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Expert Point of View: James O. Armitage, MD

In an accompanying editorial entitled “Who Benefits From Surveillance Imaging?” James O. Armitage, MD, University of Nebraska Medical Center, Omaha, noted that data on surveillance imaging (CT or PET/CT) indicate a general absence of survival benefit in adults with lymphomas, while pointing out...

lymphoma

Study Shows Routine CT Surveillance Overused in Pediatric Hodgkin Lymphoma

The value of routine CT surveillance monitoring of pediatric patients for recurrence of Hodgkin lymphoma has been unclear. A study of CT surveillance recently reported by Stephan D. Voss, MD, PhD, and colleagues from the Children’s Oncology Group (COG) in the Journal of Clinical Oncology showed...

multiple myeloma

Carfilzomib: New Drug with Accelerated Approval for Multiple Myeloma

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 July 2012, carfilzomib (Kyprolis) was granted...

breast cancer

No Advantage to Longer Adjuvant Chemotherapy in Women with Early Breast Cancer: CALGB 40101 Trial

The ideal duration of adjuvant therapy for women with lower-risk primary breast cancer remains unknown. The National Surgical Adjuvant Breast and Bowel Project (NSABP) B-15 trial, reported more than 20 years ago, found no difference in outcomes between six cycles of cyclophosphamide, methotrexate,...

Ziv-aflibercept with FOLFIRI in Metastatic Colorectal Cancer

In August 2012, the antiangiogenic agent ziv-aflibercept (Zaltrap) was approved for use in combination with FOLFIRI (fluorouracil, leucovorin, irinotecan) for the treatment of metastatic colorectal cancer resistant to or progressing after an oxaliplatin-containing regimen.1,2 Approval was based on...

colorectal cancer

New Indication for Cetuximab plus FOLFIRI to Treat EGFR-positive, Wild-type KRAS 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. Indication In July 2012, cetuximab (Erbitux) was approved for use...

TRIM27 as Target in Cancer Development

The tripartite motif family protein 27 (TRIM27) is a transcriptional repressor that reduces induction of cell senescence by retinoblastoma-associated protein (RB1). High levels of TRIM27 expression occur in several human cancers and have been associated with poor prognosis in breast and endometrial ...

VEGF Pathway Biomarker for Outcome with Bevacizumab

No biomarkers are available to guide patient selection for treatment with the anti-VEGF monoclonal antibody bevacizumab (Avastin). Lambrechts and colleagues from VIB and KULeuven and University Hospital Gasthuisberg, Belgium, and F. Hoffmann-La Roche in Basel, Switzerland, have identified a locus...

Evolutionary Pathways in BRCA1-associated Breast Tumors

BRCA1 germline mutations are associated with elevated risk of breast and ovarian cancers, and somatic loss of the wild-type BRCA1 allele has been thought to be a rate-limiting initiating step in tumor development. BRCA1-associated breast tumors acquire additional somatic alterations during...

Metastasis Promoted by Cleaving and Inhibiting Proapoptotic Effect of von Willebrand Factor

Mochizuki and colleagues from Keio University in Tokyo, the Chemo-Sero-Therapeutic Research Institute in Kumamoto, and RIKEN in Saitama have shown that von Willebrand factor has proapoptotic effects and that a disintegrin and metalloproteinase 28 (ADAM28) promotes metastasis by cleaving and...

Predictive Markers for Outcome with Pazopanib in Metastatic Renal Cell Cancer

Several targeted drugs are approved for treatment of metastatic renal cell cancer, but no validated biomarkers are available for prediction of clinical outcome of treatment with these agents. In a recent study, Tran and colleagues from The University of Texas MD Anderson Cancer Center in Houston,...

