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palliative care

Practicing the Humanistic and Holistic Approach to End-of-Life Care

In 1990, when Bruce (B.J.) ­Miller, MD, was an undergraduate at Princeton University, the practice of medicine was far from his mind. Then a student in Chinese and Asian studies and later an art history major, Dr. Miller would come to pursue a career specializing in palliative medicine after an...

cost of care

The Complex Interactions of Treatment Costs, Clinical Outcomes, and Patient Expectations

A clinical dilemma that is receiving a great deal of attention in the oncology community is the undue financial burden some patients face during their treatment and into survivorship. While much emphasis is put on methods to reduce and help patients navigate the complex payment system, little is...

issues in oncology
health-care policy

Cancer Care in Low-Resource Areas: Some Improvements Over the Years, but Serious Problems Remain

Low- and middle-income countries bear a larger share of the global cancer burden than does the developed world,” said Greta ­Massetti, PhD, Associate Director for Science, Centers for Disease Control and Prevention (CDC) Division of Cancer Prevention and Control and Co-Chair of the National Cancer...

global cancer care

Cancer on the Global Stage: Incidence and Cancer-Related Mortality in Argentina

The ASCO Post is pleased to continue this special feature on the worldwide cancer burden. In this issue, we feature a close look at the cancer incidence and mortality rates in Argentina. The aim of this special feature is to highlight the global cancer burden for various countries of the world. For ...

skin cancer

Gut Bacteria May Facilitate Efficacy of Anti–PD-L1 Agents

Could the manipulation of bacteria in the gut pack the same punch in melanoma as antibodies targeting the programmed cell death protein and its ligand (PD-1/PD-L1)? It’s possible, at least in mice, according to research from the University of Chicago, recently published in Science.1 The researchers ...

Making a Difference for Patients: An Interview With Dr. Daniel F. Hayes, 2015–2016 President-Elect

Daniel F. Hayes, MD, FASCO, began his term as ASCO President-Elect this past June, and will serve as President in 2016–2017. A breast cancer specialist, he is Professor of Internal Medicine, the Stuart B. Padnos Professor in Breast Cancer, and the Clinical Director of the Breast Oncology Program at ...

NCCN Foundation Appoints Three New Representatives to Board of Directors

The National Comprehensive Cancer Network (NCCN) Foundation has appointed three new representatives to its Board of Directors: Heather Kopecky, PhD, MBA; Marc Samuels, JD, MPH; and Susan Stein, MPH. There are currently 15 members of the Board of Directors, responsible for the strategic direction...

breast cancer

Nodal Irradiation in Node-Positive Breast Cancer: It Is Not Time to Change Practice

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...

breast cancer

Regional Nodal Irradiation in Early Breast Cancer Yields Significant Disease-Free Survival Benefit in Two Trials

Two phase III trials recently reported in The New England Journal of Medicine indicated that the addition of regional nodal irradiation was associated with no or marginal overall survival benefit but significantly improved disease-free survival in patients with early-stage breast cancer.1,2 NCIC...

lung cancer

Nivolumab Improves Overall Survival vs Docetaxel in Advanced Previously Treated Squamous Cell NSCLC

In a phase III trial reported in The New England Journal of Medicine, ­Julie Brahmer, MD, of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, and colleagues found that treatment with the programmed cell death protein 1 (PD-1) immune checkpoint inhibitor antibody nivolumab...

skin cancer

Cobimetinib in BRAF-Mutant Unresectable or Metastatic Melanoma in Combination With Vemurafenib

In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs On November 10, 2015, the U.S. Food and Drug Administration...

hematologic malignancies

Molecularly Targeted Therapy Brings New Hope to Patients With Relapsed/Refractory Hairy Cell Leukemia

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...

kidney cancer
skin cancer

Nivolumab Receives Two FDA Approvals in November

Nivolumab (Opdivo) is a monoclonal antibody that binds to the programmed cell death protein 1 (PD-1) receptor and blocks its interaction with its ligands PD-L1 and PD-L2, releasing PD-1 pathway–mediated inhibition of the immune response. Late last month, the U.S. Food and Drug Administration (FDA)...

hematologic malignancies
leukemia

BRAF Inhibition Successful in Relapsed/Refractory Hairy Cell Leukemia

In two phase II studies reported in The New England Journal of Medicine, ­Enrico Tiacci, MD, of the University of Perugia, Italy, and colleagues found that the BRAF inhibitor vemurafenib (Zelboraf) produced responses in nearly all patients with BRAF V600E–positive hairy cell leukemia that relapsed...

