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issues in oncology

Adoptive Cell Therapy—Act 1: The Beginning

ON AUGUST 30, 2017, the first genetically engineered T-cell therapy (tisagenlecleucel [Kymriah]) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of patients up to 25 years of age with B-cell precursor acute lymphoblastic leukemia that is refractory or in second or...

skin cancer

Overall Survival With Nivolumab/Ipilimumab, or Nivolumab Alone, vs Ipilimumab in Advanced Melanoma

Overall survival outcomes in the phase III CheckMate 067 trial indicate improved survival with nivolumab (Opdivo)/ipilimumab (Yervoy) vs ipilimumab and with nivolumab vs ipilimumab in patients with previously untreated advanced melanoma. These findings were reported in The New England Journal of...

thyroid cancer

The Rising Incidence of Thyroid Cancer Reconsidered

Despite a significant rise in the incidence of thyroid cancer, the U.S. Preventive Services Task Force (USPSTF), a panel of independent experts in primary care and screening, has given thyroid cancer screening a D recommendation, which is a recommendation against screening. To shed light on this...

global cancer care

Emerging Global Leaders in Biosimilar Development: Regulatory Guidance and Cost Impact

BIOLOGICS PLAY A KEY ROLE in cancer treatment and are the principal components of many therapeutic regimens.1 However, they require complex manufacturing processes, resulting in high cost and occasional shortages in supply, limiting the accessibility of cancer treatment for many patients, more so ...

gastrointestinal cancer

Positioning Lu-177 Dotatate Therapy and 68-Ga Dotatate Scans in Management of Neuroendocrine Tumors

The results of the phase III NETTER-1 trial, recently published in The New England Journal of Medicine,1 have been met with great interest by clinicians who treat neuroendocrine tumors. In patients with advanced midgut lesions, treatment with the radiopharmaceutical lutetium Lu-177 dotatate...

prostate cancer

Long-Term Follow-up in PIVOT Trial Shows No Significant Benefit of Surgery vs Observation for Overall or Prostate Cancer Mortality

After 19.5 years of follow-up in the PIVOT trial, radical prostatectomy was not associated with significantly improved all-cause or prostate cancer mortality vs observation among men with localized prostate cancer.1 The long-term follow-up was reported in The New England Journal of Medicine by...

lung cancer

Non–Small Cell Lung Cancer: Emerging Concepts for Checkpoint Inhibitors

With checkpoint inhibitors vitally important in the treatment of advanced non–small cell lung cancer (NSCLC), clinicians must become familiar with the nuances of their use. At the 2017 Debates and Didactics in Hematology and Oncology Conference in Sea Island, Georgia, Suresh S. Ramalingam, MD,...

hematologic malignancies

Recent FDA Actions Include New Formulation, Expanded Indications for Oncology-Hematology Drug Products

The U.S. Food and Drug Administration (FDA) recently granted approval to olaparib tablets (Lynparza) as a maintenance therapy for ovarian cancer and to inotuzumab ozogamicin (Besponsa), for the treatment of adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL)....

prostate cancer

Long-Term Follow-up of PIVOT Argues for Immediate Treatment of Men With Unfavorable-Risk and Possibly High-Volume, Low-Risk Prostate Cancer

The updated results of the PIVOT1 study—reported in The New England Journal of Medicine by Wilt et al and reviewed in this issue of The ASCO Post—did not show a statistically significant difference between treatment and observation for the initial management approach to men with newly diagnosed...

prostate cancer

Brachytherapy for Prostate Cancer: An Old Form of Radiation Treatment That Is Still One of the Most Effective

BRACHYTHERAPY HAS a long track record in treating cancer, dating back to the first reported use of an implanted radioactive source in 1901, and brachytherapy for the treatment of prostate cancer dates back to 1914, when Pasteu and Degrais used a radium source inserted through a urethral catheter. ...

hepatobiliary cancer

Pursuing Combination Strategies With Checkpoint and Tyrosine Kinase Inhibitors in Hepatocellular Carcinoma

PRIMARY LIVER CANCER is the second leading cause of cancer-related death worldwide. Hepatocellular carcinoma accounts for 90% of liver cancer, with around 800,000 new cases diagnosed globally each year.1 In contrast to the stable or declining trends observed for most neoplasms, the incidence and...

prostate cancer

International Consensus (or Not) on Management of Advanced Prostate Cancer

ALTHOUGH THE National Comprehensive Cancer Network® (NCCN®) Clinical Practice Guidelines in Oncology (NCCN Guidelines®) strongly influence the management of advanced prostate cancer, they do not always reflect actual clinical practice. It turns out that in the real world, there are multiple areas ...

multiple myeloma

Cutting-Edge Induction Strategies and Novel Approach to Reducing Skeletal-Related Events Explored in Multiple Myeloma

