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issues in oncology

Is Health Care in the United States a Basic Human Right or an Entitlement?

Mercy Killers is a one-man show that details the consequences of a medical health-care catastrophe (breast cancer) in a family.1 This disturbing fictional account is actually a daily event in cancer centers: losing insurance for technicalities, losing a home because of an inability to pay the...

pancreatic cancer

Irinotecan Liposome Injection Plus Fluorouracil/Leucovorin to Treat Patients With Metastatic Pancreatic 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 October 22, 2015, irinotecan liposome injection (Onivyde)...

cns cancers

Study Lowers the Age Bar for Radiation in Children With Ependymoma

The good news is that children as young as 1 year old with the aggressive brain tumor ependymoma can be treated safely and effectively with immediate postoperative radiation therapy, according to the results of a trial presented at the 2015 ASTRO Annual Meeting.1 “Ependymoma is the third most...

leukemia

Does Low-Dose Radiation Cause Leukemia?

Data from A-bomb survivors, persons with ankylosing spondylitis and neoplasms treated with radiation therapy, and many other sources show a strong association between exposure to ionizing radiation (particles or electromagnetic waves with sufficient energy to cause an ionization such as photons and ...

multiple myeloma

Daratumumab in Previously Treated Multiple Myeloma

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 16, 2015, daratumumab injection (Darzalex) was...

Parotid Tumor Excision, Albumen Print, Paris, February 1872

A Century of Progress The text and photographs on this page are excerpted from a four-volume series of books titled Oncology Tumors & Treatment: A Photographic History, by Stanley B. Burns, MD, FACS. The photos below are from the volume titled “The Anesthesia Era 1845-1875.” To view additional...

integrative oncology

Foot Care in Oncology: The Cancer Patient From Ankle to Toe

There is as yet no clinical or research focus on foot complications that result from cancer therapies. Foot conditions, however, are common and have a considerable negative impact on patients’ ambulation, quality of life, and consistent dosing of antineoplastic agents.1-4 There are currently no...

UC San Diego Robotic Surgeon Christopher J. Kane, MD, Named Joseph D. Schmidt, MD, Presidential Chair in Urology

Christopher J. Kane, MD, a specialist in prostate cancer and an expert in robotic and other minimally invasive procedures for urologic surgery at the University of California, San Diego (UCSD), has been appointed the inaugural holder of the Joseph D. Schmidt, MD, Presidential Chair in Urology in...

supportive care

Cancer Care Through Nonpharmacologic Symptom Management

Nonpharmacologic approaches to managing pain have a fairly robust base of science and research supporting their use but are not as widely accepted and understood as drug therapy in the realm of cancer care. In a breakout session at the 2015 Palliative Care in Oncology Symposium in Boston, experts...

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 ...

hematologic malignancies
leukemia
myelodysplastic syndromes

Selected Abstracts From 2015 ASH Annual Meeting

Here are several abstracts selected from the proceedings of this year’s American Society of Hematology (ASH) Annual Meeting and Exposition, highlighting therapeutics in acute leukemias and myelodysplastic syndromes. For full details of these study abstracts, visit...

breast cancer
issues in oncology

Travel Distance Is Still a Barrier to Breast Reconstruction After Mastectomy

Long travel distances continue to be a significant obstacle to breast reconstruction after mastectomy for breast cancer, according to a study published by Abornoz et al in Plastic and Reconstructive Surgery. “While greater patient awareness and insurance coverage have contributed to greater...

gynecologic cancers
gynecologic cancers

European Trial Shows Front-Line Addition of Nintedanib to Standard Chemotherapy Improves Progression-Free Survival in Advanced Ovarian Cancer

In a European phase III trial (AGO-OVAR 12) reported in The Lancet Oncology, du Bois et al found that adding the antiangiogenic multikinase inhibitor nintedanib (Ofev) to carboplatin/paclitaxel improved progression-free survival in patients with newly diagnosed ovarian cancer. Gastrointestinal...

leukemia

ASH 2015: Venetoclax Shows Promise for Ultra–High-Risk Chronic Lymphocytic Leukemia With 17p Deletion

In a study to be presented at the 57th American Society of Hematology (ASH) Annual Meeting by Stilgenbauer et al, monotherapy with the investigational agent venetoclax (ABT-199/GDC-0199) induced deep remissions—including complete remission and undetectable minimal residual...

hematologic malignancies
multiple myeloma

Study Finds Better Outcome With Melphalan Plus ASCT vs Chemotherapy Plus Lenalidomide Consolidation in Multiple Myeloma

