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The Puzzle Table

The ASCO Post is pleased to reproduce installments of the “Art of Oncology” as published previously in the Journal of Clinical Oncology. These articles focus on the experience of suffering from cancer or of caring for people diagnosed with cancer, and they include narratives, topical essays,...

St. John’s Wort

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, Jun J. Mao, MD, MSCE, and Jyothirmai Gubili, MS, explore the role of St....

lymphoma

Obinutuzumab in Previously Untreated Follicular Lymphoma

On November 16, 2017, obinutuzumab (Gazyva) was granted regular approval in combination with chemotherapy, followed by obinutuzumab monotherapy for patients achieving at least a partial remission, for the treatment of adult patients with previously untreated stage II bulky, III, or IV follicular...

issues in oncology
legislation

Medical Aid in Dying: When Legal Safeguards Become Burdensome Obstacles

In 2017, the District of Columbia (DC) became the seventh jurisdiction in the United States to legalize medical aid in dying,1 which gives terminally ill patients the option of how and when they die. The new DC statute is nearly identical to earlier enacted medical aid in dying statutes in...

leukemia

Bosutinib for First-Line Use in Chronic Myeloid Leukemia: Is Three a Crowd?

BOSUTINIB ( BOSULIF) is the latest tyrosine kinase inhibitor that has shown a superior molecular response profile when compared with imatinib.1,2 An orally available dual SRC/ABL1 inhibitor, the drug was shown in preclinical studies to have a potent inhibitory activity against BCR-ABL1 and minimal ...

lymphoma

Front-Line Brentuximab Plus AVD vs Standard ABVD in Advanced Hodgkin Lymphoma

FRONT-LINE TREATMENT of advanced Hodgkin lymphoma with brentuximab vedotin (Adcetris) plus doxorubicin/ vinblastine/dacarbazine (A+AVD) achieved superior outcomes compared with the standard four-drug regimen of doxorubicin/bleomycin/vinblastine/dacarbazine (ABVD). The substitution of brentuximab...

lymphoma

BTK Inhibitor in Relapsed or Refractory Mantle Cell Lymphoma

A phase II study (ACE-LY-004) reported in The Lancet by Wang et al showed durable responses with the Bruton tyrosine kinase inhibitor acalabrutinib (Calquence) in patients with relapsed or refractory mantle cell lymphoma. The study supported the recent approval of acalabrutinib in this setting....

lymphoma

ASH 2017: ALCANZA Trial: Brentuximab Vedotin in CD30-Expressing Cutaneous T-Cell Lymphoma

Updated results from the phase III ALCANZA clinical trial evaluating brentuximab vedotin (Adcetris) in CD30-expressing cutaneous T-cell lymphoma (CTCL) were presented by Horwitz et al at the 59th American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 1509). The presentation...

solid tumors

Anti–PD-L1 Antibody in Advanced Urothelial Carcinoma After Platinum Failure

As reported in The Lancet Oncology by Patel et al, the anti–programmed cell death ligand 1 (PD-L1) antibody avelumab (Bavencio) produced durable responses in patients with locally advanced or metastatic urothelial carcinoma after failure of platinum-based therapy in two expansion cohorts of...

lymphoma

ASH 2017: JULIET Trial: 6-Month Analysis of Tisagenlecleucel in Relapsed/Refractory DLBCL Shows Sustained Responses

Six months after receiving a single dose of tisagenlecleucel, a chimeric antigen receptor (CAR) T-cell therapy that targets CD-19, high response rates persist among adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), according to findings reported by Schuster et al at...

solid tumors
breast cancer

Genomic Characteristics and Immune Infiltration in Triple-Negative Breast Cancer

In a study reported in JAMA Oncology, Thomas Karn, PhD, of Goethe-University Frankfurt, and colleagues found that triple-negative breast cancers with high immune gene expression levels were characterized by lower clonal heterogeneity, reduced copy number alterations, and lower somatic mutation,...

solid tumors
gynecologic cancers

Olaparib Tablets for Maintenance Treatment in Ovarian Cancer

On August 17, 2017, olaparib -(Lynparza) in tablet form was granted regular approval for maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to platinum-based chemotherapy.1,2 Olaparib...

solid tumors

First-Line Pembrolizumab in Cisplatin-Ineligible Advanced Urothelial Cancer

As reported in The Lancet Oncology by Arjun V. Balar, MD, of Perlmutter Cancer Center of New York York Langone Medical Center, and colleagues, first-line pembrolizumab (Keytruda) produced durable responses in cisplatin-ineligible patients with locally advanced and unresectable or metastatic...

