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How to Tell Patients They Have Cancer

The following essay by Stan Winokur, MD, is adapted, with permission, from The Big Casino: America’s Best Cancer Doctors Share Their Most Powerful Stories, which was coedited by Stan Winokur, MD, and Vincent Coppola and published in May 2014. The book is available on Amazon.com and...

lung cancer

Lung Cancer Researcher Melissa Johnson, MD, Benefits From Father’s Perspective as Career Military Officer

Lung cancer researcher Melissa Johnson, MD, is a self-described “military brat,” whose father was a career officer in the Marine Corps, serving for more than 35 years. She was born in Oklahoma City and moved nine times during her childhood. When Dr. Johnson was in high school, her father was...

When Illness and Culture Collide

“‘Sickness’ is what is happening to the patient. Listen to him. Disease is what is happening to science and to populations.” —Lawrence Weed, MD, 1978 America’s massive health-care system is highly complex, with its own unique language, methods, technologies, and scientific approaches, developed and ...

issues in oncology

Electronic ‘Datarrhea’ and Wellness

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...

A Career Path Shaped by Unlimited Possibilities for Clifford A. Hudis, MD, FACP, FASCO

In this installment of the Living a Full Life series, guest editor Jame Abraham, MD, interviewed Clifford A. Hudis, MD, FACP, FASCO, ASCO’s Chief Executive Officer. Prior to his current position, Dr. Hudis served in a variety of roles at ASCO, including President during ASCO’s 50th anniversary...

issues in oncology
immunotherapy

The Abscopal Effect: A Reemerging Field of Interest

For the past 50 years or more, oncologists have designed their treatment plans around the three pillars: surgery, chemotherapy, and radiation. Now, with a series of recent successes, immunotherapy is rapidly reemerging as the fourth pillar in the oncologic armamentarium. Despite major advancements...

lymphoma

FDA Expands Approved Use of Brentuximab Vedotin in Some Types of PTCL

ON NOVEMBER 16, 2018, the U.S. Food and Drug Administration (FDA) expanded the approved use of brentuximab vedotin (Adcetris) injection in combination with chemotherapy for adult patients with certain types of peripheral T-cell lymphoma (PTCL)—adults with previously untreated systemic anaplastic...

solid tumors

Iobenguane I-131 for Advanced Pheochromocytoma or Paraganglioma

ON JULY 30, 2018, the radiotherapeutic agent iobenguane I-131 (Azedra) was approved for the treatment of adult and pediatric patients (aged ≥ 12 years) with iobenguane scan–positive, unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who require systemic anticancer...

leukemia

FDA Approves Glasdegib for Patients With Newly Diagnosed AML Who Cannot Undergo Intensive Chemotherapy

Today, the U.S. Food and Drug Administration (FDA) approved glasdegib (Daurismo) tablets to be used in combination with low-dose cytarabine for the treatment of newly diagnosed acute myeloid leukemia (AML) in adults who are 75 years of age or older or with comorbidities that may preclude the use of ...

issues in oncology
legislation

Pharmacy ‘Gag Clause’ Bills Signed Into Law

This past month, President Trump signed a pair of bills into law aimed at increasing transparency with regard to drug prices in the United States. The Patient Right to Know Drug Prices Act (S.2554) and the Know the Lowest Price Act (S.2553) prohibit so-called “gag clauses,” which prevent...

issues in oncology

ASCO President-Elect Candidates Identify Key Issues Facing the Field of Oncology

Lori J. Pierce, MD, FASTRO, FASCO, of the University of Michigan, and Carolyn D. Runowicz, MD, FASCO, of Herbert Wertheim College of Medicine, Florida International University, Miami, were selected by the ASCO Nominating Committee as candidates for President-Elect. Why do you want to serve as ASCO...

Your Voice Matters: Vote in the ASCO Election by December 3

Each year, we call upon the ASCO members to place their votes to select our Society’s future leaders. This year, we are asking that you not only vote for the open leadership positions, but also for a proposed bylaw change. ASCO’s mission is more urgent than ever in today’s landscape of fast-moving ...

skin cancer

Cemiplimab-rwlc for Metastatic or Locally Advanced Cutaneous Squamous Cell Carcinoma

On September 28, 2018, cemiplimab-rwlc (Libtayo) was approved for the treatment of patients with metastatic cutaneous squamous cell carcinoma or locally advanced cutaneous squamous cell carcinoma who are not candidates for curative surgery or curative radiation.1 Supporting Efficacy Data Approval...