In a phase III trial reported in The Lancet Oncology, Gay et al found that progression-free survival was shorter with lenalidomide (Revlimid) plus chemotherapy vs high-dose melphalan plus autologous stem cell transplantation in transplant-eligible patients with multiple myeloma, with no significant ...

issues in oncology

A Cancer Diagnosis Can Lead to Significant Loss of Working Hours, Income

A new analysis indicates that when American adults are diagnosed with cancer, they experience significant decreases in the probability of working, in the number of hours they work, and correspondingly, in their incomes. Such negative impacts of a cancer diagnosis are particularly pronounced among...

gynecologic cancers
supportive care
issues in oncology

ASTRO 2015: Image-Guided Intensity-Modulated Radiation Therapy Reduces Bowel Side Effects in Cervical Cancer Patients

For cervical cancer patients undergoing postsurgical radiation therapy, image-guided intensity-modulated radiation therapy (IMRT) resulted in a 14% reduction in moderate-to-severe bowel side effects when compared to conventional three-dimensional conformal radiation therapy (3D CRT), according to...

colorectal cancer
issues in oncology

Many Patients Do Not Accurately Recall Important Colonoscopy Details as Time Lapses

As time lapses, many patients who have undergone a colonoscopy become less and less likely to recall when and where they last had the procedure performed, who the doctor was who performed it, whether polyps were found, and, if so, the number and size of those polyps, according to new study results...

multiple myeloma

Anti-CD19 Chimeric Antigen Receptor T-Cell Treatment Produces Response in Patient With Refractory Multiple Myeloma

As reported by Garfall et al in The New England Journal of Medicine, a patient with refractory multiple myeloma who had undergone prior autologous stem cell transplantation and multiple lines of therapy exhibited a complete response to a second autologous transplantation followed by infusion of...

colorectal cancer

Improved Overall Survival With FOLFOXIRI/Bevacizumab vs FOLFIRI/Bevacizumab in First-Line Treatment of Metastatic Colorectal Cancer

In an updated analysis of the Italian phase III TRIBE trial reported in The Lancet Oncology, Cremolini et al found that FOLFOXIRI (fluorouracil [5-FU], leucovorin, oxaliplatin, irinotecan) plus bevacizumab (Avastin) significantly prolonged overall survival in patients with unresectable metastatic...

issues in oncology
issues in oncology

ASCO Releases Updated Policy Statement on Genetic and Genomic Testing for Cancer Susceptibility

The American Society of Clinical Oncology (ASCO) issued an updated policy statement on genetic and genomic testing for cancer susceptibility. Published in the Journal of Clinical Oncology, the statement reviews the ways in which new technologies are transforming the assessment and identification of ...

FDA Approves Eltrombopag for Pediatric Patients With Chronic Immune Thrombocytopenia

The U.S. Food and Drug Administration approved eltrombopag (Promacta) for the treatment of thrombocytopenia in pediatric patients aged 1 year and older with chronic immune thrombocytopenia who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy. The approval was...

breast cancer

Study Evaluates Breast Cancer Mortality in Women With DCIS

In a study reported in JAMA Oncology, Narod et al found that the risk of breast cancer mortality was elevated in some patients with ductal carcinoma in situ compared with the general population, with the risk being higher in younger vs older women and black vs white women. Approximately half of...

issues in oncology
issues in oncology

Study Finds Underinvestment in Long-Term Cancer Research

Pharmaceutical firms underinvest in long-term research to develop new cancer-fighting drugs due to the greater time and cost required to conduct such research, according to a newly published study authored by Massachusetts Institute of Technology (MIT) economists. These findings were published by...

gynecologic cancers
issues in oncology
issues in oncology

Modified Mullerian-Inhibiting Substance Suppresses Growth of Some Recurrent Ovarian Tumors in Mouse Model

Use of gene therapy to deliver a protein that suppresses the development of female reproductive organs may improve the survival of patients with ovarian cancer that has recurred after chemotherapy. In a study published by Pepin et al in PNAS Early Edition, a Massachusetts General Hospital (MGH)...

skin cancer

FDA Approves Sonidegib for Locally Advanced Basal Cell Carcinoma

The U.S. Food and Drug Administration (FDA) approved sonidegib (Odomzo) for the treatment of patients with locally advanced basal cell carcinoma that has recurred following surgery or radiation therapy or those who are not candidates for surgery or radiation therapy. The approval was based on...

colorectal cancer

Adding Neoadjuvant mFOLFOX6 After Chemoradiation May Improve Pathologic Complete Response Rate in Locally Advanced Rectal Cancer

In a phase II trial reported in The Lancet Oncology, Garcia-Aguilar et al found that adding neoadjuvant mFOLFOX6 (modified fluorouracil [5-FU], leucovorin, oxaliplatin) after chemoradiation improved the pathologic complete response rate in patients with locally advanced rectal cancer undergoing...

