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issues in oncology

Molecular Tests and Precision Medicine: Not So Fast Now!

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...

cost of care

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...

colorectal cancer

Maintenance Treatment Delays Progression in Metastatic Colorectal Cancer 

For patients with unresectable metastatic colorectal cancer, maintenance treatment with capecitabine (Xeloda) and bevacizumab (Avastin) significantly delayed disease progression and improved overall survival in the phase III CAIRO3 study by the Dutch Colorectal Cancer Group. Miriam Koopman, MD,...

prostate cancer

Printed and Web-Based Decision Aids Improved Informed Decision-Making but Didn’t Alter Screening 

Amid conflicting recommendations for prostate cancer screening and mixed messages communicated to the public about screening effectiveness, decision aids can assist men in making informed choices. A comparison of two different types of decision aids, one print-based and one Web-based, found that...

gynecologic cancers

'Best-Ever' Published Prognostic Factor for Early-Stage Type 1 Endometrial Cancer 

Immunohistochemical demonstration of the L1 cell adhesion molecule (L1CAM; CD171) “has been shown to be the best-ever published prognostic factor” in Federation Internationale de Gynecologie et d’Obstetrique (FIGO) stage I, type I endometrial cancers “and shows clear superiority over the standardly ...

breast cancer

Long-Term Current Use of Calcium Channel Blockers Is Associated With Higher Risk of Breast Cancer  

Long-term use of a calcium channel blocker to treat hypertension is associated with higher breast cancer risk, according to a report published online by JAMA Internal Medicine. Researchers evaluated associations between various classes of hypertensives, the most commonly prescribed class of...

breast cancer

Nodal Metastases More Likely if Tumors Have Breast Cancer Stem and Progenitor Cells With PI3K/Akt Signaling Defects 

Patients with breast tumors in which breast cancer stem and progenitor cells have a genetic abnormality of the PI3K/Akt signaling pathway are more likely to have lymph node metastases, according to a study in JAMA Surgery. “These oncogenic defects may be missed by gross molecular testing of the...

lung cancer

Role of Erlotinib in EGFR Wild-Type Lung Cancer 

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...

prostate cancer

Active Surveillance of Very Low-Risk Prostate Cancer Might Not Be Suitable Option for African American Men 

African American men with prostate cancer that meets current criteria for very low-risk disease might actually be harboring larger and more aggressive tumors that make active surveillance a less viable option, according to the results of a study published online in the Journal of Clinical Oncology1 ...

lymphoma
survivorship

I'm Not the Person I Was Before Cancer 

I’ve been the caretaker for my husband Will since he suffered three strokes in March 2011, followed by a diagnosis of leukemia a few months later. Now, our roles have reversed, and Will is taking care of me as I go through treatment for stage III follicular non-Hodgkin lymphoma (NHL). It’s been a...

issues in oncology

Family Members of Children With Cancer Are Also at Risk for the Disease 

Parents and siblings of children with cancer have between a two- and four-times increased risk of developing cancer than first-degree relatives with no childhood cancer patients, according to a study published in the International Journal of Cancer.1 The study, led by Joshua Schiffman, MD, Medical...

issues in oncology
health-care policy

Combining Community Practice and Health Policy Advocacy 

Barbara L. McAneny, MD, is a board-certified medical oncologist/hematologist with a robust community practice in Albuquerque, New Mexico. Dr. McAneny, who has held many leadership roles in oncology associations, became a delegate to the American Medical Association (AMA) from ASCO in 2002, was...

ASCO University® Appoints First Editor-in-Chief

ASCO has appointed Daniel G. Haller, MD, as the first Editor-in-Chief of ASCO University®, an eLearning center designed to serve as the educational home for physicians, nurses, advanced practice providers, and patient educators at every stage of their careers. As head of the editorial board, Dr....

