortality gap between blacks and whites for some cancers, while the gap has widened or remained level for two leading cancers: breast cancer in women and colorectal cancer in men. The findings are included in Cancer Statistics for African...

lymphoma

Weight and Height During Adolescence May Impact Future Risk of Developing Non-Hodgkin Lymphoma

A new analysis indicates that higher body weight and taller stature during adolescence increase the risk of developing Non-Hodgkin lymphoma (NHL). The findings were published by Leiba et al in Cancer. Rates of NHL have increased worldwide, and research suggests that rising rates of obesity may be...

issues in oncology

Quality Improvement Projects Aim at Reducing Errors in Prescribing IV and Oral Chemotherapy

Two quality improvement projects described in the Journal of Oncology Practice resulted in reduced errors in prescribing intravenous (IV) and oral chemotherapy. A project at the University of Texas Medical Branch in Galveston outpatient infusion centers first identified 15 different types of...

survivorship

Eye Movement Affected in Some Former Childhood Cancer Patients

A study from Lund University in Sweden has shown that commonly used chemotherapy toxins impair the eyesight in childhood cancer survivors in a way that indicates an impact on the central nervous system. The results were published by Einarsson et al in PLOS One. It was not the former patients' ...

prostate cancer

ASCO Endorses Cancer Care Ontario Guideline on Active Surveillance for Management of Localized Prostate Cancer

As reported by Ronald C. Chen, MD, MPH, of the University of North Carolina at Chapel Hill, and colleagues in the Journal of Clinical Oncology, ASCO has endorsed, with qualifications, the 2015 Cancer Care Ontario (CCO) guideline on active surveillance for management of localized prostate cancer....

pancreatic cancer

Chemotherapy Preferable to Radiotherapy to Reduce Distant Pancreatic Cancer Recurrences

Patients who received chemotherapy after surgical resection of pancreatic cancer have fewer distant disease recurrences and longer overall survival than those who also had adjuvant chemoradiation therapy. While a course of radiotherapy in addition to chemotherapy and a cancer operation reduced the...

head and neck cancer

2016 Head and Neck Cancer Symposium: Induction Chemotherapy Does Not Predict Survival Advantage Over Concurrent Chemoradiation

Head and neck cancer patients who receive induction chemotherapy rather than the standard treatment of concurrent chemoradiation do not benefit from increased survival rates and are less likely to receive a full course of radiation, according to research presented by Stokes et al at the 2016...

issues in oncology
gynecologic cancers
head and neck cancer

100% of NCI-Designated Cancer Centers Endorse the Promotion of the HPV Vaccination for Cancer Prevention

All National Cancer Institute (NCI)-designated cancer centers have united to support human papillomavirus (HPV) vaccination (see below). A team of HPV experts drafted a consensus statement that advises widespread use of HPV vaccines to prevent cancer. HPV causes cancer of the cervix, anus, and...

colorectal cancer

Patients Diagnosed With Stage I to III Rectal Cancer at Younger Age Have Increased Risk for Positive Lymph Nodes

Patients diagnosed with stage I to III rectal cancer at a younger age are at increased risk of having positive lymph nodes, according to an analysis of data published in the Journal of the National Cancer Institute. “This finding merits further investigation and may ultimately impact treatment...

integrative oncology

Mistletoe

The use of dietary supplements by patients with cancer has increased significantly over the past 20 years despite insufficient evidence of safety and effectiveness. Finding reliable sources of information about dietary supplements can be daunting. Patients typically rely on family, friends, and...

breast cancer

Men Get Breast Cancer Too

Like many men, it never occurred to me that I could get breast cancer. But it turns out it is more common—and deadly—than I thought, with about 2,600 men diagnosed each year with invasive breast cancer and nearly 440 dying of the disease.1 In 2010, I became one of those men, and the diagnosis was...

Global Cancer: The Current Reality and the Future Need for Action

The estimated number of cancer cases worldwide in 2008 was 12.7 million, with 7.6 million deaths. By 2030, it is estimated that there will be 22 million newly diagnosed cancer cases and 12 million deaths, shocking to contemplate in dollars and human suffering. Although this impending disaster has...

A Surgeon’s Inspiring Journey to Death

Every so often, a memoir comes along in which the story speaks to universal themes. For that magic to occur, the author must step aside at times and let others tell their story, too. Moreover, the writing must be clear, vibrant, and above all else honest to the core. The recently published memoir...

skin cancer

Nivolumab Plus Ipilimumab in Unresectable or Metastatic Melanoma Regardless of BRAF Mutation Status

On January 23, 2016, the indication for nivolumab (Opdivo) plus ipilimumab (Yervoy) in unresectable or metastatic melanoma was expanded through accelerated approval to include patients regardless of BRAF V600 mutation status.1 The combination was previously approved for treatment of patients with...

