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issues in oncology
cost of care

Expensive Cancer Drugs Don’t Work if Patients Can’t Afford Them

Eight years ago, I was having a series of colds I couldn’t shake and pain that radiated throughout my back. Still, my symptoms weren’t concerning until, on Halloween morning in 2010, I stepped out of bed and fell to the floor in excruciating pain, unable to move. A visit to the emergency room and a ...

sarcoma

Addition of Dose-Intensified Doxorubicin to Standard Chemotherapy in Rhabdomyosarcoma

As reported by Bisogno et al in The Lancet Oncology, a phase III trial (EpSSG RMS 2005) has shown no benefit of adding doxorubicin to standard IVA (ifosfamide, vincristine, dactinomycin) in 3-year event-free survival among patients with high-risk rhabdomyosarcoma. Study Details In the open-label...

integrative oncology
supportive care

Mindfulness in Cancer Care: Hype or Help?

GUEST EDITOR Integrative Oncology is guest edited by Jun J. Mao, MD, MSCE, Laurance S. Rockefeller Chair in Integrative Medicine and Chief, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York.   “Mindfulness” has gained significant popularity in the lay press in recent...

issues in oncology
survivorship

Raising Awareness of the Financial Impact of Cancer on Young Adult Survivors

GUEST EDITOR Adolescent and Young Adult Oncology explores the unique physical, psychosocial, social, emotional, sexual, and financial challenges adolescents and young adults with cancer face. The column is guest edited by Brandon Hayes-Lattin, MD, FACP, Associate Professor of Medicine and Medical...

kidney cancer

Percutaneous Ablation vs Nephrectomy in T1a Kidney Cancer

Many cases of early-stage kidney cancer can be treated with a relatively new, nonsurgical procedure used to destroy tumors, a new study by Talenfeld et al in Annals of Internal Medicine suggests. The procedure, called percutaneous ablation, involves the insertion of a needle through the skin into...

lung cancer

Addition of Veliparib to Temozolomide in Recurrent Small Cell Lung Cancer

In a phase II trial reported in the Journal of Clinical Oncology, Pietanza et al found no benefit of adding the PARP inhibitor veliparib to temozolomide (Temodar) in recurrent platinum-sensitive or platinum-refractory small cell lung cancer. Benefit was observed with the combination in the subgroup ...

breast cancer

Addition of Panitumumab to Neoadjuvant Chemotherapy in Primary HER2-Negative Inflammatory Breast Cancer

In a single-center phase II study reported in JAMA Oncology, Matsuda et al found that adding the EGFR inhibitor panitumumab (Vectibix) to neoadjuvant chemotherapy produced high pathologic complete response (pCR) rates in patients with primary triple-negative inflammatory breast cancer. Study...

hepatobiliary cancer

Sodium Thiosulfate to Prevent Cisplatin-Induced Hearing Loss in Pediatric Standard-Risk Hepatoblastoma

In a phase III International Liver Tumor Strategy Group trial (SIOPEL 6) reported in The New England Journal of Medicine, Brock et al found that sodium thiosulfate reduced cisplatin-induced hearing loss in pediatric patients with standard-risk hepatoblastoma. Study Details The trial enrolled a...

skin cancer

Educational Interventions Decrease Sunburns Among Operators of Heavy Equipment

The implementation of educational interventions among heavy equipment operators, or operating engineers, in Michigan significantly increased the use of sunscreen and decreased the number of sunburns, reported Duffy et al in Cancer Epidemiology, Biomarkers & Prevention. “The rates of...

lung cancer
immunotherapy

FDA Accepts sBLA for First-Line Nivolumab Plus Low-Dose Ipilimumab in NSCLC With Tumor Mutational Burden ≥ 10 mut/mb

The U.S. Food and Drug Administration (FDA) recently accepted a supplemental biologics license application (sBLA) for nivolumab (Opdivo) plus low-dose ipilimumab (Yervoy) for the first-line treatment of advanced non–small cell lung cancer (NSCLC) in patients with a tumor mutational burden...

breast cancer
immunotherapy

Trastuzumab Biosimilar vs Reference Trastuzumab in HER2-Positive Early Breast Cancer

In the phase III LILAC equivalence trial reported in The Lancet Oncology, von Minckwitz et al found similar efficacy and safety with the trastuzumab biosimilar ABP 980 vs reference trastuzumab (Herceptin) in HER2-positive early breast cancer. On local review, the risk difference and risk ratio (RR) ...

solid tumors
supportive care

Prognostic Model for Malignant Pleural Effusion

As reported in The Lancet Oncology, Psallidas et al developed a model that is predictive of 3-month survival in patients with malignant pleural effusion. Study Details The PROMISE study involved an analysis of 5 independent data sets from randomized trials to discover, validate, and prospectively ...