issues in oncology
breast cancer
issues in oncology
issues in oncology

Study Finds More Selective Ordering of Breast Biomarker Tests Could Save Millions in Health-Care Dollars

A review of medical records for almost 200 patients with breast cancer suggests that more selective use of biomarker testing for such patients has the potential to save millions of dollars in health-care spending without compromising care, according to Johns Hopkins researchers. Specifically,...

kidney cancer
kidney cancer

Phase II Trial Indicates No Benefit of Sorafenib, Temsirolimus, or Bevacizumab Doublets vs Bevacizumab Alone in Advanced Renal Cell Carcinoma

In a randomized phase II trial (BEST; ECOG-ACRIN E2804) reported in the Journal of Clinical Oncology, Flaherty et al found that adding the VEGFR inhibitor sorafenib (Nexavar) or the mTOR inhibitor temsirolimus (Torisel) to the VEGF inhibitor bevacizumab (Avastin) or using sorafenib-temsirolimus in...

High Graft CD8 Cell Dose Predicts Improved Survival in Allogeneic Stem Cell Transplantation With Reduced-Intensity Conditioning

In a single-institution study reported in the Journal of Clinical Oncology, Reshef et al found that high graft CD8 cell dose was associated with improved overall survival among patients with hematologic malignancy receiving allogeneic stem cell transplantation with reduced-intensity conditioning....

lung cancer

Addition of Necitumumab to First-Line Gemcitabine-Cisplatin Improves Overall Survival in Stage IV Squamous NSCLC

In the phase III SQUIRE trial reported in The Lancet Oncology, Thatcher et al found that the addition of the second-generation epidermal growth factor receptor (EGFR) antibody necitumumab to first-line gemcitabine-cisplatin improved overall survival among patients with stage IV squamous...

head and neck cancer

ASCO 2015: Pembrolizumab Produces Clinically Meaningful Response in Patients With Recurrent or Metastatic Head and Neck Cancer

Immunotherapy with pembrolizumab (Keytruda) produced a clinically meaningful overall response rate in a study among 132 patients with recurrent or metastatic squamous cell carcinoma of the head and neck. The overall objective response rate was 24.8%, and 57% of patients experienced some tumor...

skin cancer

Hedgehog Inhibitor Sonidegib Active in Advanced Basal Cell Carcinoma

In the phase II BOLT trial reported in The Lancet Oncology, Migden et al found that the hedgehog pathway signaling inhibitor sonidegib produced responses in patients with locally advanced or metastatic basal cell carcinoma at 200-mg and 800-mg dose levels. The lower dose appeared to be associated...

issues in oncology
issues in oncology

ASCO Releases Proposal for Payment Reform to Support Higher-Quality, More Affordable Cancer Care

Expanding on the Consolidated Payments for Oncology Care (CPOC) payment model circulated last year to improve the quality and affordability of care for patients with cancer, ASCO’s new Patient-Centered Oncology Payment: Payment Reform to Support Higher Quality, More Affordable Cancer Care...

Safety of Autologous Stem Cell Transplantation Without Hematopoietic Support in Jehovah’s Witnesses With Hematologic Malignancies

In a single-center study reported in the Journal of Clinical Oncology, Ford et al found that autologous stem cell transplantation can be safely performed without hematopoietic support in Jehovah’s Witnesses with hematologic malignancies. Jehovah’s Witnesses traditionally refuse...

lymphoma

Circulating Tumor DNA Is a Promising Biomarker for Progression in Diffuse Large B-Cell Lymphoma

In a study reported in The Lancet Oncology, Roschewski et al found that interim monitoring of circulating tumor DNA in patients with diffuse large B-cell lymphoma distinguished more and less rapid progression and that surveillance monitoring identified recurrence well before clinical evidence was...

colorectal cancer

Addition of Ramucirumab to Second-Line FOLFIRI Improves Overall Survival in Metastatic Colorectal Cancer

In the phase III RAISE trial reported in The Lancet Oncology, Tabernero et al found that the addition of the antiangiogenic anti-VEGFR2 antibody ramucirumab (Cyramza) to second-line FOLFIRI (leucovorin, fluorouracil, irinotecan) improved overall survival in patients with metastatic colorectal...

pancreatic cancer

Improved Quality Metrics for Robotic Pancreaticoduodenectomy With Increased Performance

In a retrospective single-institution study reported in JAMA Surgery, Boone et al found significant improvements in blood loss, incidence of conversion to open surgery, pancreatic fistula incidence, and operative time with increased number of patients treated with robotic pancreaticoduodenectomy....