Expect Questions About Updated Dietary Guidelines

The 2015–2020 Dietary Guidelines for Americans1 have generated comments and controversy, with some organizations expressing concern that the guidelines did not recommend limiting the consumption of red and processed meat. These organizations include the American Institute for Cancer Research...

issues in oncology

Failure of Updated Dietary Guidelines to Advise Limiting Red and Processed Meat Deemed a ‘Missed Opportunity’

“A missed opportunity” is how Susan Higginbotham, PhD, RD, Vice President for Research, American Institute for Cancer Research (AICR), described the “failure” of updated dietary guidelines to recommend limiting consumption of red and processed meat. Doing so would have “the potential to save...

hematologic malignancies
multiple myeloma

Selected Abstracts From 2015 ASH Annual Meeting: Part 3

Here are several more abstracts selected from the proceedings of the 2015 American Society of Hematology (ASH) Annual Meeting and Exposition, focusing on newly diagnosed multiple myeloma, relapsed/refractory multiple myeloma, and amyloid light-chain (AL) amyloidosis. For other selected abstracts...

Candid Discussions on Living With and After Cancer at An Evening for Cancer Survivors and Caregivers

On January 14, 2016, the Cancer Survivorship Symposium opened with An Evening for Cancer Survivors and Caregivers, an event featuring networking, a panel discussion, and an open forum to share the challenges of living with or after a cancer diagnosis. The audience included Symposium attendees as...

issues in oncology
lung cancer
geriatric oncology

Management of Advanced Lung Cancer in the Elderly: A Reason to Rejoice or a Cause for Concern?

There is ample evidence to suggest that older adults with a good performance status (0 or 1) with advanced non–small cell lung cancer (NSCLC) should be treated with combination chemotherapy akin to younger patients.1,2 However, older adults comprise a heterogeneous group that has been...

leukemia

Ofatumumab for Extended Treatment of Patients With Recurrent or Progressive Chronic Lymphocytic Leukemia

On January 19, 2016, ofatumumab (Arzerra) was approved for extended treatment of patients in complete or partial response after at least two lines of therapy for recurrent or progressive chronic lymphocytic leukemia (CLL).1,2 Ofatumumab was previously approved for treatment of untreated patients...

health-care policy
issues in oncology

Evolving Tools for Clinical Decision-Making

Value in cancer care—and how to define it—is a hot topic. There is general agreement that it is some measure of benefit vs cost, but “should the focus be on providing value to patients at a population level or at an individual level?” asked Alan Balch, PhD, CEO of the Patient Advocate Foundation,...

Expert Point of View: Elizabeth Plimack, MD

The Egyptian study presented by Brian Baumann, MD, of the University of Pennsylvania, Philadelphia, was a “valiant effort” to determine whether sequential adjuvant chemotherapy added to adjuvant radiation would improve disease-free survival, said formal discussant of this trial Elizabeth Plimack,...

bladder cancer

Adjuvant Chemoradiotherapy in Locally Advanced Bladder Cancer: Hint of Benefit That Needs Confirmation

Adjuvant sequential chemotherapy plus radiation therapy and adjuvant radiation therapy alone significantly improved local tumor control compared with adjuvant chemotherapy alone in locally advanced bladder cancer but the improvement in disease-free survival (3-year disease-free survival of 68% vs...

prostate cancer

Active Holistic Surveillance May Prevent Unnecessary Biopsies in Low- and Low/Intermediate-Risk Prostate Cancer

The use of prostate-specific antigen (PSA) screening has led to a dramatic rise in the number of men diagnosed with low-grade prostate cancer. Active surveillance is recommended to manage patients with favorable-risk, low-grade prostate cancer, with the goal of avoiding overtreatment of these...

Expert Point of View: Oliver Sartor, MD

“This platform has no selection bias. Phlebotomy samples are drawn at key decision points. We begin to see that heterogeneity of circulating tumor cells predicted for shorter progression and survival times with selected androgen receptor–directed therapies. We need to study this prospectively,”...

prostate cancer

New Technology to Characterize Circulating Tumor Cells Suggests Better Treatment Decision-Making in Prostate Cancer

An early study showed that an experimental blood test (ie, “liquid biopsy”) that characterizes the phenotype and genomic characteristics of circulating tumor cells appears to have utility in personalizing treatment decisions for individual men with advanced prostate cancer.1 The assay—developed and ...

survivorship

Study Finds Abnormal Insulin and Glucose Dynamics in Childhood Survivors Treated With Abdominal Radiation

An ongoing pilot study, designed to assess dynamic indices of insulin and glucose homeostasis in childhood cancer survivors exposed to abdominal radiation, has found a variety of derangements in glucose and insulin homeostasis in this cohort.1 According to an analysis presented at the 2016 Cancer...

Expert Point of View: Kathryn Schmitz, PhD, MPH

Discussant Kathryn Schmitz, PhD, MPH, Professor of Epidemiology at the Perelman School of Medicine, University of Pennsylvania, lauded the researchers’ successful intervention in what can be a challenging setting. “Dr. Yung presented evidence that it is feasible to conduct an evidence-based,...

survivorship

Clinic-Based Weight-Loss Intervention Successful in Cancer Survivors

A randomized clinical trial examining the effect of a 15-week healthy living program on weight loss in cancer survivors showed a 5.3% decrease in baseline body weight in those participating in the program.1 “Cancer survivors randomized to a 15-week clinic-based weight-loss intervention lost an...

Expert Point of View: Chunkit Fung, MD, MSCE

Moderator of the session Chunkit Fung, MD, MSCE, Assistant Professor at the Wilmot Cancer Center, University of Rochester, New York, said that the analysis shows the cost-effectiveness of performing yearly physical examinations. “In addition to the cost savings,” Dr. Fung observed, “clinicians need ...

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