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issues in oncology

The Paradox of Positive Thinking

The ASCO Post is pleased to reproduce installments of the “Art of Oncology” as published previously in the Journal of Clinical Oncology (JCO). These articles focus on the experience of suffering from cancer or of caring for people diagnosed with cancer, and they include narratives, topical essays,...

breast cancer

CLEOPATRA Overall Survival Analysis: Significant Benefit for Pertuzumab Plus Trastuzumab/Docetaxel in HER2-Positive Metastatic Breast Cancer

As reported in The New England Journal of Medicine by Sandra M. Swain, MD, of Washington Cancer Institute, MedStar Washington Hospital Center, and colleagues, the final prespecified overall survival analysis in the phase III CLEOPATRA study showed a significant 15.7-month increase in median overall ...

solid tumors

Living With a Rare Cancer—My Dr. Seuss World

No one ever expects to hear the words “you have cancer,” but over the course of the day, over 5,000 people in the United States are given that news.1 I first heard those words in the summer of 2007 and have been living with cancer ever since. At the time of my diagnosis, I knew this would forever...

A Less Is More View of Medicine

BOOKMARKTitle: Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical CareAuthor: H. Gilbert Welch, MDPublisher: Beacon PressPublication date: March 3, 2015Price: $24.95; hardcover, 241 pages He’s the best physician that knows the worthlessness of most medicines. —Benjamin Franklin...

2015 Oncology Meetings

MAY American Association for Cancer Research: Advances in Brain Cancer ResearchMay 27-30 • Washington, DC For more information: www.aacr.org ASCO Annual MeetingMay 29-June 2 • Chicago, Illinois For more information: am.asco.org 2015 ASCO State Affiliates’ ReceptionMay 31 • Chicago, Illinois For...

skin cancer

FDA Accepts Supplemental Biologics License Application for Nivolumab in Patients With Previously Untreated Advanced Melanoma

The U.S. Food and Drug Administration (FDA) has accepted for filing and review Bristol-Myers Squibb’s supplemental Biologics License Application (sBLA) for nivolumab ­(Opdivo) for the treatment of previously untreated patients with unresectable or metastatic melanoma. The FDA also granted Priority...

colorectal cancer

Ramucirumab With FOLFIRI in Metastatic Colorectal 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 April 24, the monoclonal antibody ramucirumab ­(Cyramza) was...

skin cancer

Pembrolizumab vs Ipilimumab: Good vs Better

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...

skin cancer

Anti–PD-1 Antibody Pembrolizumab Improves Progression-Free and Overall Survival vs Ipilimumab in Advanced Melanoma

In the phase III KEYNOTE-006 trial reported in The New England Journal of Medicine,1 Caroline Robert, MD, PhD, Head of the Dermatology Unit at the Institut Gustave Roussy, Paris, and colleagues found that the anti–programmed cell death protein 1 (PD-1) antibody pembrolizumab (Keytruda) increased...

issues in oncology
geriatric oncology

Guidelines for the Treatment of Older Cancer Patients: Task Forces of the International Society of Geriatric Oncology

Geriatrics for the Oncologist is guest edited by Stuart Lichtman, MD, FACP, FASCO, and developed in collaboration with the International Society of Geriatric Oncology (SIOG). Visit SIOG.org for more on geriatric oncology. The Task Forces of the International Society of Geriatric Oncology (SIOG) are ...

supportive care

Potential Power of Meaning-Centered Group Psychotherapy in Patients With Advanced Cancer

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,...

supportive care
survivorship

Physiatry Has Become a Valuable Component of Survivorship Care in Cancer Centers

The role of a physical medicine and rehabilitation physician at cancer centers continues to grow, as survivors live longer and national cancer organizations advocate for more rehabilitation services throughout the continuum of survivorship care. Working with physiatrists at your institution can...

thyroid cancer

Welcome to Multikinase Inhibitors in Radioiodine-Refractory Thyroid Cancer

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...

thyroid cancer

Large Improvement in Progression-Free Survival With Lenvatinib in Radioiodine-Refractory Thyroid Cancer