supportive care
palliative care

Caring for the Frail, Older Patient With Cancer: Four Practical Approaches

Cancer may be a disease of aging, but data suggest that older patients with cancer are undertreated, especially with respect to chemotherapy. One analysis showed that approximately 40% of patients in their 70s—and 60% of patients in their 80s—do not receive adjuvant therapy after surgery for colon...

supportive care
palliative care

‘Triple Threat’ Conditions May Predict Mortality in Patients With Cancer Presenting to Emergency Departments

Dyspnea, delirium, and poor performance—so-called “triple threat” conditions—are known to predict short survival in palliative care. According to data presented at the 2017 Palliative and Supportive Care in Oncology Symposium,1 however, the presence of at least two of these symptoms in patients...

supportive care
palliative care

Concurrent Palliative Care: Recommendations From the ASCO Clinical Practice Guideline

Updated in 2016, the ASCO clinical practice guideline on the integration of palliative care into standard oncology care provides evidence-based recommendations to oncology clinicians, patients, family and friend caregivers, and palliative care specialists about providing high-quality care for...

The 27 NCCN Member Institutions

Fred & Pamela Buffett Cancer Center, Omaha Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland City of Hope Comprehensive Cancer Center, Duarte, California Dana-Farber/Brigham and Women’s Cancer...

hematologic malignancies
lymphoma
multiple myeloma

CAR T-Cell Therapy Makes Further Inroads in Lymphoma and Myeloma

With the recent U.S. Food and Drug Administration (FDA) approvals of two chimeric antigen receptor (CAR) T-cell products, this novel approach seems to be moving into the mainstream. The approvals were tisagenlecleucel (also known as CTL019; Kymriah) for the treatment of pediatric B-cell acute...

hematologic malignancies
multiple myeloma

Evidence-Based Support for Triplet Therapies in Multiple Myeloma

Over the past 15 years, multiple myeloma has garnered among the highest number of regulatory approvals by the U.S. Food and Drug Administration (FDA) for the management of all phases of the disease. This fast-expanding repertoire of treatment options has pushed the median survival of multiple...

issues in oncology
cost of care

ASCO Applauds New Report on Making Medicines Affordable

Today, ASCO President Bruce E. Johnson, MD, FASCO, released the following statement: “A report released today by the National Academies of Sciences, Engineering, and Medicine underscores the imperative our nation faces to address the affordability of drugs for medical conditions that have...

gynecologic cancers

Olaparib Tablets as Maintenance in BRCA1/2-Mutant Relapsed Ovarian Cancer

A phase III trial (SOLO2/ENGOT-Ov21) has shown improved progression-free survival with an olaparib tablet formulation vs placebo as maintenance therapy in patients with BRCA1/2-mutant platinum-sensitive relapsed ovarian cancer. These study results were reported by Eric Pujade-Lauraine, MD, of the...

prostate cancer

Bone-Targeted Therapies for Men With Prostate Cancer Receiving Androgen-Deprivation Therapy

Among men diagnosed with prostate cancer, about one in two will receive androgen-deprivation therapy, which is associated with many potential adverse side effects, including significant bone loss and increased risk for low trauma or fragility fractures similar to those found in people with primary ...

hematologic malignancies
breast cancer
lung cancer
lymphoma

FDA Approvals in November 2017: Novel Drugs, New Indications

THE U.S. FOOD AND DRUG ADMINISTRATION (FDA) approved a number of novel drugs and new indications in November 2017. Several of them are listed here.  Fulvestrant/Abemaciclib Combination in Breast Cancer  ON NOVEMBER 15 , the FDA approved fulvestrant (Faslodex) in combination with abemaciclib...

hepatobiliary cancer

Nivolumab in Hepatocellular Carcinoma Previously Treated With Sorafenib

ON SEPTEMBER 22, 2017, nivolumab (Opdivo) was granted accelerated approval for treatment of hepatocellular carcinoma in patients previously treated with sorafenib (Nexavar).1,2  Supporting Efficacy Data  APPROVAL WAS based on findings in a 154-patient subgroup of the CheckMate 040 trial consisting...

cns cancers

Gene Therapy Shows Early Efficacy Against Recurrent Brain Cancer

MORE THAN A QUARTER of patients with recurrent high-grade glioma treated with the retroviral vector Toca 511 and the prodrug of the chemotherapy fluorouracil (5-FU), Toca FC, were alive more than 3 years after treatment, according to data from a subset of patients in a phase I clinical trial, Toca ...

hematologic malignancies

Recent Study Findings in Hematologic Malignancies

HERE IS A BRIEF LOOK at the study findings and clinical implications of several recent and important clinical trials in neoplastic hematology. Attention is focused on clonal myeloid disorders, acute lymphoblastic leukemia, lymphoma, and plasma cell dyscrasias.  Clonal Myeloid Disorders  STUDY:...

