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issues in oncology
pain management

Opioid Prescriptions in Patients With Cancer in Southwest Virginia

In a study in residents of rural southwest Virginia reported in the Journal of Oncology Practice, Virginia T. LeBaron, PhD, and colleagues found that most patients with cancer never received a prescription opioid medication, that few patients were admitted to hospital for opioid use disorders, and...

skin cancer

Long-Term Analysis of Vemurafenib/Cobimetinib in Patients With BRAF-Mutated Melanoma

A phase Ib study evaluating the safety and long-term benefit of combination treatment with the BRAF inhibitor vemurafenib plus the MEK1 inhibitor cobimetinib in patients with advanced BRAF V600E–mutated melanoma has found that nearly 40% of the patients experienced extended survival of 4 to 5 years ...

head and neck cancer
immunotherapy

Pembrolizumab With or Without Chemotherapy vs Cetuximab Plus Chemotherapy in Recurrent or Metastatic HNSCC

As reported in The Lancet by Barbara Burtness, MD, and colleagues, the phase III KEYNOTE-048 trial has shown improved overall survival with first-line pembrolizumab plus chemotherapy vs cetuximab plus chemotherapy among patients with recurrent or metastatic squamous cell carcinoma of the head and...

FDA Approves Givosiran for Acute Hepatic Porphyria

On November 20, the U.S. Food and Drug Administration (FDA) approved givosiran (Givlaari) for adults with acute hepatic porphyria, a genetic disorder resulting in the buildup of toxic porphyrin molecules which are formed during the production of heme. “This buildup can cause acute attacks, known...

leukemia
lymphoma

FDA Approves Acalabrutinib for CLL/SLL as Part of Project Orbis

On November 21, as part of Project Orbis—a collaboration with the Australian Therapeutic Goods Administration (TGA) and Health Canada—the U.S. Food and Drug Administration (FDA) granted supplemental approval to acalabrutinib (Calquence) for the treatment of adults with chronic lymphocytic leukemia...

lung cancer

What Is the Best Palliation for End-Stage Lung Cancer?

Patients with advanced lung cancer can experience burdensome symptoms at the end of life. Pulmonologists can alleviate some of this suffering, but it’s a balancing act between doing too much and not enough, according to specialists who spoke at CHEST 2019, the annual meeting of the American College ...

issues in oncology

Two Societies Issue Statements on E-Cigarettes

Today, the American Cancer Society (ACS) announced an update to the organization’s position on e-cigarettes, and the American Medical Association (AMA) called for a total ban on all e-cigarette and vaping products that do not meet U.S. Food and Drug Administration (FDA) approval as cessation ...

issues in oncology

Does Testosterone Replacement Therapy Benefit Young Male Cancer Survivors?

Young male cancer survivors may significantly benefit from testosterone replacement therapy—especially after testicular cancer. Research published by Walsh et al in PLOS Medicine looked at one of the most common late-onset side effects experienced by young male survivors—reduced levels of the male...

kidney cancer
immunotherapy

Atezolizumab/Bevacizumab in Metastatic Renal Cell Carcinoma With Variant Histology or Sarcomatoid Features

In a phase II trial reported in the Journal of Clinical Oncology, Toni K. Choueiri, MD, and colleagues found that the combination of atezolizumab and bevacizumab was active in metastatic renal cell carcinoma with variant histology and clear cell renal cell carcinoma with ≥ 20% sarcomatoid...

leukemia

Late Bone Marrow Relapse Risk Stratification in Pediatric Patients With B-Cell Acute Lymphoblastic Leukemia

In an analysis of the German ALL-REZ BFM 2002 trial, reported in the Journal of Clinical Oncology, Eckert et al found that postinduction minimal residual disease (MRD)-based treatment stratification resulted in “excellent survival” in pediatric patients with late relapse of B-cell precursor acute...

issues in oncology
pain management

Prescribed Opioid Use and Infection Risk in Patients With Cancer and Treatment-Associated Neutropenia

In a German study reported in a research letter in JAMA Internal Medicine, Jakob et al found that prescribed opioid use did not appear to increase risk of infection in hospitalized patients with cancer who developed treatment-associated neutropenia. According to the investigators, recent data have...

breast cancer

Expert Point of View: Charles L. Loprinzi, MD

Charles L. Loprinzi, MD, Regis Professor of Breast Cancer Oncology at the Mayo Clinic, Rochester, Minnesota, discussed this abstract on sexual health in women treated for breast cancer. Addressing patients’ questions, offering advice, and providing appropriate referrals should improve patient care, ...

breast cancer

Study Finds Sexual Health Issues Are a Concern Among Majority of Women With Breast Cancer

