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issues in oncology

Can Whole-genome Sequencing Predict Cancer Risk and Improve Public Health?

If, as expected, the cost of whole-genome sequencing continues to drop, perhaps down to the $1,000 vicinity, it may become an alluring option for consumers who want to know about their risks for cancer and other diseases. But can genome sequencing really provide practical information about...

lymphoma

Radiotherapy in Early-stage Hodgkin Lymphoma

The treatment of patients with Hodgkin lymphoma is one of the major success stories in medical oncology. Depending on clinical stage, clinical risk factors, and the treatment given, 60% to 90% of all patients can be cured of their malignancy long-term. Hodgkin lymphoma survivors represent one of...

Tracing Breast Cancer Luminary’s Path to Oncology, from Hungary to Houston

Gabriel N. Hortobagyi, MD, FACP, ASCO Past President (2006-2007), grew up under the oppressive regime of communist Hungary during the Cold War. “As college-educated intellectuals, my family was among the ‘politically undesirables,’ and if we had not escaped Hungary, neither my two sisters nor I...

lymphoma

Multicenter Phase II Trial Supporting Approval of Brentuximab Vedotin in Anaplastic Large-cell Lymphoma

Systemic anaplastic large-cell lymphoma (ALCL) is an aggressive T-cell lymphoma subtype characterized by uniform expression of CD30. Apart from low- to intermediate-risk patients with ALK-positive disease, patients with ALCL have a poor prognosis when treated with conventional, anthracycline-based...

issues in oncology

Medical Ethicists Reflect on Their Personal Cancer Experiences

The recently published book, Malignant: Medical Ethicists Confront Cancer, takes a personal look at the cancer experience from the perspective of seven medical ethicists who were also patients with cancer or cared for spouses with cancer.1 The book’s editor, Rebecca Dresser, JD, MS, who teaches law ...

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. ...

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...

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...

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 ...

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...

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...

integrative oncology

Astragalus

The use of dietary supplements by cancer patients has risen significantly over the past 2 decades despite insufficient evidence of safety and effectiveness. Finding reliable sources of information about dietary supplements can be daunting. Patients typically rely on family, friends, and the...

breast cancer

Pertuzumab: New Drug for HER2-positive Metastatic Breast 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. Indication In June 2012, pertuzumab (Perjeta) was approved for use...

issues in oncology
health-care policy

As Conflicting Guidelines Evolve, Experts Continue to Debate the Merits of Cancer Screening

In the 1930s and 1940s, when the American Cancer Society [ACS] first brought forth the message that early cancer detection saves lives, it was a broad brushstroke and an appropriate message. The problem now is that new technology enables us to find [tumors that would never progress to invasive...

prostate cancer
issues in oncology

Rethinking the Role of PSA Screening in Public Health

Population screening to identify preclinical disease is considered a central factor in the decades-long decrease in mortality seen in certain cancers. However, hope in the face of deadly disease can sometimes blind us to the scientific evidence. According to the recent U.S. Preventive Services Task ...

Kidney Transplant Recipients Switching to Sirolimus Had Lower Risk of Secondary Squamous Cell Carcinomas

Kidney transplant recipients with at least one previous cutaneous squamous cell carcinoma decreased their risk of developing new cutaneous squamous cell carcinomas by switching from calcineurin inhibitors (cyclosporine or tacrolimus) to sirolimus (Rapamune) in a multicenter phase III study. New...

prostate cancer

Letter to the Editor: Dr. Ablin’s Reply

Given my explanation and widely publicized opinion on the improper use of the prostate-specific antigen (PSA) test for screening asymptomatic men for prostate cancer—most recently expressed in a feature article in The ASCO Post (August 15, 2012)—I was pleased to read that Drs. James Mohler and...

prostate cancer

Enzalutamide Significantly Prolonged Survival in Men with Castrate-resistant Metastatic Prostate Cancer

“Enzalutamide significantly prolonged the survival of men with metastatic castration-resistant prostate cancer after chemotherapy” in an international phase III, double-blind, placebo-controlled trial, investigators reported in The New England Journal of Medicine. Median overall survival, the...

supportive care
palliative care

Dying Patients with Cancer Who Avoid Aggressive Care but Stay Connected with an Oncologist Have Better Quality of Life

Dying patients with cancer who avoided hospitalizations and life-prolonging measures, who worried less, prayed or meditated, were visited by a pastor, and maintained a therapeutic alliance with their oncologist had the highest quality of life at the end of life, according to a study recently...

Expert Point of View: Fritz H. Schröder, MD

I am happy to accept the invitation by The ASCO Post to comment on the recent, long-awaited publication of the PIVOT study (Wilt et al: N Engl J Med 367:203-213, 2012) and the accompanying editorial by Thompson and Tangen (N Engl J Med 367:270-271, 2012). The editorial both points out weaknesses of ...

prostate cancer
issues in oncology

No Survival Benefit of Radical Prostatectomy vs Observation for Localized Prostate Cancer Detected by PSA Testing

The relative benefits of surgery or observation in men with prostate cancer detected by prostate-specific antigen (PSA) testing have not been defined. Randomized trials comparing radical prostatectomy with observation were conducted before widespread use of PSA testing and an observational study...