Anticancer Effect of Diabetes Drug Metformin

Retrospective analyses have indicated that the antidiabetic agent metformin may be associated with a quite substantial reduction in risk of cancers. There is evidence that the anticancer effects of metformin are related to inhibition of the growth of certain cancers via activation of AMP kinase...

prostate cancer
issues in oncology

No Survival Benefit of Radical Prostatectomy vs Observation for Localized Prostate Cancer Detected by PSA Testing

The relative benefits of surgery or observation in men with prostate cancer detected by prostate-specific antigen (PSA) testing have not been defined. Randomized trials comparing radical prostatectomy with observation were conducted before widespread use of PSA testing and an observational study...

prostate cancer

Enzalutamide for Metastatic Castrate-resistant Prostate 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 August 31, enzalutamide (Xtandi) was approved for the ...

prostate cancer

Hormonal Therapy with Enzalutamide Increases Survival in Castrate-resistant Prostate Cancer after Chemotherapy

The androgen receptor–signaling inhibitor enzalutamide (Xtandi) is reported to differ from conventional antiandrogen agents in that it inhibits androgen receptor nuclear translocation, DNA binding, and coactivator recruitment, has a greater affinity for the androgen receptor, and induces tumor...

leukemia

Bosutinib in Chronic Myelogenous Leukemia Patients with Resistance or Intolerance of Prior Therapy

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 September 4, 2012, bosutinib (Bosulif) was approved...

leukemia

Kinase Inhibitors Compared in First-line Treatment of CML

Bosutinib (Bosulif) is an oral dual Src/Abl kinase inhibitor that is active against many Bcr-Abl mutations associated with imatinib (Gleevec) resistance and that has reduced activity against nonspecific molecular targets associated with toxicities reported for other second-generation kinase...

Neuropathy Not Predictive of Outcomes with Adjuvant Taxane Therapy in Breast Cancer

Neuropathy is a common and potentially disabling adverse effect of taxane therapy, particularly weekly paclitaxel. A number of recent studies have identified single nucleotide polymorphisms that appear to increase risk of grade 2 to 4 neuropathy in patients with breast cancer who receive taxanes....

skin cancer

Vismodegib: Novel Agent for Treating Advanced Basal Cell Carcinoma

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, vismodegib (Erivedge) was approved...

issues in oncology

Genome-wide Analysis Reveals Molecular Pathway Aberrations in Uterine Serous Cancer

The molecular pathogenesis of uterine serous carcinoma, the most aggressive form of uterine cancer, remains largely undefined. Kuhn and colleagues from Johns Hopkins Medical Institutions recently identified prominent genetic alterations in uterine serous carcinoma using whole-exome sequencing....

issues in oncology

Whole-blood RNA Expression Profiles as Prognostic Models for Castration-resistant Prostate Cancer

Survival among patients with castration-resistant prostate cancer is highly variable, and there is a scarcity of prognostic markers that could be used to stratify patients in clinical trials, improve treatment, and accelerate drug development. Two recent studies reported in Lancet Oncology have...

issues in oncology

Noninvasive Measurement of Interstitial Fluid Pressure as Marker of Tumor Aggressiveness

Increased interstitial fluid pressure in tumors can cause metastatic dissemination and treatment resistance. Study of interstitial fluid pressure has been challenging due to a lack of noninvasive imaging strategies. In a recent study, Hompland and colleagues from the Institute of Cancer Research at ...

lung cancer
issues in oncology

Phase II Study Suggests Advantage of Irreversible Pan-HER Inhibition in Advanced NSCLC

Dacomitinib is a new tyrosine kinase inhibitor that forms irreversible covalent bonds with the ATP domain of each of the three kinase-active members of the HER family—EGFR/HER1, HER2, and HER4. Agents such as erlotinib (Tarceva) and gefitinib (Iressa), which are of proven benefit in advanced...

Impaired Plasmacytoid Dendritic Cell IFN-α Production May Contribute to Breast Cancer Progression

Infiltration and dysfunction of immune cells has been observed in numerous cancers. After finding that plasmacytoid dendritic cells (pDC) in primary breast tumors correlated with unfavorable prognosis, Sisirak and colleagues from INSERM (Institut National de la Santé et de la Recherche Médicale)...

breast cancer

Mutational Activation of PI3K-AKT Pathway and Change in HER2 Expression in Trastuzumab-resistant Breast Cancer

Insensitivity of HER2-amplified breast cancer to trastuzumab (Herceptin) has been associated with both changes in HER2 expression and activation of the PI3K-AKT pathway in laboratory studies. Chandarlapaty and colleagues from Memorial- Sloan Kettering Cancer Center in New York and Fox Chase Cancer...

breast cancer

HIV Protease Inhibitor Nelfinavir Selectively Inhibits HER2-positive Breast Cancer Cells

Shim and colleagues from Johns Hopkins School of Medicine in Baltimore, the National Cancer Institute in Bethesda, and Emory University School of Medicine in Atlanta have recently shown that the HIV protease inhibitor nelfinavir (Viracept) is a selective inhibitor of HER2-positive breast cancer...

