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Showing 2201 - 2250Long-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...
S9704 Trial: Autologous Transplantation as Consolidation in Aggressive Lymphoma
Autologous bone marrow or stem cell transplantation has had an important role in the treatment of aggressive lymphoma for several decades. The important results of the PARMA study1 demonstrated that patients in first relapse who remained chemosensitive had improved progression-free and overall...
Autologous Transplantation as Consolidation Improves Progression-Free Survival in Aggressive Non-Hodgkin Lymphoma
The strategy of autologous stem-cell transplantation as consolidation in high-intermediate– or high-risk diffuse aggressive non-Hodgkin lymphoma (NHL) has not been specifically examined in the rituximab (Rituxan) era. In the phase III Southwest Oncology Group (SWOG)-led intergroup 9704 trial...
Consent Is Informed and Shared, But Is It Compassionate?
A 72-year-old, obese male patient and a poor operative candidate is diagnosed with esophageal carcinoma. He has multiple comorbidities and a past history of colon carcinoma. His staging workup, which included a colonoscopy, revealed recurrent colon carcinoma. Thus, we have a patient who we...
Call for Expanded Genetic Profiling in Colorectal Cancer
Testing for codons 12 and 13 on the KRAS gene and BRAF testing can predict whether patients with colorectal cancer will respond to anti–epidermal growth factor receptor (EGFR) therapies. However, genetic alterations not captured by testing for KRAS codon 12 and 13 mutations may play an important...
Role of Autologous Stem Cell Transplant in High-Risk NHL
As described in the December 15 issue of The ASCO Post, Stiff and colleagues treated patients with high-intermediate– or high-risk diffuse, aggressive non-Hodgkin lymphoma with five cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CHOP plus rituximab (Rituxan)....
Assessing Patients for Palliative Care
In 2012, ASCO issued a provisional clinical opinion addressing the integration of palliative care services into standard oncology practice at the time a patient is diagnosed with metastatic or advanced cancer and for patients with uncontrolled symptoms.1 However, despite ASCO’s provisional clinical ...
Stress and Tumor Biology: Insights Into Managing Stress to Help Improve Cancer Care
Stress is ubiquitous in our society, especially for people diagnosed with a life-threatening illness. There is a common misconception that stress is derived from a particular negative event. However, the event itself (the stressors, such as cancer diagnoses and treatment) does not causes stress....
Adjuvant Gefitinib in Patients With NSCLC: Bad Idea or Wrong Patient Selection?
Despite optimal surgical resection and adjuvant chemotherapy with cisplatin-based doublets, the 5-year overall survival for patients with early-stage non–small cell lung cancer (NSCLC) remains suboptimal. In the International Association for the Study of Lung Cancer (IASLC) staging project, the...
ESMO Releases Position Paper on Med-Oncs' Role in Cancer Care
A new position statement from the European Society for Medical Oncology (ESMO) reports that medical oncologists have a vital role to play in cancer care.1 According to the position statement, medical oncologists are specialist cancer physicians trained to provide treatment with drugs, spanning from ...
IFM 2005-02 Update Differs From CALGB 100104: Why?
The updated analysis of the Intergroupe Francophone du Myelome (IFM) 2005-02 trial in newly diagnosed multiple myeloma patients showed that lenalidomide (Revlimid) maintenance prolongs progression-free survival after stem cell transplantation, but does not improve overall survival, according to...
Surprising Findings for Lenalidomide Maintenance in Updated IFM 2005-02 Analysis
A new analysis of the multiple myeloma Intergroupe Francophone du Myelome (IFM) 2005-02 trial showed that lenalidomide (Revlimid) maintenance prolongs progression-free survival after stem cell transplantation, but does not improve overall survival.1 This is possibly attributed to the shorter...
Overall Survival Improved by Adding Panitumumab to FOLFOX4 but Only in Metastatic Colorectal Cancer Without RAS Mutation
Patients with metastatic colorectal cancer that harbors KRAS mutations in exon 2 and patients with other activating RAS mutations do not benefit from anti–epidermal growth factor receptor (EGFR) therapy and may in fact be harmed by it. In an analysis reported in The New England Journal of Medicine ...
Mounting Success in Trials of Genetically Engineered T Cells to Treat Leukemias and Lymphomas
Reports have been trickling in from centers conducting research on the use of chimeric antigen receptor–modified T cells (CAR-T) in hematologic cancer, and the news is encouraging. When directed against CD19, such personalized therapeutic T cells are known as CTL019, and small pilot trials of this...
