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breast cancer

Use of 21-Gene Recurrence Score vs Adjuvant! Online May Alter Chemotherapy Decisions in Breast Cancer

In a population-based cohort study in Ontario, Canada, reported in the Journal of Clinical Oncology, Levine et al found that use of the 21-gene recurrence score (RS) assay altered decisions regarding receipt of chemotherapy compared with use of Adjuvant! Online in patients with axillary...

breast cancer

No Benefit Shown With Afatinib in HER2-Positive Breast Cancer With Progressive Brain Metastases

In the phase II LUX-Breast 3 trial reported in The Lancet Oncology, Cortés et al found that afatinib (Gilotrif) alone or combined with vinorelbine did not increase patient benefit vs investigator choice of treatment in patients with HER2-positive breast cancer and progressive brain...

palliative care
supportive care
issues in oncology

Italian Study Shows Low-Dose Morphine Better Than Weak Opioids in Relieving Moderate Cancer Pain

In an Italian trial reported in the Journal of Clinical Oncology, Bandieri et al found that low-dose morphine provided better and more rapid pain relief than weak opioids in patients with moderate cancer pain. Study Details In the open-label 28-day trial, 240 adults with moderate cancer pain from ...

solid tumors
lung cancer
cns cancers

Everolimus Improves Progression-Free Survival in Advanced Neuroendocrine Tumors of the Lung or Gastrointestinal Tract

In a phase III RADIANT-4 trial reported in The Lancet, Yao et al found that everolimus (Afinitor) and supportive care significantly prolonged progression-free survival vs placebo and supportive care in patients with advanced nonfunctional neuroendocrine tumors of the lung or gastrointestinal tract. ...

prostate cancer

Androgen Deprivation Therapy May Lead to Castration Resistance in Prostate Cancer

Although androgen-deprivation therapy is effective in inducing regression of androgen-dependent prostate cancer, relapse often occurs in an androgen-independent manner and is associated with poor prognosis. The mechanisms underlying castration resistance are not fully understood. Sung and...

Targeted Mutations in ATR Pathway and Implications for Combination Strategies

Many chemotherapy agents work by causing DNA strand breaks or accumulation of DNA replication intermediates. ATR (ataxia-telangiectasia mutated and Rad 3-related protein) is a potential target for combination drug strategies, because signaling of this protein in response to such altered DNA...

issues in oncology

Targeted Massively Parallel Sequencing Identifies Clinically Relevant Alterations in Cancer Genes

Systematic methods for profiling tumor genomic alterations remain underdeveloped, with current clinical profiling usually being confined to identification of limited numbers of oncogene point mutations. At present, there is no systematic technique for interrogating tumor samples in situ for a...

lymphoma

New Data Guide Treatment for Rare Form of Hodgkin Lymphoma

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) accounts for approximately 5% of Hodgkin lymphoma cases. It is distinguished from classic Hodgkin lymphoma by a variety of clinical and pathologic features, including expression of B-cell associated antigens such as CD20. Given that the...

leukemia

Erwinia chrysanthemi Asparaginase for Acute Lymphoblastic Leukemia in Patients with Hypersensitivity to E coli–derived Asparaginase

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 Erwinia chrysanthemi asparaginase (Erwinaze) was...

lung cancer

Not All KRAS Mutations Are Alike in Non–Small Cell Lung Cancer

Mutations in the KRAS oncogene play a critical role in cancer cell growth and resistance to treatment. In colorectal cancer, the presence of any mutant amino acid substitution in the K-Ras protein predicts a poorer response to targeted therapy. In non–small cell lung cancer (NSCLC), however, there...

breast cancer

Neoadjuvant Aromatase Inhibitor Therapy Converts Many Patients to Candidates for Breast-conserving Surgery

The American College of Surgeons Oncology Group (ACOSOG) Z1031 trial examined the effect of neoadjuvant aromatase inhibitor therapy on clinical response and breast-conservation rates in postmenopausal women with estrogen receptor (ER)-rich stage II or III breast cancer. An update of the surgical...

solid tumors

Using Imatinib for Adjuvant Treatment after Resection of Kit (CD117)-positive Gastrointestinal Stromal Tumors

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, imatinib mesylate (Gleevec) was granted ...

