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Eastern Cooperative Oncology Group (ECOG) trials have demonstrated that recurrence patterns are different for estrogen receptor (ER)-positive vs ER-negative breast cancer. While ER-negative disease carries a high risk for early recurrence—peaking around year 1.5 from diagnosis—risk steadily...
Can Molecular Profiling Identify ER-positive Patients Destined for Relapse?
Estrogen receptor (ER)-positive breast cancer often recurs years after the initial diagnosis, and understanding the patterns of timing regarding relapse could identify patients needing more aggressive treatment. At the 2011 San Antonio Breast Cancer Symposium, several investigative teams reported...
Expert Point of View: Benefits of Some Bisphosphonates Confirmed in Breast Cancer Outcomes, but Questions Remain
James Ingle, MD, of the Mayo Clinic, Rochester, Minnesota, formally discussed the ABCSG-12 and ZO-FAST bisphosphonate studies presented at the 2011 San Antonio Breast Cancer Symposium, noting, “There is a lot of interest in the effect of bisphosphonates on the tumor microenvironment and the impact ...
Benefits of Some Bisphosphonates Confirmed in Breast Cancer Outcomes, but Questions Remain
The story of bisphosphonates, and their disease-modifying potential in breast cancer, is still evolving. While some studies presented at the 2011 San Antonio Breast Cancer Symposium failed to show gains, others found benefits. The theme that is emerging is that bisphosphonates may be most...
Expert Point of View: Bevacizumab Progression-free Survival Benefit Upheld in AVEREL Trial
Modest benefit reported from AVEREL1 triggered comments among trialists about the future of bevacizumab (Avastin) in breast cancer. “Although there’s controversy about the recent revoking of FDA approval of bevacizumab for metastatic breast cancer, I think there is a consensus in our disappointment ...
Bevacizumab Progression-free Survival Benefit Upheld in AVEREL Trial
Bevacizumamb (Avastin) added to trastuzumab (Herceptin) and docetaxel as first-line therapy for HER2-positive advanced breast cancer moderately improved progression-free survival in the phase III AVEREL trial, presented at the 2011 San Antonio Breast Cancer Symposium by Luca Gianni, MD, of the San ...
SIDEBAR: Lessons Learned from Other HER2 trials
From studies presented at the San Antonio Breast Cancer Symposium and elsewhere, important observations have emerged that will eventually advance our understanding of HER2-positive disease. According to C. Kent Osborne, MD, of Baylor College of Medicine, Houston, key findings include the following: ...
Expert Point of View: Dual HER2 Blockade Substantially Delays Disease Progression
The availability of effective therapies for HER2-positive tumors has made breast cancer a better managed disease, but outcomes could be further enhanced through the targeting of other players in this pathway, emerging data suggest. C. Kent Osborne, MD, of Baylor College of Medicine, Houston,...
Dual HER2 Blockade Substantially Delays Disease Progression
There is an emerging theme in HER2-positive breast cancer: The greater the pathway inhibition, the better the outcome. The latest evidence comes from the phase III Clinical Evaluation of Pertuzumab and Trastuzumab (CLEOPATRA) trial of 808 patients with previously untreated metastatic disease. The...
Atypical Breast Lesions: How High Is the Cancer Risk?
Women with atypical breast lesions have approximately a 5% to 11% risk of developing breast cancer within 5 years, depending on histology, and this risk can be reduced with chemoprevention, according to a presentation at the 2011 San Antonio Breast Cancer Symposium.1 Investigators tracked the...
Important News Briefs: New Data Reported in Gastric, Colorectal, and Hepatocellular Cancers
Findings presented at the 2012 Gastrointestinal Cancers Symposium will impact the future care of patients with these malignancies. The ASCO Post has summarized some of the most newsworthy data in the following briefs. In the phase III GRANITE-1 trial (n = 656), single-agent treatment with...
Expert Point of View: Maintenance with Lenalidomide or Bortezomib Prolongs Remission in Elderly Patients with Multiple Myeloma
David S. Siegel, MD, PhD, of the John Theurer Cancer Center at Hackensack University Medical Center in New Jersey, commented to The ASCO Post that essentially all patients with multiple myeloma could be candidates for maintenance therapy. “But I don’t know that we have established that maintenance...