Contagious Cancer and an Unexplained Phenomenon Might Inspire Future Therapies

A deadly contagious cancer known as devil facial tumor disease is pushing the world’s largest carnivorous marsupial, the Tasmanian devil (Sarcophilius harrisii), to the brink of extinction. The loss of an interesting creature aside, the plight of the Tasmanian devil raises provocative questions...

lymphoma

Management of a Patient with Relapsed and Refractory Hodgkin Lymphoma

Case Summary presented by Andreas Engert, MD, Chairman, German Hodgkin Study Group, University Hospital of Cologne, Cologne, Germany This is a case report of a 23-year-old female patient who was diagnosed with Hodgkin lymphoma in January 2009. She received two cycles of ABVD (doxorubicin,...

lymphoma

ABVD and BEACOPP Yield Equivalent Survival in Hodgkin Lymphoma

In the EORTC 20012 randomized phase III trial comparing eight cycles of ABVD vs eight cycles of BEACOPP, Hodgkin lymphoma patients achieved equivalent overall survival with either regimen, but BEACOPP was more toxic.1 “Our approach, and that of most U.S. centers, is to use ABVD,” Michael E....

SIDEBAR: Does Lapatinib Prevent CNS Metastases in HER2-positive Breast Cancer?

Lapatinib has shown some efficacy against existing brain metastases in patients with HER2-positive breast cancer but not in preventing them in the first place, according to Hope S. Rugo, MD, Professor of Medicine and Director, Breast Oncology and Clinical Trials Education at the UCSF Helen Diller...

New Therapies Capitalize on Lung Cancer’s Molecular Vulnerabilities

Research reported at this year’s ASCO Annual Meeting attests to the tremendous molecular diversity of non–small cell lung cancer (NSCLC) and the power of appropriately selected treatment, according to Leora Horn, MD, of Vanderbilt University Medical Center, who presented data on molecular findings...

integrative oncology

Antioxidant Supplementation in Patients with Cancer: Is It Safe and Effective?

Antioxidant supplements are widely used by healthy individuals as a preventive measure against cancer and heart disease and by patients with cancer to promote healing and prevent recurrence. Studies suggest that dietary supplements are used by up to 81% of cancer survivors, and that 14% to 32%...

issues in oncology

Tweeting at ASCO Annual Meetings Can Enhance the Experience

Tweeting at concerts or plays may earn you scornful looks or even stern warnings from ushers, but tweeting at the ASCO Annual Meeting may enhance the meeting experience for you and others. In a study comparing trends in Twitter use by physicians during the 2010 and 2011 ASCO Annual Meetings, some...

prostate cancer

Enzalutamide for Metastatic Castrate-resistant Prostate 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. Indication In August 31, enzalutamide (Xtandi) was approved for the ...

prostate cancer

Hormonal Therapy with Enzalutamide Increases Survival in Castrate-resistant Prostate Cancer after Chemotherapy

The androgen receptor–signaling inhibitor enzalutamide (Xtandi) is reported to differ from conventional antiandrogen agents in that it inhibits androgen receptor nuclear translocation, DNA binding, and coactivator recruitment, has a greater affinity for the androgen receptor, and induces tumor...

Pediatric Pathologist Sidney Farber, MD: The ‘Father of Modern Chemotherapy’ and Cofounder of the Jimmy Fund

In June 3, 1948, The New England Journal of Medicine published a study by Sidney Farber, MD, showing that a synthetic compound, 4-aminopteroylglutamic acid (aminopterin), could induce remissions in seriously ill children with acute leukemia.1 Although the study was small—just 16 children—10 showed...

breast cancer

Anthracycline Use Steadily Declining in Early Breast Cancer Population

Anthracycline use in early-stage breast cancer has been steadily declining, especially for patients with stage I/II or HER2-positive disease, according to an analysis of patients treated at the University of California, San Francisco (UCSF) School of Medicine.1 Treatment Alternatives Lead author...

breast cancer

Feminist Author Babette Rosmond Helped Propel the Adoption of Patients’ Rights to Choose Their Cancer Treatment

Then writer and editor Babette Rosmond was diagnosed with breast cancer in 1971, the second wave of the Women’s Liberation Movement that began in the mid-1960s was in its infancy. Still, when told by her doctor that she would need a radical mastectomy—a procedure developed by William Stewart...

supportive care
pain management

SIDEBAR: Don’t Expect Direct Questions from Patients about Pain

Just asking patients “Is there something else you want to address in the visit,” rather than “Is there anything else you want to address in the visit today,” dramatically reduced patients’ unmet concerns during a primary care visit, according to a 2007 study.1 That learning can be applied to...