solid tumors
lung cancer

Addressing Disparities in Use of Lung Cancer Screening With Community Outreach

African Americans and members of other communities of lower socioeconomic status have higher burdens of lung cancer mortality. Therefore, targeting underserved patient populations with lung cancer screening is of the utmost importance, according to Christopher Lathan, MD, MS, MPH, a medical...

solid tumors
breast cancer
issues in oncology
health-care policy

Health-Care Access Unlikely to Explain Racial/Ethnic Disparities in Breast Cancer Outcomes

Even with equivalent access to care, black patients with breast cancer may fare worse than white patients with breast cancer, according to Lawrence H. Kushi, ScD, Director of Scientific Policy at the Kaiser Permanente Northern California Division of Research in Oakland. “Accounting for...

solid tumors
breast cancer

Gene-Expression Assays in Early-Stage Breast Cancer: Who Should Order Them and When?

A deeper understanding of biology has allowed significant advances in the treatment of breast cancer. In the early-stage setting, standard pathology measures can help identify which subset of patients with hormone receptor–positive breast cancers are more likely to experience benefit from...

solid tumors
breast cancer

Surgeon-Initiated Gene-Expression Profile Testing in Early-Stage Breast Cancer Reduces Time to Start of Chemotherapy

In a single-center study reported in the Journal of Oncology Practice, Katya Losk, MPH, of Dana-Farber Cancer Institute, and colleagues found that an intervention including surgeon initiation of gene-expression profile testing with Oncotype DX significantly reduced the time to testing, receipt of...

supportive care
palliative care
cost of care
issues in oncology

Palliative Care Intervention Reduces Total Health-Care Costs in Patients With Advanced Cancer

A matched case-controlled study among Medicare beneficiaries with metastatic lung, colorectal, breast, and prostate cancers has found that palliative care consultation significantly reduced total health-care costs following intervention. According to data presented at the 2017 Palliative and...

supportive care
palliative care

Digital Palliative Care Curriculum Improves Knowledge, Skills, and Opioid Prescribing Behavior

A new electronic curriculum delivered via e-mail with push technology may provide an efficient, cost-effective solution to the shortage of palliative care faculty serving the nation’s oncology fellowship programs. According to data presented at the 2017 Palliative and Supportive Care in Oncology...

issues in oncology

Informed Consent and the Oncologist: Legal Duties to Discuss Costs of Treatment

For 50 years, clinicians in the United States have had a legal duty to disclose to patients with cancer the risks, benefits, and alternatives to a proposed cancer treatment. Until recently, however, it has been unclear whether clinicians have a similar duty to discuss the costs of that treatment....

supportive care
palliative care

Advancing Care Across the Cancer Continuum

Addressing the need to integrate palliative and supportive care practices into medical specialties to ensure optimal patient-centered care across the cancer continuum and the evidence-based remedies to accomplish that goal were the focus of the nearly 300 study abstracts presented at the 2017...

integrative oncology
symptom management

Cognitive Behavior Therapy for Insomnia: Sleeping Well With Cancer and Beyond

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, Sheila N. Garland, PhD, R Psych, and Jun J. Mao, MD, MSCE, present...

The Man in the Vest

It had been an uneventful Sunday morning, and I was writing my final note for the day, hopeful to make a stealth exit and perhaps join my family at church. But as I closed the chart and looked up, I saw Ruthie, my oncology fellow, approaching with a grim expression. “I just left the room of a...

skin cancer

Melanoma Mutations: What You Need to Know

CLINICIANS ARE now well acquainted with BRAF mutations in advanced melanoma, but there is more to genomics in this disease than identifying BRAF and prescribing a BRAF inhibitor.  At the 2017 Debates and Didactics Conference, held at Sea Island, Georgia, Melinda L. Yushak, MD, MPH, of Emory...

solid tumors
lung cancer

Brigatinib in Crizotinib-Pretreated Metastatic ALK-Positive Non–Small Cell Lung Cancer

On April 28, 2017, brigatinib (Alunbrig) was granted accelerated approval for the treatment of patients with metastatic anaplastic lymphoma kinase (ALK)-positive non–small cell lung cancer (NSCLC) who have had disease progression on or are intolerant to crizotinib (Xalkori).1,2 Supporting Efficacy...