Maintenance with Lenalidomide or Bortezomib Prolongs Remission in Elderly Patients with Multiple Myeloma
The benefit of maintenance therapy in newly diagnosed multiple myeloma patients ineligible for stem cell transplant, such as the elderly, is still debated, though value appears to be emerging, according to studies presented at the 2011 American Society of Hematology (ASH) Annual Meeting....
Expert Point of View: Next-generation Sequencing in Metastatic Triple-negative Breast Cancer Yields Rewards
Hope Rugo, MD, of the University of California, San Francisco, commented on Dr. O’Shaughnessy’s presentation on molecular pathways in triple-negative breast cancer at the 2011 San Antonio Breast Cancer Symposium. “The really exciting thing is that we have moved from intrinsic subtyping of breast...
SIDEBAR: Genotype and Treatment Outcomes
At the 2011 San Antonio Breast Cancer Symposium, Joyce O’Shaughnessy, MD, described how the genetic profiles of 12 patients with metastatic triple-negative breast were used to guide treatment for metastatic disease Patient #10 was a 59-year-old African-American woman with primary...
Next-generation Sequencing in Metastatic Triple-negative Breast Cancer Yields Rewards
The startling molecular heterogeneity of metastatic triple-negative breast cancer is now obvious and helps to explain the poor outcomes observed in this patient subset. Comprehensive genomic and transcriptomic interrogation of metastatic triple-negative breast cancer is elucidating the molecular...
New Assays, Surveillance Techniques Reported for GI Malignancies
Two studies highlighted in press conferences and one presented during an invited lecture at the 2012 Gastrointestinal Cancers Symposium, held recently in San Francisco, suggest that early detection of pancreatic, esophageal, and colorectal cancers could soon improve. Enzyme Immunoassay Spots...
Expert Point of View: Re-analysis of RADIANT-2 Finds Benefit for Everolimus in Patients with Carcinoid Tumors
Timothy J. Hobday, MD, of the Mayo Clinic in Rochester, Minnesota, discussed the findings of the RADIANT-2 re-analysis at the 2012 Gastrointestinal Cancers Symposium. Speaking from the perspective of a clinical researcher, he said, “the conclusions of the study are reasonable” and provide “valuable ...
Re-analysis of RADIANT-2 Finds Benefit for Everolimus in Patients with Carcinoid Tumors
A re-analysis of the RADIANT-2 trial, which evaluated everolimus (Afinitor) in patients with advanced nonpancreatic neuroendocrine tumors, has yielded prognostic factors that identify a group of patients who are not only at high risk for recurrence but who may derive benefit from treatment with...
SIDEBAR: International Study Confirms ACOSOG Z0011
Preliminary findings of the International Breast Cancer Study Group (IBCSG) 23-01 trial1 show no benefit for axillary lymph node dissection in patients with only minimally involved sentinel nodes, thereby supporting the results of the American College of Surgeons Oncology Group (ACOSOG) Z0011...
Advances in Axillary Surgery for Patients with Breast Cancer
Results from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial, which found no benefit for completion axillary nodal dissection in patients with breast cancer involving one to two positive sentinel nodes,1 have led to changes in breast cancer management, though points of...
Survival Analysis by Gastric Cancer Subtypes in AVAGAST Phase III Trial
Subset analysis of the AVAGAST trial, which evaluated the benefit of bevacizumab (Avastin) in advanced gastric cancer, has demonstrated distinct differences in outcomes according to disease subtype, reported Manish A. Shah, MD, of Weill Cornell Medical College and New York Presbyterian Hospital, at ...
Targeting KRAS in GI Cancers: The Hunt for the Holy Grail in Cancer Research
The RAS oncogenes are the most frequently mutated class of oncogenes in human cancers, and this has prompted a search for Ras inhibitors to effectively treat tumors with these mutations. Despite intensive efforts, however, none has materialized clinically because K-Ras is proving to be a very...
Expert Point of View: ColoPrint Gene Assay Can Guide Treatment Decisions in Stage II Colon Cancer
Axel Grothey, MD, of the Mayo Clinic, Rochester, Minnesota, told The ASCO Post that he finds the data “intriguing” and that the study exemplifies the value of developing molecular signatures for use in colon cancer. “It identifies patients with an excellent prognosis, who perhaps should not be...
ColoPrint Gene Assay Can Guide Treatment Decisions in Stage II Colon Cancer
ColoPrint, an 18-gene expression profile assay for patients with early-stage colon cancer, accurately stratifies patients by recurrence risk and identifies a subset who can be adequately treated by surgery alone, investigators reported at the 2012 Gastrointestinal Cancers Symposium.1 According to...