THE ADDITION of daratumumab (Darzalex) to a triplet induction regimen led to good responses in newly diagnosed multiple myeloma, but not without toxicities. And in the treatment of myeloma bone disease, denosumab (Xgeva) in place of zoledronic acid preserved renal function and may be associated...

prostate cancer

Deep Androgen Suppression Plus Abiraterone and Prednisone: Effective Strategy for Hormone-Naive Prostate Cancer

ANTAGONISM OF THE ANDROGEN AXIS remains a cornerstone of systemic therapy for high-risk localized and metastatic prostate cancer, reflecting the central role of androgen-dependent biologic mechanisms in hormone-naive disease. Despite the use of standard androgen-deprivation therapy, men with...

lung cancer

Updates of Key Trials in Metastatic Non–Small Cell Lung Cancer: KEYNOTE-024 and AvaALL

IMMUNOTHERAPY AND ANTIANGIOGENESIS were highlighted in a session on metastatic non–small cell lung cancer (NSCLC) at the Best of ASCO New Orleans meeting. Matthew Gubens, MD, MS, presented the selected abstracts from the ASCO Annual Meeting.1 Dr. Gubens is Associate Professor of Thoracic Medical...

supportive care
integrative oncology

Turmeric

The ASCO Post’s Integrative Oncology series is intended to facilitate the availability of evidence-based information on integrative and complementary therapies commonly used by patients with cancer. In this installment, Gary Deng, MD, PhD, and Jyothirmai Gubili, MS, present information on...

breast cancer

Triple-Negative Breast Cancer: Practical Approach, Promising Research

Triple-negative breast cancer has a reputation for being a particularly challenging malignancy, but breast cancer specialist Nancy Davidson, MD, Senior Vice President of the Clinical Research Division at the Fred Hutchinson Cancer Research Center, Seattle, put this in perspective in a recent...

leukemia

Blinatumomab in Advanced Acute Lymphoblastic Leukemia: A Brighter Therapeutic Outlook

NEW DRUGS that will improve the outcome of adult patients who develop a deadly disease such as acute leukemia are badly needed; combinations of cytotoxic chemotherapeutic drugs may have reached an upper limit of utility. Agents that eradicate leukemia by alternative mechanisms would be of...

leukemia

Improved Overall Survival With Blinatumomab vs Chemotherapy in Advanced Acute Lymphoblastic Leukemia

IN THE PHASE III TOWER TRIAL reported in The New England Journal of Medicine, Hagop Kantarjian, MD, of The University of Texas MD Anderson Cancer Center, and colleagues found that blinatumomab (Blincyto) treatment improved overall survival vs chemotherapy in heavily pretreated patients with B-cell ...

lung cancer

Alectinib: A New Standard for First-Line Therapy of ALK-Rearranged NSCLC?

ANAPLASTIC LYMPHOMA KINASE (ALK) was first identified in anaplastic large cell lymphoma. The ALK gene itself is not oncogenic, but it can become oncogenic by at least three mechanisms: by forming a fusion gene with a number of other partner genes, by copy number gain, or by mutations in the gene....

breast cancer

One Size May Not Fit All: Thoughts on the New Adjuvant Bisphosphonate Guideline for Early-Stage Breast Cancer

The oncology community has now conducted several prospectively designed, hypothesis-driven randomized clinical trials among women with breast cancer to address this question: Do adjuvant bisphosphonates decrease the risk of breast cancer bone metastases and other recurrence? A meta-analysis1 by...

breast cancer

Advances in the Treatment of Triple-Negative Breast Cancer

WITHIN THE SPECTRUM of breast cancer subtypes, triple-negative disease is “particularly troubling,” but better scientific understanding of this malignancy is leading to advances in its treatment, according to breast cancer expert Nancy Davidson, MD.  Triple-negative breast cancer does not express...

genomics/genetics

Convergence of Precision Medicine and Immuno-oncology

“THE CONVERGENCE of two very hot and interesting topics—precision medicine and immuno-oncology”—is being advanced by next-generation sequencing, Douglas B. Johnson, MD, MSCI, made clear at the inaugural OncoSET Symposium: Emerging Approaches to Precision Medicine,” sponsored by the Robert H. Lurie ...

global cancer care

Cancer on the Global Stage: Incidence and Cancer-Related Mortality in Angola

The ASCO Post is pleased to continue this special feature on the worldwide cancer burden. Each installment focuses on a country from one of the six regions of the world, as defined by the World Health Organization (ie, Africa, the Americas, South-East Asia, Europe, Eastern Mediterranean, and...

breast cancer

MammaPrint Test Addressed in ASCO Breast Cancer Guideline Update

New recommendations on the use of the MammaPrint genomic test issued on July 10 will help guide decisions on adjuvant systemic therapy for women with early breast cancer. The recommendations update the ASCO 2016 clinical practice guideline on the use of biomarkers in these patients. The guideline ...