lung cancer
immunotherapy

FDA Expands Approval of Pembrolizumab for First-Line Treatment of NSCLC

The U.S. Food and Drug Administration (FDA) recently granted accelerated approval to the immune checkpoint inhibitor pembrolizumab (Keytruda) for use in combination with chemotherapy as a first-line treatment for patients with metastatic non–small cell lung cancer (NSCLC). KEYNOTE-021 This...

breast cancer

Long-Term Results of Adjuvant Endocrine Therapy in Premenopausal Breast Cancer

In an analysis of long-term outcomes in the SOFT and TEXT trials reported at the 2018 ASCO Annual Meeting and in The New England Journal of Medicine, Francis et al found that the addition of ovarian suppression to adjuvant tamoxifen significantly improved 8-year rates of disease-free and overall...

gynecologic cancers
lymphoma

Pembrolizumab Receives FDA Approval for Relapsed or Refractory Primary Mediastinal Large B-Cell Lymphoma, Advanced Cervical Cancer

THE U.S. FOOD and Drug Administration (FDA) granted accelerated approval to pembrolizumab (Keytruda) for the treatment of adult and pediatric patients with refractory primary mediastinal large B-cell lymphoma or who have relapsed after two or more prior lines of therapy on June 13, 2018. The newest ...

prostate cancer

Bipolar Androgen Therapy After Disease Progression in Metastatic Castration-Resistant Prostate Cancer

In a single-center phase II study reported in The Lancet Oncology, Teply et al found that bipolar androgen therapy can induce prostate-specific antigen (PSA) response and resensitization to enzalutamide (Xtandi) in men with metastatic castration-resistant prostate cancer whose disease progressed on ...

cns cancers

Addition of Tumor-Treating Fields to Maintenance Temozolomide in Glioblastoma

The final results of a phase III trial reported by Roger Stupp, MD, of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and colleagues in JAMA indicate that adding antimitotic treatment with tumor-treating fields to maintenance temozolomide is associated with improved...

lung cancer

Disparities Found in Lung Cancer Care, Survival in United States vs England

DESPITE STEADY declines in death rates in recent years, lung cancer remains the leading cause of cancer deaths in wealthy countries. In a study published by Anita Andreano, MD, of the University of Milan-Ciocco, and colleagues in the Journal of Thoracic Oncology,1 Yale researchers collaborated with ...

issues in oncology
survivorship

Handheld Device for Detecting Heart Dysfunction in Anthracycline-Exposed Survivors of Childhood Cancer

Cardiovascular complications, such as anthracycline-related heart failure, are a leading cause of morbidity and mortality in survivors of childhood cancer, often developing at a time when these survivors are least engaged in long-term survivorship care, prompting the need for new paradigms in...

leukemia

Suboptimal Use of Initial Chemotherapy in Newly Diagnosed AML

In a study of National Cancer Database data reported in Blood Advances, Bhatt et al found that 25% of patients with newly diagnosed acute myeloid leukemia (AML) did not receive initial chemotherapy, despite evidence that chemotherapy is associated with a survival benefit and improvement in symptoms ...

integrative oncology

Green Tea

The ASCO Post’s Integrative Oncology series is intended to facilitate the availability of evidence-based information on integrative and complementary therapies sometimes used by patients with cancer. Gary Deng, MD, PhD, and Jyothirmai Gubili, MS, present information on the potential health benefits ...

hematologic malignancies

From Italy to Boston, A Love of Molecular Diagnostics Shapes a Career for Valentina Nardi, MD

Valentina Nardi, MD, is a staff pathologist at Massachusetts General Hospital, and her current clinical work includes implementing molecular assays for hematologic malignancies at the Center for Integrated Diagnostics. “I was born in Rome, but I did my high school and college education in Genoa. I ...

ESMO Prioritizes Cancer Care at 71st World Health Assembly

AT THE 71ST World Health Assembly in Geneva, the European Society for Medical Oncology (ESMO) delivered two statements positioning cancer as a priority on the global agenda of the World Health Organization (WHO). Presenting its recommendations for action to the international community, ESMO...

leukemia

Patients With AML Have Reduced Risk of Early Mortality at NCI-Designated Cancer Centers

RESEARCHERS AT the University of California (UC), Davis, have shown that patients with acute myeloid leukemia (AML) who received their care at a National Cancer Institute (NCI) cancer center in California had a dramatically reduced risk of early mortality. Using data from the California Cancer...

issues in oncology

Resilience While Caring for Seriously Ill Patients: Skills and Strategies to Prevent Burnout

A career in oncology can be extremely rewarding. Fast-paced advances in research and treatment, exciting changes in the practice environment, and the opportunity to build strong relationships with and provide critical support to patients can be incredibly professionally satisfying—but they can...

breast cancer

Regular Mammograms Linked to Less Aggressive Treatment in Patients With Breast Cancer

A STUDY evaluating the impact of breast cancer screening has shown that the benefits of regular mammograms extend well beyond reduced mortality. According to data presented at the American Society of Breast Surgeons (ASBrS) 2018 Annual Meeting, women with breast cancer who underwent regular...

breast cancer

AJCC Breast Cancer Staging System More Clinically Relevant

THE RECENTLY issued 8th revision to the American Joint Committee on Cancer (AJCC) Breast Cancer Staging System incorporates tumor biology and prognostic stage groups and thus has become more accurate and clinically relevant, according to two speakers at the 2018 Miami Breast Cancer Conference.1,2...

