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issues in oncology

2012 Annual Meeting to Highlight NCI’s ‘Provocative Questions’ and Offer First-ever Pre–Annual Meeting Seminars

As this year’s ASCO Annual Meeting was being planned, the NCI was developing and releasing its “Provocative Questions” project—an effort to stimulate the cancer community to ask itself 24 key questions in order to advance the treatment of cancer and provide better care. It quickly became clear to...

breast cancer

2012 Breast Cancer Symposium to Expand Tumor Board Session, Add ‘Meet the Professors’ Session

The days of attending the Breast Cancer Symposium, just quietly listening to useful lectures, and then going home are over. In recent years, the meeting’s sponsors and planners have worked to make the 3-day gathering far more interactive and as intimate as a meeting with 1,500 attendees can be....

lung cancer

An Expert Shares Insight into the Future of Lung Cancer Treatment

Despite growing national focus on early detection, prevention, and new molecular-based treatments, lung cancer persistently remains the number 1 cause of cancer death for men and women in the United States. The ASCO Post spoke to lung cancer specialist Paul A. Bunn, Jr, MD, Executive Director,...

Constructing a Top Five List in Oncology

The American Society of Clinical Oncology has joined the American Board of Internal Medicine (ABIM) Foundation and eight other medical specialty societies to take a collective stand in improving patient care and addressing rising health-care costs. As part of the ABIM Foundation’s Choosing Wisely®...

breast cancer

Defining Meaningful Benefit: The Debate Continues in Bevacizumab’s Wake

The events surrounding the labeling of bevacizumab (Avastin) have been well covered since last November when the FDA withdrew the drug’s accelerated approval as a treatment for metastatic breast cancer. However, the controversy initiated a debate over the value of endpoints in clinical trials in...

Expert Point of View: More New Data Support Use of Daily Aspirin to Prevent Cancers

Is it time to recommend aspirin for cancer prevention? “It’s the question we are asking,” said Andrew T. Chan, MD, Massachusetts General Hospital and Harvard Medical School, who wrote a commentary accompanying three new studies in The Lancet and Lancet Oncology. The studies, by Peter M. Rothwell,...

global cancer care
pain management
palliative care

Untreated Cancer Pain Remains a Significant Global Problem

“Physicians are afraid of morphine … Doctors [in Kenya] are so used to patients dying in pain … they think that this is how you must die. They are suspicious if you don’t die this way — [and feel] that you died prematurely.” —Human Rights Watch interview with Dr. John Weru of Nairobi Hospice,...

prostate cancer

Advances in Prostate Cancer Accompanied by Ongoing Debates

Scientific advances have markedly improved prostate cancer survival, but this clinical success story is not without its share of controversy. From screening through treatment, a growing array of options offer an admixture of promise and confusion for clinicians and patients. Moreover, today’s...

survivorship

Risk Stratification and Targeted Therapy, Abetted by Collaboration, Improve Outcomes for Children with Cancer

Outcomes for children with cancer have “improved over the course of the years incrementally, mostly not from the development of new drugs, because virtually all the drugs that we use now in leukemia were available in the 1970s. It is really through better understanding of the heterogeneity of the...

colorectal cancer

To Scan or Not to Scan for Colon Cancer Recurrence?

Over the past 2 decades, we have seen a substantial increase in the 5-year survival of patients with stage II and III colon cancer, marking an evolving oncologic success story. However, in the postoperative setting, the value of regular CT screening to monitor for recurrence has been greeted with...

issues in oncology

Medical Ethicists Reflect on Their Personal Cancer Experiences

The recently published book, Malignant: Medical Ethicists Confront Cancer, takes a personal look at the cancer experience from the perspective of seven medical ethicists who were also patients with cancer or cared for spouses with cancer.1 The book’s editor, Rebecca Dresser, JD, MS, who teaches law ...

breast cancer

Older Breast Cancer Drugs Prove Superior to Newer Ones

In the treatment of metastatic breast cancer, established older agents outperformed newer, more expensive drugs in two studies that made news at the 2012 ASCO Annual Meeting. Microtubule Inhibitors In the phase III open-label CALBG 40502/NCCTG N063H trial of 799 chemotherapy-naive patients with...

