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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. ...

colorectal cancer

Adjuvant Chemotherapy May Confer Survival Benefit in Patients Older than 75 with Stage III Disease

Because few people over 75 participate in clinical trials, it is unknown whether adjuvant chemotherapy could benefit this population. Faced with this gap in clinical trial evidence, researchers reviewed data from 5,489 patients ≥ 75 years with stage III colon cancer. The review suggests that...

solid tumors

Screening Should Begin Early for Survivors of Childhood Cancer

Survivors of childhood cancer, particularly those treated for childhood Hodgkin lymphoma or Wilms tumor with abdominal radiation, procarbazine (Matulane), and platinum chemotherapy, are at an increased risk of developing gastrointestinal subsequent malignant neoplasms, according to a retrospective...

prostate cancer

Pretreatment Tumor Hypoxia Predicts Biochemical Failure after Radiotherapy for Prostate Cancer

Hypoxia often occurs early in solid tumor development as a result of imbalances between oxygen supply and consumption and may lead to genetic and molecular signaling that influences the biology and clinical behavior of tumors and response to treatment. Milosevic and colleagues from Princess...

SIDEBAR: Expect Questions from Your Patients

Promising results announced at the recent ASCO Annual Meeting from studies with BRAF and MEK inhibitors have made headlines, but only one of these agents—the BRAF inhibitor vemurafenib (Zelboraf)—has been approved by the FDA. The others are still investigational. Patients interested in gaining...

skin cancer

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...

solid tumors

Identification of Novel Mechanism for Suppression of Antitumor Immunity

The efficacy of cancer immunotherapy has been limited, likely reflecting in large part the incomplete understanding of the complex interactions between tumors and the immune microenvironment. A study presented at the 2012 ASCO Annual Meeting helps clarify some of these interactions. Changes in...

breast cancer

My Breast Cancer Had Been Coming for Years

I’ve never had a normal mammogram screening. There was always something suspicious the test picked up: macrocalcifications in one breast 1 year and a cyst in the other breast the next year. Over a period of 3 years, I had six tissue biopsies, all benign for cancer. So when I flunked another...

supportive care
pain management
palliative care

Early Access to Palliative/Supportive Care vs Usual Care Improves Pain Management

Many cancer patients remain undertreated for pain despite availability of guidelines and educational efforts to improve pain treatment. In a recent Annals of Oncology article, Bandieri and colleagues from the Italian Epidemiologia Clinico-Assistenziale del Dolore in Ospedale (ECAD-O) group report a ...

breast cancer
integrative oncology

Soy Phytoestrogens and Breast Cancer: An Enduring Dilemma

The impact of soy consumption on breast cancer diagnosis and outcome has remained of concern to clinicians and researchers for the past 20 years. Although studied extensively in epidemiologic studies as well as lab and animal research, no medical consensus on soy’s effects has emerged. Many studies ...

Expert Point of View: Samuel A. Wells, MD

This study follows earlier phase I and II trials showing remarkable responses in patients with advanced medullary thyroid carcinoma, some of whom had progressed on prior tyrosine kinase inhibitor therapy, explained formal discussant of this trial, Samuel A. Wells, MD, of the Center for Cancer...

thyroid cancer

Cabozantinib Prolongs Progression-free Survival in Advanced Medullary Thyroid Cancer

Cabozantinib prolonged progression-free survival in patients with unresectable, locally advanced, or metastatic medullary thyroid cancer with documented disease progression in the phase III EXAM trial. Based on these results, Exelixis submitted a New Drug Application to the FDA in May 2012. The...

breast cancer

NK Cell Signature Associated with Favorable Prognosis in Breast Cancer

Tumor cell recognition by natural killer (NK) cells is mediated by the interaction of activating and inhibitory NK cell receptors with ligands expressed on the tumor cells. NK cells also express adhesion molecules that facilitate formation of the immune synapse with tumor targets. Maria Libera...

solid tumors
colorectal cancer

Single Nucleotide Polymorphisms Predict Severe Toxicity of Adjuvant Therapy in Colorectal Cancer

Oxaliplatin/fluoropyrimidine–based adjuvant therapy is of benefit in patients with resected stage II/III colon cancer, but the ability to predict risk of toxicity could improve care by permitting individualization of treatment. Ana Custodio, MD, and colleagues from GEMCAD (Grupo Español...

solid tumors

Alterations in PTEN Insufficient to Predict Sensitivity to Drugs Targeting PI3K/mTOR Pathway

PTEN acts as a tumor-suppressor gene through the action of its phosphatase protein product, which participates in regulation of the cell cycle to prevent too-rapid cell growth and division. Loss of PTEN function has been shown to increase PI3K/mTOR signaling, and preclinical data suggest that PTEN...

breast cancer

New Study Examines Racial Disparities in Breast Cancer Mortality

According to the first national study looking at racial disparity in breast cancer mortality rates at the city level in the United States, societal factors—especially poverty and residential segregation—are resulting in the unnecessary deaths of five black women every day—more than 1,700 deaths a...