In a phase III trial reported in The New England Journal of Medicine, Martin Schlumberger, MD, of Institut Gustave Roussy, and colleagues found that the multikinase inhibitor lenvatinib (Lenvima) produced a large improvement in progression-free survival vs placebo in patients with advanced...

breast cancer

A Closer Look at the Disparities in Breast Cancer Outcome by Race and Ethnicity

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 ...

breast cancer

Optimizing Treatment for Small, Lymph Node–Negative, HER2-Overexpressing Breast Cancers

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 ...

breast cancer

High Invasive Disease-Free Survival With Adjuvant Paclitaxel and Trastuzumab in Small, Node‑Negative, HER2-Positive Breast Cancers

In a phase II study reported in The New England Journal of Medicine, Sara M. Tolaney, MD, MPH, of Dana-Farber Cancer Institute, and colleagues found that adjuvant paclitaxel and trastuzumab (Herceptin) was associated with high invasive disease-free survival in women with small, node-negative,...

breast cancer

Increased Risk of Secondary Bone Marrow Neoplasia After Adjuvant Breast Cancer Treatment: Risk/Benefit Analysis and Biologic Insights

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...

breast cancer

Higher-Than-Expected Incidence of Marrow Neoplasms After Adjuvant Therapy for Breast Cancer

In a study reported in the Journal of Clinical Oncology, Antonio C. Wolff, MD, of Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, and colleagues found a low but higher-than-expected incidence of marrow neoplasms in patients receiving adjuvant radiation therapy or chemotherapy...

integrative oncology

Maitake

The use of dietary supplements by patients with cancer has increased significantly over the past 2 decades 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...

Taking the Next Step in a Storied Career

On March 31, 2015, Harold Varmus, MD, left his position as Director of the National Cancer Institute (NCI) to join the faculty of Weill Cornell Medical College in New York as its Lewis Thomas University Professor of Medicine. Dr. Varmus was also named Senior Associate Core Member of the New York...

Exploring the History and Psychology of Pain: Beyond the Clinical Setting

BOOKMARKTitle: The Story of Pain: From Prayer to PainkillersAuthor: Joanna BourkePublisher: Oxford University PressPublication date: 2014Price: $34.95: hardcover, 416 page   “Pain may even kill. It may overwhelm the nervous system by its mere magnitude & duration.” —Peter Mere Latham, 1871...

prostate cancer

MAINSAIL Trial: Worse Outcomes With Addition of Lenalidomide to Docetaxel-Prednisone in Prostate Cancer

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 ...

prostate cancer

Addition of Lenalidomide to Docetaxel-Prednisone Worsens Survival in Chemotherapy-Naive Metastatic Castration-Resistant Prostate Cancer

In the phase III MAINSAIL trial reported in The Lancet Oncology, Daniel P. Petrylak, MD, of Yale Cancer Center, New Haven, Connecticut, and colleagues found that the addition of lenalidomide (Revlimid) to docetaxel-prednisone in chemotherapy-naive men with metastatic castration-resistant prostate...

hematologic malignancies

Answers: Case Report on Chronic Myelogenous Leukemia

Question 1: In the current era of tyrosine kinase inhibitor therapy, which prognostic model is best to assess the prognosis of a person with a new diagnosis of CML? Correct Answer: D. All of the above Expert Perspective Despite not being perfect, all of these scores are reasonably effective at...

Prognostic Models in CML

Sokal Score1 Derives from a multivariate analysis of survival of 813 patients diagnosed with chronic phase CML between 1962 and 1981 (0.0116 × (age [years] – 43.4)) + (0.0345 × (spleen size [cm] – 7.51) + (0.188 × ((platelets [109/L]/700)^2 – 0.563)) + (0.0887 × (blasts [%] – 2.10)). Smaller...

leukemia

Prognostic Models and Front-Line Treatment Options for Chronic-Phase Chronic Myelogenous Leukemia

The ASCO Post is pleased to present “Hematology Expert Review,” an occasional feature that includes a case report detailing a particular hematologic condition followed by questions. Answers to each question, along with expert commentary, can be found in the sidebar. In this installment, we present...

prostate cancer
survivorship

Prostate Cancer Survivorship: Identifying Opportunities for Improvement

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...