Endocrine therapy has been a lifesaver for women with estrogen receptor–positive breast cancer, but decreases in recurrence and cancer-related mortality have come with substantial side effects, according to data presented at the 2019 Supportive Care in Oncology Symposium.1 The results of a...

integrative oncology

Boswellia

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. In this installment, Gary Deng, MD, PhD, and Jyothirmai Gubili, MS, focus on the herbal extract...

skin cancer

Role of Voriconazole in Cutaneous Squamous Cell Carcinoma Development

For the last decade, medical experts have known that voriconazole—an antifungal medication used to prevent infections in patients with compromised immune systems—is linked to the development of particularly aggressive squamous cell carcinoma in skin exposed to ultraviolet (UV) rays. However, the...

issues in oncology

Disparities in Culturally Competent Cancer Care

Many nonwhite minority cancer survivors place importance on seeing doctors who share or understand their culture, but are less likely than non-Hispanic whites to be able to see such physicians, according to a new study. The study, which is one of the first nationally-representative studies to...

solid tumors
immunotherapy

Pembrolizumab in Noncolorectal MSI-H/dMMR Solid Tumors

As reported in the Journal of Clinical Oncology by Marabelle et al, the phase II KEYNOTE-158 trial has shown robust activity of pembrolizumab in patients with noncolorectal microsatellite instability­–high (MSI-H)/mismatch repair–deficient (dMMR) solid tumors. Findings in the study supported the...

hematologic malignancies

Outcomes With Haploidentical Stem Cell Transplantation Plus Cyclophosphamide in Adults With Hematologic Cancers

In a meta-analysis reported in JAMA Oncology, Gagelmann et al found that overall survival with haploidentical stem cell transplantation with post-transplantation cyclophosphamide was poorer vs matched related donor transplantation and similar vs matched unrelated donor transplantation in adult...

lung cancer

Gefitinib Alone vs Gefitinib Plus Chemotherapy in EGFR-Mutated Metastatic NSCLC

In the Japanese phase III NEJ009 trial reported in the Journal of Clinical Oncology, Hosomi et al found that the addition of first-line gefitinib to carboplatin/pemetrexed improved progression-free survival vs gefitinib alone in patients with EGFR-mutated metastatic non–small cell lung cancer...

multiple myeloma

Selinexor Plus Dexamethasone Studied in Triple-Class Refractory Multiple Myeloma

In a phase IIb study (STORM Part 2) reported in TheNew England Journal of Medicine, Ajai Chari, MD, of Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, and colleagues found that oral selinexor and dexamethasone were active in some patients with multiple myeloma refractory to prior...

Expert Point of View: Alfredo Falcone, MD

The invited discussant of BEACON CRC, Alfredo Falcone, MD, of the Department of Oncology and Translational Medicine at the University of Pisa, Italy, commented: “The ‘story’ of BEACON represents a good example of the European Society for Medical Oncology Congress theme: Translating Science Into...

colorectal cancer

Targeted Triplet Therapy Improved Overall Survival in BRAF-Mutated Colorectal Cancer

For patients with metastatic colorectal cancer harboring BRAF V600E mutations, three drugs seem to be better than two, the most recent analysis of the phase III BEACON CRC study has shown.1 The results, presented at the 2019 European Society for Medical Oncology (ESMO) Congress, were concurrently...

gastrointestinal cancer

Maximizing Benefit in the Treatment of Immune-Mediated Colitis

Immune-related colitis is the second most common toxicity associated with checkpoint inhibitors, affecting up to 40% of patients. The ASCO Post interviewed Yinghong Wang, MD, PhD, Director of Medication-Induced Colitis and Enteritis, Director of Fecal Microbiota Transplantation, and Associate...

ADMIRAL Trial of Gilteritinib vs Salvage Chemotherapy in FLT3-Mutated Acute Myeloid Leukemia

The ADMIRAL trial evaluated gilteritinib vs salvage chemotherapy in FLT3-mutated acute myeloid leukemia—we'll discuss recently reported overall survival results from The New England Journal of Medicine. Then, we’ll move onto findings from a pooled analysis of the relationship between lung cancer...

lymphoma

FDA Grants Accelerated Approval to Zanubrutinib for Pretreated Mantle Cell Lymphoma

On November 14, the U.S. Food and Drug Administration (FDA) granted accelerated approval to zanubrutinib (Brukinsa) for adult patients with mantle cell lymphoma who have received at least one prior therapy. “Mantle cell lymphoma usually responds well to initial treatment, but eventually returns or ...

geriatric oncology

Improving Communication With Older Patients Using Geriatric Assessment During Oncology Visits

In the COACH study, reported in JAMA Oncology, Supriya G. Mohile, MD, MS, and colleagues found that including geriatric assessment in oncology visits for older adults with advanced cancer improved patient and caregiver satisfaction with communication regarding aging-related concerns. Study Details...

