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issues in oncology

Emerging Technology Will Help Tackle Tumor Complexity

Emerging laboratory technology will be “moving the bar forward” in terms of molecular markers, genomics, and gene-expression profiling, with the potential for huge payoffs to oncologists and patients, according to Mark Pegram, MD, the Susy Yuan-Huey Hung Professor of Medicine at Stanford School of...

breast cancer

Genetic Testing in Breast Cancer Offers Much Information but Poses Challenges in Interpretation

For breast cancer patients with robust family histories, medical oncologists should be testing not only for BRCA1/2 mutations, but also for large duplications and deletions as well as for PALB2 mutations. “These [findings] have proven utility in testing breast cancer patients,” said Louise E....

colorectal cancer
hepatobiliary cancer

Colorectal Liver Metastases: Thumbs Up for Radiofrequency Ablation, Jury Still Out for Selective Internal Radiotherapy

Two “firsts” in studies of colorectal liver metastases were highlighted at the 2015 ASCO Annual Meeting: the first prospective randomized trial to evaluate radiofrequency ablation plus chemotherapy1 and the first large randomized phase III trial to study liver-directed selective internal radiation...

lymphoma

Indolent Lymphoma: A More Complex Malignancy Than Once Thought

With a growing number of options for follicular lymphoma, clinicians may wonder whether there is one best regimen. James O. Armitage, MD, FACP, FRCP, Professor of Medicine at the University of Nebraska, Omaha—and Editor-in-Chief of The ASCO Post—tackled this question and offered recommendations at...

lung cancer
issues in oncology

Positioning Targeted and Immunotherapy-Based Approaches in Lung Cancer

With immunotherapy changing the face of lung cancer, is there still a place for targeted therapy? Two experts from Emory University debated this issue at the 2015 Debates and Didactics in Hematology and Oncology Conference held in Sea Island, Georgia. Fadlo Khuri, MD, was recently named President...

Expert Point of View: James Jett, MD, and Martin J. ­Edelman, MD

James Jett, MD, of National Jewish Health in Denver, moderated the press briefing where the study results were presented and called MAPS a “landmark study” that could change the standard of care in this malignancy. Martin J. ­Edelman, MD, Professor of Medicine at the University of Maryland,...

lung cancer

Bevacizumab Plus Standard Chemotherapy Improves Survival in Mesothelioma

The standard of care for malignant pleural mesothelioma may be poised for change, judging by results from a study by the French Cooperative Thoracic Intergroup. The addition of bevacizumab (Avastin) in the first-line setting to the current standard of care, pemetrexed (Alimta)/cisplatin, improved...

head and neck cancer

HPV-Positive Head and Neck Cancer: When Can Chemotherapy Be Omitted?

Are there patients with locally advanced squamous cell carcinoma of the head and neck associated with human papillomavirus (HPV) for whom chemotherapy can be omitted? Experts debated this question at the 2015 Debates and Didactics in Hematology and Oncology Conference in Sea Island, Georgia,...

lymphoma

Mantle Cell Lymphoma: Is Transplantation Still Necessary?

Autologous stem cell transplantation has played a critical role in the treatment of mantle cell lymphoma, but in the age of novel treatments, is it always warranted? Two experts in the field explored the question at the 2015 Debates and Didactics in Hematology and Oncology Conference sponsored by...

Dr. Cohen’s Approach to Managing Double-hit Lymphoma

All patients with aggressive non Hodgkin lymphoma should be evaluated for MYC and BCL2/6 gene expression, if possible, by fluorescent in situ hybridization and immunohistochemistry. Several intensive treatment regimens are available. Dr. Cohen favors dose-adjusted R-EPOCH for patients with...

lymphoma

Double-Hit Lymphoma: Many Treatment Strategies, No Standard of Care

"Double-hit lymphoma” represents a challenging malignancy without a standard-of-care treatment, although outcomes for some patients are better than was once believed, according to Jonathon B. ­Cohen, MD, Assistant Professor of Hematology and Medical Oncology at Emory University, Atlanta. Dr. Cohen...

Expert Point of View: Glenwood Goss, MD, FRCPC, FCPSA

Glenwood Goss, MD, FRCPC, FCPSA, Professor of Medicine and Director of Clinical and Translational Research at the Ottawa Hospital Cancer Centre and University of Ottawa, Canada, formally discussed the findings. He noted that this combination in advanced melanoma showed “limited progression-free...

lung cancer

First-Line Nivolumab/Ipilimumab Combination in Non–Small Cell Lung Cancer Shown to Be Tolerable

For advanced non–small cell lung cancer (NSCLC), first-line treatment with combined immune checkpoint blockade—in novel doses and schedules—was associated with deep and durable responses, encouraging progression-free survival, and much better tolerability than has been previously observed with...

