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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...

2017 Palliative Care in Oncology Symposium

The 2017 Palliative Care in Oncology Symposium took place October 27–28 in San Diego. Photos shown here, from left to right, as follows: 1. Eduardo Bruera, MD, of The University of Texas MD Anderson Cancer Center leads a group of attendees on a poster walk and discussion; 2. Charles Loprinzi, MD,...

solid tumors

Factors Associated With Outcome in Pediatric Adrenocortical Tumors

In a St. Jude Adrenocortical Tumor Registry and Children’s Oncology Group study reported in the Journal of Clinical Oncology, Pinto et al found that a positive Ki67 labeling index was associated with a poorer outcome in children with adrenocortical tumors independent of germline TP53 mutation ...

multiple myeloma

ENDEAVOR Trial Endeavors to Make Case for Carfilzomib: Despite Survival Advantage, Should We Be Surprised?

LOCATION! LOCATION! LOCATION! That’s what home buyers are frequently cautioned about before purchasing a property. For trialists, and more importantly, practicing oncologists, a study’s design, akin to a property’s location, must be taken into account prior to buying into the results and changing ...

multiple myeloma

Results From Phase III ARROW Study of Once-Weekly Carfilzomib in Relapsed/Refractory Multiple Myeloma

On October 23, topline results of the phase III ARROW trial were announced, showing carfilzomib (Kyprolis) administered once weekly at 70 mg/m2 with dexamethasone allowed relapsed and refractory multiple myeloma patients to live 3.6 months longer without their disease worsening than...

lung cancer

2-Year Survival Outcomes With Immunotherapy in Advanced NSCLC

Analysis of 2-year overall survival with nivolumab (Opdivo) vs docetaxel in the phase III CheckMate 017 and 057 trials showed a continued survival benefit with nivolumab in patients with previously treated advanced non–small cell lung cancer (NSCLC). The findings were reported by Horn et al...

prostate cancer

Combination Therapy for Docetaxel-Pretreated Metastatic Castration-Resistant Prostate Cancer

The phase III AFFINITY trial has shown no survival benefit with the addition of the antisense oligonucleotide custirsen to cabazitaxel (Jevtana)/prednisone in patients with metastatic prostate cancer previously treated with docetaxel. These findings were reported in The Lancet Oncology by Beer et...

hematologic malignancies

Anti–T-Lymphocyte Globulin and Chronic GVHD-Free Survival in Unrelated Myeloablative HCT

A double-blind phase III trial has shown no benefit of anti–T-lymphocyte globulin (ATLG) vs placebo on chronic graft-vs-host disease (GVHD)-free survival in patients undergoing human leukocyte antigen (HLA)-matched unrelated myeloablative hematopoietic cell transplantation (HCT). The study...

palliative care

2017 ASCO Palliative Care: Resilience Intervention Improves Quality of Life for Adolescents and Young Adults With Cancer

Although a cancer diagnosis is daunting at any age, adolescents and young adults (AYAs) with the disease often face unique challenges and are at risk for poor psychosocial outcomes than older patients. A randomized study investigating whether a brief, age-appropriate, skills-based intervention...

kidney cancer

Enhancer of Zeste Homolog 2 Expression and Prognosis in Localized Renal Cell Carcinoma

As reported in the Journal of Clinical Oncology, Ho et al found that tumor-based enhancer of zeste homolog 2 (EZH2) gene or protein expression was independently predictive of prognosis in localized clear cell renal cell carcinoma. EZH2 is a chromatin remodeler implicated in the pathogenesis of...

multiple myeloma

Carfilzomib May Be a Strong Candidate for Salvage Therapy in Relapsed/Refractory Multiple Myeloma—but Questions Remain

WITH THE INCLUSION of proteasome inhibitors and immunomodulatory agents first into salvage and then as components of first-line, consolidation, and maintenance regimens, response rates, depth of response, and median progression-free and overall survival have all improved for patients suffering...

multiple myeloma

Carfilzomib Improves Overall Survival vs Bortezomib in Relapsed/Refractory Multiple Myeloma

AT A PRESPECIFIED interim analysis, the phase III ENDEAVOR trial has shown a significant overall survival benefit for carfilzomib (Kyprolis) vs bortezomib (Velcade) in patients with relapsed/refractory multiple myeloma, as reported by Meletios A. Dimopoulos, MD, of the National and Kapodistrian...

skin cancer

Regional Radiation Therapy Reduces Risk of Regional Recurrence in Node-Positive Cutaneous Melanoma