lymphoma
immunotherapy

Polatuzumab Vedotin Plus Bendamustine/Rituximab for Transplantation-Ineligible Relapsed or Refractory DLBCL

In a phase Ib/II trial reported in the Journal of Clinical Oncology, Laurie H. Sehn, MD, MPH, and colleagues found that the addition of polatuzumab vedotin to bendamustine/rituximab improved response rate and progression-free and overall survival among transplantation-ineligible patients with...

issues in oncology

Presenting Symptoms and Cancer Stage at Diagnosis

In a population-based study reported in The Lancet Oncology, Koo et al found that presenting symptoms of cancer were mostly associated with stage earlier than stage IV, suggesting a benefit of symptom awareness campaigns based on common symptoms. As stated by the investigators, “Early diagnosis...

Expert Point of View: Eduardo Bruera, MD, FAAHPM

Eduardo Bruera, MD, FAAHPM, Chair of the Department of Palliative, Rehabilitation, and Integrative Medicine at The University of Texas MD Anderson Cancer Center, Houston, explained the rationale behind this treatment approach. “We know that the tumor mass and the tumor function talk to the brain...

gynecologic cancers
immunotherapy

Nivolumab Plus Bevacizumab in Relapsed Ovarian Cancer

In a phase II trial reported in JAMA Oncology, Liu et al found evidence of the activity of combined nivolumab and bevacizumab in relapsed ovarian cancer, with activity appearing to be greater in platinum-sensitive disease. Study Details In the trial, 38 women with relapsed epithelial ovarian cancer ...

symptom management

Dexamethasone Plus Exercise May Reduce Fatigue in Patients With Advanced Cancer

A novel treatment approach may help to alleviate one of the most common and debilitating symptoms associated with cancer and its treatments—fatigue. According to data presented at the 2019 Supportive Care in Oncology Symposium,1 the combination of short-course dexamethasone plus standardized...

skin cancer

Reflections on Long-Term Outcomes With BRAF/MEK Inhibition in Advanced Melanoma

For the treatment of BRAF V600-mutated advanced melanoma, we now have three BRAF/MEK inhibitor combinations that are approved by the U.S. Food and Drug Administration: dabrafenib/trametinib, vemurafenib/cobimetinib, and encorafenib/binimetinib. Although the toxicity profiles for these combinations ...

skin cancer

5-Year Efficacy Outcomes With Dabrafenib Plus Trametinib in BRAF-Mutated Metastatic Melanoma

As reported in The New England Journal of Medicine by Caroline Robert, MD, PhD, of the Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif, and colleagues, the long-term follow-up of the phase III COMBI-d and COMBI-v trials has shown a pooled 5-year overall survival rate of 34% ...

solid tumors

Long-Term Effects of Denosumab in Patients With Giant Cell Tumor of Bone

As reported by Chawla et al in The Lancet Oncology, long-term data from the final analysis of an international phase II study suggest that a favorable risk-benefit ratio is maintained over time with denosumab treatment of patients with giant cell tumor of bone. Benefit of denosumab was indicated in ...

prostate cancer
breast cancer
bladder cancer
pancreatic cancer
kidney cancer
thyroid cancer
gynecologic cancers
immunotherapy

ESMO Congress 2019: Quick Takes From Key Clinical Trials

The ESMO Congress continues to grow as a pivotal platform for research in clinical oncology. At the ESMO Congress 2019, important findings were showcased in more than 2,200 studies, including 93 late-breaking abstracts. The ASCO Post summarized much of that news in separate articles over several...

lung cancer
neuroendocrine tumors
immunotherapy

Novel Therapies for Small Cell Lung Cancer and Neuroendocrine Tumors

Here is a glimpse at updated clinical trial data on newer therapies under study for the small cell lung cancer (SCLC) and advanced extrapancreatic neuroendocrine tumors. IMpower133 and ALTER: Novel Therapies for SCLC The treatment of small cell lung cancer has seen little progress in recent years, ...

gastrointestinal cancer

Pivotal Phase III Study Evaluates Investigational TKI in Fourth-Line Setting for Advanced GIST

In a late-breaking, oral presentation at the ESMO Congress 2019, Margaret von Mehren, MD, presented results from ­INVICTUS, a pivotal phase III clinical trial of ripretinib in patients with advanced gastrointestinal stromal tumor (GIST).1 Ripretinib is an investigational tyrosine kinase inhibitor...

hepatobiliary cancer

Targeted Treatment Advances in Cholangiocarcinoma

For one of the rarest and most aggressive of tumors—cholangiocarcinoma—two novel molecularly targeted agents yielded encouraging outcomes in advanced disease in studies reported at the European Society for Medical Oncology (ESMO) Congress 2019. In the phase III ClarIDHy trial, the risk of disease...