Conquer Cancer Foundation Donor and ASCO Member Denis Hammond, MD: Spreading the Word to Help Conquer Cancer

Oncology care professionals answer hundreds of questions from patients and their families every day. Over the course of months and years doctors and nurses address everything from medical questions about drug regimens and side effects, to personal questions about how cancer may affect work or...

integrative oncology

American Ginseng Improves Cancer-Related Fatigue 

In a collaborative phase III trial of the North Central Cancer Treatment Group and Mayo Clinic (N07C2) reported in Journal of the National Cancer Institute by Debra L. Barton, RN, PhD, AOCN, FAAN, of the Mayo Clinic and colleagues, patients with cancer-related fatigue were treated with Wisconsin...

head and neck cancer

Meta-Analysis: Addition of Taxane to Cisplatin/5-FU Induction Improves Outcome in Locally Advanced Head and Neck Cancers 

Cisplatin plus fluorouracil (5-FU) induction chemotherapy has been compared with taxane (docetaxel or paclitaxel), cisplatin, and 5-FU in randomized trials in locoregionally advanced head and neck cancers. An updated individual patient data meta-analysis reported in the Journal of Clinical Oncology ...

prostate cancer

Study Suggests Low-Grade Prostate Cancers May Not Progress Over Time 

Data analyzed from a large cohort study of men diagnosed with prostate cancer found that prostate cancer aggressiveness may be established when the tumor is formed and not changed over time. The researchers of the study, Kathryn L. Penney, ScD, Instructor in the Department of Medicine at Harvard...

issues in oncology

Integrating Genomic Sequencing Into Clinical Care  

Although the price of next-generation genomic sequencing is coming way down, making it available to more people interested in determining their risk for disease, figuring out how to interpret the results and applying that information in the routine medical care of individual patients remains a...

survivorship

Fertility Rates in Childhood Cancer Survivors Suggest Strategies for Follow-up Care 

Childhood cancer survivors with clinical infertility have a good chance of achieving pregnancy, according to new findings from the Childhood Cancer Survivor Study (CCSS). Study Background As a group, women who survive childhood cancer are known to have lower fertility rates. This study, however,...

lung cancer

Non–Small Cell Lung Cancer Maintenance Therapy: None, Single Agent, Multiple Agents? 

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...

lung cancer

Bevacizumab/Pemetrexed Maintenance Increases Progression-Free Survival vs Bevacizumab Alone in Advanced Nonsquamous NSCLC 

Maintenance therapy is associated with improved survival in non–small cell lung cancer (NSCLC), but few studies have compared active agents in this setting. In a phase III trial (AVAPERL trial) reported in the Journal of Clinical Oncology by Fabrice Barlesi, MD, PhD, of Aix Marseille...

lung cancer

Pattern in Lung Cancer Pathology May Predict Recurrence After Surgery 

A new study by thoracic surgeons and pathologists at Memorial Sloan-Kettering Cancer Center shows that a specific pattern found in the tumor pathology of some lung cancer patients is a strong predictor of recurrence. Knowing that this feature exists in a tumor’s pathology could be an important...

lung cancer

Pemetrexed Maintenance in PARAMOUNT: Continuation Proves to Be a Strong Option for Advanced NSCLC, Although Not a Mandate 

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...

cns cancers

No Event-Free Survival Difference With Chemotherapy Before vs After Radiotherapy in Children With High-Risk Medulloblastoma 

A number of different strategies for combining chemotherapy and radiation therapy have been evaluated in the effort to improve survival in patients with high-risk medulloblastoma. In a trial (POG 9031) reported in Journal of Clinical Oncology, Nancy J. Tarbell, MD, of Massachusetts General...

lymphoma

Obinutuzumab Shows Activity in Relapsed/Refractory Diffuse Large B-cell Lymphoma or Mantle Cell Lymphoma and Indolent Non-Hodgkin Lymphoma 

Obinutuzumab is a type II, glycoengineered, humanized anti-CD20 monoclonal antibody. In the phase II GAUGUIN studies reported in the Journal of Clinical Oncology by Franck Andre Morschhauser, MD, PhD, of Centre Hospitalier Régional Universitaire de Lille and Gilles A. Salles, MD, PhD, of Hospices...

lymphoma

Molecular Profiling Improves Classification of Nodal Peripheral T-Cell Lymphomas 

The differential diagnosis of the most common peripheral T-cell lymphoma subtypes is difficult. In a diagnostic accuracy study reported in the Journal of Clinical Oncology, Pier Paolo Piccaluga, MD, PhD, of the University of Bologna, and colleagues in the European T-Cell Lymphoma Study Group and...

