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Showing 2151 - 2200More Prudent Interpretation of Thyroid Ultrasound Could Reduce Unnecessary Biopsies
Thyroid ultrasound imaging could be used to identify patients who have a low risk of thyroid cancer for whom biopsy could be deferred, according to a retrospective case-control study reported in JAMA Internal Medicine. Reviewing 11,618 thyroid ultrasound imaging examinations from 8,806 patients...
Preventing Tobacco Use in Children
The U.S. Preventive Services Task Force recently released its final recommendation statement on primary care interventions to prevent tobacco use in children and adolescents.1 The Task Force recommends that primary care clinicians provide interventions, including education or brief counseling, to...
Tackling Overdiagnosis and Overtreatment, by Words and by Deeds
The complexity of the pathologic condition called cancer,” according to a Viewpoint article in the Journal of the American Medical Association,1 “complicates the goal of early diagnosis.” Failure to recognize that cancers are heterogeneous, and that not all progress to metastases and death, can...
The BEATRICE Study: Where Does Targeting Breast Cancer Vasculature Stand in 2013?
Antiangiogenic strategies using the anti–vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab (Avastin) gained traction in breast cancer with the publication of the Eastern Cooperative Oncology Group (ECOG) 2100 trial in 2007. That study demonstrated a progression-free survival ...
Undertreatment of Cancer Pain Remains a Persistent Problem in Oncology
Data indicate that for more than 2 decades, cancer pain has been undertreated in the United States. The paradox of this stubborn clinical problem is that oncology has the ability to manage the great majority of cancer pain. To clarify this issue, The ASCO Post recently spoke with nationally...
Herb-Drug Interactions in Oncology
Guest Editor Integrative Oncology is guest edited by Barrie R. Cassileth, MS, PhD, Chief of the Integrative Medicine Service and Laurance S. Rockefeller Chair in Integrative Medicine at Memorial Sloan-Kettering Cancer Center, New York. The Integrative Medicine Service at Memorial Sloan-Kettering...
ALSYMPCA Trial: Updated Analysis of Survival With Radium-223 Treatment in Metastatic Prostate Cancer
In a trial (ALSYMPCA trial) reported in The New England Journal of Medicine, Chris Parker, MD, from Royal Marsden Hospital in Surrey, UK, and colleagues compared the alpha emitter radium-223 dichloride (Xofigo) with best standard of care in men with castration-resistant prostate cancer and bone...
Progression-Free Survival With Pazopanib Not Inferior to Sunitinib Benefit in Metastatic Renal Cell Carcinoma
Pazopanib (Votrient) and sunitinib (Sutent) have been shown to provide progression-free survival benefit compared with placebo or interferon in phase III trials in metastatic renal cell carcinoma. In a noninferiority trial reported in The New England Journal of Medicine by Robert J. Motzer, MD, of...
More Active Physician Intervention Needed to Keep Patients From Smoking
More active support and interventions by physicians are required to get patients who still smoke to stop, according to two articles published online by the Journal of Oncology Practice (JOP),1,2 and to prevent school-aged children and adolescents from starting to use tobacco, according to a U.S....
Contemporary Studies Dispute Findings of Radiation-Induced Cardiotoxicity
At the 2013 Breast Cancer Symposium, studies suggested that with current radiotherapy techniques the mean radiation doses to the heart are much lower—and thus radiotherapy is presumably much safer—than findings suggested by an article published in The New England Journal of Medicine last spring.1...
Breast Cancer Radiotherapy and Cardiotoxicity: What Is the True Risk?
Evidence has long been accumulating that radiotherapy involving the heart can result in premature ischemic heart disease, but interest peaked last spring when a case control study published in The New England Journal of Medicine1 found an increased risk for cardiac-related deaths in breast cancer...
Calcium Channel Blockers Linked to Increased Risk of Lobular/Ductal Breast Cancer
Women who are currently using calcium channel blockers and have been doing so for 10 or more years are at increased risk of the two most common histologic types of breast cancer, invasive ductal carcinoma and invasive lobular carcinoma, according to a population-based case control study. “While...
