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issues in oncology

Value: What Do We Mean, Who Should Decide?

Oscar Wilde famously defined a cynic as “a man who knows the price of everything and the value of nothing.” I do not think that oncologists need to be as cynical as this, but it was very appropriate that a major theme of this year’s ASCO Annual Meeting was the concept of “value.” It is clear that...

colorectal cancer

Bevacizumab More Cost-Effective Than Cetuximab in Metastatic Colorectal Cancer

The landmark CALGB/SWOG 80405 trial concluded that bevacizumab (Avastin) and cetuximab (Erbitux) provide comparable benefit in the treatment of metastatic colorectal cancer. However, in terms of cost, bevacizumab was recently declared the winner. In an economic analysis presented at the 2015 ASCO...

skin cancer

Public Urged Not to Overreact to Study Finding Link Between Citrus Fruits and Melanoma Risk

A study finding a link between citrus consumption and increased risk of melanoma1 may provide food for thought about the findings and implications as well as whet the appetite for more evidence, but according to several experts commenting on the study, it does not mean you should stop eating citrus ...

breast cancer

The Conundrum of Estrogen-Receptor Signaling in HER2-Positive Breast Cancer

BOLERO-1—reviewed in this issue of The ASCO Post—is the next installment in a series of randomized trials evaluating the addition of everolimus (Afinitor) to standard therapy in metastatic breast cancer.1 The initial evaluation of everolimus in the HER2-positive metastatic setting looked extremely...

cost of care

Calculating the Value of Cancer Drugs

For nearly a decade, Peter B. Bach, MD, MAPP, Director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York, has been a leading voice in sounding the alarm over the escalating cost of cancer drugs and in seeking a solution to the problem. In 2012, Dr....

health-care policy

‘Right to Try’ Laws: Helpful or Harmful?

Since 2014, “Right to Try” legislation has been sweeping the nation. Created to enable terminally ill patients to gain access to experimental drugs, biologics, and devices by sidestepping the approval process of the U.S. Food and Drug Administration (FDA), at press time, 22 states have enacted...

lymphoma

Increased Lifetime Risk of Cardiovascular Disease for Patients Treated for Hodgkin Lymphoma

Survivors of Hodgkin lymphoma treated as adolescents or adults are at increased risk of cardiovascular diseases throughout their lives, according to results of a retrospective cohort study of 2,524 Dutch patients followed for a median of 20 years. “Treating physicians and patients should be aware...

issues in oncology

Access to Cancer Medicines Not Uniform Across Europe

Access to cancer medicines—including some old standbys—is inconsistent across Europe, depriving many patients of treatments that are the standard of care elsewhere,1 according to Alexandru E. Eniu, MD, PhD, Chair of the European Society for Medical Oncology (ESMO) Emerging Countries Committee and...

lung cancer

Roswell Park Cancer Institute Partners With Cuban Scientists to Develop Lung Cancer Vaccine

Just 4 months after President Barack Obama’s announcement in December 2014 that there would be an easing of the trade embargo between the United States and Cuba, a deal was struck between Roswell Park Cancer Institute in Buffalo, New York, and the Center for Molecular Immunology (CIM) in Havana,...

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....

issues in oncology

New Techniques in Oncologic Surgery and Radiology: Some Worth the Expense, Some Not So Much

In recent years, patients with cancer have had the benefit of much high technology: proton-beam radiotherapy, intensity-modulated radiation therapy, various minimally invasive surgery techniques, and robots in the operating room. They all receive hype in the professional and public press, and...

multiple myeloma

Adding Elotuzumab to Lenalidomide Plus Dexamethasone Improves Progression-Free Survival in Refractory Multiple Myeloma

In an interim analysis of the phase III ELOQUENT-2 trial reported in The New England Journal of Medicine, Sagar Lonial, MD, of Emory University School of Medicine, Meletios Dimopoulos, MD, of National and Kapodistrian University of Athens, and colleagues found that the addition of elotuzumab to...

leukemia

Azacitidine Increased Median Overall Survival Among Patients Aged 65 and Older With > 30% Blasts

A multicenter, randomized, open-label, phase III trial among the difficult-to-treat population of patients aged aged 65 and older with acute myeloid leukemia (AML) with > 30% bone marrow blasts “showed that azacitidine was associated with a clinically meaningful improvement” in median overall...