Effects of LKB1 Mutation and mTOR Inhibition on IGFR1 Pathway in NSCLC

LKB1 is a serine/threonine kinase that has been found to be mutated in approximately 20% to 30% of patients with non–small cell lung cancer (NSCLC). LKB1 acts as a tumor suppressor by activating AMPK, and loss of LKB1 by point mutation or deletion suppresses AMPK, leading to increased mTOR...

PD-1 Blockade Increases Transferred T-cell Migration to Tumors

One reason that adoptive cell transfer has met with limited clinical success is that approaches based on this strategy have not fully taken into account the role of the tumor microenvironment as a limiting factor in immunotherapy. Recently reported studies by Peng and colleagues1 from The...

Ruxolitinib: Novel Drug for Myelofibrosis

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 November 2011, ruxolitinib (Jakafi) was approved for...

Intermittent Androgen Suppression in Prostate Cancer Noninferior to Continuous Suppression, Associated with Some QOL Benefit

A recently reported National Cancer Institute of Canada (NCIC) Clinical Trials Group study, reported by Crook and colleagues in The New England Journal of Medicine, showed that intermittent androgen suppression was associated with noninferior overall survival when compared with continuous...

Albumin-bound Paclitaxel in First-line Treatment of Advanced NSCLC

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 October 11, 2012, paclitaxel protein-bound particles...

Nab-paclitaxel vs Solvent-based Paclitaxel in First-line Treatment of Advanced Non–Small Cell Lung Cancer: Final Results

Nanoparticle albumin-bound (nab)-paclitaxel (Abraxane) is a solvent-free paclitaxel formulation intended to reduce solvent-related adverse reactions and improve tumor penetration via the physiologic transport properties of albumin. The final results of a phase III trial comparing nab-paclitaxel and ...

Adjuvant Chemotherapy for Breast Cancer Predicted by Disease, Age, and Insurance Type, but Not by Race

Breast cancer mortality has been found to be higher among black and Hispanic women than among white women, with the differences in outcome being attributed in part to more advanced disease stage and greater frequency of unfavorable tumor biology among black and Hispanic women. Studies to date have...

Regorafenib, Multikinase Inhibitor, for 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. Indication On September 27, 2012, regorafenib (Stivarga) was...

Trastuzumab Emtansine Improves Survival vs Capecitabine plus Lapatinib in Second-line HER2-positive Breast Cancer

Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate composed of trastuzumab bound to the cytotoxic microtubule inhibitor emtansine (DM1, derivative of maytansine) by a stable linker. Trastuzumab targets the conjugate to HER2 receptors, and the linker releases the cytotoxic agent when the...

No Survival Benefit for Oxaliplatin Added to Adjuvant Therapy in Stage II or Elderly Patients with Colon Cancer

Oxaliplatin plus fluorouracil (5-FU)/leucovorin or capecitabine (Xeloda) is a standard of care in adjuvant therapy for stage III colorectal cancer. There is ongoing debate about whether any adjuvant therapy is of benefit in patients with stage II disease, and it is not routinely recommended in this ...

prostate cancer
issues in oncology

Role of Glutamate and Effect of Its Blockade in Prostate Cancer

Glutamate plays a role in oncogenic metabolic and signaling pathways. In a recently reported study, Koochekpour and colleagues from the Roswell Park Cancer Institute in Buffalo, NY, investigated potential correlations of glutamate levels with prostate cancer in patients with primary or...

issues in oncology

Significant Reduction in Cancer Risk Seen with Daily Multivitamin Use in Middle-aged and Older Men