Expert Point of View: Solange Peters, MD, PhD

Solange Peters, MD, PhD, of the Lausanne University Hospital, Switzerland, put these updates in context of what is known about programmed cell death protein 1 (PD-1) antibodies in non–small cell lung cancer (NSCLC), concluding that nivolumab (Opdivo) is “one of the best options” for...

lung cancer

Nivolumab in Lung Cancer Supported by Updated Trial Data

For the treatment of advanced squamous non–small cell lung cancer (NSCLC), the programmed cell death protein 1 (PD-1) antibody nivolumab (Opdivo) continues to show results in key trials that now report 18-month data. The updates were reported at the 16th World Conference on Lung Cancer in Denver,...

lung cancer

Lung Cancer Rates Doubling Among Nonsmokers

Lung cancer is becoming an equal-opportunity malignancy—with rates rising among never-smokers, especially females, according to studies presented at the 16th World Conference on Lung Cancer in Denver. British investigators reported that in one large tertiary medical center, the proportion of...

Expert Point of View: Martin Reck, MD, PhD

Martin Reck, MD, PhD, of the Department of Thoracic Oncology at the Lung Clinic Grosshansdorf in Germany, discussed the studies. In pretreated patients, he said, “We have seen confirmed efficacy” [for AZD9291] and “impressive activity.” In the first-line setting, its efficacy is still being...

lung cancer

AZD9291 Updates Encouraging for Treatment-Resistant NSCLC

At the 16th World Conference on Lung Cancer, several studies showed consistent activity with the investigational third-generation inhibitor AZD9291 in patients with advanced non–small cell lung cancer (NSCLC) that is resistant to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors....

Expert Point of View: Robert Pirker, MD

Robert Pirker, MD, Professor of Medicine and Program Director for Lung Cancer at the Medical University of Vienna, Austria, discussed the findings at the “Top Abstracts” session of the 16th World Conference on Lung Cancer. Based on these results and the findings of similar studies, Dr. Pirker...

lung cancer

EGFR Gene Copy Number as Biomarker for Antibody Treatment in Squamous Cell NSCLC

Two studies presented at the 16th World Conference on Lung Cancer suggest that high expression of the epidermal growth factor receptor (EGFR), or gene copy number, may indicate potential benefit from EGFR antibodies in squamous cell non–small cell lung cancer (NSCLC). The studies were presented by...

issues in oncology

Delays in Drug Approval Are Deadly, Highlighting the Need for Improved Regulatory Efficiency

Researchers have determined just how many lives are lost when effective investigational drugs are not approved in a timely manner. These delays in the process of anticancer drug approvals result in thousands of premature deaths each year, according to an analysis presented at the 16th World...

lung cancer

Smoking Cessation Reduces Mortality in Lung Cancer Screening Population

Data from an analysis of lung cancer screening programs in Italy add further evidence that smoking cessation reduces mortality. Heavy smokers screened by low-dose computed tomography (CT) who stopped smoking before or during the screening period had a three- to fivefold reduction in mortality...

Expert Point of View: Clifford Hudis, MD

Clifford Hudis, MD, Chief of the Breast Medicine Service at Memorial Sloan Kettering Cancer Center, New York, said the findings suggest there is essentially no meaningful benefit from chemotherapy in the recurrence score low-risk subset. “It is clinically appropriate to offer endocrine therapy...

breast cancer

TAILORx: Chemotherapy Not Necessary for Women With a Low Recurrence Score

The long-awaited first results are in from the TAILORx study, showing that patients with early breast cancer considered at low risk for recurrence can forgo chemotherapy and be treated with endocrine therapy alone.1 “Women with axillary node-negative, estrogen receptor–positive, HER2-negative...

Expert Point of View: Enrique Grande, MD

Enrique Grande, MD, Head of the Endocrine and Genitourinary Tumors Section of the Medical Oncology Service at Ramon y Cajal University Hospital, Madrid, discussed the NETTER-1 and RADIANT-4 studies at the Presidential Session of the 2015 European Cancer Congress. “There is now a stronger rationale...

neuroendocrine tumors

Treatment Options Expanding for Neuroendocrine Tumors

Patients with advanced neuroendocrine tumors have two promising new treatment options, according to studies that earned spots in the Presidential Session of the 2015 European Cancer Congress, held recently in Vienna, Austria. The phase III studies evaluated the mTOR inhibitor everolimus (Afinitor)...