solid tumors
lung cancer

Dabrafenib and Trametinib in BRAF V600E–Mutant Metastatic NSCLC

On June 22, 2017, regular approvals were granted to dabrafenib (Tafinlar) and trametinib (Mekinist) given in combination for the treatment of patients with metastatic non–small cell lung cancer (NSCLC) with BRAF V600E mutation as detected by a U.S. Food and Drug Administration (FDA)-approved...

solid tumors
breast cancer

Neratinib for Extended Adjuvant Treatment of Early-Stage HER2-Positive Breast Cancer

On July 17, 2017, neratinib (Nerlynx) a dual inhibitor of HER2 and epidermal growth factor receptor (EGFR), was approved for extended adjuvant treatment of adults with early-stage HER2-overexpressed/amplified breast cancer following adjuvant trastuzumab (Herceptin)-based therapy.1,2 Supporting...

solid tumors
breast cancer

Abemaciclib in Hormone Receptor–Positive, HER2-Negative Breast Cancer

On September 28, 2017, the cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitor abemaciclib (Verzenio) was approved for use in combination with fulvestrant (Faslodex) for women with hormone receptor–positive, HER2-negative advanced or metastatic breast cancer with disease progression following...

solid tumors
breast cancer

Gauging the Impact of Weight Loss Intervention on Breast Cancer Outcomes

“Growing research suggests that body weight is not only related to the risk of developing malignancy, but also prognosis after diagnosis, especially in breast cancer,” said Jennifer A. Ligibel, MD, of Dana-Farber Cancer Institute and Harvard Medical School, at the 19th Annual Lynn Sage Breast...

hematologic malignancies
lymphoma

Copanlisib in Relapsed Follicular Lymphoma

On September 14, 2017, copanlisib (Aliqopa) was granted accelerated approval for treatment of adult patients with relapsed follicular lymphoma who have received at least two prior systemic therapies.1,2 Supporting Efficacy Data Approval was based on durable responses observed in a multicenter phase ...

lung cancer

ESMO Asia 2017: Analysis of Mutations in Cerebrospinal Fluid in Lung Cancer With Brain Metastases

In a study presented at the European Society for Medical Oncology (ESMO) Asia 2017 Congress (Abstract 35P_PR), researchers analyzed the presence of mutations in the cerebrospinal fluid of patients with lung cancer and brain metastases. Tumor tissue from brain metastasis is difficult to obtain,...

hematologic malignancies
leukemia

Clinical Relevance of Minimal Residual Disease Monitoring Limited in Acute Myeloid Leukemia

Although a majority of major cancer centers may test for minimal residual disease (MRD), a recent survey conducted by researchers at Moffitt Cancer Center, Tampa, Florida, suggests most oncologists remain uncertain about what to do with the results. At the National Comprehensive Cancer Network®...

lymphoma

FDA Approves Brentuximab Vedotin for Primary Cutaneous Anaplastic Large Cell Lymphoma

Today, the U.S. Food and Drug Administration (FDA) granted regular approval to brentuximab vedotin (Adcetris) for the treatment of adult patients with primary cutaneous anaplastic large cell lymphoma (pcALCL) or CD30-expressing mycosis fungoides who have received prior systemic therapy. ALCANZA...

hematologic malignancies

FDA Approves Letermovir for Prophylaxis of Cytomegalovirus Infection and Disease in Allogeneic Stem Cell Transplant Patients

Today, the U.S. Food and Drug Administration (FDA) approved letermovir (Prevymis) once-daily tablets for oral use and injection for intravenous infusion. Letermovir is indicated for prophylaxis of cytomegalovirus (CMV) infection and disease in adult CMV-seropositive recipients of an allogeneic...

gynecologic cancers

ARIEL3 Investigators Clarify the Effects of Rucaparib on the Liver

PRIMARY RESULTS from the randomized, placebo-controlled, phase III study ARIEL3—presented at the European Society for Medical Oncology (ESMO) 2017 Congress and published recently in The Lancet1—demonstrated that maintenance treatment with the poly(ADP-ribose) polymerase (PARP) inhibitor rucaparib ...

issues in oncology

Worldwide Cancer Incidence and Mortality Among Persons Aged 20 to 39 in 2012

In a study reported in The Lancet Oncology, Fidler et al found that cancer burden was higher worldwide among women vs men aged 20 to 39 in 2012 and that the incidence was higher but mortality lower in very high vs low Human Development Index regions. Study Details The study involved data from the ...

Fall Wrap-Up: Research Community Forum and 2017 ASCO Advocacy Summit

ASCO Research Community Forum The ASCO Research Community Forum (RCF) Annual Meeting was held September 24–25, with the theme of Advancing Cancer Care Through Research Partnerships. The RCF Annual Meeting brings together ASCO leaders, regulatory experts, physician investigators, and research staff...

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