Large-scale trials over the past several years have shown a general lack of effect of single vitamins or small numbers of vitamins given at high doses in preventing cancer. However, as recently reported in JAMA by Gaziano and colleagues, the Physicians’ Health Study II has found a modest but...

cns cancers

Revised Everolimus Dosing and New Safety/Efficacy Data for Approval in Subependymal Giant Cell Astrocytoma

On August 29, 2012, everolimus in a tablet for oral suspension form (Afinitor Disperz) was given accelerated approval for the treatment of pediatric and adult patients with tuberous sclerosis complex who have subependymal giant cell astrocytoma (SEGA) that requires therapeutic intervention but...

hematologic malignancies
leukemia

SIDEBAR: REPORT ADVERSE EVENTS

Health-care professionals should report all serious adverse events suspected to be associated with the use of any medicine or device to FDA’s MedWatch Reporting System by completing a form online at http://www.fda.gov/medwatch/report.htm, by faxing (1-800-FDA-0178), by mailing the postage-paid...

hematologic malignancies
leukemia

Liposomal Vincristine for Adult Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia

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 August 2012, vinCRIStine sulfate LIPOSOME injection...

lung cancer

Effects of LKB1 Mutation and mTOR Inhibition on IGFR1 Pathway in Non-small Cell Lung Cancer

LKB1 is a serine/threonine kinase that has been found to be mutated in approximately 20% to 30% of patients with non–small cell lung cancer (NSCLC). LKB1 acts as a tumor suppressor by activating AMPK, and loss of LKB1 by point mutation or deletion suppresses AMPK, leading to increased mTOR...

issues in oncology
symptom management

Statin Use Associated with Reduced Cancer-related Mortality in Danish Study

Cancer-related mortality among patients in the Danish population receiving a diagnosis of cancer at age ≥ 40 years between 1995 and 2007 was significantly reduced in those who were receiving statin therapy at the time of diagnosis, according to an analysis reported by Nielsen and colleagues in The...

solid tumors

Gene Profiling Directs Site-specific Therapy for Carcinoma of Unknown Primary Site

Patients with carcinoma of unknown primary site usually receive empiric therapy (eg, with taxane/platinum or gemcitabine/platinum regimens), resulting in a median overall survival of approximately 9 months. As reported recently in Journal of Clinical Oncology, Hainsworth and colleagues have shown...

lymphoma

Faster Rituximab Infusion for Previously Untreated Follicular Non-Hodgkin and Diffuse Large B-cell Lymphomas 

On October 19, 2012, FDA approved a 90-minute infusion for rituximab (Rituxan) starting at cycle 2 for patients with previously untreated follicular non-Hodgkin or diffuse large B-cell lymphoma who do not experience a grade 3 or 4 infusion-related reaction during cycle 1.1 Patients with clinically...

leukemia

Omacetaxine for Chronic or Accelerated Phase CML Patients with Resistance/Intolerance to Tyrosine Kinase Inhibitors

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 October 26, 2012, the FDA granted accelerated...

supportive care

Tumor Grade Is Associated with Risk for Venous Thromboembolism

Recent data suggest that risk for venous thromboembolism is associated with biologic aggressiveness of cancer. Findings in the Vienna Cancer and Thrombosis Study, recently reported by Ahlbrecht and colleagues in Journal of Clinical Oncology, indicate that patients with higher-grade tumors are at...

issues in oncology

Most Patients Do Not Report that Cure Is Highly Unlikely with Chemotherapy for Advanced Cancer  

Chemotherapy for metastatic lung or colorectal cancer can provide palliation and modestly prolong life, but is not curative. In a study recently reported in The New England Journal of Medicine, Jane C. Weeks, MD, of Dana-Farber Cancer Insitute, and colleagues found that the majority of patients...

SIDEBAR: REPORT ADVERSE EVENTS

Health-care professionals should report all serious adverse events suspected to be associated with the use of any medicine or device to FDA’s MedWatch Reporting System by completing a form online at http://www.fda.gov/medwatch/report.htm, by faxing (1-800-FDA-0178), by mailing the postage-paid...

thyroid cancer

Cabozantinib in Metastatic 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 On November 29, 2012, cabozantinib (Cometriq) was...

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