Risk-Based Breast Cancer Screening: Studies Suggest Alternatives to Age-Based Guidelines
Measuring certain hormone levels could help determine a woman’s risk for breast cancer and add a key factor to current risk-prediction models, according to investigators from Harvard Medical School. Their new study results were presented at the American Association for Cancer Research (AACR) Annual ...
Some Lung Cancers Detected by Low-Dose CT in National Lung Screening Trial May Be Indolent
More than 18% of all lung cancers detected by low-dose computed tomography in the National Lung Screening Trial (NLST) may be clinically insignificant. Overdiagnosis should be considered when describing the risks of [low-dose computed tomography] screening for lung cancer, according to a review of...
Lung Cancer Screening Facts
The U.S. Preventive Services Task Force has posted a supplemental fact sheet for clinicians on its final recommendation statement on screening for lung cancer.1 This resource is meant to help health-care professionals talk about lung cancer screening with their patients and determine if screening...
In CLL With Coexisting Conditions, Chlorambucil Produces Better Outcomes With Obinutuzumab Than With Rituximab
A randomized phase III trial conducted in 26 countries found that combining chlorambucil (Leukeran) with an anti-CD20 antibody—either obinutuzumab (Gazya) or rituximab (Rituxan)—produced better outcomes among patients with previously untreated chronic lymphocytic leukemia (CLL) and coexisting...
Expect Questions from Patients
Like all early detection strategies, screening mammography involves trade-offs,” H. Gilbert Welch, MD, MPH, and Honor J. Passow, PhD, of the Dartmouth Institute for Health Policy & Clinical Practice, Hanover, New Hampshire, wrote in a Special Communication in JAMA Internal Medicine.1 They...
Confronting Uncertainty About the Harms and Benefits of Screening Mammography
“If women are to truly participate in the decision of whether or not to be screened [for breast cancer using mammography], they need some quantification of its benefits and harms,” asserted H. Gilbert Welch, MD, MPH, Professor of Medicine, and Honor J. Passow, PhD, Instructor, at The Dartmouth...
Kava
Kava Scientific Name: Piper methysticum Common Names: Kava-kava, kawa, kavain, rauschpfeffer, intoxicating long pepper, tonga, yagona, and yaqona. Overview Kava, a perennial shrub indigenous to the Hawaiian Islands and the Pacific Rim, is known for its relaxant effects and used for social and...
Trametinib and Dabrafenib in Combination for Unresectable or Metastatic Melanoma With BRAF V600E or V600K Mutations
On January 9, 2014, the combination of trametinib (Mekinist) and dabrafenib (Tafinlar) was granted accelerated approval for the treatment of patients with unresectable or metastatic melanoma with BRAF V600E or V600K mutations as detected by a U.S. Food and Drug Administration (FDA)-approved...
HER2 Testing: The Next Chapter
Late last year, the American Society of Clinical Oncology and College of American Pathologists published a comprehensive update of guidelines for HER2 testing,1 the first such update since their initial landmark publication in 2007.2 This new report, summarized in this issue of The ASCO Post,...
ASCO and College of American Pathologists Guideline Update: Recommendations for HER2 Testing in Breast Cancer
The American Society of Clinical Oncology (ASCO) and College of American Pathologists (CAP) recently convened an Update Committee to conduct a systematic literature review and update recommendations for optimal HER2 testing. In particular, the Committee identified criteria and areas requiring...
Cancer Pain: The Humbling Reality
As a medical oncologist and palliative care physician, I’ve had the privilege of caring for cancer patients and delivering primary palliative care and symptom control, as well as the chance to care for patients especially referred for complex pain and symptom problems (in secondary and even...
Overdiagnosis of Breast Cancer: New Research Directions
Currently, one of the most challenging problems in oncology is to accurately predict whether neoplastic lesions detected by screening tests will progress. The focus on developing ever-more sensitive cancer screening tests has produced the clinical dilemma of overdiagnosis. Overdiagnosis occurs when ...
The Canadian National Breast Screening Trial Had So Many Flaws That Its Results Should Not Be Used to Guide Screening Recommendations
If a randomized, controlled trial of therapy for breast cancer was submitted for publication in which 1. The drug being tested was old and ineffective, and 2. prior to randomization, the women underwent a clinical breast examination and the study coordinators knew who had the largest cancers, and...