supportive care
pain management

Pain Remains Prevalent among Oncology Outpatients, with Odds of Undertreatment Twice as High among Minority Patients

In 1994, a landmark study of pain among oncology outpatients prompted a host of pain management initiatives.1 More than 18 years later, a recent study among more than 2,000 cancer outpatients has found that “one-third of the patients who had pain or used analgesics received inadequate treatment for ...

skin cancer

Vismodegib: Novel Agent for Treating Advanced Basal Cell Carcinoma

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. Indication In January 2012, vismodegib (Erivedge) was approved...

breast cancer

One Year of Trastuzumab Remains the Standard of Care in HER2-positive Breast Cancer

For HER2-positive early breast cancer, 1 year of treatment with trastuzumab (Herceptin)—rather than 6 months or 2 years—remains the standard of care, based on two pivotal studies presented at the 2012 European Society for Medical Oncology (ESMO) Congress. The optimal duration of anti-HER2 adjuvant ...

Ignoring Level 1 Evidence in Invasive Bladder Cancer: Is Ignorance Bliss?

I’ve been part of the uro-oncology community for more than 30 years and have been proud to be involved in a good number of well-powered, enthusiastically subscribed randomized clinical trials. These have dated back to a time before randomization was necessarily the fashion. I have had the pleasure...

skin cancer

Combination of BRAF and MEK Inhibitors Paves Way for Phase III Studies in BRAF-mutated Metastatic Melanoma

Two late-breaking studies presented at the 2012 European Society for Medical Oncology (ESMO) Congress highlight the promising potential of combining dual BRAF and MEK inhibitors for the treatment of BRAF-mutated metastatic melanoma. A phase II study showed that combining full doses of the BRAF...

2012-2013 Oncology Meetings

November 2012 AACR-NCI-EORTC Molecular Targets and Cancer TherapeuticsNovember 12-16 • San Francisco, California For more information: www.aacr.org Connective Tissue Oncology Society 17th Annual MeetingNovember 14-17 • Prague, Czech Republic For more information: www.ctos.org Controversies in the...

issues in oncology

Media Campaign with Real Smokers a Success

Real smokers sharing in graphic terms what it is like to live with disfiguring or disabling tobacco-related diseases were the featured spokespersons for the Centers for Disease Control and Prevention (CDC) national media campaign to encourage smokers to quit. Based on short-term response, the CDC...

Strong Association Increasingly Recognized Between Obesity and Cancer Incidence/Poor Prognosis

The rise in obesity in the United States coincides with greater recognition of the role of obesity in cancer and other diseases.1 While decades of research have indicated a strong association between obesity and cancer, “several forces have made that association increasingly recognized,” according...

Conquer Cancer Foundation of ASCO Honors Researchers for Work in Measuring and Improving Quality of Cancer Care

The Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO) recently announced the first-ever recipients of its Quality Care Symposium Merit Awards. This year’s recipients will be recognized at ASCO’s inaugural Quality Care Symposium, taking place November 30 and December 1 in ...

integrative oncology

Dong Quai

Scientific Name: Angelica sinensis Common Names: Chinese angelica, dang gui, tang kuei, tan kue Overview Dong quai is a perennial herb indigenous to China, Japan, and Korea. Its root has been used for centuries as a spice, tonic, and medicine. Dong quai is mentioned in Shen Nong Ben Cao Jing, the...

Ruxolitinib: Novel Drug for Myelofibrosis

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. Indication In November 2011, ruxolitinib (Jakafi) was approved for...

Intermittent Androgen Suppression in Prostate Cancer Noninferior to Continuous Suppression, Associated with Some QOL Benefit

A recently reported National Cancer Institute of Canada (NCIC) Clinical Trials Group study, reported by Crook and colleagues in The New England Journal of Medicine, showed that intermittent androgen suppression was associated with noninferior overall survival when compared with continuous...

Expert Point of View: Fausto Roila, MD

Thromboprophylaxis for patients with a central venous catheter is at present not recommended by the international oncologic associations. This is based on the results of four recent randomized controlled trials, three of them double-blind, in which there was no statistically significant difference...

Trastuzumab Emtansine Improves Survival vs Capecitabine plus Lapatinib in Second-line HER2-positive Breast Cancer

Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate composed of trastuzumab bound to the cytotoxic microtubule inhibitor emtansine (DM1, derivative of maytansine) by a stable linker. Trastuzumab targets the conjugate to HER2 receptors, and the linker releases the cytotoxic agent when the...

SIDEBAR: Mammography Study Stokes Overdiagnosis Debate

Overdiagnosis and the harms associated with unnecessary procedures is becoming a vibrant subject in today’s health-care dialogue, with serious implications for providers and patients alike. A new study from the Norwegian Screening Program concluded that 15% to 25% of breast cancers identified on...

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