Be Counted—Complete the 2018 ASCO Practice Census Today

ASCO invites you to participate in the 2018 ASCO Practice Census. Just as you monitor the health of your patients, ASCO regularly gathers information on the oncology practice environment, and we need your help to do so. The ASCO Practice Census is an annual survey designed to capture comprehensive, ...

issues in oncology

Changes to Maintenance of Certification: New Pathways for Assessment

As you know, for more than 2 years, ASCO has been working closely with the American Board of Internal Medicine (ABIM) to shape the future of maintenance of certification (MOC) and assessment for our specialty. The ASCO MOC Task Force was charged by ASCO’s membership to make the process for...

solid tumors
prostate cancer

Prostate Cancer Therapy in Evolution: Time to Rethink and Redirect?

The ASCO updated guidelines on the treatment of metastatic non-castrate prostate cancer penned by Morris and his colleagues1 provide valuable information annotated to the strengths of evidence in recently reported prostate cancer studies. CHAARTED, GETUG-AFU 15, LATITUDE, and STAMPEDE have...

issues in oncology

Parents See Cancer Prevention Potential as Best Reason for HPV Vaccination

Parents of adolescents believed that the potential to prevent certain types of cancer is the best reason for their children to receive the human papillomavirus (HPV) vaccine, whereas other reasons health-care providers often give were far less persuasive. Findings from this study were published by...

breast cancer

ASCO/CAP Clinical Practice Guideline Focused Update on HER2 Testing in Breast Cancer

As reported in the Journal of Clinical Oncology by Antonio C. Wolff, MD, of Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, and colleagues, ASCO and the College of American Pathologists (CAP) have issued a clinical practice guideline focused update on HER2 testing in breast cancer....

solid tumors
prostate cancer

ASCO Clinical Practice Guideline: Optimizing Anticancer Therapy in Metastatic Non-castrate Prostate Cancer

As reported in the Journal of Clinical Oncology by Michael J. Morris, MD, of Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, and colleagues, ASCO has released a clinical practice guideline on optimizing anticancer therapy in men with metastatic non-castrate prostate cancer.1 To ...

solid tumors
gastrointestinal cancer

Optimizing Biologics in Metastatic Colon Cancer

Biologics are credited with increasing median overall survival in colorectal cancer to approximately 30 months. Their optimal use was discussed by Axel Grothey, MD, Professor of Oncology at the Mayo Clinic, Rochester, Minnesota, in an article he coauthored for the Journal of Oncology Practice 1...

hematologic malignancies
leukemia

Phase I Study Shows Safety, Efficacy of Ivosidenib in Acute Myeloid Leukemia

Ivosidenib, an isocitrate dehydrogenase-1 (IDH1) inhibitor, yielded durable and molecular remissions in some patients with IDH1-mutated advanced relapsed or refractory acute myeloid leukemia (AML). At a dose of 500 mg/d, ivosidenib was associated with a low frequency of grade 3 or higher...

solid tumors
gastrointestinal cancer
colorectal cancer

Care for Colorectal Cancer Costs Twice as Much in Western Washington vs British Columbia, With Similar Survival

It is widely acknowledged that the costs of cancer care are much higher in the United States than in Canada, with outcomes that are thought to be similar. A new study presented at the 2018 ASCO Annual Meeting supports that view, by documenting and quantifying the differences in health-care costs...

hematologic malignancies
lymphoma

Outcomes in Waldenström’s Macroglobulinemia Improved With Ibrutinib Plus Rituximab

In patients with Waldenström’s macroglobulinemia, the risk of disease progression was reduced by 80% with the combination of ibrutinib (Imbruvica) and rituximab (Rituxan) over rituximab alone, in the international phase III iNNOVATE trial, reported at the 2018 ASCO Annual Meeting1 and...

solid tumors
gastrointestinal cancer
colorectal cancer

Less Is More: No Benefit Reported for Hyperthermic Intraperitoneal Chemotherapy in Colorectal Cancer

With a growing emphasis on value in cancer care, some types of resource-intensive therapies may need to be reconsidered. One such treatment may be hyperthermic intraperitoneal chemotherapy, which showed no benefit during surgery for colorectal cancer confined to the peritoneum in the PRODIGE 7...