NCCN Clinical Practice Guidelines: Important Updates for 2012
The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology have become the most widely used guidelines in oncology practice. The Guidelines cover 97% of all patients with cancer and are continually updated by expert panels. The 2012 Guidelines include some completely...
Expert Point of View: Novel Multikinase Inhibitor Improves Survival in Metastatic Colorectal Cancer
The results of the CORRECT trial created some degree of “buzz” at the 2012 Gastrointestinal Cancers Symposium, with experts predicting that regorafenib will become FDA-approved and have strong clinical utility. While numerically, the benefit appeared small, “There is a real difference with this...
Novel Multikinase Inhibitor Improves Survival in Metastatic Colorectal Cancer
The novel tyrosine kinase inhibitor regorafenib, given as a single agent to patients with treatment-refractory metastatic colorectal cancer, significantly improved overall survival and delayed disease progression in an international phase III trial presented at the 2012 Gastrointestinal Cancers...
Epidemiology, Diagnosis, and Treatment of Breast Cancer Explored at the American Society of Breast Surgeons Meeting
Over 1,300 breast surgeons attended the 13th Annual Meeting of the American Society of Breast Surgeons, held May 2–6 in Phoenix. Presentations included investigations on recurrence after lumpectomy, gender differences in breast cancer, and the potential role of infrared thermography in diagnosing...
Postsurgical Local Breast Cancer Therapies Compared in Two Large Studies
A study presented at the 13th Annual Meeting of the American Society of Breast Surgeons suggested that accelerated partial-breast irradiation (APBI) using brachytherapy might control the tumor bed better than whole-breast irradiation (WBI), while another study suggested that radiofrequency ablation ...
Expert Point of View: Dual BRAF and MEK Inhibition Is Active in Advanced Melanoma
Commenting on the trial of combined BRAF and MEK inhibition in advanced melanoma, Michael K.K. Wong, MD, PhD, Professor of Medicine at Keck School of Medicine, University of Southern California, Los Angeles, called the findings “nothing short of extraordinary” and a potential “game changer.”...
Dual BRAF and MEK Inhibition Is Active in Advanced Melanoma
In advanced melanoma, combination therapy with two investigational drugs—one targeting BRAF and the other the MEK pathway—achieved a median progression-free survival of 7.4 months, which rose to 10.8 months in patients who were optimally dosed, reported Jeffrey S. Weber, MD, PhD, Director of the...
Expert Point of View: Crizotinib Yields Benefits in Aggressive Pediatric Tumors
Michael P. Link, MD, 2011–2012 President of ASCO and a pediatric oncologist himself (at Stanford University School of Medicine and the Lucile Salter Packard Children’s Hospital at Stanford), said the crizotinib study by Mosse and colleagues has far-ranging implications. “The molecular driver (ALK)...
Crizotinib Yields Benefits in Aggressive Pediatric Tumors
The value of the targeted agent crizotinib (Xalkori) may not be restricted to the 5% of patients with non–small cell lung cancer who have abnormalities in the ALK gene. In a phase I study conducted by the Children’s Oncology Group consortium, crizotinib halted tumor growth and, in some cases,...
Expert Point of View: T-DM1 Proves More Effective, Less Toxic Than Standard Treatment for Metastatic Breast Cancer
“Stated simply, T-DM1 really works in this patient population,” said Louis Weiner, MD, Director of the Georgetown-Lombardi Cancer Center in Washington, DC, and the invited discussant of the presentation. “It is an important new weapon in the therapeutic armamentarium for breast cancer.” While...
T-DM1 Proves More Effective, Less Toxic Than Standard Treatment for Metastatic Breast Cancer
Positive results continue to be reported for trastuzumab emtansine (T‑DM1), the antibody-drug conjugate linking trastuzumab (Herceptin) to a cytotoxic agent. Early results of the international phase III EMILIA study, presented at the 2012 ASCO Annual Meeting, showed a 35% reduction in risk of...
Expert Point of View: Kathy Miller, MD
“Our old friends are sometimes worth keeping, and that is certainly true for weekly paclitaxel,” said the invited discussant of CALGB 40502, Kathy Miller, MD, of Indiana University School of Medicine, Indianapolis, at the ASCO Annual Meeting. She noted that Dr. Rugo must “remain strict to the...