The Best of SIO

The following five abstracts were chosen as the best studies presented at the 12th International Conference of the Society for Integrative Oncology (SIO) because of their quality and the impact they will have on the field of integrative medicine, according to Suzanna Zick, ND, MPH, Immediate Past...

Mind-Body Therapies Were the Focus at the 12th International Conference of the Society for Integrative Oncology

Among the highlights at the 12th International Conference of the Society for Integrative Oncology (SIO) was a 1-day joint meeting on acupuncture, oncology, and fascia cosponsored by SIO, the Society for Acupuncture Research, the Fascia Research Society, and the Osher Center for Integrative...

multiple myeloma

FDA Approves Elotuzumab in Combination With Lenalidomide and Dexamethasone for Multiple Myeloma

The U.S. Food and Drug Administration (FDA) has granted approval for elotuzumab (Empliciti) in combination with two other therapies to treat patients with multiple myeloma who have received one to three prior medications. “We are continuing to learn about the ways the immune system interacts with...

2015 Review of Newly Approved Oncologic Therapies

Over the past year or so, a host of new agents were approved for the treatment of patients with various types of cancer (see related article on page 1). Patrick Medina, PharmD, of the University of Oklahoma College of Pharmacy, Oklahoma City, and Monique Giordana, PharmD, BCOP, of Regions...

lung cancer
supportive care

Anamorelin Improves Cachexia Symptoms in Patients With Advanced Non–Small Cell Lung Cancer

The investigational agent anamorelin significantly increased lean body mass, body weight, total body mass, and fat mass in patients with advanced non–small cell lung cancer (NSCLC) and cachexia, according to Jennifer S. Temel, MD, who presented the results of two phase III studies at the 2015...

supportive care

Olanzapine Significantly Reduces Chemotherapy-Induced Nausea and Vomiting

The addition of olanzapine to standard antiemetics significantly reduced chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy, according to Rudolph M. Navari, MD, PhD, and colleagues. “As far as I know, this is the first trial that looked at no nausea as the ...

breast cancer

ASCO Guideline on the Use of Biomarkers in Treatment Decisions in Metastatic Breast Cancer: Shedding Light on an Often Mysterious Art

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...

solid tumors
hematologic malignancies

FDA Oncology New Drug/New Indication Approvals for 2015

The following new hematology/oncology agents and expanded indications were approved by the U.S. Food and Drug Administration (FDA) Center for Drug Evaluation and Research in 2015: Alectinib (Alecensa), an ALK inhibitor, for the treatment of patients with anaplastic lymphoma kinase (ALK)-positive...

Mixing Metaphors to Change the Language of Cancer

BookmarkTitle: Malignant Metaphor: Confronting Cancer MythsAuthor:  Alanna MitchellPublisher: ECW PressPublication date: September 15, 2015Price: $24.95; hardcover, 184 pages Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom...

breast cancer

Breast Care Services at Henry Ford Health System Gains New Director, Three New Surgeons

Internationally renowned breast cancer surgeon Lisa A. Newman, MD, MPH, has joined Henry Ford Health System to lead its metro Detroit breast cancer program and new international breast cancer research center. She begins work in December as the Director of the Breast Cancer Program at Henry Ford....

solid tumors
prostate cancer

Decline in PSA Testing and Incidence of Early Prostate Cancer Coincide With 2012 Recommendation Against PSA Screening

Two recent studies1,2 found that the rates of prostate-specific antigen (PSA) screening have declined since the U.S. Preventive Services Task Force (USPSTF) recommended against PSA screening in 2012. One of those studies additionally found that the incidence of early-stage prostate cancer also...