prostate cancer

Association Between Vasectomy and Prostate Cancer

A systematic review and meta-analysis has found no association between vasectomy and high-grade, advanced, or fatal prostate cancer but a weak association with any prostate cancer. These findings were reported in JAMA Oncology by Bhindi et al. Study Details The analysis involved 53 studies,...

head and neck cancer

Pembrolizumab and Cetuximab-Treated Head and Neck Cancer: Activity Confirmed But No Surprises

WITH THE RECENT efficacy findings, improvements in survival, and resultant U.S. Food and Drug Administration (FDA) approvals of programmed cell death protein 1 (PD-1) immune checkpoint inhibitors across multiple solid tumor indications, the publication of yet another positive trial adds to the...

bladder cancer

Pembrolizumab in Second-Line Therapy for Advanced Urothelial Carcinoma

THE TREATMENT OF metastatic urothelial carcinoma experienced a long period of stagnation until the recognition that targeting the programmed cell death protein 1 (PD-1) pathway could yield deep and durable responses.1-3 Cisplatin-based combination chemotherapy has been the reference standard for...

bladder cancer

Pembrolizumab Improves Overall Survival vs Chemotherapy in Second-Line Therapy for Advanced Urothelial Carcinoma

IN THE PHASE III KEYNOTE-045 trial reported in The New England Journal of Medicine, Joaquim Bellmunt, MD, PhD, of Dana-Farber Cancer Institute, and colleagues found that pembrolizumab (Keytruda) significantly improved overall survival vs investigator choice of chemotherapy as second-line treatment ...

supportive care
integrative oncology

Music Therapy: Relevance in Oncology

The ASCO Post’s Integrative Oncology series is intended to facilitate the availability of evidence-based information on integrative and complementary therapies commonly used by patients with cancer. In this installment, authors Karen Popkin, LCAT, MT-BC, and Jyothirmai Gubili, MS, present the case ...

pancreatic cancer

Stereotactic Body Radiotherapy for Poor Performance Status Patients With Pancreatic Cancer

There are few data to guide the management of nonmetastatic pancreatic ductal adenocarcinoma in patients who are elderly or have a poor performance status. Although most such patients are offered supportive care or gemcitabine alone, the addition of stereotactic body radiotherapy may improve...

supportive care
palliative care

Advance Care Planning: Ensuring Patients’ End-of-Life Wishes Are Honored

When Amy Berman, BSN, LHD (aged 58), stood in front of the mirror to perform a routine breast self-exam and saw redness and dimpling on her right breast, she feared they were the telltale signs of inflammatory breast cancer. “I have never self-diagnosed myself before, but I had recently read an...

lymphoma

Encouraging Results With Pembrolizumab in Relapsed/Refractory Classical Hodgkin Lymphoma

AN EFFECTIVE antitumor immune response relies on cytotoxic T cells that are activated and able to target the malignant clone. As T cells become activated, they upregulate suppressive receptors including programmed cell death protein 1 (PD-1). Upregulation of inhibitory signals is important to...

geriatric oncology

Preparing for Future Challenges in Geriatric Surgical Oncology

In the past decade, advances in surgical oncology have been echoed in the field of geriatric oncology. The current literature regarding older people with cancer includes mainly retrospective cohort studies, focusing on alternatives to radical surgery in comorbid patients. More recently, work has...

ASCO’s TAPUR Study Continues Its Expansion of Sites, Participants, and Collaborators

ASCO’s Targeted Agent and Profiling Utilization Registry (TAPUR) Study continues to expand and now has more than 300 participants enrolled on study drugs, more than 100 sites in 20 states, new partnerships, and a -revised protocol to lower the age of eligibility. Recently, eight new centers in 36...

pain management
supportive care

Pediatric Cancer Pain May Be Misunderstood and Largely Undertreated

Cancer pain in children poses certain unique challenges. Over the past decade, insightful research into pediatric cancer pain has focused on pain management that incorporates nonopioid therapies into standard care. To shed light on this important issue, The ASCO Post spoke with Christine T....

issues in oncology

Overcoming Sexism in Academic Medicine

The troubling results from a survey1 investigating the sexual harassment and discrimination experiences of academic medical faculty show that such incidents continue to happen with unexpected frequency despite increasing awareness of the problem. The study by Reshma Jagsi, MD, DPhil, and...

myelodysplastic syndromes

High-Risk Mutations Predict Poor Outcomes for Patients With Myelodysplastic Syndromes Undergoing Transplantation

Although several treatment options are available for patients with myelodysplastic syndromes (MDS), hematopoietic stem cell transplantation (HSCT) remains the only curative therapy.1 The risks of complications and death from transplantation can be substantial. Determining which patients may...