Expert Point of View: Charles G. Drake, MD, PhD and Hatem H. Soliman, MD

Formal discussant of the GeparNuevo presentation, Charles G. Drake, MD, PhD, of the Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, New York, said, “It is important that neoadjuvant immunotherapy combinations are being studied. There is a lot of enthusiasm for...

breast cancer
immunotherapy

Priming the Immune System: Neoadjuvant Durvalumab Plus Chemotherapy May Be Beneficial in Triple-Negative Breast Cancer

The addition of durvalumab -(Imfinzi) to anthracycline/taxane-based chemotherapy had encouraging results as neoadjuvant therapy for early triple-negative breast cancer in the randomized phase II GeparNuevo study presented at the 2018 ASCO Annual Meeting.1 The results were positive in a subgroup of...

lymphoma

EHA 2018: Tazemetostat in Relapsed or Refractory Follicular Lymphoma

Positive interim data were recently presented from an ongoing phase II study of tazemetostat—a potent, selective, orally available EZH2 inhibitor—as a monotherapy for patients with relapsed or refractory follicular lymphoma. The data, presented by Salles et al at the 23rd Annual...

solid tumors
kidney cancer

Nephrectomy May Be Avoided in Some Patients With Advanced Renal Cell Carcinoma

In the modern era of targeted therapy, some patients with metastatic renal cell carcinoma may be able to forgo nephrectomy and be treated with sunitinib (Sutent) alone, according to results of the phase III CARMENA trial reported during the Plenary Session at the 2018 ASCO Annual Meeting.1 The...

solid tumors
skin cancer

The Raven

The call from the dermatologist came at noon on Good Friday, just after my wife left with our two young daughters for a week on her family’s tree farm in Northern Michigan. I was on call for the hospital inpatient leukemia service, so I could not join them. When the dermatologist solemnly began,...

hematologic malignancies
leukemia

Minimal Residual Disease Testing in AML: Still a Shifting Target

Testing for minimal residual disease (MRD) has become an established part of the management of acute lymphoblastic leukemia (ALL), but in acute myeloid leukemia (AML), the technology still warrants validation. To address issues and set new standards, the European LeukemiaNet Working Party recently ...

leukemia

EHA 2018: Single-Agent Quizartinib vs Chemotherapy in Relapsed or Refractory AML

Results from the phase III QuANTUM-R study of single-agent quizartinib in relapsed or refractory acute myeloid leukemia (AML) were presented by Cortes et al at the 23rd Annual Congress of the European Hematology Association (EHA) (Abstract LB2600). Study Findings QuANTUM-R study results showed...

multiple myeloma

Once- vs Twice-Weekly Carfilzomib in Relapsed or Refractory Multiple Myeloma

An interim analysis of the phase III ARROW trial reported in The Lancet Oncology by Moreau et al indicated that a higher-dose once-weekly schedule of carfilzomib was associated with prolonged progression-free survival vs a twice-weekly schedule in patients with relapsed or refractory multiple...

lymphoma
immunotherapy

EHA 2018: Tisagenlecleucel Demonstrates More Than 1-Year Durability of Response in Adults With Relapsed or Refractory DLBCL

Fourteen-month results from the JULIET clinical trial showed ongoing durable responses are achievable with tisagenlecleucel (Kymriah) when administered to adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). This updated analysis was presented by Borchmann et al at ...

multiple myeloma

EHA 2018: Elotuzumab Plus Pomalidomide and Low-Dose Dexamethasone vs Pomalidomide/Dexamethasone Alone in Relapsed or Refractory Multiple Myeloma

The ELOQUENT-3 trial, an international phase II study evaluating the addition of elotuzumab (Empliciti) to pomalidomide (Pomalyst) and low-dose dexamethasone in patients with relapsed/refractory multiple myeloma, achieved its primary endpoint, showing a statistically significant and clinically...

hepatobiliary cancer
immunotherapy

KEYNOTE-224: Pembrolizumab in Advanced Hepatocellular Carcinoma Pretreated With Sorafenib

As reported in The Lancet Oncology by Zhu et al, the phase II KEYNOTE-224 study has shown activity of pembrolizumab in advanced hepatocellular carcinoma (HCC) pretreated with sorafenib. Study Details In the study, 104 eligible patients who were intolerant of or progressed on sorafenib were...

palliative care
issues in oncology

AMA Rejects Recommendation to Reaffirm Opposition to Medical Aid in Dying

On June 11, the American Medical Association (AMA) House of Delegates voted 56% to 44% to reject a report by its Council on Ethical and Judicial Affairs (CEJA) that recommended the AMA maintain its Code of Medical Ethics’ opposition to medical aid in dying. Instead, the House of Delegates...

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