IN A LARGE single-institution study reported in the Journal of the National Comprehensive Cancer Network, Tobin Strom, MD, and colleagues found that regional radiotherapy was associated with a reduced risk of regional recurrence in patients with node-positive cutaneous melanoma, including those...

lung cancer

No Progression-Free Survival Benefit With First-Line Nivolumab vs Chemotherapy in Advanced PD-L1–Positive NSCLC

AS REPORTED BY David P. Carbone, MD, PhD, of The Ohio State University Comprehensive Cancer Center, Columbus, and colleagues in The New England Journal of Medicine, the phase III CheckMate 026 trial has shown no progression-free survival benefit for first-line nivolumab (Opdivo) vs platinum-based...

lung cancer

Phase III Trial Shows No Survival Benefit to Adding First-Line Ipilimumab to Chemotherapy in Advanced Squamous NSCLC

IN A PHASE III trial reported by Ramaswamy Govindan, MD, of Washington University School of Medicine, and colleagues in the Journal of Clinical Oncology, the addition of first-line ipilimumab (Yervoy) to paclitaxel/carboplatin did not improve overall survival in patients with advanced squamous...

skin cancer

Nivolumab Treatment Beyond Disease Progression in Advanced Melanoma

In a retrospective analysis reported in JAMA Oncology, Georgina V. Long, MBBS, PhD, of the Melanoma Institute Australia, North Sydney, and colleagues found that a substantial proportion of patients with advanced melanoma derived benefit from continued nivolumab (Opdivo) treatment after Response...

solid tumors
breast cancer

Breast Cancer Has Changed Me, But the Change Has Been Positive

I’ve always had dense breasts and avoided doing breast self-exams because I couldn’t tell if the lumpiness I was feeling was something serious or merely normal fibrous tissue. Instead I relied on my yearly mammogram to spot any early signs of cancer. Four years ago, I was once again relieved to...

Patient-Physician Communication and Quality of Life Featured at 2017 Palliative and Supportive Care in Oncology Symposium

NEW RESEARCH examining patient-physician communication, yoga as supportive care, and psychosocial support for people with cancer will be featured at the 2017 Palliative and Supportive Care in Oncology Symposium on October 27–28, 2017, in San Diego. Featured sessions include randomized trials on...

ASCO Recognizes New Jersey Representative Leonard Lance With Congressional Leadership Award

ASCO HAS PRESENTED Representative Leonard Lance, of New Jersey’s 7th district, with its second annual Congressional Leadership Award in recognition of the lawmaker’s exceptional commitment to supporting cancer research and treatment. ASCO President Dr. Bruce Johnson presented the award to...

23 ASTRO Members Awarded Fellows Designation

The American Society for Radiation Oncology (ASTRO) has selected 23 distinguished members to receive the ASTRO Fellow designation. The 2017 class of Fellows was recognized during the Awards Ceremony at ASTRO’s 59th Annual Meeting, which was held September 24–27 in San Diego. The Fellows Program,...

solid tumors

Immunotherapy Plus Radiation Appears Active in Patients With Solid Tumors and Lung or Liver Metastases

THE NOVEL COMBINATION of immunotherapy with ipilimumab (Yervoy) plus radiation achieved a clinical benefit in up to 57% of patients with solid tumors and metastases to the lungs or liver, according to evidence from a phase II trial presented at the 2017 Annual Meeting of the American Society for...

issues in oncology

Smashing the Glass Ceiling in Medicine

IT IS A SAD TRUTH that academic medicine, like many other professions, has a glass ceiling that hampers its ambitions. In medicine, this glass ceiling blocks women and minority faculty from reaching the highest ranks of leadership. Even if the root cause is not yet known, we want to eliminate...

lung cancer

IASLC 2017: Poziotinib Yields High Response Rates in Patients With NSCLC With EGFR Exon 20 Insertion

A targeted therapy studied at The University of Texas MD Anderson Cancer Center has produced high response rates among patients with metastatic non–small cell lung cancer (NSCLC) that carries a highly treatment-resistant mutation. Preliminary results were presented at the International...

supportive care
integrative oncology

Melatonin

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, Ting Bao, MD, DABMA, MS, and Jyothirmai Gubili, MS, present information on...

gastrointestinal cancer

Immunotherapy for Previously Treated Advanced Gastric Cancer

In an Asian phase III trial (ONO-4538-12, ATTRACTION-2) reported in The Lancet, Kang et al found that nivolumab (Opdivo) produced an improvement in overall survival vs placebo in patients with advanced gastric or gastroesophageal junction cancer who had disease refractory to or who were intolerant...