issues in oncology

Patients With Cancer in Rural America Remain Underserved

Despite growing national awareness of health-care inequities, the plight of rural Americans diagnosed with cancer has persistently remained inadequate. Speaking with The ASCO Post, Jan Probst, PhD, Professor at the Arnold School of Public Health, University of South Carolina, Columbia, noted, “We...

hematologic malignancies
leukemia

Duvelisib in Resistant Chronic Lymphocytic Leukemia: Expanding the Treatment Armamentarium

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...

hematologic malignancies
leukemia
lymphoma

Duvelisib vs Ofatumumab in Relapsed or Refractory CLL/SLL

As reported in Blood by Ian W. Flinn, MD, PhD, Director of the Lymphoma Research Program at Sarah Cannon Research Institute, and colleagues, the phase III DUO trial has shown significantly prolonged progression-free survival with the phosphoinositide 3-kinase (PI3K)-δ/γ inhibitor duvelisib...

pain management
supportive care

Parenteral Opioid Shortage Threatens Appropriate Pain Care for Patients With Cancer

In response to the opioid-overdose epidemic, several measures have been put in place, such as the reclassification of hydrocodone as a Schedule II opioid and new requirements for physician review of prescription drug–monitoring program databases in most states. Moreover, the Surgeon General and...

issues in oncology

Inflammation, DNA Damage, and Cancer

The link between inflammation and cancer is a field of growing interest in the oncology community. Biologists have theorized that simultaneous DNA damage and cell division during inflammation could lead to cancer. To shed light on this important issue, The ASCO Post recently spoke with Jennifer...

lung cancer

Dacomitinib for Metastatic EGFR-Mutant NSCLC

On September 27, 2018, dacomitinib (Vizimpro) received approval for the first-line treatment of patients with metastatic non–small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 L858R substitution mutations, as detected by a test approved by the...

lung cancer

FDA Approves Lorlatinib for Second- or Third-Line Treatment of ALK-Positive Metastatic NSCLC

On November 2, 2018, the U.S. Food and Drug Administration granted accelerated approval to lorlatinib (Lorbrena) for patients with anaplastic lymphoma kinase (ALK)-positive metastatic non–small cell lung cancer (NSCLC) whose disease has progressed on crizotinib (Xalkori) and at least one other ALK ...

hematologic malignancies

Ibrutinib Plus Rituximab in Adult Patients With Waldenström’s Macroglobulinemia

In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms of action, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. On August 27, 2018, ibrutinib (Imbruvica) was approved...

leukemia
immunotherapy

Azacitidine Plus Nivolumab in Relapsed or Refractory AML

A combination of the chemotherapy drug azacitidine with the immune checkpoint inhibitor nivolumab (Opdivo) demonstrated an encouraging response rate and overall survival in patients with relapsed or refractory acute myeloid leukemia (AML), according to findings from a phase II study published...

gynecologic cancers

Neoadjuvant Chemotherapy vs Upfront Debulking Surgery in Advanced Tubo-Ovarian Cancer

As reported in The Lancet Oncology by Vergote et al, a pooled analysis of individual patient data in long-term follow-ups of the phase III EORTC 55971 and CHORUS trials indicated that overall survival is similar with neoadjuvant therapy vs upfront debulking surgery in advanced tubo-ovarian cancer....

colorectal cancer

Multimodality Therapy and Lateral Local Recurrence in Rectal Cancer

In a study reported in the Journal of Clinical Oncology, Ogura et al found that lateral lymph node dissection (LLND) reduced the risk of lateral local recurrence in patients with lateral nodes ≥ 7 mm undergoing neoadjuvant chemoradiation or radiation and total mesorectal excision in clinical...

Steven A. Rosenberg, MD, PhD, Works to Unmask Cancer’s Achilles Heel

Steven A. Rosenberg, MD, PhD, knew from the start of his medical career that if treatments for cancer were to become curative, research in new therapies would have to move away from the mainstay one-size-fits-all approach of systemic chemotherapy to an innovative, personalized strategy that...

breast cancer

Quality of Life With Postmastectomy Radiotherapy vs No Radiotherapy in Intermediate-Risk Breast Cancer

In a 2-year follow-up of the phase III SUPREMO trial reported in The Lancet Oncology, Galina Velikova, PhD, of the Leeds Cancer Centre, St. James’s University Hospital, United Kingdom, and colleagues found worse chest wall symptoms in women with intermediate-risk breast cancer who did vs did not...

prostate cancer

ASTRO/ASCO/AUA Guideline for Early-Stage Prostate Cancer Supports Use of Hypofractionated Radiotherapy

Three prominent medical organizations have issued a new clinical guideline for physicians treating men with early-stage prostate cancer using external-beam radiation therapy (EBRT). Developed by a panel of experts from the American Society for Radiation Oncology (ASTRO), ASCO, and the American...