Better Risk Communication Strategies Needed to Ensure Decision to Have Contralateral Prophylactic Mastectomy Is Evidence-Based
Overestimating the risk that cancer in one breast will affect the other breast may cause many young women with breast cancer to choose contralateral prophylactic mastectomy even though most know it does not clearly improve survival. In a survey of 123 women who were diagnosed with cancer in one...
Lung Cancer Screening: Actionable Evidence
This recent paper in The New England Journal of Medicine outlines the details of the clinical outcomes with two incidence screens that were conducted as part of the National Lung Screening Trial (NLST).1 In the wake of the positive review of the U.S. Preventive Services Task Force (USPSTF) draft...
Low-Dose CT Screening Identifies More Early Lung Cancer but Has Lower Positive Predictive Value vs Radiography
Results of the two rounds of annual incidence screening with low-dose computed tomography (CT) vs radiography in the National Lung Screening Trial (NLST) were recently reported by Denise R. Aberle, MD, Professor of Radiology and Bioengineering at the University of California at Los Angeles and...
Aspirin Protects Against Colorectal Cancer Recurrence in PIK3CA-Mutant Tumors
At the 2013 European Cancer Congress, two investigative teams attempted to explain how aspirin may protect against colorectal cancer recurrences, with one study showing PIK3CA mutations associated with protection from aspirin, but not a COX-2 inhibitor, and the other study implicating HLA class I...
Optimizing Anti-HER2 Treatment for Metastatic Breast Cancer in 2013
The good news about HER2-positive breast cancer is that recurrent disease is plummeting, owing to the impact of adjuvant trastuzumab [Herceptin]. Hopefully, first-line metastatic treatment is becoming a thing of the past,” said Harold Burstein, MD, PhD, of Dana-Farber Cancer Institute, Boston....
The Power of Human Attachment
For those patients with cancer who may be single, widowed, separated, or divorced, those for whom a natural social support system may be weak, the role of the cancer support group should not be overlooked. In leading a previous trial of supportive-expressive group therapy as a key pathway to foster ...
Omega-3
Common Name: Polyunsaturated fatty acids (PUFAs) Brand Names: Omegaven, Max-EPA The use of dietary supplements by patients with cancer has increased significantly over the past 2 decades despite insufficient evidence of safety and effectiveness. Finding reliable sources of information about...
Yoga to Manage Sleep Disruption in Cancer Survivors: A Low-Risk Intervention With High Potential for Benefit
Impaired sleep quality is a concerning problem for many patients with cancer, and pharmacologic treatments come with many negative effects. Several small studies indicate that yoga improves persistent fatigue, sleep disturbance, anxiety, and quality of life, in addition to reducing the need for...
Evidence-Based Opportunity to Personalize Breast Cancer Risk: The Data Are Building
The worldwide data from prospective studies of the relationship between levels of endogenous sex hormones and breast cancer risk in postmenopausal women show multiple and complex relationships.1 Nine prospective studies (different from those reported here) of women not taking exogenous sex hormones ...
Illness Is Personal!
For clinicians and health service researchers striving to improve care for people living with life-threatening conditions, September was a sobering month. The Dartmouth Atlas group released a brief report on Trends in Cancer Care Near the End of Life1 showing that while the proportion of patients...
Finasteride for Prostate Cancer Prevention: Long-Term Results Disappointing but Reassuring
All medical care should seek to achieve one or more of three goals: to relieve suffering, to prevent future suffering, or to prolong life. Care for cancer is no exception, and minimizing suffering from cancer and prolonging life has primarily resulted from advances in treatment. Although there are...
No Difference in Long-Term Survival With Finasteride or Placebo in the Prostate Cancer Prevention Trial
In the Prostate Cancer Prevention Trial (PCPT), initially reported in 2003, finasteride significantly reduced the risk of prostate cancer by 24.8% but was associated with a relative 26.9% increase in risk of high-grade disease compared with placebo. In a study reported in The New England Journal of ...
Neoadjuvant Treatment of Early Breast Cancer
INSIDE THE BLACK BOX is an occasional column providing insight into the FDA and its policies and procedures. In this first installment, FDA Clinical Reviewers Laleh Amiri-Kordestani, MD, and Suparna Wedam, MD, discuss FDA’s recent approval of pertuzumab (Perjeta) for the neoadjuvant treatment of...