lymphoma

Circulating Tumor DNA in Blood May Predict Recurrence in Patients With Diffuse Large B-Cell Lymphoma

A study assessing whether circulating tumor DNA encoding the clonal immunoglobulin gene sequence could be detected in the serum of patients with diffuse large B-cell lymphoma has found that surveillance circulating tumor DNA enabled detection of microscopic disease before it could be seen on CT...

leukemia

No Improvement in Complete Remission Rate With Cytarabine Plus Amonafide L-Malate vs Daunorubicin in Secondary AML

In a phase III trial reported in the Journal of Clinical Oncology, Stone et al found that the combination of cytarabine and amonafide L-malate, a DNA intercalator and non–ATP-dependent topoisomerase II inhibitor, did not improve complete remission rate compared with cytarabine plus...

lymphoma

PET-Adapted Sequential Salvage Therapy With Brentuximab and Augmented ICE Produces High Response Rate in Relapsed/Refractory Hodgkin Lymphoma

In a phase II study reported in The Lancet Oncology, Moskowitz et al found that a salvage strategy involving brentuximab vedotin (Adcetris) treatment followed by 18F-fluorodeoxyglucose positron-emission tomography (PET) and augmented ifosfamide, carboplatin, and etoposide (ICE) in PET-positive...

solid tumors
issues in oncology

Comprehensive Genomic Profiling Shows Distribution of Targetable Alterations in Carcinomas of Unknown Primary Site

In a study reported in JAMA Oncology, Ross et al found potentially targetable genomic alterations in most carcinomas of unknown primary site using comprehensive genomic profiling. Adenocarcinomas of unknown primary site frequently harbored receptor tyrosine kinase/Ras/MAPK pathway alterations....

colorectal cancer

Left-Sided Primary Tumor Location More Common and Associated With Better Survival in Metastatic Colorectal Cancer

In a study reported in the Journal of the National Cancer Institute, Loupakis et al found that most treatment-naive patients with metastatic colorectal cancer had left-sided primary tumor location and that left-sided tumor location was associated with improved overall survival. Study Details The...

lung cancer

No Benefit of High- vs Standard-Dose Radiotherapy or for Addition of Cetuximab to Chemoradiation in Stage IIIA or IIIB NSCLC

As reported in The Lancet Oncology by Bradley and colleagues, the phase III Radiation Therapy Oncology Group 0617 trial showed no survival benefit of high- vs standard-dose radiotherapy or for addition of cetuximab (Erbitux) to concurrent paclitaxel-carboplatin chemoradiation in patients with...

lung cancer

Addition of Linifanib to Carboplatin-Paclitaxel Increases Progression-Free Survival and Toxicity in Advanced Nonsquamous NSCLC

In a phase II trial reported in Journal of Clinical Oncology, Ramalingam et al found that the addition of the VEGFR and PDGFR inhibitor linifanib to carboplatin-paclitaxel increased progression-free survival in patients with advanced nonsquamous non–small cell lung cancer (NSCLC). The...

breast cancer

Are Physicians Choosing Wisely When Imaging for Distant Metastases in Early-Stage Breast Cancer?

Patients with early-stage breast cancer still undergo imaging for distant metastases despite evidence-based local, national, and international guidelines, and a recommendation from ASCO to avoid such imaging, according to a retrospective review of staging imaging for distant metastases in patients...

leukemia

Long Noncoding RNAs Are a Novel Prognostic Marker in Older Patients With Acute Leukemia

A new study led by researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) describes a novel marker that might help doctors choose the least toxic, most effective treatment for many...

breast cancer

About 25% of Patients Undergoing Breast-Conservation Surgery for Stage 0 to II Carcinoma Have Subsequent Surgery

“Approximately one-fourth of all patients who undergo initial breast-conservation surgery for breast cancer will have a subsequent operative intervention,” concluded a study published online in JAMA Surgery. “The rate of repeat surgeries varies by patient, tumor, and facility...

colorectal cancer
issues in oncology

Wide Geographic Variation in Use of Laparoscopic Colectomy for Colon Cancer

There has been a dramatic increase in the use of laparoscopic colectomy for colon cancer. In a Medicare data study reported in the Journal of Clinical Oncology, Reames and colleagues found that use of laparoscopic colectomy varied from 0% to 66.8% across hospital referral regions in the United...

prostate cancer

Higher Levels of Cholesterol and Triglycerides May Increase the Risk of Prostate Cancer Recurrence

Prostate cancer survivors with higher levels of total cholesterol and triglycerides had an increased risk for disease recurrence, according to a study by Allott et al. The study findings, coupled with evidence that statin use is associated with reduced recurrence risk, suggest that lipid levels...

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