Expert Point of View: Cora N. Sternberg, MD, FACP

Cora N. Sternberg, MD, FACP, Chief of Medical Oncology at San Camillo Forlanini Hospital in Rome, Italy, formally discussed CheckMate 025 at the Presidential Session of the 2015 European Cancer Congress as well as findings from the METEOR trial of cabozantinib (Cometriq) in metastatic renal cell...

kidney cancer

Nivolumab Produces Survival Benefit in Advanced Renal Cell Carcinoma

Patients with advanced renal cell carcinoma treated with nivolumab (Opdivo) were 27% less likely to die than those receiving everolimus (Afinitor), in a planned interim analysis of the open-label phase III CheckMate 025 trial.1 These positive results prompted an early termination of the study by...

NCCN Unveils Graphic Evidence Blocks to Guide Decision-Making

Treatment decision-making for oncologists and their patients may become simpler through the use of graphic NCCN Evidence Blocks™, which were unveiled at the NCCN 10th Annual Congress: Hematologic Malignancies™ sponsored by the National Comprehensive Cancer Network® (NCCN¨). The first of the NCCN...

Expert Point of View: Martin Reck, MD, PhD

These are interesting results,” said Martin Reck, MD, PhD, Head of the Department of Thoracic Oncology at the Lung Clinic Grosshansdorf in Germany, who discussed the study at the Presidential Session of the 2015 European Cancer Congress. Responses to rovalpituzumab tesirine, he noted, “are superior ...

lung cancer

Antibody-Drug Conjugate Makes Strong Showing in Small Cell Lung Cancer

The antibody-drug conjugate rovalpituzumab tesirine has shown strong clinical activity as second- and third-line treatment for small cell lung cancer in a phase I/Ib multicenter study,1 especially in the subset with high expression of the delta-like protein 3 (DLL3), which the drug targets. This...

Expert Point of View: Martin Reck, MD, PhD

Martin Reck, MD, PhD, Head of the Department of Thoracic Oncology at the Lung Clinic Grosshansdorf in Germany, discussed the study at the Presidential Session, calling it “very important work.” This study shows that, with more sensitive assays, T790M mutations are much more frequent than previously ...

lung cancer

Combined EGFR and VEGF Inhibition Ameliorates the Impact of  the EGFR T790M Mutation in NSCLC

Treatment with erlotinib and bevacizumab (Avastin) may help overcome the poor prognosis associated with T790M mutations present at diagnosis in advanced non–small cell lung cancer (NSCLC), according to the results of the phase II BELIEF trial.1 At the 2015 European Cancer Congress, Rolf A. Stahel,...

Expert Point of View: Fabrice André, MD, PhD, and Peter Naredi, MD, PhD

In discussing the findings of this study on genetic sequencing of breast cancer tissue, Fabrice André, MD, PhD, of the Gustave Roussy Institute, in Villejuif, France, questioned whether all the genes that were found to be enriched in the relapsed samples were driving the relapse and whether any...

breast cancer

Primary vs Metastatic Breast Cancer: The Genetic Landscape Varies

Breast tumors that recur appear to have a different genetic profile than those that do not, and they often demonstrate targetable mutations, according to the largest study of genetic sequencing of breast cancer tissue to date.1 This finding was presented at the 2015 European Cancer Congress. “We...

solid tumors
bladder cancer
skin cancer

PD-1/PD-L1 Inhibitors Show Promise in Additional Tumor Types

While inhibitors of programmed cell death protein 1 (PD-1) or its ligand (PD-L1) are becoming established in melanoma, non–small cell lung cancer, and renal cell carcinoma, their efficacy is also being evaluated in numerous other tumor types, with promising results, according to studies presented...

Expert Point of View: Christian Blank, MD

Christian Blank, MD, Group Leader of Immunology at the Netherlands Cancer Institute, Amsterdam, formally discussed the COMBI-v findings. He first credited targeted therapy and immunotherapy for almost tripling the chance of patients with metastatic melanoma living beyond 1 year; however, he noted...

skin cancer

Survival Benefit in Metastatic Melanoma Grows Larger in COMBI-v Update

Combined BRAF and MEK inhibition was superior to BRAF inhibition alone in unresectable metastatic melanoma, according to the updated survival analysis of the large randomized COMBI-v trial.1 These findings were reported at the 2015 European Cancer Congress recently held in Vienna, Austria....