gynecologic cancers

PARP Inhibitors: The First Potential Treatment of Hereditary Ovarian Cancers

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...

gynecologic cancers

American College of Physicians Releases Best Practice Advice for Cervical Cancer Screening in Average-Risk Women

In April 2015, the American College of Physicians (ACP) released its clinical advice guideline, Cervical Cancer Screening in Average-Risk Women: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians.1 The guideline aims to reduce the overuse of cervical...

gynecologic cancers

PARP Inhibitors Have ‘Clear Benefit’ for Patients With Ovarian Cancer and BRCA Mutations, but When and at What Cost?

PARP inhibitors offer a promising alternative for targeted therapy in ovarian cancer” and have “clear benefit in BRCA-mutation carriers,” but questions remain about when is the best time to use them and the cost-effectiveness of maintenance therapy, Elizabeth M. Swisher, MD, of the University of...

colorectal cancer
issues in oncology

HPV-Related Anal Cancer on the Rise

More than 7,200 cases of anal cancer were diagnosed in 2014—approximately 2,600 in men and 4,600 in women—representing an increase of more than 4,000 from 8 years ago. In more than 90% of patients, infection with the human papillomavirus (HPV) is the cause, tagging anal cancer as a largely...

symptom management

Adoptive T-Cell Therapy Successfully Treats Devastating Complication of Stem Cell Transplantation

A new “off-the-shelf” treatment promises to induce remission in rituximab (Rituxan)-refractory Epstein-Barr virus (EBV)-associated lympho­proliferative disorder, a potentially fatal complication of hematopoietic stem cell transplantation. Historically, this complication has been difficult to treat...

pancreatic cancer
issues in oncology

Many Miles to Go: Targeted Treatment Based on Whole-Genome Sequencing

The ability to do genomic analysis of patients’ tumors holds great promise for revolutionizing cancer treatment, and genomics has already made some great strides. However, the Individualized Molecular Pancreatic Cancer Therapy ­(IMPaCT) trial is a cautionary tale about the hurdles involved in...

lung cancer

Pembrolizumab Safe and Effective in Patients With NSCLC, Especially in Those With Tumors Showing High Levels of PD-L1 Expression

Add lung cancer to the growing list of cancers that may derive benefit from immunotherapy. The KEYNOTE-001 trial found that pembrolizumab (Keytruda) achieved durable responses in a proportion of patients with non–small cell lung cancer (NSCLC) and high levels of expression of the protein PD-L1...

skin cancer
breast cancer
multiple myeloma
leukemia
colorectal cancer
prostate cancer
pancreatic cancer

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): 2015 Updates

For 2 decades, the NCCN Guidelines® have been recognized as the standard of cancer care in the United States, combining evidence, experience, and choice, so that multidisciplinary cancer treatment teams—including patients—are empowered to make informed decisions about cancer care,” said Robert W....

skin cancer

Simple Means of Preventing Nonmelanoma Skin Cancer Reported

Two daily doses of nicotinamide, a form of vitamin B3, significantly reduced the occurrence of nonmelanoma skin cancers by 23% in individuals considered at high risk for these lesions in an Australian study. Results of the phase III ONTRAC trial, which will be presented at the 2015 ASCO Annual...

Expert Point of View: Philip L. McCarthy, MD

Another exciting multiple myeloma treatment will be presented at the 2015 ASCO Annual Meeting,” Philip L. McCarthy, MD, Professor of Oncology and Director of the Blood and Marrow Transplant Center at Roswell Park Cancer Institute, Buffalo, New York, commented in an interview with The ASCO Post....

multiple myeloma

Novel Agent Elotuzumab Added to Lenalidomide/Dexamethasone Extends Progression-Free Survival in Multiple Myeloma

The monoclonal antibody elotuzumab, given with lenalidomide (Revlimid) and dexamethasone, extended progression-free survival by a median of 5 months, compared with lenalidomide/dexamethasone alone, in the eagerly awaited phase III ELOQUENT-2 trial, which will be presented at the 2015 ASCO Annual...

prostate cancer

Docetaxel Combined With Hormone Therapy Extends Survival in Advanced Prostate Cancer

Results from the STAMPEDE trial showed that the addition of docetaxel to standard hormone therapy improved overall survival by a median of 10 months over hormone therapy alone in men with newly diagnosed, advanced, hormone therapy–naive prostate cancer.1 The study also showed that zoledronic acid...

