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issues in oncology

Vertebral Compression Fracture Risk Increased After Spinal Stereotactic Body Radiotherapy 

In a study reported in Journal of Clinical Oncology, Arjun Sahgal, MD, of Princess Margaret Cancer Centre in Toronto, and colleagues evaluated the occurrence of vertebral compression fractures in patients undergoing spinal stereotactic body radiotherapy.1 Vertebral compression fractures occurred in ...

lymphoma

Two Patients in One, Mom and Baby: Managing Coincident Pregnancy and Lymphoma

The news that she is both pregnant and has been found to have a potentially lethal malignancy is one of the most emotionally wrenching events any young woman ever faces. Understandably, the patient, her partner, their families, and even their caregivers find this experience fraught with anxiety and ...

lymphoma

Multicenter Analysis of Outcomes of Lymphoma in Pregnancy

Lymphoma is the fourth most frequent cancer to occur in pregnant women. In a multicenter retrospective analysis reported in Journal of Clinical Oncology, Andrew M. Evens, DO, MSc, Chief of Hematology/Oncology at Tufts University Medical Center, Boston, and colleagues examined treatment,...

palliative care

Illness Is Personal!

For clinicians and health service researchers striving to improve care for people living with life-threatening conditions, September was a sobering month. The Dartmouth Atlas group released a brief report on Trends in Cancer Care Near the End of Life1 showing that while the proportion of patients...

breast cancer

Breast Cancer Index Assay Prognostic for Distant Recurrence in Estrogen Receptor–Positive, Node-Negative Breast Cancer

In a study reported in The Lancet Oncology, Dennis C. Sgroi, MD, of Massachusetts General Hospital, and colleagues compared the ability of the breast-cancer index (BCI) assay, 21-gene recurrence score (Oncotype DX), and an immunohistochemical prognostic model (IHC4) to predict early and late...

lung cancer

Interim Data Reported From Phase IB Study of Investigational Anti-PD-1 Immunotherapy for NSCLC 

Interim data from a Phase IB trial evaluating the investigational anti-PD-1 immunotherapy, MK-3475, in patients with previously treated non-small cell lung cancer (NSCLC) were presented recently at the 15th World Conference on Lung Cancer in Sydney, Australia. Edward Garon, MD, Director of Thoracic ...

breast cancer

Pertuzumab in Neoadjuvant Treatment of HER2-Positive Early Breast 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. Indication On September 30, 2013, pertuzumab injection (Perjeta)...

prostate cancer

Finasteride for Prostate Cancer Prevention: Long-Term Results Disappointing but Reassuring

All medical care should seek to achieve one or more of three goals: to relieve suffering, to prevent future suffering, or to prolong life. Care for cancer is no exception, and minimizing suffering from cancer and prolonging life has primarily resulted from advances in treatment. Although there are...

prostate cancer

No Difference in Long-Term Survival With Finasteride or Placebo in the Prostate Cancer Prevention Trial 

In the Prostate Cancer Prevention Trial (PCPT), initially reported in 2003, finasteride significantly reduced the risk of prostate cancer by 24.8% but was associated with a relative 26.9% increase in risk of high-grade disease compared with placebo. In a study reported in The New England Journal of ...

breast cancer

Neoadjuvant Treatment of Early Breast Cancer

INSIDE THE BLACK BOX is an occasional column providing insight into the FDA and its policies and procedures. In this first installment, FDA Clinical Reviewers Laleh Amiri-Kordestani, MD, and Suparna Wedam, MD, discuss FDA’s recent approval of pertuzumab (Perjeta) for the neoadjuvant treatment of...

SIDEBAR: Brian J. Druker, MD, Discusses Ponatinib

In an interview with The ASCO Post following FDA’s recommendation that sales of ponatinib (Iclusig) be suspended, (see here) Brian J. Druker, MD, Director of Oregon Health & Science University Knight Cancer Institute and JELD-WEN Chair of Leukemia Research, had concerns about obtaining the drug ...

hepatobiliary cancer

Brivanib Fails to Live Up to the Promise of Early Studies

Hepatocellular carcinoma is a devastating disease worldwide. Although advances in liver transplantation, surgery, and locoregional therapies have made tumor control or even cure possible for a minority of patients, the majority of patients diagnosed with hepatocellular carcinoma will develop...

hepatobiliary cancer

Brivanib Studied in First- and Second-Line Therapy for Advanced Hepatocellular Carcinoma 

The investigational drug brivanib is a dual inhibitor of vascular endothelial growth factor and fibroblast growth factor signaling, both implicated in hepatocellular carcinoma. The agent was recently evaluated in two phase III trials, one comparing first-line brivanib with sorafenib (Nexavar) in...