Reflections from the Old World

A few years ago, I was a key witness for a patent dispute at a trial in Delaware. Acting for the complainant, I was briefed that the opening gambit of the opposition lawyer would be to discredit my CV and, therefore, the value of my testimony. “So you are a full Professor at the University of...

lung cancer

Second-line Treatments Tested in Patients with Non-Small Cell Lung Cancer

Results of two late-breaking phase III trials presented at 2012 ASCO Annual Meeting add to the evolving understanding of how best to treat non–small cell lung cancer (NSCLC). The TAILOR trial suggested the benefit of chemotherapy over EGFR-targeted therapy as second-line treatment of patients with...

lymphoma

Children with Favorable-risk Disease and Complete Response to Chemotherapy Have High Survival Rates without Radiotherapy

Among children with favorable-risk Hodgkin lymphoma, those who achieved a complete response after two cycles of chemotherapy and received no radiotherapy had high rates of survival similar to those who had a less complete response to chemotherapy and received radiotherapy, according to a study in...

Genomics vs Site of Cancer Origin as Basis for Treatment of Cancer Is ‘False Dichotomy’

In the News focuses on media reports that your patients may have questions about at their next visit. This continuing column will provide summaries of articles in the popular press that may prompt such questions, as well as comments from colleagues in the field. Despite recent news reports...

prostate cancer
issues in oncology

Rethinking the Role of PSA Screening in Public Health

Population screening to identify preclinical disease is considered a central factor in the decades-long decrease in mortality seen in certain cancers. However, hope in the face of deadly disease can sometimes blind us to the scientific evidence. According to the recent U.S. Preventive Services Task ...

It’s Time to Get Ready for New Medicare Reporting Requirements

As if you didn’t already have enough to worry about, now add this: If your practice doesn’t meet the requirements of the Physicians Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive, you don’t just miss out on the bonuses the programs offered as incentive in recent years....

prostate cancer

Letter to the Editor: More Thoughts on PSA

An article that appeared in the August 15 issue of The ASCO Post (“Rethinking the Role of PSA Screening in Public Health”) contains false statements about the discovery of prostate-specific antigen (PSA) and its effectiveness as a test for early detection of prostate cancer. Contrary to what’s...

Faculty Q&A Discussion: Anaplastic Large-cell Lymphoma

 Dr. Armitage: For ALK-negative anaplastic large cell lymphoma, brentuximab vedotin is the best thing we have to deal with patients with recurrent disease, and who knows where it will end up in primary therapy. But if the patient is ALK-positive, there is a potential for crizotinib (Xalkori) to...

multiple myeloma

Will Carfilzomib Add Value to Multiple Myeloma Treatment?

Carfilzomib (Kyprolis), the next-generation proteasome inhibitor recently approved by the FDA for relapsed/refractory multiple myeloma, showed strong activity in the front-line setting when paired with lenalidomide (Revlimid) and low-dose dexamethasone (CRd).1 The study evaluated stringent complete ...

SIDEBAR: Is Watch and Wait the Best Strategy for Indolent NHL in the Rituximab Era?

Data from the RESORT and its planned subanalysis can guide oncologists in optimizing treatment for indolent non-Hodgkin lymphoma (NHL) with low–tumor burden advanced-stage disease, according to Michael E. Williams, MD, of the University of Virginia Cancer Center in Charlottesville. The phase III...

SIDEBAR: Should EGFR Tyrosine Kinase Inhibitors Be Continued Beyond Progression?

It is not yet clear if it is beneficial to continue first-line EGFR tyrosine kinase inhibitors in patients with EGFR-mutated lung cancer who experience progression and are started on chemotherapy, according to Dr. Horn. Two trials, one in Asia (looking at gefitinib [Iressa]) and one in North...

Successful Use of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy May Hinge on Prior Experience

A review of 60 consecutive patients with peritoneal carcinomatosis who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC)—sometimes called “hot chemotherapy”—found 0% mortality and 33% morbidity, with “a significant reduction of grade III/IV morbidity,...

solid tumors

Noncolorectal GI Cancer Evidence Incorporated into Guidelines

The noncolorectal gastrointestinal cancer studies selected for this year’s Best of ASCO meetings include some whose results are being folded into practice guidelines or are good candidates for incorporation, according to Alexandria T. Phan, MD, Associate Professor at The University of Texas MD...