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,...

cost of care

Making Their Voices Heard: 118 Oncologists Speak Out About Stemming the High Cost of Cancer Drugs

In a bold move to shed light on the ramifications of the ever-increasing cost of cancer drugs for patients with cancer and for the health-care system, 118 prominent oncologists came together to write a commentary in Mayo Clinic Proceedings detailing their concerns.1 To learn more about these...

global cancer care

Measuring Global Health Issues, Seven Billion Times

BOOKMARK Title: Epic Measures: One Doctor. Seven Billion PatientsAuthor: Jeremy N. SmithPublisher: Harper WavePublication date: April 7, 2015Price: $26.99; hardcover, 352 pages Health measures are essential tools in assessing public health and safety. Collecting large amounts of data is a laborious ...

NIH Awards Nearly $35 Million to Research Natural Products

Five research centers will focus on the safety of natural products, how they work within the body, and the development of cutting-edge research technologies. The centers, jointly funded by the National Institutes of Health’s Office of Dietary Supplements (ODS) and the National Center for...

issues in oncology

NCCN Turns 20: Value-Based Care Has Arrived

Twenty years ago, the National Comprehensive Cancer Network (NCCN) began as a cooperative effort of 12 prestigious cancer centers, working to define and promote national guidelines for the care of patients with cancer. A major goal was to encourage uniformity in the management of malignant...

$12 Million Multi-institutional SPORE Grant to Focus on Mutations in the NF1 Gene

A new, multi-institution research endeavor brings together scientists from nine leading institutions to find treatments for a group of rare cancers, all caused by a particular gene mutation.   The researchers won a 5-year, $12 million grant through the National Cancer Institute’s (NCI) competitive...

colorectal cancer

Trifluridine/Tipiracil in Previously Treated Metastatic Colorectal 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. On September 22, 2015, trifluridine/tipiracil (Lonsurf) was...

lung cancer

Anti-EGFR Therapy in Squamous Cell Lung Carcinoma: Swimming With or Against the Tide?

Lung cancer is the most common, lethal, and costly cancer worldwide, accounting for at least 1.8 million new cases per year (12.9% of the total).1 Over the past decade, there has been a major shift in the treatment of non–small cell lung cancer (NSCLC), especially in adenocarcinoma, accompanied 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...

breast cancer

MRI Improves Breast Cancer Detection in Women at Average Risk

Magnetic resonance imaging (MRI) screening of women at average risk for breast cancer achieved a mean additional cancer yield of 15.8 cases per 1,000 women, greatly surpassing yields for supplemental digital breast tomosynthesis (1.25 per 1,000) or supplemental ultrasound (4.1 per 1,000). The...

breast cancer

Aromatase Inhibitors May Decrease Risk of Contralateral Breast Cancer in BRCA Mutation–Positive Patients

Given that BRCA1 and BRCA2 mutation carriers have an estimated 40% to 85% lifetime risk of breast cancer and an increased risk of developing contralateral breast cancer, risk reduction in this population remains essential. According to a study presented at the 2015 Breast Cancer Symposium, use of...

breast cancer
issues in oncology

Ovarian Suppression During Chemotherapy Preserves Fertility in Young Women With Breast Cancer

Several studies have addressed the risks and benefits of ovarian suppression during chemotherapy for breast cancer in women of childbearing age. A new meta-analysis of randomized trials found that it prevented premature ovarian failure and was associated with a higher number of pregnancies post...

symptom management

Management of Aromatase Inhibitor–Induced Musculoskeletal Symptoms: A Physiatric Approach

Aromatase inhibitors have demonstrated efficacy in reducing the risk of breast cancer recurrence in hormone receptor–positive patients, but medication compliance can be limited by uncomfortable side effects, including musculoskeletal pain and dysfunction. Musculoskeletal symptoms have been reported ...