Atlantic Health System Announces Collaboration to Further Patient Access to Innovative Cancer Therapies

The Atlantic Health System, an integrated health-care delivery system, recently announced a partnership with the Translational Genomics Research Institute, an affiliate of City of Hope, and Origin Commercial Ventures to create a new platform to deliver economically viable immunotherapies and other...

issues in oncology
global cancer care

Building Improved and Sustainable Health-Care Systems Through Telemedicine

Telemedicine—the remote diagnosis and treatment of patients via telecommunications technology—has changed the way oncology care is delivered in rural parts of the world. Patients in rural areas are now able to connect remotely with their physicians without having to deal with the time, expense, and ...

issues in oncology

Modern Clinical Trials: Engaging Stakeholders at the Front Lines of Care

Randomized clinical trials have been providing high-quality evidence for decades, but there are limitations to the traditional design. At the 2018 ASCO Quality Care Symposium, George J. Chang, MD, MS, FACS, FASCRS, discussed the need to modernize clinical trials, so they continue to provide...

geriatric oncology
palliative care

Katherine C. Lee, MD, on Emergency Surgery and End-of-Life Care

Katherine C. Lee, MD, of Massachusetts General Hospital, discusses her study findings that showed older patients with metastatic cancer who survived emergency general surgery experienced higher intensity end-of-life care than similar patients who did not undergo surgery (Abstract 56).

Expert Point of View: Sandro Pignata, MD

The study’s invited discussant, Sandro Pignata, MD, of the Istituto Nazionale Tumori di Napoli in Italy, called the data from AGO OVAR 2.21 “very strong.” He added: “We now have robust evidence from a trial of more than 600 patients, in which previous bevacizumab (Avastin) was allowed, that...

gynecologic cancers

Study Identifies Suitable Partner for Bevacizumab in Recurrent Ovarian Cancer

For patients with recurrent ovarian cancer who receive platinum-based retreatment, the more suitable partner for bevacizumab (Avastin) may be carboplatin plus pegylated liposomal doxorubicin, rather than carboplatin and gemcitabine, according to the results of a phase III ENGOT/GCIG Intergroup...

Expert Point of View: Caroline Robert, MD, PhD

The paper’s invited discussant, Caroline Robert, MD, PhD, of the Institut de Cancérologie Gustave Roussy, Villejuif, France, said OpACIN-neo attained its goal of reducing toxicity and maintaining efficacy. The regimen of two courses of ipilimumab (Yervoy) at 1 mg/kg plus nivolumab (Opdivo) at 3...

skin cancer
immunotherapy

Neoadjuvant Therapy With Reduced-Dose Immunotherapy for Stage III Melanoma

In patients with stage III melanoma, a reduced-dose neoadjuvant immunotherapy combination was well tolerated and led to high pathologic response rates, in the phase II OpACIN-neo trial presented at the European Society for Medical Oncology (ESMO) 2018 Congress.1 “Neoadjuvant ipilimumab (Yervoy) at...

Expert Point of View: Daniel Heinrich, MD, and Silke Gillessen, MD

Formal discussant of the ERA 223 trial, Daniel Heinrich, MD, of Akershus University Hospital, Lørenskog, Norway, reminded listeners at the European Society for Medical Oncology (ESMO) 2018 Congress that radium-223 was developed in Norway. “When the ALSYMPCA results came out, we were celebrating....

prostate cancer

Treatment With Radium-223 Plus Abiraterone Not Advisable in Metastatic Prostate Cancer

The combination of radium-223 plus AAP (abiraterone acetate [Zytiga] and prednisone) was not superior to placebo plus AAP in the phase III ERA 223 trial, which enrolled men with asymptomatic bone-predominant metastatic castration-resistant prostate cancer.1 Patients treated with the combination had ...

Expert Point of View: Viktor Grünwald, MD, PhD

Formal discussant Viktor Grünwald, MD, PhD, of the Hannover Medical School, Germany, agreed that the results of JAVELIN Renal 101 were impressive, but he was more cautious about accepting avelumab (Bavencio)/axitinib (Inlyta) as a new standard of care without longer follow-up and quality-of-life...

kidney cancer
immunotherapy

Immunotherapy and Tyrosine Kinase Inhibitor Combination in Advanced Renal Cell Carcinoma

In the JAVELIN Renal 101 phase III study, the combination of the immune checkpoint inhibitor avelumab (Bavencio), a programmed death ligand-1 (PD-L1) blocking antibody, plus the tyrosine kinase inhibitor axitinib (Inlyta) significantly improved progression-free survival in previously untreated...