2015 Oncology Meetings

JUNE 13th International Conference on Malignant Lymphoma (ICML)June 17-20 • Lugano, Switzerland For more information: www.lymphcon.ch/imcl/index.php2 Yale ASCO® Review 2015: Highlights of the Annual MeetingJune 19 • New Haven, Connecticut For more information:...

Andrew C. von Eschenbach, MD, Went From the Front Lines of Cancer Care to a Bird’s-Eye View of the Changing Oncology Landscape

At the end of the day, I’m still a kid from South Philly,” Andrew C. von Eschenbach, MD, former Director of the National Cancer Institute (NCI) and Commissioner of the U.S. Food and Drug Administration (FDA), told The ASCO Post. Dr. von Eschenbach is the product of a closely knit yet culturally...

myelodysplastic syndromes

Nationally Recognized Leader in Myeloid Malignancies, Alan F. List, MD, Has High Hopes for the Future of Oncology

The Tampa Bay area of Florida is a haven for golfers and fishermen looking to unwind under the warm tropical skies. And the clean highways stretching through the scenic west coast of Florida are also a perfect excuse for weekend motorcycle enthusiasts, such as Alan F. List, MD, the President and...

lymphoma

Lymphoma Expert and Industry Leader Sandra J. Horning, MD, Pushes the Frontiers of Drug Development and Oncology Research

Due to childhood health issues, Sandra J. Horning, MD, formed an opinion about doctors at a young age: They were good people who helped other people. By her early teens, Dr. Horning began to ponder a career in medicine, which offered the possibility of blending her love of science with a career...

Carolyn R. ‘Bo’ Aldigé Reflects on 30 Years of Cancer Prevention

In 1985, Carolyn R. “Bo” Aldigé founded the Prevent Cancer Foundation in honor of her father, who had died the previous year of head and neck cancer. She started the Foundation in her kitchen with a typewriter, a sheath of carbon copy paper, and a telephone. “I quickly rented an office because a...

leukemia

First-Line Imatinib With Early Switch to Nilotinib May Be Preferable to First-Line Use of More Potent Agents in CML

Using imatinib to treat chronic-phase chronic myeloid leukemia (CP-CML) first line, with selective switching to nilotinib (Tasigna) “leads to excellent molecular response and survival” and “may be preferable to universal first-line use of more potent agents, considering efficacy, toxicity, and...

gynecologic cancers

POLE Proofreading Mutations Predict Better Outcome in Endometrial Cancer

In a study reported in the Journal of the National Cancer Institute, Church and colleagues assessed whether proofreading mutations in POLE (which encodes the DNA polymerase epsilon catalytic subunit) were associated with prognosis in endometrial cancer. Such mutations have been reported in...

issues in oncology
hematologic malignancies
solid tumors

Incidence of Fractures Is ‘Compellingly Higher’ After Hematopoietic Stem Cell Transplantation

The incidence of fractures is “compellingly higher” after receiving hematopoietic stem cell transplantation, according to a retrospective study of patients receiving transplants for treatment of multiple myeloma, other hematologic malignancies, and some solid tumors (mostly breast and ovarian) as...

thyroid cancer
gastroesophageal cancer
lymphoma

Cancer Will Always Be Part of My Life

My first experience with cancer was when I was just 9 years old, and a lump the size of an egg popped out on the right side of my neck. A biopsy of the tumor found that it was Hodgkin lymphoma, and I was given huge doses of external-beam radiotherapy applied to my neck, chest, and underarm lymph...

2015 Oncology Meetings

JUNE The International Society of Ocular Oncology (ISOO) MeetingJune 16-19 • Paris, France For more information: http://www.isoo.org 13th International Conference on Malignant Lymphoma (ICML)June 17-20 • Lugano, Switzerland For more information: www.lymphcon.ch/imcl/index.php2 Yale ASCO® Review...

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