global cancer care

Cancer on the Global Stage: Incidence and Cancer‑Related Mortality in Algeria

The ASCO Post is pleased to continue this special focus on the worldwide cancer burden. In this issue, we feature a close look at the cancer incidence and mortality rates in Algeria. The aim of this special feature is to highlight the global cancer burden for various countries of the world. For the ...

neuroendocrine tumors

Telotristat Etiprate Added to Standard Therapy for Carcinoid Syndrome Shows Clinical Benefit in Patients With Metastatic Neuroendocrine Tumors

The investigational drug telotristat etiprate was shown to have clinical benefit when added to somatostatin analog therapy for carcinoid syndrome not adequately controlled by long-acting somatostatin analog therapy, the current standard of care, in patients with metastatic neuroendocrine tumors....

breast cancer

Survival and Bevacizumab in Early Breast Cancer: Time to Reconsider?

In metastatic HER2-negative breast cancer, several trials have shown that the addition of the anti–vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab (Avastin) to different chemotherapy regimens significantly improved response rates and progression-free survival by various...

health-care policy

The Independent Payment Advisory Board in a Nutshell

The Affordable Care Act established a 15-member Independent Payment Advisory Board (IPAB) to reduce Medicare spending growth using a target system and fast-track legislative approval process. By April 30 of each year, the Centers for Medicare & Medicaid Services will project whether Medicare’s...

issues in oncology

Study Finds Quality of Physician Recommendation to Parents Key to Encourage/Discourage HPV Vaccination of Adolescents

A nationwide online survey of 776 pediatricians and family physicians assessing the quality of their human papillomavirus (HPV) vaccine recommendations to parents has found that approximately 27% of respondents said they do not strongly endorse HPV vaccination; further, 26% and 39% of respondents...

lung cancer

Intensity-Modulated Radiotherapy Gains Ground for Treatment of Stage III Non–Small Cell Lung Cancer

Intensity-modulated radiation therapy appears to be preferable to three-dimensional (3D) conformal radiation therapy as part of treatment for patients with locally advanced (stage III) non–small cell lung cancer (NSCLC). Compared with 3D conformal radiotherapy, intensity-modulated radiotherapy...

breast cancer

Mediterranean Diet Supplemented With Extra-Virgin Olive Oil Reduces Risk for Invasive Breast Cancer

As reported in JAMA Internal Medicine by Estefania Toledo, MD, MPH, PhD, and colleagues, a large Spanish primary prevention nutrition intervention trial in patients at high cardiovascular risk (PREDIMED) showed a large reduction in the risk for invasive breast cancer among women 60 to 80 years of...

breast cancer

Accelerated Partial-Breast vs Whole-Breast Irradiation After Surgery for Early Breast Cancer

As reported in The Lancet by Vratislav Strnad, MD, of University Hospital Erlangen, Germany, and colleagues, 5-year results of a phase III noninferiority trial showed no difference in local relapse, disease-free survival, or overall survival with adjuvant accelerated partial breast irradiation...

skin cancer

Talimogene Laherparepvec for Treatment of Unresectable Cutaneous, Subcutaneous, and Nodal Melanoma Lesions

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. On October 27, 2015, talimogene laherparepvec (Imlygic) was...

prostate cancer

Hypofractionated Radiotherapy Makes Inroads as Primary Treatment of Prostate Cancer

Several studies presented at the 2015 ASTRO Annual Meeting explored the use of hypofractionation (delivering higher doses of radiation in fewer fractions) in the treatment of patients with prostate cancer. These studies found comparable outcomes in terms of efficacy and adverse events. Although...

Antoni Ribas, MD, PhD, Receives NCI Outstanding Investigator Award

UCLA Jonsson Comprehensive Cancer Center member ­Antoni Ribas, MD, PhD, has received a National Cancer Institute (NCI) Outstanding Investigator Award of $4.2 million in recognition of his research conducted in the development of new immunotherapies that utilize the human body’s own natural defenses ...

leukemia

Does Low-Dose Radiation Cause Leukemia?