lung cancer

Pemetrexed Improves Progression-Free Survival vs Gefitinib in Second-Line Setting for EGFR Wild-Type Nonsquamous NSCLC

Both pemetrexed (Alimta) and gefitinib (Iressa) are standard second-line treatments for advanced nonsquamous non–small cell lung cancer (NSCLC) in East Asia. In a phase II trial (CTONG 0806) reported at the International Association for the Study of Lung Cancer’s 15th World Conference on Lung...

lung cancer

Investigational ALK Inhibitor Shows Promise in Patients With Crizotinib-Refractory, ALK-Positive NSCLC

Patients with non–small cell lung cancer (NSCLC) whose tumors have the ALK gene rearrangement usually respond to the drug crizotinib (Xalkori), with a median duration of response of approximately 10 months. In a study reported by Shirish Gadgeel, MD, of Karmanos Cancer Institute in Detroit, and...

lung cancer

Oncogene Addiction and the Rationale for Molecular Targeted Therapy in Lung Cancer

Over the past decade, Fadlo R. Khuri, MD, Professor and Roberto C. Goizueta Distinguished Chair of Hematology and Medical Oncology, and Deputy Director of the Winship Cancer Institute of Emory University, Atlanta, has focused his research and clinical career on investigating novel approaches in the ...

colorectal cancer

Long-Term Colorectal Cancer Incidence and Mortality After Lower Endoscopy

Colonoscopy and sigmoidoscopy have been shown to provide protection against colorectal cancer, but the magnitude and duration of protection, particularly against proximal colon cancer, remain undefined. A study of long-term colorectal cancer incidence and mortality after lower endoscopy reported in ...

gynecologic cancers

One Dose of HPV 16/18 Vaccine Produces Durable Response, Study Finds

Results from the Costa Rica HPV 16/18 Vaccine Trial indicate that 4-year efficacy against 12-month HPV 16/18 persistent infection was similarly high among women who received one, two, or the recommended three doses of the bivalent HPV16/18 L1 virus-like particle vaccine (Cervarix). The findings...

colorectal cancer

In Mismatch Repair–Deficient Colon Cancer, Side Matters

In general, we have come to think of mismatch repair–deficient colon cancer as having a more favorable prognosis, being less likely to metastasize to regional nodes or distant sites, and being resistant to fluoropyrimidines. Much of our data, however, come from trials combining stage II and III...

colorectal cancer

Impact of Deficient DNA Mismatch Repair on Disease-Free Survival in Stage III Colon Cancer 

In an analysis reported in the Journal of Clinical Oncology, Frank A. Sinicrope, MD, of the Mayo Clinic and North Central Cancer Treatment Group (NCCTG), and colleagues investigated the association of deficient DNA mismatch repair with prognosis in patients with stage III colon cancer treated with...

breast cancer
head and neck cancer
kidney cancer
lung cancer

Important News Briefs: New Data Reported in Breast, Renal Cell, Head and Neck, and Lung Cancer

The 2013 European Cancer Congress (ECC), held September 27 to October 1 in Amsterdam, was jointly sponsored by the European Society of Medical Oncology, the European Cancer Organization, and the European Society of Radiation Oncology. With the Congress theme being “Reinforcing Multidisciplinarity,” ...

Expert Point of View: Rebecca Kristeleit, MD

Formal discussant of the AURELIA and ICON7 presentations, Rebecca Kristeleit, MD, University College London Hospital, London, said that a consistent message in both trials was the benefit of bevacizumab (Avastin) in high-risk disease. “Angiogenesis seems to be a particular driver of advanced...

gynecologic cancers

Two Trials Explore the Evolving Role of Bevacizumab in Ovarian Cancer

The optimal use of bevacizumab (Avastin) in ovarian cancer appears to be in high-risk subgroups and in patients with platinum-resistant ovarian cancer, according to results of two phase III trials presented at the 2013 European Cancer Congress (ECC) in Amsterdam. AURELIA investigated the safety and ...

Expert Point of View: Antonio Casado, MD

Formal discussant of the TRINOVA-1 presentation, Antonio Casado, MD, Hospital Universitario San Carlos, Madrid, said that the study showed a clinically meaningful benefit with the addition of trebananib in this pretreated group of patients with recurrent epithelial ovarian cancer. Also, the drug...

gynecologic cancers

Trebananib Improves Progression-Free Survival in Recurrent Ovarian Cancer

Trebananib, an investigational antiangiogenesis inhibitor with a different mechanism of action than bevacizumab (Avastin), significantly improved progression-free survival in recurrent platinum-resistant and partially platinum-sensitive ovarian cancer in the phase III TRINOVA-1 trial. The addition...