SMAC Mimetics Induce Proinflammatory Cancer Cell Death and Adaptive Antitumor Immune Response

SMAC/DIABLO (second mitochondria-derived activator of caspase/direct inhibitor of apoptosis-binding protein with low pI) is a proapoptotic mitochondrial protein that is released in response to various apoptotic stimuli. Molecular mimetics of SMAC are being investigated for use in cancer treatment,...

hepatobiliary cancer

Bone Morphogenesis Protein 4 Pathway as Treatment Target in Hepatocellular Carcinoma

Bone morphogenesis protein 4 (BMP4), which belongs to the transforming growth factor (TGF)-β family, is a multifunctional cytokine that is known to be involved in human carcinogenesis. The cytokine exerts its effects through pathways dependent on and independent of SMAD proteins, which are the...

breast cancer

Targeting Human Endogenous Retrovirus K Envelope Protein Inhibits Breast Cancer Growth

The human genome contains a large variety of endogenous retroviral sequences (approximately 8% of the genome). Although most of these are highly defective, the human endogenous retrovirus type K (HERV-K) family shows conservation of apparently intact retroviral genes and is transcriptionally active ...

breast cancer

PEDF Has Cytotoxic Effect on Breast Cancer Cells and Neuron-protective Effect

The cytokine pigment epithelium–derived factor (PEDF) is downregulated in brain metastases of breast cancer by approximately 14-fold compared with primary breast tumors, suggesting that promoting its expression might inhibit metastatic spread. Normal breast epithelial cells express high levels of...

colorectal cancer

Inhibition of IL-8 Receptor Reduces Colorectal Cancer Proliferation and Sensitizes the Disease to Oxaliplatin

Recent studies have shown that interleukin-8 (IL-8) and its receptors CXCR1 and CXCR2 are significantly upregulated in colorectal cancer tumors and their microenvironment and act as regulators of proliferation, angiogenesis, and metastasis. Ning and colleagues from the University of Southern...

breast cancer

Characteristics of Field Cancerization in Histologically Normal Tissue Adjacent to Breast Tumors

It has been shown that a field of genetically altered but histologically normal tissue extends 1 cm or more from the margins of human breast tumors. The characteristics of this field are not fully understood, although it is clear that the molecular alterations in affected cells could provide...

symptom management

Oral Rivaroxaban Is Noninferior to Standard Anticoagulant Therapy in Acute Pulmonary Embolism

Thromboembolic disease is common in patients with cancer and increases risk of mortality. Recent studies showed that the oral factor Xa inhibitor rivaroxaban (Xarelto) was as effective and safe as standard anticoagulant therapy in treating deep-vein thrombosis, with superior efficacy of rivaroxaban ...

lung cancer
geriatric oncology

Canadian Registry Study of Adjuvant Therapy for NSCLC Shows Increased Use in Elderly Patients and Improved Survival

Cisplatin-based adjuvant therapy is recommended for patients with resected stage II–IIIA non–small cell lung cancer (NSCLC). There have been no trials of adjuvant therapy in elderly patients with NSCLC, who constitute a large part of the NSCLC population. A number of analyses indicate that older...

bladder cancer

Expert Point of View: Chemoradiation with Fluorouracil and Mitomycin Reduces Recurrence of Muscle-invasive Bladder Cancer

In an editorial accompanying the recently reported UK phase III Bladder Cancer 2001 (BC2001) trial, Shipley and Zietman, from Massachusetts General Hospital and Harvard Medical School, point out that this trial shows that “the addition of a very tolerable regimen of chemotherapy to radiotherapy...

bladder cancer

Chemoradiation with Fluorouracil and Mitomycin Reduces Recurrence of Muscle-invasive Bladder Cancer

Radiotherapy is an alternative to surgery in muscle-invasive bladder cancer, particularly in less-fit patients. However, it is associated with high rates of incomplete response or recurrence, with salvage surgery often being required. Although synchronous chemoradiotherapy has improved local...