Expert Point of View: Ronald de Wit, MD, PhD

Ronald de Wit, MD, PhD, of Erasmus Medical Center, Rotterdam, Netherlands, called the use of docetaxel in addition to androgen-deprivation therapy “the latest paradigm shift” in the treatment of prostate cancer. The data showing a 10% absolute improvement in survival in the metastatic setting “are...

prostate cancer

Meta-analysis Evaluates Benefit of Docetaxel and Bisphosphonates in Hormone-Sensitive Prostate Cancer

The results of a meta-analysis conducted in the United Kingdom may guide clinicians in the use of docetaxel and bisphosphonates in patients with hormone-sensitive prostate cancer.1 Claire L. Vale, PhD, Senior Research Scientist at the Medical Research Council Clinical Trials Unit at University...

solid tumors
colorectal cancer

Oncologists Encouraged to Learn More About Lesser-Known Heritable Gastrointestinal Cancers

The genetic basis for inherited colorectal cancer is proving to be a much bigger and more complicated “pie” than was appreciated just a few years ago, according to Michael Hall, MD, Director of Gastrointestinal Risk Assessment at Fox Chase Cancer Center, Philadelphia. “With next-generation...

breast cancer
kidney cancer
prostate cancer
skin cancer

Quick Takes From ECC 2015 Include New Data in Melanoma, Prostate and Breast Cancers, and Renal Cell Carcinoma

The 2015 European Cancer Congress (ECC), held recently in Vienna, represented the combined efforts of the European Cancer Organisation (ECCO), the European Society for Medical Oncology (ESMO), and other partner organisations, constituting the largest European platform for oncology education. At...

leukemia

Changing the Outlook for Chronic Lymphocytic Leukemia

Small-molecule inhibitors, especially ibrutinib (Imbruvica) and idelalisib (Zydelig), have greatly changed the outlook for patients with chronic lymphocytic leukemia. William G. Wierda, MD, PhD, Professor and Center Medical Director in the Department of Leukemia at The University of Texas MD...

hematologic malignancies

Genomics Now Driving Treatment of Waldenström’s Macroglobulinemia

The treatment of Waldenström’s macroglobulinemia has been greatly impacted by an understanding of its genomics, according to Steven P. Treon, MD, PhD, of Dana-Farber/Brigham and Women’s Cancer Center and Massachusetts General Hospital Cancer Center, Boston. Dr. Treon brought listeners up to date on ...

Expert Point of View: Clifford Hudis, MD, Shanu Modi, MD, and Richard Gelber, PhD

Discussant Clifford Hudis, MD, Chief of Breast Medicine Service at Memorial Sloan Kettering Cancer Center, New York, highlighted neratinib’s benefits while also advocating caution in interpreting the results due to incomplete data, the serious side effect of diarrhea, and the potentially...

breast cancer

Neratinib Improves Disease-Free Survival in Early-Stage HER2-Positive Breast Cancer

Patients with early-stage HER2-positive breast cancer who received neratinib as extended adjuvant therapy demonstrated improved invasive disease–free survival, with an absolute benefit of 2.3% at 2 years.1 However, these results of the ExteNET trial, previously presented at the 2015 ASCO Annual...

leukemia

Chronic Myelogenous Leukemia: What Drug for Which Patient?

Treatment of chronic myelogenous leukemia (CML) with tyrosine kinase inhibitors is “the golden child success story of targeted treatment,” Jerald P. Radich, MD, of the Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, Seattle, Washington, told attendees at the National...

Expert Point of View: Ricky A. Sharma, MA, MB, BChir, PhD

Ricky A. Sharma, MA, MB, BChir, PhD, of Gray Institute for Radiation Oncology and Biology at the University of Oxford, United Kingdom, formally discussed the paper. He disclosed that he is a co-principal investigator for the FOXFIRE study, which is currently evaluating selective internal radiation...

Chemoradiotherapy for Liver Metastases

The phase III SIRFLOX trial showed that selective internal radiation therapy delivered to liver metastases in patients with colorectal cancer, plus chemotherapy, improved local control, although median progression-free survival for the whole population was not affected. Median progression-free...

colorectal cancer

Selective Internal Radiation Therapy Impacts Liver Metastases in Colorectal Cancer

A novel interventional approach to treating liver metastases associated with colorectal cancer improved control of liver metastases, according to the SIRFLOX study presented at the 2015 ASCO Annual Meeting.1 The addition of selective internal radiation therapy to first-line chemotherapy extended...

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