Mitotane-containing Regimens Explored for a Rare Tumor

Response rates and progression-free survival rates were significantly better among patients with advanced adrenocortical carcinoma receiving mitotane (Lysodren) plus EDP (etoposide, doxorubicin, and cisplatin) than in patients receiving mitotane with streptozocin (Zanosar), according to results of...

global cancer care
health-care policy

Cancer Care in Rwanda: A Model of Creative Partnerships

While disparities in cancer care remain problematic in wealthy industrial nations like the United States, the challenges faced in poorer regions of the world are, by comparison, inestimable. Nationally regarded health-care expert Lawrence N. Shulman, MD, of Dana-Farber Cancer Institute, is part of...

Sarcoma Foundation of America Teams with Conquer Cancer Foundation to Fund Potentially Life-saving Research

When Matthew Alsante signed on to serve as Executive Director of the Sarcoma Foundation of America (SFA) 6 years ago, he had a visceral understanding of the importance of the organization’s work. Mr. Alsante had lost his father to lung cancer in 1999. “Right up until the last day of his life, if...

YIA and CDA: Abbreviations of Great Importance to Continued Progress in Cancer Research

Behind the scenes researchers—who are well acquainted with the human cost of cancer and see the vast scientific and clinical opportunities for conquering it—are working to unlock the secrets of cancer in its many forms. Some are well established in their careers and have been conducting studies for ...

ASCO Launches Oncology Practice Census

How many oncologists are in private practice and how many are employed by hospitals and academic medical centers in the United States? No one knows the answer for sure, but ASCO is undertaking an ambitious national effort to determine where oncologists are practicing these days. Online Survey...

Proton Therapy System Granted 510(k) Clearance

Mevion Medical Systems, Inc, announced that it has received FDA 510(k) clearance for its Mevion S250 Proton Therapy System. According to Mevion, the new system delivers precise, noninvasive treatment comparable to that available with larger, more complex proton therapy systems but with higher...

colorectal cancer

FDA Approves Cetuximab plus FOLFIRI/Therascreen in Colorectal Cancer

The FDA has granted approval to cetuximab (Erbitux) for use in combination with FOLFIRI (irinotecan, fluorouracil, leucovorin) for first-line treatment of patients with KRAS mutation–negative (wild-type), EGFR-expressing metastatic colorectal cancer as determined by FDA-approved tests for this use. ...

SIDEBAR: Key Findings

When asked to comment on implications of this study, lead author Frank A. Greco, MD, remarked, “The use of this gene-expression profile assay (CancerTYPE ID, bioTheranostics, Inc) on the biopsy material of patients with carcinoma of unknown primary provides a single tissue of origin diagnosis in...

issues in oncology

Gene Profiling–guided Therapy May Improve Survival in Patients with Carcinoma of Unknown Primary

Molecular gene-expression profiling is an emerging technique to determine tissue of origin in patients with carcinoma of unknown primary, although the value of predictions from such profiling in improving treatment outcomes is unclear. In a prospective trial using tumor profiling results to direct...

lung cancer
issues in oncology

After a Decade of Decline in Smoking Rates, Progress Has Stalled

Approximately 20% of all Americans smoke, and 443,000 of them will die each year as a result. Tobacco use is the leading cause of preventable death in the United States and the greatest behavioral determinant of morbidity and mortality (6%–10% of U.S. health-care costs). Nearly 30% of all cancer...

leukemia

Prognostic Value of Integrated Cytogenetic and Mutational Risk Classification in Acute Myeloid Leukemia

Jay P. Patel, BS, and colleagues from Memorial Sloan-Kettering Cancer Center in New York recently performed mutational analysis of 18 genes in a subgroup of newly diagnosed acute myeloid leukemia (AML) patients who had been randomized to receive cytarabine plus high-dose or standard-dose...

leukemia

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...

leukemia

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. ...

Richard Goldberg, MD, Gives First Moertel Lecture

Richard Goldberg, MD, Physician-in-Chief of The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, presented the first Charles G. Moertel Lecture of the Alliance for Clinical Trials in Oncology during the plenary session of the group’s recent...

issues in oncology

New Study on Communicating Bad News, from the Patient’s Perspective

There is limited evidence in the literature about how oncologists should discuss bad or serious news with their patients. A recent study sought to understand what patients with cancer value when their doctors communicate news of recurrence.1 The ASCO Post spoke with the study’s lead author, Anthony ...

colorectal cancer

Increased Adjuvant Therapy Use and Improved Survival in Dutch Elderly Patients with Stage III Colon Cancer: A Direct Correlation?

A survival benefit of adjuvant chemotherapy has been reported for select elderly patients with stage III colon cancer, but many elderly patients are not candidates for or are not given adjuvant therapy due to comorbidities and fear of toxicity. In a recent Annals of Oncology article, van...

Expert Point of View: Axel Grothey, MD

Over the past 10 years, agents targeting the VEGF system, such as bevacizumab, have become standard components of anticancer therapy in various malignancies. Recently, it has become increasingly evident that prolonged duration of anti-VEGF therapy is needed to optimize the therapeutic effect of...

colorectal cancer

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...

breast cancer
lymphoma
survivorship

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 ...