gynecologic cancers

Cediranib Achieves 'Groundbreaking' Results in Relapsed Ovarian Cancer

The investigational oral vascular endothelial growth factor (VEGF) inhibitor cediranib extended progression-free survival when given with platinum-based chemotherapy and improved overall survival when given as maintenance therapy in patients with recurrent ovarian cancer. Experts are hopeful that...

skin cancer

Ipilimumab Conveys Long-Term Survival Benefit in Pooled Analysis of Metastatic Melanoma Patients

In the treatment of metastatic or locally advanced unresectable melanoma, the anti–CTLA-4 monoclonal antibody ipilimumab (Yervoy) conveys long-term survival benefits, with some patients alive out to 10 years, according to the largest survival analysis of the immunomodulating agent, presented at the ...

colorectal cancer

One in Three American Adults Do Not Comply With Screening Guidelines for Colorectal Cancer 

The percentage of American adults aged 50 to 75 who are up-to-date with recommended screening for colorectal cancer “increased from 54% in 2002 to 65% in 2010, primarily driven by increased use of colonoscopy,” according to data from the 2012 Behavioral Risk Factor Surveillance System survey....

head and neck cancer

It Sounds Crazy, but Cancer Has Made Me a Better Chef

I was diagnosed with stage IVB squamous cell carcinoma of the tongue in 2007, when I was just 33 years old, but the cancer had started to show itself long before then. I first noticed a white dot on the left side of my tongue in 2002, and as time went on, the sore became annoying and hurt when it...

cost of care
legislation

ASH as Part of 'NDD United' Releases Report on Effects of Sequestration 

A new report recently released and supported by the American Society of Hematology (ASH) details the crippling effects of sequestration on programs that rely on discretionary federal funding, including the National Institutes of Health (NIH). In “Faces of Austerity: How Budget Cuts Have Made Us...

gynecologic cancers
breast cancer

'Reasonable but Not Required' for Women With BRCA Mutations to Have Hysterectomy Concurrent With Salpingo-Oophorectomy 

For women with BRCA1 or BRCA2 mutations who choose to have salpingo-oophorectomy to reduce their risks of ovarian and breast cancer, also choosing to have a hysterectomy is “reasonable but not required,” noted Noah D. Kauff, MD, Director of the Ovarian Cancer Screening and Prevention Program and...

breast cancer
cost of care

Evaluation of Breast Cancer MRI Screening Strategies

Recent years have witnessed much heated debate about the benefits of breast cancer screening and optimal screening strategies. Unlike with mammography, no randomized data are available to determine whether screening with magnetic resonance imaging (MRI) reduces mortality from breast cancer....

head and neck cancer

Novel EGFR Inhibitor Added to Radiotherapy Fails to Improve Outcomes in Head and Neck Cancer

The addition of zalutumumab, an investigational epidermal growth factor receptor (EGFR) inhibitor, to primary chemoradiotherapy did not increase locoregional control or improve survival at 3 years in patients with squamous cell carcinoma of the head and neck compared with chemoradiotherapy alone,...

head and neck cancer

Spanning a Spectrum of Issues Related to Head and Neck Cancers

Five recent articles in JAMA Otolaryngology–Head & Neck Surgery1-5 span a spectrum of issues related to head and neck cancers. These include risk factors, concentration of care to teaching hospitals, avoiding venous thromboembolism, and encouraging patients to eat and do swallowing exercises to ...

Expert Point of View: Monica Morrow, MD, and Chau T. Dang, MD

In an editorial accompanying the article by Boughey et al, Monica Morrow, MD, and Chau T. Dang, MD, of Memorial Sloan-Kettering Cancer Center, New York, question whether sentinel lymph node biopsy can be considered a part of standard management in patients with initial clinically node-positive...

breast cancer

Alliance Trial Evaluates Sentinel Node Surgery After Neoadjuvant Chemotherapy for Node-Positive cN1 Breast Cancer

Sentinel lymph node surgery provides reliable nodal staging information and is associated with less morbidity than axillary lymph node dissection in patients with clinically node-negative (cN0) breast cancer. The American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) trial examined...

survivorship
palliative care

Living With Cancer: The Role of Palliative Care in Long-Term Survivorship Care

According to data from the Surveillance, Epidemiology, and End Results Program (SEER) and the U.S. Census Bureau registries,1 there are currently about 13.7 million cancer survivors in the United States, and that number is projected to grow to 18 million by 2022. In addition, 64% of this population ...

breast cancer

Where Is Adjuvant Bisphosphonate Therapy Now? 