skin cancer

Merkel Cell Carcinoma: Hints of Immune Mediation May Enhance Treatment Options 

Merkel cell carcinoma is a rare but aggressive skin cancer with poor outcomes and suboptimal therapeutic options. With a 46% mortality rate, it is three times more lethal than melanoma, and its reported incidence is rising. “Merkel cell carcinoma is a nasty cancer and we have zero FDA-approved...

gynecologic cancers

Olaparib Shows Robust Progression-Free Survival Benefit in Patients With BRCA Mutations 

Maintenance therapy with olaparib extended progression-free survival and the time to disease progression after a second subsequent therapy in patients with platinum-sensitive relapsed serous ovarian cancer and a BRCA mutation, according to an updated analysis of Study 19 presented at the 2013 ASCO...

lung cancer

Researchers Identify Gene Variations in Lung Cancer Patients That May Help Predict an Individual's Treatment Response

Researchers at the Moffitt Cancer Center have identified four inherited genetic variants in patients with non–small cell lung cancer that can help predict survival and treatment response. Their findings, published in Carcinogenesis,1 could help lead to more personalized treatment options and...

lung cancer

Paul A. Bunn, Jr, MD, Offers Insights About a Hopeful Era in Lung Cancer Treatment 

The treatment of non–small cell lung cancer (NSCLC) is rapidly evolving as molecular targets are being refined and targeted drugs are designed to combat acquired resistance. In his State of the Art Lecture at the 14th International Lung Cancer Congress, Dr. Bunn, Professor of Medicine and the James ...

lung cancer

Will Funding for Lung Cancer Ever Improve?

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...

issues in oncology

Access to and Appropriate Use of Oncology Drugs Called Into Question by ASCO Studies 

Studies presented at this year’s ASCO Annual Meeting suggest that despite the wealth of amazing oncolytics on the market, drug shortages persist, drug substitutions are common, off-label use of drugs occurs frequently, and patients find their costs burdensome. Drug Shortage Persists The shortage of ...

skin cancer

Addressing the Key Clinical Questions in Advanced Melanoma 

At the 3rd Annual World Cutaneous Malignancies Congress, in La Jolla, California, Steven J. O’Day, MD, Director of Clinical Research at the Beverly Hills Cancer Center and Adjunct Member of the John Wayne Cancer Institute, Los Angeles, addressed what he labeled the “key clinical questions” about...

multiple myeloma

Panobinostat Combined With Bortezomib and Dexamethasone Can Recapture Responses in Heavily Pretreated Patients 

The combination of the investigational histone deacetylase inhibitor panobinostat (Faridak) with bortezomib (Velcade) and dexamethasone was able to recapture responses in 34.5% of heavily pretreated, bortezomib-refractory patients with multiple myeloma in the phase II PANORAMA 2 trial. The 55...

head and neck cancer

Many Patients With Head and Neck Cancer Report Being Depressed, but Few Use Mental Health Services  

Despite a relatively high rate of depression among patients with head and neck cancer following radiation therapy, mental health services were severely underutilized in this group, concluded researchers who analyzed questionnaire results from 211 patients. The patients had been previously treated...

leukemia

Clinical Trials, Crossover, and Clinical Equipoise: A Patient's Perspective

I am writing with regard to two articles on the ethical imperative of clinical equipoise written by Susan O’Brien, MD, and Stephen J. Schuster, MD, and published recently in The ASCO Post.1,2 I was a victim of Pharmacyclics’ policies during one of their randomized ibrutinib trials (PCI-32765)...

issues in oncology

Preventing Tobacco Use in Children

The U.S. Preventive Services Task Force recently released its final recommendation statement on primary care interventions to prevent tobacco use in children and adolescents.1 The Task Force recommends that primary care clinicians provide interventions, including education or brief counseling, to...