prostate cancer

Expert Point of View: Eleni Efstathiou, MD

Formal study discussant Eleni Efstathiou, MD, of MD Anderson Cancer Center, Houston, commented on results of the PROfound trial at the ESMO Congress 2019. “This is the first phase III targeted therapy trial to deliver a positive outcome in metastatic castration-resistant prostate cancer,” she...

prostate cancer

Phase III PROfound Study Evaluates Olaparib in Setting of Metastatic, Castration-Resistant Prostate Cancer

Treatment with the poly (ADP-ribose) polymerase (PARP) inhibitor olaparib delayed disease progression and appears to improve survival, compared with newer hormonal agents in men with pretreated metastatic castration-resistant prostate cancer and homologous recombinant repair (HRR) genetic...

immunotherapy
gynecologic cancers

Expert Point of View: Nicoletta Colombo, MD

The invited discussant of the two trials in cervical and endometrial cancers presented at the ESMO Congress 2019 was Nicoletta Colombo, MD, of the University of Milan-Bicocca in Italy, who commented on what she called “exciting results in cancers with unmet needs.” Dr. Colombo noted: “The studies...

immunotherapy
gynecologic cancers

Immunotherapy Shows Strong Benefit in Two Gynecologic Cancers

In studies reported at the ESMO Congress 2019, immunotherapy yielded encouraging outcomes in two gynecologic cancer populations in need of new treatments, including patients with advanced cervical cancer that is microsatellite-stable and patients previously treated for advanced endometrial cancer.  ...

multiple myeloma

Selinexor Plus Dexamethasone Studied in Triple-Class Refractory Multiple Myeloma

In a phase IIb study (STORM Part 2) reported in The New England Journal of Medicine, Ajai Chari, MD, of Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, and colleagues found that oral selinexor and dexamethasone were active in some patients with multiple myeloma refractory to prior...

hepatobiliary cancer

Oral Direct-Acting Antiviral Therapy May Improve Survival in Patients With Hepatitis C Virus–Related HCC

Data from a new study presented by Dang et al at The Liver Meeting (Abstract 40) found that patients with hepatitis C virus–related hepatocellular carcinoma (HCC) who achieved sustained virologic response (denoting an undetectable level of the virus) with any oral direct-acting antiviral therapy...

lung cancer
issues in oncology

Rates of Non–Guideline-Concordant Lung Cancer Treatment in the United States

Only about 6 in 10 patients with lung cancer in the United States receive the minimal lung cancer treatments recommended by National Comprehensive Cancer Network® (NCCN) Guidelines, according to new research published by Blom et al in the Annals of the American Thoracic Society. Erik F. Blom, MD,...

hepatobiliary cancer

Hepatic Arterial Infusion of Floxuridine Plus Systemic Gemcitabine/Oxaliplatin for Unresectable Intrahepatic Cholangiocarcinoma

In a single-center phase II trial reported in JAMA Oncology, Andrea Cercek, MD, and colleagues found that hepatic arterial infusion of floxuridine in combination with systemic gemcitabine/oxaliplatin produced high response and disease control rates and was associated with promising overall survival ...

issues in oncology
survivorship

Exercise Intolerance in Adult Survivors of Childhood Cancer

In a study reported in the Journal of Clinical Oncology, Ness et al found a high rate of exercise intolerance among adult survivors of childhood cancer, irrespective of exposure to cardiotoxic treatment. Exercise intolerance was associated with poorer overall survival. The study involved 1,041...

multiple myeloma

Lenalidomide vs Observation in Asymptomatic Smoldering Multiple Myeloma

In a phase III trial reported in the Journal of Clinical Oncology, Sagar Lonial, MD, and colleagues found that lenalidomide significantly improved progression-free survival vs observation in patients with intermediate- or high-risk smoldering multiple myeloma. As noted by the investigators,...

Expert Point of View: Sanjay Popat, FRCP, PhD

Formal discussant of the CheckMate 227 trial, Sanjay Popat, FRCP, PhD, of the Royal Marsden Hospital, London, had some reservations about endorsing nivolumab/ipilimumab as a new standard of care, mainly related to toxicity. “The landscape of treating advanced non–small cell lung cancer has changed ...

lung cancer
immunotherapy

CheckMate 227: Nivolumab Plus Ipilimumab Presents Another Option in First-Line Treatment of Advanced Non–Small Cell Lung Cancer

The combination of nivolumab and ipilimumab improved overall survival compared with chemotherapy as first-line therapy for patients with advanced non–small cell lung cancer (NSCLC) and programmed cell death ligand 1 (PD-L1) expression of at least 1%, according to the results of CheckMate 227....

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