Data from A-bomb survivors, persons with ankylosing spondylitis and neoplasms treated with radiation therapy, and many other sources show a strong association between exposure to ionizing radiation (particles or electromagnetic waves with sufficient energy to cause an ionization such as photons and ...

skin cancer

Increased Risk of Second Nonmelanoma Skin Cancer Among Patients Receiving Immunosuppressive Therapy

Patients with rheumatoid arthritis treated with methotrexate had an increased risk of a second nonmelanoma skin cancer, and adding anti–tumor necrosis factor (TNF) may increase that risk, according to results of a retrospective cohort study reported in JAMA Dermatology. A similar association was...

survivorship

Cancer Survival Improves in Europe, With Wide Regional Variations

EUROCARE-5, the latest in a series of comprehensive reports on the state of cancer survival in Europe, shows an improvement in 5-year survival from 1998 to 2007, with large variations among regions of Europe, according to a presentation at the European Cancer Congress.1 Furthermore, although 5-year ...

issues in oncology
health-care policy

Cancer Care in Low-Resource Areas: Some Improvements Over the Years, but Serious Problems Remain

Low- and middle-income countries bear a larger share of the global cancer burden than does the developed world,” said Greta ­Massetti, PhD, Associate Director for Science, Centers for Disease Control and Prevention (CDC) Division of Cancer Prevention and Control and Co-Chair of the National Cancer...

breast cancer

Convergence of Breast Cancer Incidence but Continued Divergence of Mortality in Black Women and White Women

In an article published in CA: A Cancer Journal for Clinicians, Carol E. ­DeSantis, MPH, and colleagues from the American Cancer Society reported that the incidence of breast cancer in black women has caught up to that in white women, whereas the risk of mortality continues to be higher in black...

hematologic malignancies
leukemia

BRAF Inhibition Successful in Relapsed/Refractory Hairy Cell Leukemia

In two phase II studies reported in The New England Journal of Medicine, ­Enrico Tiacci, MD, of the University of Perugia, Italy, and colleagues found that the BRAF inhibitor vemurafenib (Zelboraf) produced responses in nearly all patients with BRAF V600E–positive hairy cell leukemia that relapsed...

multiple myeloma

Better Quality of Life With Melphalan and Prednisone Used With Lenalidomide Than With Thalidomide

A phase III Eastern Cooperative Oncology Group (ECOG) trial (E1A060) comparing melphalan, prednisone, and thalidomide (Thalomid) with melphalan, prednisone, and lenalidomide (Revlimid) in elderly patients with untreated multiple myeloma found that at the end of the induction period, patients...

solid tumors
prostate cancer

Decline in PSA Testing and Incidence of Early Prostate Cancer Coincide With 2012 Recommendation Against PSA Screening

Two recent studies1,2 found that the rates of prostate-specific antigen (PSA) screening have declined since the U.S. Preventive Services Task Force (USPSTF) recommended against PSA screening in 2012. One of those studies additionally found that the incidence of early-stage prostate cancer also...

pancreatic cancer

Clinical Trials Actively Recruiting Patients With Pancreatic Cancer

The information contained in this Clinical Trials Resource Guide includes actively recruiting clinical studies for patients with pancreatic cancer. The trials are investigating preoperative rehabilitation; chimeric antigen receptors; T-cell transplants; combination chemotherapy; chemoradiotherapy; ...

2015 NCI Outstanding Investigator Award Recipients

The first class of National Cancer Institute (NCI) Outstanding Investigator Award recipients showcases the cutting edge of oncologic research and the 43 investigators behind it. NCI’s Outstanding Investigator Award supports accomplished leaders in cancer research, who are providing significant...

A Primary Care Doctor’s Tough-Love Medicare Fix

Bookmark Title: Curing Medicare: One Doctor’s View of How Our Health Care System Is Failing the Elderly and How to Fix It Author:  Andy Lazris, MD Publisher: CreateSpace Publication date: September 13, 2014 Price: $13.75; paperback, 290 pages Several years ago I decided to write a book about...

lymphoma

Q: Primary Diffuse Large B-Cell Lymphoma of the Central Nervous System

The ASCO Post is pleased to present Hematology Expert Review, an occasional feature that includes a case report detailing a particular hematologic condition followed by questions. Answers to each question appear on page 84 with expert commentary. In the November 10 issue of The ASCO Post, part 2 of ...

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