Expert Point of View: Amanda Psyrri, MD, PhD

Formal discussant of this trial, Amanda Psyrri, MD, PhD, of the University of Athens Medical School, Attikon Hospital, Athens, Greece, commented on these results, suggesting they would affect clinical practice “tomorrow.” “Cisplatin/radiotherapy remains the standard of care for low-risk human...

head and neck cancer

Phase III Study Supports Use of Cisplatin Over Cetuximab in HPV-Positive Oropharyngeal Cancer

In the United States and European countries, many oncologists are using cetuximab (Erbitux)/radiotherapy instead of cisplatin/radiotherapy in the treatment of human papillomavirus (HPV)-positive oropharyngeal cancer, based on the belief that cetuximab is equally effective with less toxicity than...

Expert Point of View: Jean-Pascal Machiels, MD, PhD, and Tanguy Seiwert, MD

Invited discussant Jean-Pascal Machiels, MD, PhD, Head of the Department of Medical Oncology at the Cliniques universitaires Saint-Luc, UCLouvain, Brussels, called the study “very important,” especially for showing that in patients with high expression of programmed cell death ligand 1 (PD-L1),...

head and neck cancer
immunotherapy

Pembrolizumab Improves Survival in Advanced Head and Neck Cancer

An overall survival advantage has now been shown for first-line immunotherapy in recurrent or metastatic head and neck cancer, researchers reported at the European Society for Medical Oncology (ESMO) 2018 Congress.1 In the phase III KEYNOTE-048 trial, treatment with the anti–programmed cell death...

Expert Point of View: Julien Taieb, MD, PhD

The invited discussant for the CheckMate-142 findings was Julien Taieb, MD, PhD, Professor of Medicine at Paris Descartes University in France. Dr. Taieb called the findings “impressive” but said longer follow-up is needed, especially since median outcomes have not yet been reached. After a...

gastrointestinal cancer
colorectal cancer
immunotherapy

First-Line Immunotherapy Shows Benefit in Metastatic Colorectal Cancer Subset

In previously untreated patients with metastatic colorectal cancer and tumors demonstrating microsatellite instability–high (MSI-high) or mismatch repair deficiency (dMMR), immunotherapy with nivolumab (Opdivo) and low-dose ipilimumab (Yervoy) produced a durable clinical benefit in the...

prostate cancer

Treatment With ADT May Be Linked to Higher Risk of Heart Failure in Patients With Prostate Cancer

Androgen-deprivation therapy (ADT) use was associated with a higher risk of heart failure in a study of patients with prostate cancer, according to findings published by Kao et al in The Journal of Clinical Pharmacology.  Study Methods, Findings Study authors used data from the Taiwan...

Expert Point of View: George Coukos, MD, PhD

George Coukos, MD, PhD, Director of the Department of Oncology at the University Hospitals of Canton Vaud and Director of the Lausanne branch of the Ludwig Institute for Cancer Research at the University of Lausanne in Switzerland, was the invited discussant of the NICHE study at the European...

gastrointestinal cancer

Neoadjuvant Immunotherapy Yields Major Response in Colon Cancer Subset

In a small study of patients with early-stage colon cancer, neoadjuvant ipilimumab (Yervoy) plus nivolumab (Opdivo) produced major pathologic responses in 100% of patients with mismatch repair (MMR)-deficient tumors but in none of the patients with MMR-proficient tumors, researchers reported at the ...

prostate cancer

Adding Pelvic Node Radiation and Short-Term Hormone Therapy to Salvage Radiation Provides Significant Benefit in Prostate Cancer

For patients with prostate cancer who have persistent or rising prostate-specific antigen (PSA) levels after radical prostatectomy, the addition of short-term androgen-deprivation therapy and radiotherapy to the pelvic lymph nodes demonstrated increased rates of freedom from disease progression,...

Expert Point of View: Catherine C. Park, MD, FASTRO

Discussant of the 12-year report from the NRG/RTOG 9804 trial, Catherine C. Park, MD, FASTRO, Professor and Chair of the Department of Radiation Oncology at the University of California, San Francisco, underscored the high prevalence of ductal carcinoma in situ, which comprises approximately 20%...

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