myelodysplastic syndromes

Mutations in Myelodysplastic Syndrome Associated With Poorer Outcome After Stem Cell Transplantation

In a study reported in The New England Journal of Medicine, R. Coleman Lindsley, MD, PhD, of Dana-Farber Cancer Institute, and colleagues found that a number of mutations present in patients with myelodysplastic syndromes (MDS) were associated with poorer clinical outcome after allogeneic...

colorectal cancer

FDA Approves Panitumumab for Use in Wild-Type RAS Metastatic Colorectal Cancer

On June 30, 2017, the U.S. Food and Drug Administration (FDA) approved the supplemental Biologics License Application (sBLA) for panitumumab (Vectibix) for patients with wild-type RAS (defined as wild-type in both KRAS and NRAS as determined by an FDA-approved test for this use) metastatic...

leukemia

Adding Midostaurin to Chemotherapy in Newly Diagnosed Acute Myeloid Leukemia With FLT3 Mutation

In a phase III trial (Cancer and Leukemia Group B 10603 [RATIFY]/Alliance) reported in The New England Journal of Medicine, Stone et al found that the addition of midostaurin (Rydapt) to standard chemotherapy improved overall survival in patients with newly diagnosed acute myeloid leukemia with...

breast cancer

Positive Results for APHINITY, but Value of Benefit of Dual HER2 Blockade Questioned

The results of the long-awaited APHINITY trial are in, and although the phase III study met its primary endpoint, it failed to establish dual HER2 blockade as the optimal adjuvant treatment for early HER2-positive breast cancer. After 3 years of follow-up, the addition of pertuzumab (Perjeta) to...

neuroendocrine tumors

Major Breakthrough in Development of Systemic Targeted Therapy for Midgut Neuroendocrine Tumors

This issue of The ASCO Post discusses a recent trial reported by Strosberg et al in The New England Journal of Medicine that is the first phase III randomized international multicenter clinical trial evaluating lutetium Lu-177 dotatate as a peptide receptor radionuclide therapy in midgut...

neuroendocrine tumors

Lu-177 Dotatate Improves Progression-Free Survival in Advanced Progressive Midgut Neuroendocrine Tumors

In the phase III NETTER-1 trial reported in The New England Journal of Medicine, Jonathan R. Strosberg, MD, of the Moffitt Cancer Center in Tampa, Florida, and colleagues found that the addition of the targeted radiotherapeutic agent lutetium Lu-177 dotatate to the long-acting repeatable (LAR)...

colorectal cancer

ASCP/CAP/AMP/ASCO Colorectal Cancer Biomarker Guideline: A Clinician's Perspective

The joint American Society for Clinical Pathology (ASCP), College of American Pathologists (CAP), Association for Molecular Pathology (AMP), and ASCO guideline reported by Sepulveda et al, and reviewed in this issue of The ASCO Post, represents a collaboration of three pathology societies and ASCO ...

leukemia

Newer Approaches With CAR T Cells Explored in CLL

Chimeric antigen receptor (CAR) T-cell therapy is a hot area of research and development in hematologic malignancies and, more recently, some solid tumors. Results have been particularly good in acute lymphocytic leukemia, and one or more CAR T-cell products may be getting close to approval by the ...

breast cancer

Olaparib Improves Progression-Free Survival in BRCA-Associated Breast Cancer

The PARP INHIBITOR olaparib (Lynparza) improved progression-free survival in women with HER2-negative metastatic breast cancer that was either hormone receptor–positive or triple-negative in patients who had a germline BRCA mutation.1,2 These results of the international, randomized, open-label,...

prostate cancer

Two Studies Show Abiraterone Plus Prednisolone/Prednisone Added to Standard Hormone Therapy Improves Survival in Advanced Prostate Cancer

The addition of abiraterone acetate (Zytiga) plus prednisolone/prednisone to standard androgen-deprivation therapy improves survival in men starting treatment for locally advanced or metastatic, hormone--naive prostate cancer, according to the results of two potentially practice-changing studies...

prostate cancer

Expect Questions About Shift in Prostate Cancer Screening Recommendation

A draft recommendation from the U.S. Preventive Services Task Force (USPSTF) advises that for men aged 55 to 69, the decision to be screened for prostate cancer should be an individual one, based on the man’s own values and priorities and discussions with a clinician about the potential benefits...

prostate cancer

USPSTF Emphasizes Importance of Informed Discussions About PSA Screening for Men Aged 55 to 69 Years

For a man aged 55 to 69 years, the decision to be screened for prostate cancer should be an individual one, based on the man’s own values and priorities and discussions with a clinician about the potential benefits and harms of screening, the U.S. Preventive Services Task Force (USPSTF) advised in ...

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