NIH Awards City of Hope $4.8 Million to Study Environment and Breast Cancer

The National Institutes of Health has awarded City of Hope a 5-year, $4.8 million grant to study the possible role of chemicals in the environment in the development of breast cancer during the menopausal transition in women. The coprincipal investigators on the study are two City of Hope...

The Lawless and Uncertain World of Medicine

Bookmark Title: The Laws of Medicine: Field Notes From an Uncertain Science Author: Siddhartha Mukherjee Publisher: TED Books/Simon & Schuster Publication date: October 13, 2015 Price: $16.99; hardcover, 96 pages The Emperor of All Maladies, written by the Indian-born American oncologist...

issues in oncology

How to Help Mentees Succeed

Although formal mentoring programs in medical education were not launched in the United States until the late 1990s,1 today they are regarded as playing an essential role in the career development of medical trainees and have been associated with improvements in research, teaching, and patient...

hematologic malignancies
leukemia
issues in oncology

Acute Myeloid Leukemia in the Elderly: Trial Data Stir Hope for the Transplant Option

Older patients with acute myeloid leukemia (AML) have high relapse rates after induction chemotherapy, low survival rates, and fewer treatment options compared with younger patients. One of the options for both younger and older patients is hematopoietic cell transplantation, but relatively few...

ASCO Guides Members Through MACRA Implementation With a Robust Set of New Resources

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), passed earlier this year, repealed the fundamentally flawed Sustainable Growth Rate formula and introduced significant changes in how Medicare will pay oncologists for the care they provide in the coming years. The new law will be...

issues in oncology

The Promise of Immune Checkpoint Blockade in Cancer Therapy

The concept of using activation of the innate immune system and an inflammatory response against a bacterial component to instigate an antitumor response was studied in the 1960s, which led to the development of intravesical bacillus Calmette-Guérin, now used in the treatment of superficial bladder ...

lymphoma

A: Primary Diffuse Large B-Cell Lymphoma of the Central Nervous System

Question 1: Based on the rationale for the current “standard of care” for primary diffuse large B-cell lymphoma of the CNS, what is the optimal induction therapy? Correct Answer: C. A high-dose methotrexate–based regimen. Expert Perspective Untreated primary diffuse large B-cell lymphoma of the CNS ...

St. Jude Opens First Proton Therapy Center for Children

St. Jude Children’s Research Hospital has opened the St. Jude Red Frog Events Proton Therapy Center, the first proton therapy center in the world dedicated solely to children with cancer. Patients are now being treated at the center using precisely delivered, high-energy protons to kill or shrink...

lung cancer

Necitumumab in Metastatic Squamous Non–Small Cell Lung Cancer

In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. On November 24, 2015, necitumumab (Portrazza) was approved for use ...

lung cancer

ASCO Endorsement of ACCP Guideline on Treating SCLC: Moving Forward to Better Outcomes in Oncology

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...

breast cancer

Ductal Carcinoma in Situ and Relevant Endpoints for Omission of Standard Treatments: Are We There Yet?

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...

breast cancer

Surgical Excision Without Radiation Therapy in Women With Low-Risk Ductal Carcinoma in Situ

Lawrence J. Solin, MD, of Albert Einstein Healthcare Network, Philadelphia, and colleagues reported the 12-year results from the ECOG-ACRIN E5194 trial in the Journal of Clinical Oncology. Among women with ductal carcinoma in situ with low-risk clinical and pathologic characteristics, they found...

colorectal cancer

Minimally Invasive Surgery for Rectal Cancer: An Evolving Issue

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...

solid tumors
colorectal cancer

Phase III Trials Fail to Show Noninferiority of Surgical Outcome for Laparoscopic vs Open Resection in Rectal Cancer