Brivanib Fails to Live Up to the Promise of Early Studies
Hepatocellular carcinoma is a devastating disease worldwide. Although advances in liver transplantation, surgery, and locoregional therapies have made tumor control or even cure possible for a minority of patients, the majority of patients diagnosed with hepatocellular carcinoma will develop...
Long-Term Colorectal Cancer Incidence and Mortality After Lower Endoscopy
Colonoscopy and sigmoidoscopy have been shown to provide protection against colorectal cancer, but the magnitude and duration of protection, particularly against proximal colon cancer, remain undefined. A study of long-term colorectal cancer incidence and mortality after lower endoscopy reported in ...
Two Trials Explore the Evolving Role of Bevacizumab in Ovarian Cancer
The optimal use of bevacizumab (Avastin) in ovarian cancer appears to be in high-risk subgroups and in patients with platinum-resistant ovarian cancer, according to results of two phase III trials presented at the 2013 European Cancer Congress (ECC) in Amsterdam. AURELIA investigated the safety and ...
'Reasonable but Not Required' for Women With BRCA Mutations to Have Hysterectomy Concurrent With Salpingo-Oophorectomy
For women with BRCA1 or BRCA2 mutations who choose to have salpingo-oophorectomy to reduce their risks of ovarian and breast cancer, also choosing to have a hysterectomy is “reasonable but not required,” noted Noah D. Kauff, MD, Director of the Ovarian Cancer Screening and Prevention Program and...
Where Is Adjuvant Bisphosphonate Therapy Now?
The adjuvant use of bisphosphonates in breast cancer continues to yield seemingly contradictory data despite a sound biologic basis and smaller pilot studies suggesting that dampening bone turnover with bisphosphonates can lessen the bone reservoir of micrometastases.1,2 Early adjuvant trials with...
Has a New Standard of Care for Metastatic Pancreatic Cancer Been Established?
For a number of years following the approval of gemcitabine for advanced pancreatic cancer, one phase III clinical trial after the next failed to demonstrate a survival benefit of combination chemotherapy compared to gemcitabine alone. Even the one positive study from the mid-2000s—the PA.3 trial...
Addition of Nab-Paclitaxel to Gemcitabine Improves Survival in Previously Untreated Metastatic Pancreas Cancer
In a phase III trial reported in The New England Journal of Medicine, Daniel D. Von Hoff, MD, of Translational Genomics Research Institute in Phoenix, and colleagues assessed the addition of albumin-bound paclitaxel (nab-paclitaxel [Abraxane]) to gemcitabine in patients with previously untreated...
Long-Term CONKO-001 Results: Adjuvant Therapy Improves Survival
From 12% to 15% of the approximately 45,000 patients diagnosed with pancreas adenocarcinoma undergo a potentially curative resection each year in North America, translating into roughly 5,000 to 7,000 patients who are candidates for adjuvant therapy. About 80% of these patients will relapse and...
Time to Think Beyond KRAS in Metastatic Colorectal Cancer
Eric Van Cutsem, MD, PhD, Professor of Internal Medicine at the University of Leuven in Belgium, told attendees at the 2013 European Cancer Congress that in the management of metastatic colorectal cancer, it is time to expand KRAS testing to include more rare mutations. Until recently, KRAS status...
What Does ‘Myeloma’ Mean?
Over the centuries it has become clear that, as physicians, what we say and how we say it can have a major impact on those who seek our help. Our pronouncement that a patient is in remission or harbors a serious illness carries with it a large number of spoken and unspoken implications. So when we...
Using Life Expectancy, Not Age, to Make Cancer Screening Decisions Can Maximize Potential Benefits
Using life expectancy, rather than chronologic age, to inform decisions about whether to continue cancer screening for older persons can maximize the potential benefits of screening, while minimizing the harms, according to results of a population-based cohort study of 407,749 people over 66...
SIDEBAR: Expect Questions From Patients
Not discussing the costs of medical interventions could result in “financial toxicity” for patients who have trouble paying out-of-pocket costs, as well as problems adhering to expensive treatment regimens. “The problem is perhaps starkest in cancer care, but it applies to all complex illness,”...