Despite the Rhetoric, Cancer Care Costs Keep Skyrocketing: Is There a Solution?

Although health-care experts routinely agree that the rising costs of oncology services are untenable, there is disagreement about how to reduce expenditures without harming access and quality of care. At this year’s ASCO Annual Meeting, Thomas J. Smith, MD, FACP, offered some interesting ideas...

gynecologic cancers

SIDEBAR: All Eyes on Trials of IV vs IP Chemotherapy for Ovarian Cancer

The positive findings from the NOVEL trial add to the debate about how intravenous (IV) chemotherapy stacks up against intraperitoneal (IP) chemotherapy when treating ovarian cancer and the role of dose-dense approaches in general, according to Jonathan S. Berek, MD, of the Stanford Women’s Cancer...

Delivering Affordable Cancer Care: Is It Possible and What Will It Entail?

Many experts agree that at 18% of gross domestic product, health care (to paraphrase Shakespeare) is eating the country out of house and home. “The average cost of treating the most common cancers has increased, and as more expensive targeted therapies and other new technologies become the...

A New Gift to Add to Your List—One to Conquer Cancer

Conquering cancer requires the faith, talent, and resources of all members of our community. It requires the innovation of researchers and the insight of clinicians. It requires the courage of our worldwide community of patients and survivors, and it requires the generosity of everyone who believes ...

SIDEBAR: Mammography Study Stokes Overdiagnosis Debate

Overdiagnosis and the harms associated with unnecessary procedures is becoming a vibrant subject in today’s health-care dialogue, with serious implications for providers and patients alike. A new study from the Norwegian Screening Program concluded that 15% to 25% of breast cancers identified on...

Ambitious Call to Arms Seeks a Shift in Priorities to Eradicate Cancer

It has been more than 4 decades since our nation loaded its medical cannons and declared war on cancer, self-assured that money and American scientific resolve would lead to victory. But cancer has proved to be a humbling enemy. The war is now fought in targeted skirmishes; the weaponry is a...

issues in oncology
cost of care
health-care policy

The Ethics of Rationing Cancer Care

Should cost be a consideration when deciding on treatment for patients with cancer, and if so, what kind of ethical dilemma does that pose for oncologists? With U.S. spending on oncology drugs expected to climb more than 20% annually over the next decade—reaching $173 billion by 2020, according to...

health-care policy

How Sequestration May Affect Cancer Research

Senator Sherrod Brown (D-Ohio) began his political career in 1974 as a state representative in Ohio. He served as Ohio’s Secretary of State between 1983 and 1991, went on to serve in the U.S. Congress from 1993 to 2006, and was elected to the Senate in 2006. A supporter of biomedical and cancer...

Gene-expression Profiles of Triple-negative Breast Cancers Differ between African American and Native African Women

Triple-negative breast cancers in African-American women and native African women have differing gene-expression profiles that may have implications for treatment, according to the first study to directly compare tumor gene expression between these populations. Results were reported at the Fifth...

Screening for Ovarian Cancer: A Gynecologic Oncologist’s Perspective

The recent U.S. Preventive Services Task Force (USPSTF) Reaffirmation Recommendation Statement concluded that in the population of asymptomatic women without known genetic mutations that increase risk for ovarian cancer, clinicians should not screen for ovarian cancer using transvaginal ultrasound...

leukemia

Chlorambucil, but Not Fludarabine, Confers Significant Benefit in Older Patients with CLL

Among patients aged 70 years and older with chronic lymphocytic leukemia (CLL), “front-line therapy with fludarabine does not improve outcomes” compared to chlorambucil (Leukeran), according to an analysis of patients enrolled in successive front-line Cancer and Leukemia Group B (CALGB) studies...

issues in oncology

Developing Cancer Care Pathways for the New Environment

As community practices and the insurance industry seek cost-effective ways to adapt to the Patient Protection and Affordable Care Act, the evolving concept of cancer care pathways is emerging as a strategy that may help control oncology costs and add value to care. At ASCO’s recent Quality Care...

issues in oncology

National Comprehensive Cancer Network Appoints New CEO

The National Comprehensive Cancer Network (NCCN) recently appointed nationally regarded breast cancer expert Robert W. Carlson, MD, as its new CEO. Previously, Dr. Carlson was Professor of Medicine in the Division of Oncology and Medical Informatics, Stanford University Medical Center; he first...

issues in oncology

Are We Winning the War on Cancer?