The adjuvant use of bisphosphonates in breast cancer continues to yield seemingly contradictory data despite a sound biologic basis and smaller pilot studies suggesting that dampening bone turnover with bisphosphonates can lessen the bone reservoir of micrometastases.1,2 Early adjuvant trials with...

breast cancer

No Survival Benefit of Adjuvant Ibandronate in High-Risk Early Breast Cancer: Potential Activity in Low-Estrogen Patients 

The effect of bisphosphonate treatment in early breast cancer is controversial, with some data indicating survival benefit in the adjuvant setting. In a study reported in the Journal of Clinical Oncology (German Adjuvant Intergroup Node-Positive Study, GAIN), Gunter von Minckwitz, MD, PhD, Chairman ...

lymphoma

German Analysis in Diffuse Large B-Cell Lymphoma: Hypothesis-Generating Rather Than Definitive?

In their retrospective analysis of German High-Grade Non-Hodgkin Lymphoma Study Group trials reported in the Journal of Clinical Oncology and reviewed in this issue of The ASCO Post, Held and colleagues assessed the effects of rituximab (Rituxan) and radiotherapy in patients with aggressive B-cell...

lymphoma

Rituximab Does Not Improve Outcome in B-Cell Lymphoma With Skeletal Involvement, but Radiotherapy Benefit Found 

In a retrospective analysis of German High-Grade Non-Hodgkin Lymphoma Study Group trials reported in the Journal of Clinical Oncology, Gerhard Held, MD, of Saarland University Medical School in Homburg, and colleagues assessed the impact of rituximab (Rituxan) and radiotherapy on outcome in...

leukemia

Obinutuzumab in Previously Untreated Chronic Lymphocytic Leukemia

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. Indication On November 1, 2013, obinutuzumab (Gazyva) was approved...

supportive care

Improving Fertility Options for Patients With Cancer

Seven years ago, Teresa K. Woodruff, PhD, coined the term “oncofertility” to describe the melding of two medical specialties, oncology and reproductive endocrinology, with the goal of maximizing the reproductive potential of patients with cancer. Today, with Dr. Woodruff’s establishment of the...

gastroesophageal cancer
gastrointestinal cancer

Anti–VEGFR-2 Antibody Ramucirumab Prolongs Survival in Previously Treated Advanced Gastric or Gastroesophageal Cancer

Vascular endothelial growth factor (VEGF)– and VEGF receptor-2 (VEGFR-2)–mediated signaling and angiogenesis seem to have an important role in the pathogenesis of gastric cancer. In the phase III REGARD trial reported in Lancet, Charles S. Fuchs, MD, MPH, of Dana-Farber Cancer Institute, Boston,...

pancreatic cancer

Has a New Standard of Care for Metastatic Pancreatic Cancer Been Established?

For a number of years following the approval of gemcitabine for advanced pancreatic cancer, one phase III clinical trial after the next failed to demonstrate a survival benefit of combination chemotherapy compared to gemcitabine alone. Even the one positive study from the mid-2000s—the PA.3 trial...

pancreatic cancer

Addition of Nab-Paclitaxel to Gemcitabine Improves Survival in Previously Untreated Metastatic Pancreas Cancer 

In a phase III trial reported in The New England Journal of Medicine, Daniel D. Von Hoff, MD, of Translational Genomics Research Institute in Phoenix, and colleagues assessed the addition of albumin-bound paclitaxel (nab-paclitaxel [Abraxane]) to gemcitabine in patients with previously untreated...

pancreatic cancer

Adjuvant Gemcitabine Improves Long-Term Survival in Patients With Resected Pancreatic Cancer

An initial report from the phase III Charité Onkologie (CONKO) 001 trial of adjuvant gemcitabine vs observation in patients with completely resected pancreas cancer showed that gemcitabine treatment was associated with a significant prolongation of disease-free survival.1 As reported in JAMA by...

palliative care
cost of care

Two Studies Highlight Communication Challenges Facing Medical Oncology

In one study presented at ASCO’s second annual Quality Care Symposium in San Diego, patients receiving chemotherapy with palliative care intent were at high risk of side-effect–related hospitalization, which defeats the clinical purpose and adds preventable costs to health care.1 “There is an...

colorectal cancer

Cetuximab Confers Survival Benefit in All-RAS Wild-Type Colorectal Tumors

The FIRE-3 study compared the two epidermal growth factor receptor (EGFR) antibodies, on top of chemotherapy, in the first-line treatment of metastatic colorectal cancer. A preplanned analysis of KRAS wild-type patients without RAS mutations, ie, “all-RAS wild-type,” showed overall survival to be...

colorectal cancer

Time to Think Beyond KRAS in Metastatic Colorectal Cancer

Eric Van Cutsem, MD, PhD, Professor of Internal Medicine at the University of Leuven in Belgium, told attendees at the 2013 European Cancer Congress that in the management of metastatic colorectal cancer, it is time to expand KRAS testing to include more rare mutations. Until recently, KRAS status...

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