Two phase III trials, reported in JAMA by James Fleshman, MD, of Baylor University Medical Center, Dallas, and colleagues1 and Andrew R. Stevenson, MBBS, FRACS, of the University of Queensland, Brisbane, Australia, and colleagues,2 failed to show noninferiority of surgical outcome for laparoscopic...

survivorship

ASTRO Launches Template to Help Radiation Oncologists Guide Cancer Survivors Through Ongoing Care

A new template published by the American Society for Radiation Oncology (ASTRO) standardizes and streamlines the creation of patient-focused plans for long-term cancer survivor care following radiation therapy. As the number of cancer patients and survivors in the United States continues to...

health-care policy
issues in oncology

Clinical Trial System Badly in Need of Overhaul, Say Panelists at Friends-Brookings Conference

Cancer clinical trials in three distinct phases, as they have been conducted for decades, are probably no longer the best way to bring a drug or biologic agent to market. This was the consensus of three panels at the 8th Annual Conference on Clinical Cancer Research convened by Friends of Cancer...

hematologic malignancies

Optimizing the Treatment of HIV-Associated Lymphoma

Non-Hodgkin lymphoma (NHL) associated with human immunodeficiency virus (HIV) infection generally can be treated the same as lymphoma in non–HIV-infected patients, with a few caveats, according to Lawrence D. Kaplan, MD, of the Helen Diller Family Comprehensive Cancer Center of the University of...

palliative care

More, Earlier, and Better Goals-of-Care Conversations at the End of Life Are Feasible

An intervention called the Serious Illness Care Program helps clinicians to conduct more, earlier, and better conversations about goals of care with their seriously ill patients, according to ­Rachelle E. Bernacki, MD, MS, who presented the preliminary results of a study using this approach at the...

leukemia

Promising Upfront Combination in Older Patients With Acute Lymphoblastic Leukemia

Frontline treatment with the antibody-drug conjugate inotuzumab ozogamicin plus deintensified chemotherapy is a promising option for older patients with Philadelphia chromosome–negative acute lymphoblastic leukemia (ALL). Phase II results suggest that this combination has the ability to improve...

leukemia

Midostaurin: A New Standard of Care in Acute Myeloid Leukemia?

Upfront treatment with midostaurin added to standard chemotherapy improved survival compared with placebo plus chemotherapy in high-risk patients with acute myeloid leukemia (AML) characterized by FLT3 mutations. No new drugs have been approved for AML since 1990, and midostaurin is the first...

hematologic malignancies
leukemia
issues in oncology

Ibrutinib Bests Standard of Care for Elderly Patients With CLL

First-line treatment with the Bruton’s tyrosine kinase inhibitor ibrutinib (Imbruvica) significantly reduced the risk of dying or disease progression compared with chlorambucil (Leukeran) in older treatment-naive patients with chronic lymphocytic leukemia (CLL) in the RESONATE-2 trial. At the time...

Expert Point of View: Virginia Kaklamani, MD

Press conference moderator Virginia Kaklamani, MD, commented on these results from the ABCSG-18 trial: “It’s pretty clear that 3 years of adjuvant denosumab not only reduced fracture risk but improved disease-free survival. It’s also pretty clear that adjuvant bisphosphonates improve disease-free...

breast cancer

Adjuvant Denosumab Improves Disease-Free Survival in Estrogen Receptor–Positive Postmenopausal Breast Cancer

There is good news about denosumab (Prolia). The primary analysis of the ABCSG-18 trial showed that adjuvant denosumab (given at low doses) reduces the risk of clinical fracture by 50% in postmenopausal women with early breast cancer who are taking an aromatase inhibitor.1 More good news is that...

breast cancer

Patients With Incomplete Response to Neoadjuvant Chemotherapy Benefit From Capecitabine

Treatment with capecitabine increased disease-free and overall survival in breast cancer patients with residual disease after neoadjuvant chemotherapy, according to a study reported by researchers from Japan and Korea at the 2015 San Antonio Breast Cancer Symposium.1 “It has been unclear whether...

gynecologic cancers
issues in oncology

A Shot to End Cancer: HPV Vaccination

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...

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