thyroid cancer

Vandetanib: New Drug for Unresectable Medullary Thyroid 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 The oral kinase inhibitor vandetanib (Caprelsa) was...

prostate cancer
issues in oncology

Study Shows Continued Benefit of PSA Screening in Reducing Prostate Cancer Mortality

Studies assessing the effect of prostate-specific antigen (PSA) testing on prostate cancer mortality have produced conflicting results, and recommendations regarding PSA screening vary among authorities. The recently published 11-year follow-up of the European Randomized Study of Screening for...

breast cancer

Inhibition of SFRP2 Found to Inhibit Growth of Triple-negative Breast Tumors

Secreted frizzled related protein 2 (SFRP2), a protein that modulates the Wnt signaling pathway and is involved in embryonic development, has been thought to exert a tumor-suppressive effect via inhibition of β-catenin activation. However, researchers at the University of North Carolina at Chapel...

hepatobiliary cancer

Regional Infusion of Designer T Cells to Treat Intrahepatic Metastases

Designer T cells are modified from normal T cells to express specific immune receptors that allow them, via antibody-directed recognition or other mechanisms, to kill malignant cells bearing particular antigens. The Surgical Immunotherapy Lab at the Roger Williams Medical Center, Providence, Rhode...

pancreatic cancer

Anti-EpCAM Antibody-Drug Conjugate Shows High Activity against Pancreatic Cancer

Human epithelial cell adhesion molecule (EpCAM) is overexpressed in many cancers. Although anti-EpCAM antibodies have shown promise in preclinical studies, early-phase clinical evaluation of these antibodies has been disappointing. To determine whether the antitumor activity of anti-EpCAM antibody...

gynecologic cancers
issues in oncology

Gab2 Promotes Characteristics of Epithelial-to-Mesenchymal Transition in Ovarian Cancer

Ovarian cancer is often diagnosed at a late stage, when cancer cells have already migrated and invaded other tissues and organs. Wang and colleagues from the University of Colorado Denver and the Dana-Farber Cancer Institute in Boston, showed that Gab2—a scaffolding adaptor protein that is...

issues in oncology

Complex Relationship between Metformin and BRAF-mutant Tumors

The antidiabetic drug metformin appears to lower cancer risk in diabetic patients and has shown antitumor activity in preclinical studies. Suppression of mTOR signaling via AMP kinase (AMPK)-dependent TOR complex 1 (TORC1) inhibition is one of the proposed mechanisms by which metformin appears to...

prostate cancer

Pretreatment Tumor Hypoxia Predicts Biochemical Failure after Radiotherapy for Prostate Cancer

Hypoxia often occurs early in solid tumor development as a result of imbalances between oxygen supply and consumption and may lead to genetic and molecular signaling that influences the biology and clinical behavior of tumors and response to treatment. Milosevic and colleagues from Princess...

What You Need to Know About Glucarpidase Injection for Toxic Methotrexate Levels in Renal Impairment

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, glucarpidase injection (Voraxaze) was...

lymphoma

Newest Indication for Rituximab as Maintenance Treatment in Non‑Hodgkin 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 The CD20-directed monoclonal antibody rituximab...

Everolimus: New Indication in Renal Angiomyolipoma Associated with Tuberous Sclerosis Complex

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 April 2012, the kinase inhibitor everolimus...

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...

prostate cancer

Pretreatment Tumor Hypoxia Predicts Biochemical Failure after Radiotherapy for Prostate Cancer

Hypoxia often occurs early in solid tumor development as a result of imbalances between oxygen supply and consumption and may lead to genetic and molecular signaling that influences the biology and clinical behavior of tumors and response to treatment. Milosevic and colleagues from Princess...

sarcoma

Pazopanib: New Drug for Advanced Soft-tissue Sarcoma

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 April 2012, pazopanib (Votrient) was approved for the ...

solid tumors

Identification of Novel Mechanism for Suppression of Antitumor Immunity

The efficacy of cancer immunotherapy has been limited, likely reflecting in large part the incomplete understanding of the complex interactions between tumors and the immune microenvironment. A study presented at the 2012 ASCO Annual Meeting helps clarify some of these interactions. Changes in...

