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issues in oncology

The Promise of Immune Checkpoint Blockade in Cancer Therapy

The concept of using activation of the innate immune system and an inflammatory response against a bacterial component to instigate an antitumor response was studied in the 1960s, which led to the development of intravesical bacillus Calmette-Guérin, now used in the treatment of superficial bladder ...

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...

lung cancer

Necitumumab in Metastatic Squamous Non–Small Cell Lung 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 November 24, 2015, necitumumab (Portrazza) was approved for use ...

lung cancer

ASCO Endorsement of ACCP Guideline on Treating SCLC: Moving Forward to Better Outcomes in Oncology

In the current climate of rising health-care costs, particularly in the field of oncology, clinical guidelines provide a crucial tool to guide practitioners in evidence-based care and to improve the quality and consistency of care.1 The ASCO review and endorsement of the American College of Chest...

lung cancer

ASCO Endorses ACCP Guideline on Treatment of Small Cell Lung Cancer

As reported in the Journal of Clinical Oncology,1 ASCO has endorsed the current American College of Chest Physicians (ACCP) guideline on treatment of small cell lung cancer (SCLC), released in 2013.2 After review of evidence from an updated literature search covering 2011 to March 2015, an ASCO...

breast cancer

Ductal Carcinoma in Situ and Relevant Endpoints for Omission of Standard Treatments: Are We There Yet?

The optimal management strategy for ductal carcinoma in situ has become increasingly controversial with respect to potential overdiagnosis and overtreatment. Much of the controversy for ductal carcinoma in situ stems from its exceptional breast cancer–specific survival, which approaches close to...

breast cancer

Surgical Excision Without Radiation Therapy in Women With Low-Risk Ductal Carcinoma in Situ

Lawrence J. Solin, MD, of Albert Einstein Healthcare Network, Philadelphia, and colleagues reported the 12-year results from the ECOG-ACRIN E5194 trial in the Journal of Clinical Oncology. Among women with ductal carcinoma in situ with low-risk clinical and pathologic characteristics, they found...

survivorship

ASTRO Launches Template to Help Radiation Oncologists Guide Cancer Survivors Through Ongoing Care

A new template published by the American Society for Radiation Oncology (ASTRO) standardizes and streamlines the creation of patient-focused plans for long-term cancer survivor care following radiation therapy. As the number of cancer patients and survivors in the United States continues to...

head and neck cancer

Surgery for Head and Neck Cancer Improves Survival—in Taiwan

A large study presented at the 2015 European Cancer Congress in Vienna found that patients with advanced oropharyngeal or hypopharyngeal cancer had improved survival if their primary treatment included surgery.1 The caveat is that these patients were treated in Taiwan, and the results may not be...

Journal of Oncology Practice Expands Research Coverage and Debuts a New Look

Launched by ASCO in 2005 to provide oncologists with original research on the delivery of high-quality cancer care, the Journal of Oncology Practice (JOP) enters its 11th year with a new look and feel. Beginning in January 2016, JOP will be copublished by ASCO and Harborside Press, the publisher of ...

issues in oncology
health-care policy

Friends of Cancer Research Releases White Paper on Patient-Reported Outcomes

On November 17, Friends of Cancer Research (FOCR) released a white paper report, Enhancing Use of Patient-Centered Data in Regulatory Decision Making.1 The contents of that paper are summarized below. Improving Patient Input Many stakeholders agree that to ensure truly transformational therapies,...

health-care policy
issues in oncology

Clinical Trial System Badly in Need of Overhaul, Say Panelists at Friends-Brookings Conference

Cancer clinical trials in three distinct phases, as they have been conducted for decades, are probably no longer the best way to bring a drug or biologic agent to market. This was the consensus of three panels at the 8th Annual Conference on Clinical Cancer Research convened by Friends of Cancer...

breast cancer
survivorship

Breast Cancer Survivors May Expect More Extensive or Frequent Follow-up Testing Than Recommended

Patients who have been treated for breast cancer may overestimate the value of follow-up testing and may expect—or even ask for—more testing than recommended, Harold J. ­Burstein, MD, PhD, of the Dana-Farber Cancer Institute and Harvard Medical School, Boston, told participants at the Lynn Sage...

breast cancer

Partnering Therapies for Estrogen Receptor–Positive Breast Cancer Requires Close Monitoring and Patient Communication