On December 23, 1971, President Richard Nixon signed the U.S. National Cancer Act. This date is widely considered to mark the beginning of the so-called “War on Cancer,” although that phrase was introduced only later on. Over recent decades, journalists have from time to time questioned whether we...

breast cancer

Treatment of HER2-positive Disease in 2013 

From the initial discovery of the HER2 family of receptors in the mid-1980s to the present, a “wealth of riches” has been uncovered in terms of agents that can target pathways relevant to this aggressive breast cancer type, notes Hope S. Rugo, MD, Director of Breast Oncology and Clinical Trials...

breast cancer

Research Roundup from San Antonio: New Data on Triple-negative, HER2-positive, Local, and Advanced Breast Cancer 

The 2012 San Antonio Breast Cancer Symposium featured more than 2,500 abstracts and lectures, including timely research in the field and discussions for scientists and clinicians alike. In addition to nearly two dozen in-depth reports from the meeting, The ASCO Post brings readers the following...

breast cancer
leukemia

Chemotherapy for Breast Cancer Carries a Small, but Concerning, Risk for Leukemia 

The risk for developing a secondary malignancy after chemotherapy for breast cancer is very small, but it is statistically significantly higher than for the general population, a review of the National Comprehensive Cancer Network (NCCN) database revealed in a study presented at the 2012 San...

kidney cancer

PET/CT With 124I-Girentuximab Can Identify Clear Cell Renal Cell Carcinoma While Minimizing Invasive Diagnostic Risks 

Positron-emission tomography/computed tomography (PET/CT) with iodine-124 (124I) –girentuximab “can accurately and noninvasively identify” clear cell renal cell carcinoma, according to a phase III multicenter study reported in the Journal of Clinical Oncology. In addition, “PET/CT with...

issues in oncology
health-care policy

Focus on the Medical Oncology Association of Southern California 

For more than 2 decades, the guiding principle of the Medical Oncology Association of Southern California (MOASC) has been to ensure the continuation of the private practice of medical oncology and to provide the highest quality care to cancer patients. Founded in 1990, MOASC is the largest...

solid tumors
pancreatic cancer

Finding New Strategies to More Effectively Treat Pancreatic Cancer

While some progress has been made in understanding the molecular pathogenesis, genetic risk factors, and genomics of pancreatic adenocarcinoma, the disease remains one of the most challenging malignancies. According to Surveillance, Epidemiology, and End Results (SEER) figures, 44,000 people were...

health-care policy
legislation

Focus on the Louisiana Oncology Society 

Founded on September 1, 1992, by John M. Rainey, MD, the Louisiana Oncology Society has had numerous legislative successes (see sidebar) since that time, including leading the effort to support Louisiana’s Oral Chemotherapy Parity Law, which was passed in 2012 and is now in effect throughout the...

colorectal cancer

CT Colonography Reconsidered

The parallel SIGGAR trials recently published in Lancet add to the growing body of literature regarding the utility of computed tomographic (CT) colonography in the detection of colorectal polyps and cancers. These papers reinforce the results seen in other large multicenter trials1-3 and echo the...

NCCN Adds Two New Member Institutions

The National Comprehensive Cancer Network (NCCN) recently announced the addition of two new NCCN Member Institutions: UC San Diego Moores Cancer Center in La Jolla, California, and the University of Colorado Cancer Center in Aurora, Colorado. “We are extremely pleased that UC San Diego Moores...

prostate cancer

SIDEBAR: Two Caveats on the PCOS Follow-up 

Dr. Resnick and colleagues are to be congratulated for following men on the PCOS study out to 15 years. The main result—“At 15 years, no significant relative differences in disease-specific functional outcomes were observed among men undergoing prostatectomy or radiotherapy”—should be interpreted...

survivorship

Sexual Health after Cancer: Communicating with Your Patients 

Studies show virtually all cancer survivors will experience some form of sexual dysfunction following a cancer diagnosis and treatment. Yet few cancer survivors seek help for physical problems they may be experiencing, such as vaginal dryness, dyspareunia, chemically induced menopause, reduced...

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