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 ...

solid tumors

p53 Mutation in Advanced Solid Tumors Linked to Aggressive Course

Mutations in the tumor-suppressor protein p53, among the most common mutations in cancers, affect apoptosis, genomic stability, and angiogenesis. To determine the effect of p53 mutation on clinical characteristics and disease and treatment outcomes, Rabih Said, MD, MPH, and colleagues from The...

breast cancer

NK Cell Signature Associated with Favorable Prognosis in Breast Cancer

Tumor cell recognition by natural killer (NK) cells is mediated by the interaction of activating and inhibitory NK cell receptors with ligands expressed on the tumor cells. NK cells also express adhesion molecules that facilitate formation of the immune synapse with tumor targets. Maria Libera...

solid tumors
colorectal cancer

Single Nucleotide Polymorphisms Predict Severe Toxicity of Adjuvant Therapy in Colorectal Cancer

Oxaliplatin/fluoropyrimidine–based adjuvant therapy is of benefit in patients with resected stage II/III colon cancer, but the ability to predict risk of toxicity could improve care by permitting individualization of treatment. Ana Custodio, MD, and colleagues from GEMCAD (Grupo Español...

solid tumors

Two Single Nucleotide Polymorphisms Associated with Risk for Paclitaxel-related Peripheral Neuropathy

Peripheral neuropathy is the most common severe toxicity in patients receiving paclitaxel, and mutations in genes affecting drug metabolism, distribution, and elimination are likely to modulate risk for such neurotoxicity. In a recent study, Daniel Hertz, PharmD, and colleagues from the University...

solid tumors

Alterations in PTEN Insufficient to Predict Sensitivity to Drugs Targeting PI3K/mTOR Pathway

PTEN acts as a tumor-suppressor gene through the action of its phosphatase protein product, which participates in regulation of the cell cycle to prevent too-rapid cell growth and division. Loss of PTEN function has been shown to increase PI3K/mTOR signaling, and preclinical data suggest that PTEN...

SIDEBAR: Key Findings

When asked to comment on implications of this study, lead author Frank A. Greco, MD, remarked, “The use of this gene-expression profile assay (CancerTYPE ID, bioTheranostics, Inc) on the biopsy material of patients with carcinoma of unknown primary provides a single tissue of origin diagnosis in...

issues in oncology

Gene Profiling–guided Therapy May Improve Survival in Patients with Carcinoma of Unknown Primary

Molecular gene-expression profiling is an emerging technique to determine tissue of origin in patients with carcinoma of unknown primary, although the value of predictions from such profiling in improving treatment outcomes is unclear. In a prospective trial using tumor profiling results to direct...

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...

colorectal cancer

Increased Adjuvant Therapy Use and Improved Survival in Dutch Elderly Patients with Stage III Colon Cancer: A Direct Correlation?

A survival benefit of adjuvant chemotherapy has been reported for select elderly patients with stage III colon cancer, but many elderly patients are not candidates for or are not given adjuvant therapy due to comorbidities and fear of toxicity. In a recent Annals of Oncology article, van...

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...

lung cancer

No Improvement in Overall Survival, Worse Toxicity with Motesanib Added to Chemotherapy in Non–Small Cell Lung Cancer

Two trials (E4599 and AVAiL) have suggested a benefit to adding the anti–vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab (Avastin) to chemotherapy in patients with advanced nonsquamous non–small cell lung cancer (NSCLC). Bevacizumab acts by binding directly to circulating...

solid tumors
prostate cancer

Radiotracer Targeting of Free Prostate-specific Antigen

Serum levels of prostate-specific antigen (PSA) are widely used as a biomarker for prostate cancer, although they often do not distinguish between normal tissue and cancer and do not always accurately reflect clinical outcome. In order to overcome the fact that the small proportion of...

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