Partnering endocrine therapy with new targeted agents for women with estrogen receptor–positive breast cancer “changes the nature of endocrine therapy from something easily tolerated, with not a lot that you have to do as physicians to monitor it,” William J. Gradishar, MD, of the Robert H. Lurie...

hematologic malignancies

Optimizing the Treatment of HIV-Associated Lymphoma

Non-Hodgkin lymphoma (NHL) associated with human immunodeficiency virus (HIV) infection generally can be treated the same as lymphoma in non–HIV-infected patients, with a few caveats, according to Lawrence D. Kaplan, MD, of the Helen Diller Family Comprehensive Cancer Center of the University of...

skin cancer

Nivolumab as Single-Agent Treatment for BRAF V600 Wild-Type Unresectable or Metastatic Melanoma

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 24, 2015, nivolumab (Opdivo) was approved for use as...

palliative care

More, Earlier, and Better Goals-of-Care Conversations at the End of Life Are Feasible

An intervention called the Serious Illness Care Program helps clinicians to conduct more, earlier, and better conversations about goals of care with their seriously ill patients, according to ­Rachelle E. Bernacki, MD, MS, who presented the preliminary results of a study using this approach at the...

palliative care

ASCO and AAHPM Define Primary Palliative Care in Oncology

A new guidance statement from ASCO and the American Academy of Hospice and Palliative Medicine (AAHPM) could potentially lead to more standardized primary palliative care delivery across oncology settings, according to Kathleen E. Bickel, MD, MPhil, who presented the study findings at the 2015...

Expert Point of View: Karen Ballen, MD

This is a group of patients who have not done very well over the years. The cure rate for children with acute lymphoblastic leukemia (ALL) is over 90%, whereas this group of patients (ie, aged 18–50) typically has a 5-year survival of 40% to 50%. Use of pediatric regimens has boosted that survival, ...

leukemia

Pediatric Regimen Achieves Higher-Than-Expected Survival in Young Adults With Acute Lymphoblastic Leukemia

Adolescents and younger adults with acute lymphoblastic leukemia (ALL) had superior outcomes on a “pediatric” regimen compared with adult treatment protocols. A multicenter phase II study included patients aged 18–50, extending the upper limit of “younger,” since most other trials of this approach...

kidney cancer

Nivolumab in Advanced Renal Cell Carcinoma After Antiangiogenic Therapy

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 23, 2015, nivolumab (Opdivo) was approved for use in...

hematologic malignancies

ASH Announces Top Trainee Abstracts of 2015 Annual Meeting

The American Society of Hematology (ASH) recognized investigators with the highest-scoring abstracts in the categories of undergraduate student, medical student, graduate student, resident physician, and postdoctoral fellow at the 57th ASH Annual Meeting and Exhibition, December 5–8 in Orlando,...

leukemia

Midostaurin: A New Standard of Care in Acute Myeloid Leukemia?

Upfront treatment with midostaurin added to standard chemotherapy improved survival compared with placebo plus chemotherapy in high-risk patients with acute myeloid leukemia (AML) characterized by FLT3 mutations. No new drugs have been approved for AML since 1990, and midostaurin is the first...

Expert Point of View: Susan M. O’Brien, MD

Until recently, chlorambucil (Leukeran) was the standard of care for older patients with chronic lymphocytic leukemia (CLL) in Europe. In several studies, chlorambucil combined with newer drugs—for example, anti-CD20 antibodies, obinutuzumab (Gazyva), or ofatumumab (Arzerra)—improved survival,...

hematologic malignancies
leukemia
issues in oncology

Ibrutinib Bests Standard of Care for Elderly Patients With CLL

First-line treatment with the Bruton’s tyrosine kinase inhibitor ibrutinib (Imbruvica) significantly reduced the risk of dying or disease progression compared with chlorambucil (Leukeran) in older treatment-naive patients with chronic lymphocytic leukemia (CLL) in the RESONATE-2 trial. At the time...

breast cancer

Adjuvant Denosumab Improves Disease-Free Survival in Estrogen Receptor–Positive Postmenopausal Breast Cancer

There is good news about denosumab (Prolia). The primary analysis of the ABCSG-18 trial showed that adjuvant denosumab (given at low doses) reduces the risk of clinical fracture by 50% in postmenopausal women with early breast cancer who are taking an aromatase inhibitor.1 More good news is that...