Expert Point of View: Benjamin J. Solomon, MBBS, PhD

“The LUX-Lung 3 study has been much awaited. It is the first study to use cisplatin/pemetrexed [Alimta], which we now recognize as the best comparator arm. The study was positive for afatinib. While the use of maintenance pemetrexed may have dented the hazard ratio, I doubt this would have impacted ...

lung cancer

First-line Afatinib Superior to Standard Chemotherapy in Advanced EGFR-mutated Non–Small Cell Lung Cancer

First-line therapy with the investigational oral agent afatinib improved progression-free survival compared with standard chemotherapy (pemetrexed (Alimta)/cisplatin) in patients with advanced non–small cell lung cancer (NSCLC) harboring an EGFR mutation. Afatinib improved progression-free survival ...

Expert Point of View: Landscape for Treatment of Metastatic Melanoma Is Expanding

At an Annual Meeting press conference, ASCO spokesperson Sylvia Adams, MD, said, “BREAK-3 confirms that BRAF targeting is effective in metastatic melanoma. The tumor shrinkage seen with dabrafenib is similar to results observed for the FDA-approved drug vemurafenib, with fewer side effects. We will ...

skin cancer

Landscape for Treatment of Metastatic Melanoma Is Expanding

Metastatic melanoma was long considered untreatable and incurable. The FDA approval of ipilimumab (Yervoy) and vemurafenib (Zelboraf) ushered in a new era for this disease, and now additional treatment options are in late stages of clinical development. Dabrafenib, a novel oral BRAF inhibitor, and...

Reflections from the Old World

A few years ago, I was a key witness for a patent dispute at a trial in Delaware. Acting for the complainant, I was briefed that the opening gambit of the opposition lawyer would be to discredit my CV and, therefore, the value of my testimony. “So you are a full Professor at the University of...

health-care policy

Three Experts Weigh In on the Health-care Reform Legislation

In light of the Supreme Court ruling, The ASCO Post asked three nationally regarded experts about how the Affordable Care Act will affect the practice of oncology. Ezekiel J. Emanuel, MD, PhD, Professor and Vice Provost for Global Initiatives, University of Pennsylvania: This is an overwhelmingly...

health-care policy

The Affordable Care Act Stands: Now What?

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law—a hotly contested bill that enacted sweeping changes to the U.S. health-care system. The debate over the Affordable Care Act continued all the way to the Supreme Court, spearheaded by the case Florida...

Expert Point of View: TAILOR

Formal discussant of the TAILOR trial, Benjamin J. Solomon, MBBS, PhD, of the Peter MacCallum Cancer Centre, East Melbourne, Australia, noted that the study asks an important question about the benefit of an EGFR inhibitor in patients with wild-type EGFR. The progression-free survival reported in...

Expert Point of View: PARAMOUNT

Formal discussant Gregory Peter Kalemkerian, MD, of the University of Michigan Comprehensive Cancer Center, Ann Arbor, questioned whether all patients need maintenance therapy, since some patients on placebo lived as long as those on pemetrexed maintenance, and quality of life, as reported...

lung cancer

Second-line Treatments Tested in Patients with Non-Small Cell Lung Cancer

Results of two late-breaking phase III trials presented at 2012 ASCO Annual Meeting add to the evolving understanding of how best to treat non–small cell lung cancer (NSCLC). The TAILOR trial suggested the benefit of chemotherapy over EGFR-targeted therapy as second-line treatment of patients with...

Conquer Cancer Foundation Honors Oncology Professionals forHigh-quality Research in Breast Cancer

The Conquer Cancer Foundation of ASCO recently announced the recipients of its 2012 Breast Cancer Symposium Merit Awards, which recognize leading oncology professionals for their work in the area of breast cancer research. This year, the Foundation honors 16 individuals for their research in the...

solid tumors

Regorafenib Has ‘Notable Anticancer Activity’ after Patients Develop Resistance to Imatinib and Sunitinib

The orally administered investigational multikinase inhibitor regorafenib demonstrated “notable anticancer activity” in a phase II trial among patients with advanced gastrointestinal stromal tumor (GIST) who developed resistance to imatinib (Gleevec) and sunitinib (Sutent). Researchers reported in...

pancreatic cancer

Adjuvant Chemotherapy May Improve Survival for Patients with Periampullary Disease

The European Study Group for Pancreatic Cancer (ESPAC)-3 periampullary cancer trial found that adjuvant chemotherapy following surgical resection of periampullary adenocarcinoma “was not associated with a significant survival benefit in the primary analysis; however, multivariate analysis adjusting ...

lymphoma

Children with Favorable-risk Disease and Complete Response to Chemotherapy Have High Survival Rates without Radiotherapy

Among children with favorable-risk Hodgkin lymphoma, those who achieved a complete response after two cycles of chemotherapy and received no radiotherapy had high rates of survival similar to those who had a less complete response to chemotherapy and received radiotherapy, according to a study in...

Genomics vs Site of Cancer Origin as Basis for Treatment of Cancer Is ‘False Dichotomy’

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. Despite recent news reports...

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