Older Breast Cancer Drugs Prove Superior to Newer Ones
In the treatment of metastatic breast cancer, established older agents outperformed newer, more expensive drugs in two studies that made news at the 2012 ASCO Annual Meeting. Microtubule Inhibitors In the phase III open-label CALBG 40502/NCCTG N063H trial of 799 chemotherapy-naive patients with...
Expert Point of View: Michael Williams, MD
Michael Williams, MD, the Byrd S. Leavell Professor of Medicine and Chief of Hematologic Malignancies at the University of Virginia Cancer Center, Charlottesville, commented, “Bendamustine/rituximab provides equivalent or better responses vs R-CHOP [rituximab, cyclophosphamide, doxorubicin,...
Expert Point of View: Richard I. Fisher, MD
Richard I. Fisher, MD, the Samuel E. Durand Professor of Medicine at the University of Rochester Medical Center in Rochester, New York, cautioned that it is too early to embrace the bendamustine/rituximab regimen. Caution Advised “Bendamustine is a very active agent with moderate toxicity that...
German Study Finds Bendamustine Improves Progression-free Survival in Patients with Non-Hodgkin Lymphoma
Updated results of the StiL NHL1 study, presented at the 2012 ASCO Annual Meeting Plenary Session, showed that bendamustine plus rituximab (Rituxan) more than doubled the median progression-free survival, compared with the standard R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin,...
Expert Point of View: PD-1 Immune Checkpoint Inhibitors Look Promising in Multiple Solid Tumors
Oncologists can expect to hear more about immune checkpoint blockade, according to two discussants of these abstracts. In fact, five PD-1 immune checkpoint compounds are already in the pipeline (Table 1), according to Giuseppe Giaccone, MD, PhD, of the National Cancer Institute, Bethesda, Maryland. ...
MEK Inhibitor Reduces Progression of BRAF-mutated Melanoma and Might also Benefit Others
In the News focuses on media reports that your patients may have questions about at their next visit. This continuing column will provide summaries of articles in the popular press that may prompt such questions, as well as comments from colleagues in the field. The MEK inhibitor trametinib...
Updated Findings Further Define Role of Tyrosine Kinase Inhibitors in CML
With three available tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia (CML), attention has turned from the ability to achieve a sustained response to the possibility of “curing” patients. Updates of pivotal trials presented at ASCO may help define the role of the tyrosine...
PACE Trial Update: Ponatinib Produces High Response Rates in CML
The third-generation tyrosine kinase inhibitor ponatinib showed robust efficacy in the 10-month follow-up of the phase II PACE trial (Ponatinib Ph+ALL and CML Evaluation), which is evaluating ponatinib in treatment-refractory chronic myeloid leukemia (CML)1 At the 2012 ASCO Annual Meeting, Jorge E. ...
SIDEBAR: Other Colorectal Cancer News from ASCO
Additional noteworthy gastrointestinal cancer studies presented during oral abstract sessions at the 2012 ASCO Annual Meeting included the following trials in metastatic colorectal cancer. Perifosine/Capecitabine Fails in Phase III Trial Adding perifosine, an oral alkylphospholipid inhibitor that...
Expert Point of View: Alan Venook, MD
Invited discussant Alan Venook, MD, of the University of California, San Francisco, pointed out that the hazard ratio of 0.81 and the 1.4-month improvement in overall survival in the TML trial did not reach the target hazard ratio of 0.77 in the statistical design of the study. However, “it is...
Bevacizumab beyond Progression Prolongs Survival in Metastatic Colorectal Cancer
In a study highlighted at a press briefing during the 2012 ASCO Annual Meeting, German investigators reported that prolonging treatment with bevacizumab (Avastin) beyond disease progression extends overall survival in patients with metastatic colorectal cancer.1 Patients received bevacizumab plus...
ASCO Studies Point to Risks Associated with Treating Childhood Cancers
Risks associated with being a young cancer survivor were emphasized by two studies highlighted in press briefings at the 2012 ASCO Annual Meeting. Investigators from the Children’s Oncology Group (COG) reported that adolescents and young adults treated for high-risk B-precursor acute lymphoblastic ...
Older Chemotherapy Studies in Breast Cancer Coming of Age
Results of several long-running chemotherapy trials were reported at the 2012 ASCO Annual Meeting breast cancer oral session, reported in brief here. NSABP B-38 The final analysis of the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-38 trial showed that the addition of gemcitabine...