Prominent Surgeon and Teacher LaSalle D. Leffall, Jr, MD, Promotes Hard Work and Education to Overcome Boundaries 

Reminiscing about his 65 years in medicine, LaSalle Doheny Leffall, Jr, MD, FACS, cites three events in his early childhood that would ultimately lead him to his position today as the Charles R. Drew Professor of Surgery at Howard University College of Medicine in Washington, DC. First, he was...

issues in oncology

The Oncologist as Author: On Guiding Patients Through Cancer 

When Tumor Is the Rumor and Cancer Is the Answer is the guidebook to cancer that Kevin P. Ryan, MD, FACP, COL, USAF (ret) wished his patients had during his 30 years of practicing oncology. The book, recently published by AuthorHouse, is an authoritative, inspiring, and even philosophical guide for ...

issues in oncology

The Trials and Tribulations of a Revolutionary Cancer Drug 

A modest brass plaque above a booth in the Eagle Pub in Cambridge, notes, “On this spot, on February 28, 1953, Francis Crick and James Watson declared the discovery of DNA with these words: ‘We have discoverewd the secret of life.’” Announcing a major scientific advance over a pint of ale is a far...

lymphoma
survivorship

Celebrating 2 Decades as a Cancer Survivor 

This past June, I celebrated 20 years of being a cancer survivor by throwing myself a party. It was an interesting experience because I learned that many of the 100 guests I invited were also cancer survivors or were family members of cancer survivors, and so we celebrated their lives as well. Our...

issues in oncology

The Direction of Immunotherapy Over the Next Decade 

The use of immunotherapy to target malignant cells in a variety of cancers—especially the PD-1 inhibitors lambrolizumab and nivolumab in the treatment of metastatic melanoma and the anti–PD-L1 agent MPDL3280A in the treatment of melanoma and lung, kidney, colorectal, and gastric cancers—made...

Communicating the Promise Science Offers to Society 

ASCO President Clifford Hudis, MD, FACP, will be serving during a particularly notable year: 2014, the Society’s 50th anniversary. This occasion brings with it much to reflect on, from the advances in the field of oncology to the growth of ASCO’s influence, but Dr. Hudis takes a moment to simply...

cns cancers

Sitimagene Ceradenovec/IV Ganciclovir in Glioblastoma: Legitimizing the Gene Therapy Approach for Brain Tumors 

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...

cns cancers

Postresection Adenovirus-Mediated Gene Therapy Improves Time to Death/Reintervention but Not Survival in Adult Glioblastoma 

In an open-label phase III trial (ASPECT) reported in Lancet Oncology, Manfred Westphal, MD, of University Hospital Eppendorf in Hamburg, and colleagues assessed the effects of locally applied adenovirus-mediated gene therapy with sitimagene ceradenovec followed by IV ganciclovir after surgical...

issues in oncology

Lidia Schapira, MD: Bridging Communication Gaps Between Oncologists and Patients 

Communicating the intricacies of oncology care to vulnerable patients with cancer and their caregivers requires a firm grasp of the nuances of language. One of the oncology community’s true champions in the art of breaking down communication barriers is Lidia Schapira, MD, a medical oncologist at...

breast cancer

The BEATRICE Study: Where Does Targeting Breast Cancer Vasculature Stand in 2013? 

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 ...

breast cancer

No Invasive Disease–Free Survival Benefit for Bevacizumab Added to Adjuvant Chemotherapy in Triple-Negative Breast Cancer 

In a study (BEATRICE trial) reported in Lancet Oncology, David Cameron, MD, Professor of Oncology and Director of Cancer Services, NHS Lothian at the University of Edinburgh, and colleagues evaluated the strategy of adding the antiangiogenic agent bevacizumab (Avastin) to adjuvant chemotherapy in...

gynecologic cancers

Progesterone and Estrogen Receptor Expression Are Prognostic Markers for Endometrioid and High-Grade Serous Ovarian Cancer 

Few markers of ovarian cancer prognosis have been established, perhaps because potential subtype associations are missed in studies including patients with all histopathologic subtypes. In a study reported in The Lancet Oncology, Weiva Sieh, MD, PhD, Assistant Professor of Health Research and...

gynecologic cancers

Pretreatment Lymph Node Dissection May Improve Survival in Advanced Cervical Cancer, But for Too Few? 

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...

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