lung cancer

IASLC 2017: Lorlatinib in ALK-Positive and ROS1-Positive Advanced Non–Small Cell Lung Cancer

At the International Association for the Study of Lung Cancer (IASLC) 18th World Conference on Lung Cancer in Yokohama, Japan, Pfizer announced full results from the phase II clinical trial of the investigational, next-generation tyrosine kinase inhibitor lorlatinib. The agent exhibited clinically...

lung cancer

Addition of EGFR Tyrosine Kinase Inhibitor to Chemotherapy in Resistant Non–Small Cell Lung Cancer

As reported by Mok et al in the Journal of Clinical Oncology, overall survival analysis of the phase III IMPRESS trial indicated a poorer outcome when adding gefitinib (Iressa) vs placebo to chemotherapy after disease progression on first-line gefitinib in epidermal growth factor receptor...

bladder cancer

First-Line Immunotherapy for Cisplatin-Ineligible Patients With Advanced Urothelial Cancer

As reported in The Lancet Oncology by Balar et al, first-line pembrolizumab (Keytruda) produced durable responses in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer in the phase II KEYNOTE-052 trial. The trial supported the accelerated approval...

breast cancer

Initial Treatment With CDK4/6 Inhibitor and Aromatase Inhibitor for Advanced Breast Cancer

As reported in the Journal of Clinical Oncology by Goetz et al, an interim analysis in the phase III MONARCH 3 trial has shown a significant progression-free survival benefit with the addition of the cyclin-dependent kinase (CDK) 4/6 inhibitor abemaciclib (Verzenio) to a nonsteroidal aromatase...

colorectal cancer

Nivolumab in Advanced DNA Mismatch Repair–Deficient or Microsatellite Instability–High Colorectal Cancer

THE PHASE II CHECKMATE 142 TRIAL has shown that nivolumab (Opdivo) produces durable responses in previously treated recurrent or metastatic DNA mismatch repair–deficient (dMMR)/ microsatellite instability–high (MSI-H) colorectal cancer. These study findings were reported in The Lancet Oncology...

hepatobiliary cancer

FDA Grants Accelerated Approval to Nivolumab for Hepatocellular Carcinoma Previously Treated With Sorafenib

ON SEPTEMBER 22, 2017, the U.S. Food and Drug Administration (FDA) granted accelerated approval to nivolumab (Opdivo) for the treatment of hepatocellular carcinoma in patients who have been previously treated with sorafenib (Nexavar).  CheckMate 040  APPROVAL WAS BASED on a 154-patient subgroup of ...

kidney cancer

Nivolumab Plus Ipilimumab vs Sunitinib Alone as First-Line Therapy for Metastatic Renal Cell Carcinoma

A CHANGE IN PARADIGM may be on the horizon for the treatment of metastatic renal cell carcinoma. According to the results of CheckMate 214, the combination of ipilimumab (Yervoy) plus nivolumab (Opdivo) outperformed the standard of care—sunitinib (Sutent)—for first-line treatment, with improved...

gastrointestinal cancer

Addition of MET Inhibitor to First-Line Chemotherapy in Advanced Gastric Cancer

The phase III RILOMET-1 trial showed no survival benefit of adding the MET inhibitor rilotumumab to first-line epirubicin, cisplatin, and capecitabine in patients with advanced MET-positive gastric or gastroesophageal junction adenocarcinoma. These results were reported in The Lancet Oncology by...

solid tumors
breast cancer

Adjuvant Pertuzumab in HER2-Positive Breast Cancer: Value Yet to Be Demonstrated

The ASCO Post issue of June 25, 2017, did an excellent job of summarizing the results and controversy generated by the initial results of the APHINITY trial, reported at the 2017 ASCO Annual Meeting and published simultaneously online in The New England Journal of Medicine.1 With a median follow-up ...

issues in oncology
health-care policy
legislation

Cancer Policy Priorities Front and Center on Capitol Hill

On September 27 and 28, more than 100 ASCO volunteers headed to Capitol Hill to participate in the 2nd Annual ASCO Advocacy Summit. During the Summit, advocates met with members of Congress and staff to educate them on critical issues affecting patients and providers and to encourage policymakers...

health-care policy

ASTRO 2017: Uninsured Patients With Cancer Saw Increased Coverage for Care Following Medicaid Expansion

A new study found that Medicaid expansion enacted as part of the Patient Protection and Affordable Care Act (ACA) improved coverage for care for patients with cancer receiving radiation therapy and potentially decreased health-care disparities. Analysis of more than 197,000 patient records from one ...

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