breast cancer

Patients With Incomplete Response to Neoadjuvant Chemotherapy Benefit From Capecitabine

Treatment with capecitabine increased disease-free and overall survival in breast cancer patients with residual disease after neoadjuvant chemotherapy, according to a study reported by researchers from Japan and Korea at the 2015 San Antonio Breast Cancer Symposium.1 “It has been unclear whether...

gynecologic cancers
issues in oncology

A Shot to End Cancer: HPV Vaccination

As health-care providers, we have an obligation and a responsibility not only to care for our patients, but also to educate them—and the general public—about their cancer risk and ways to reduce or prevent it. We are living in the golden era of cancer prevention and treatment, made possible by...

Expert Point of View: Sagar Lonial, MD

At an educational session at the 2015 American Society of Hematology Annual Meeting and Exposition, Sagar Lonial, MD, of Emory University, Atlanta, elaborated upon this topic. The pooled analysis of daratumumab (Darzalex) monotherapy, he said, “demonstrated significant activity and, not only this,...

multiple myeloma

Impressive Results With Daratumumab Plus Lenalidomide/Dexamethasone in Multiple Myeloma

The anti-CD38 monoclonal antibody daratumu­mab (Darzalex) took center stage among multiple myeloma studies presented at the 57th American Society of Hematology Annual Meeting and Exposition. In relapsed/refractory patients, daratumumab plus lenalidomide (Revlimid)/dexamethasone yielded an 81%...

breast cancer
issues in oncology
issues in oncology

New Study Suggests Benefits of Regular Mammography Extend to the Elderly

Breast cancer afflicts 1 in 8 women in their lifetime, and 1 in 25 die from this disease. Although a number of randomized trials have demonstrated the clear benefits of mammography screening in women up to age 74 on reducing mortality, data are sparse in women over age 74, especially among...

survivorship

Study Finds Cardiovascular Disease Is Prevalent and Often Asymptomatic in Childhood Cancer Survivors

Although historically the leading cause of death among survivors of childhood cancer has been cancer recurrence, adverse late effects of cancer therapy have become the leading cause of death 30 years after diagnosis, and those deaths are frequently attributed to premature cardiovascular disease,...

colorectal cancer
issues in oncology

Gene Thought to Suppress Cancer May Actually Promote Spread of Colorectal Cancer

A gene that is known to suppress the growth and spread of many types of cancer has the opposite effect in some forms of colorectal cancer, University of Missouri (MU) School of Medicine researchers have found. It is a finding that may lay the foundation for new colorectal cancer treatments. Results ...

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...

leukemia
lymphoma

Adding Ibrutinib to Bendamustine/Rituximab May Increase Progression-Free Survival in Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma

In the phase III HELIOS trial reported in The Lancet Oncology, Chanan-Khan et al found that the addition of the Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib (Imbruvica) to bendamustine (Treanda)/rituximab (Rituxan) increased progression-free survival in patients with chronic lymphocytic ...

palliative care

More Than One-Third of Patients With Metastatic Cancer Continue to Work

A new analysis indicated that many patients continue working after being diagnosed with metastatic cancer, but a heavy burden of symptoms may prevent them from doing so. Published by Tevaarwerk et al in Cancer, the study illustrates the need to treat difficult symptoms so that patients can maintain ...

breast cancer

Patient-Reported Outcomes With Adjuvant Anastrozole vs Tamoxifen in Postmenopausal Women With Ductal Carcinoma in Situ

As reported in The Lancet and at the recent San Antonio Breast Cancer Symposium, Ganz et al found differences in patient-reported outcomes with anastrozole vs tamoxifen in the phase III National Surgical Adjuvant Breast and Bowel Project (NSABP) B-35 trial in postmenopausal women with hormone...

breast cancer

Jack Cuzick, PhD, FMedSci, on DCIS Recurrence Rates: Anastrozole vs Tamoxifen

Jack Cuzick, PhD, FMedSci, of Queen Mary, University of London, discusses his phase III study on postmenopausal women with DCIS who had similar outcomes whether they took tamoxifen or anastrozole for 5 years after surgery. (Abstract S6-03)

breast cancer

Andrew Seidman, MD, and Sabine Seisling, PhD, on Early-Stage Breast Cancer Outcomes: Breast-Conserving Therapy vs Mastectomy