Disclosing Medical Costs Can Help Avoid 'Financial Toxicity'
High costs of cancer treatments can be an “undisclosed toxicity” that can harm a patient’s overall health and well-being, according to an article in The New England Journal of Medicine.1 High medical bills can not only cause stress and anxiety but may also compel patients to cut back on spending...
Ibrutinib in Previously Treated Mantle Cell Lymphoma
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 On November 13, 2013, ibrutinib (Imbruvica) was granted...
Ginkgo biloba
The use of dietary supplements by patients with cancer has increased 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...
Valganciclovir in Glioblastoma, Selection Bias, and Flawed Conclusions
As reviewed in this issue of The ASCO Post, Söderberg-Nauclér et al from the Karolinska Institute have written a provocative letter to The New England Journal of Medicine suggesting that long-term administration of valganciclovir (Valcyte), a drug that targets cytomegalovirus (CMV), improves...
Investigators Report Valganciclovir May Increase Survival in Glioblastoma
In a letter to The New England Journal of Medicine, Cecilia Söderberg-Nauclér, MD, PhD, and colleagues from the Karolinska Institutet, Stockholm, described experience with the anti-cytomegalovirus (CMV) agent valganciclovir (Valcyte) in the treatment of glioblastoma, citing dramatically improved...
Correctly Assessing Pain Progression and Quality-of-Life Deterioration in Metastatic Castration-Resistant Prostate Cancer
The therapeutic landscape for the treatment of castration-resistant prostate cancer has changed dramatically in the past 4 years, as five new agents affecting different aspects of the malignant process were proven to prolong life. The results are a great benefit to patients, but at the same time...
Adding Abiraterone to Prednisone Significantly Prolongs Time to Pain Progression in Chemotherapy-Naive Men With Metastatic Castration-Resistant Prostate Cancer
An interim analysis of the COU-AA-302 phase III trial in asymptomatic or mildly symptomatic chemotherapy-naive men with metastatic castration-resistant prostate cancer showed that the addition of abiraterone (Zytiga) to prednisone significantly delayed radiographic progression and improved overall...
Adjuvant Trastuzumab Duration: When Is Enough, Enough?
The duration of adjuvant systemic chemotherapy for breast cancer has been a subject of investigation, scrutiny, and meta-analysis.1,2 With the appreciation that prolonged regimens of cytotoxic chemotherapy of, for example, 1 to 2 years in duration were not superior in reducing breast cancer...
Breast Cancer Vaccines for Primary Prevention Move Toward Clinical Use
The first candidate vaccine to prevent recurrence of breast cancer entered clinical trials about 8 years ago, and since then, the idea of a vaccine for secondary prevention has gained traction; more such vaccines are now in development. But this fall, it was vaccines for primary prevention that had ...
Expert Point of View: Kenneth C. Anderson, MD
Commenting on the evidence for treating precursor myeloma in the study by Mateos et al,1 Kenneth C. Anderson, MD, Kraft Family Professor of Medicine at Harvard Medical School and Director of the Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics at Dana-Farber Cancer ...
Treating Earlier to Avoid Progression to Multiple Myeloma
With an expanded list of drugs to treat multiple myeloma, experts are interested in whether treating precursor diseases to multiple myeloma can prevent progression to full-blown myeloma. In addition, new drugs are entering the armamentarium for treating multiple myeloma, noted Ruben Niesvizky, MD,...
Radiotherapy Benefit in Young Women With Node-Positive Breast Cancer May Vary by Intrinsic Subtypes
Radiation therapy appears to significantly decrease local recurrence in premenopausal women with node-positive and luminal A tumors, based on an analysis of two small but independent randomized series reported at the 2013 European Cancer Congress in Amsterdam.1 “Though not definitive, our study...
Transplant Now or Later for High-Risk Aggressive Non-Hodgkin Lymphoma?
The use of high-dose chemotherapy and autologous hematopoietic blood or marrow transplantation for high-risk aggressive non-Hodgkin lymphoma has been extensively evaluated over the past few decades. This treatment was originally used only for patients with relapsed aggressive lymphoma. However, as...