Andrew Seidman, MD, of Memorial Sloan Kettering Cancer Center, and Sabine Siesling, PhD, of the Netherlands Comprehensive Cancer Organization, discuss the improved overall survival after 10 years in women who received breast-conserving surgery compared with those who received mastectomy with...

leukemia

Hagop M. Kantarjian, MD, on AML: Safety and Efficacy of Guadecitabine

Hagop M. Kantarjian, MD, of MD Anderson Cancer Center, discusses a study that compared efficacy and safety results of using 5-day and 10-day regimens of a novel hypomethylating agent in 103 treatment-naïve AML patients who were not candidates for intensive chemotherapy (Abstract 458).

issues in oncology
lung cancer

ESMO Asia 2015: Results From the KEYNOTE-010 Trial Show Pembrolizumab Benefit in Patients With NSCLC

More patients with advanced non–small cell lung cancer (NSCLC) could benefit from pembrolizumab (Keytruda), said Roy Herbst, MD, PhD, Chief of Medical Oncology at Yale Cancer Center and Smilow Cancer Hospital at Yale-New Haven. Dr. Herbst presented promising results from the pivotal phase...

issues in oncology
cost of care

ESMO Asia 2015: Cancer Drives Patients to Poverty in Southeast Asia

Five percent of cancer patients and their families were pushed into poverty in Southeast Asia between March 2012 and September 2013 because of high disease-related costs, a study (Abstract 52O) by Bhoo-Pathy et al at the European Society for Medical Oncology (ESMO) Asia 2015 Congress in Singapore...

head and neck cancer

ESMO Asia 2015: Immunotherapy and Targeted Therapy Provide New Options for Difficult-to-Treat Head and Neck Cancer

Novel strategies are being explored for difficult-to-treat and advanced head and neck cancer—the most heterogeneous group of malignancies that are generally associated with poor survival—and encouraging results have been presented in two trials at the first European Society for Medical...

lung cancer

ESMO Asia 2015: Afatinib a Better Choice for EGFR-Mutated Lung Cancer in First-Line Treatment

Patients with epidermal growth factor receptor (EGFR)-activating mutations in advanced lung cancer seem to benefit more from afatinib (Gilotrif) than gefitinib (Iressa) as first-line treatment, Park et al reported in a study (Abstract LBA2) presented at the European Society for Medical Oncology...

skin cancer

FDA Expands Pembrolizumab Label to Include Approval in Initial Treatment of Unresectable or Metastatic Melanoma

On December 18, 2015, the U.S. Food and Drug Administration (FDA) expanded the pembrolizumab (Keytruda) label to include approval of the drug for the treatment of patients with unresectable or metastatic melanoma. This expansion now includes the initial treatment of patients with unresectable or...

breast cancer

Sarat Chandarlapaty, MD, PhD, on BOLERO-2 Clinical Trial Results

Sarat Chandarlapaty, MD, PhD, of the Memorial Sloan Kettering Cancer Center, discusses results from this study that showed patients with ER-positive metastatic breast cancer who had a D538G and/or a Y537S mutation in the ESR1 gene had significantly worse median overall survival (Abstract S2-07).

breast cancer
issues in oncology

Periodontal Disease Linked to Increased Risk of Breast Cancer in Postmenopausal Women, Especially Smokers

A large prospective study of postmenopausal women investigating an association between periodontal disease and breast cancer risk has found that among all women in the study, the risk of breast cancer was 14% higher in women who had periodontal disease. Among women who had quit smoking within the...

breast cancer
colorectal cancer
gynecologic cancers
issues in oncology

Follow-up Times for Colorectal Cancer Screening Abnormalities Lag Behind Others

Follow-up times of abnormal screening exams were shorter for breast cancer than they were for colorectal and cervical cancers, according to a recent study involving more than 1 million individuals who underwent these screenings. Recently published by Tosteson et al in the Journal of General...

solid tumors

Mental Health Status Prior to Radical Cystectomy Can Indicate Risk of Complications

A patient's mental health prior to surgery can influence postoperative outcomes. Removal of the bladder, or radical cystectomy, is an effective treatment for locally advanced bladder cancer, but complications occur in as many as 66% of patients. In a study published by Sharma et al in The Journal...

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