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leukemia

Reducing Doses and Stopping Tyrosine Kinase Inhibitors Gain Favor in Chronic Myeloid Leukemia

Tyrosine kinase inhibitors, such as imatinib, nilotinib (Tasigna), and dasatinib (Sprycel), have revolutionized the treatment of chronic myeloid leukemia (CML). A substantial percentage of patients achieve deep and meaningful remissions on these agents. More recently, partly driven by patients’ and ...

lymphoma

‘Clinically Useful’ Findings for Brentuximab Vedotin in CTCL, Rituximab Maintenance in MCL

Positive studies about brentuximab vedotin ­(Adcetris) in cutaneous T-cell lymphoma1 and rituximab (Rituxan) maintenance therapy in mantle cell lymphoma (MCL)2 were reported at the 2016 Annual Meeting of the American Society for Hematology (ASH). “These abstracts each focus on approved agents and...

issues in oncology
lung cancer
gastrointestinal cancer
prostate cancer
colorectal cancer

At ESMO 2016, Many Phase III Trials Fail to Meet Primary Endpoints

The 2016 European Society for Medical Oncology (ESMO) Congress revealed many important positive findings from key trials in a number of tumor types, but many highly anticipated phase III trials in advanced disease failed to meet their primary endpoints. The ASCO Post has summarized several of these ...

Expert Point of View: Laurence Albiges, MD, PhD

Formal discussant Laurence Albiges, MD, PhD, of Institut Gustave Roussy, Villejuif, France, tried to put the results of KEYNOTE-052 and CheckMate 275 into perspective. “Anti–PD-1 (programmed cell death protein 1) and anti–PD-L1 (programmed cell death ligand 1) agents represent a revolution in the...

bladder cancer

Anti–PD-1 Contenders in Advanced Urothelial Cancer

Immunotherapy with anti–PD-1 (programmed cell death protein 1) and anti–PD-L1 (programmed cell death ligand 1) agents continues to advance in metastatic urothelial cancer, with positive showings in two clinical trials presented at the 2016 European Society for Medical Oncology (ESMO) Congress. The...

lymphoma
skin cancer

Lack of Standardized Definitions of Cutaneous T-Cell Lymphomas Hampers the Collection of Reliable Data

Cutaneous T-cell lymphomas are a heterogeneous group of cancers. Some subtypes of cutaneous T-cell lymphomas are often misdiagnosed as benign skin diseases, making it challenging to gather reliable epidemiologic data. At the 3rd World Congress of Cutaneous Lymphomas (sponsored by the International...

lymphoma
skin cancer

Encouraging First Study of Pembrolizumab in Cutaneous T-Cell Lymphoma

Immunotherapy with an anti–programmed cell death protein 1 (PD-1) inhibitor—pembrolizumab (Keytruda)—showed encouraging responses in patients with advanced cutaneous T-cell lymphoma (either mycosis fungoides or Sézary syndrome). Pembrolizumab achieved a 38% overall response rate and responses...

lymphoma
skin cancer

Prospective Cutaneous Lymphoma International Prognostic Index Initiative Moves Forward

A collaboration of international experts is tackling the challenges involved in understanding and managing the treatment of cutaneous lymphomas. The Prospective Cutaneous Lymphoma International Prognostic Index ­(PROCLIPI) study from the Cutaneous Lymphoma International Consortium brings together...

Expert Point of View: Youn Kim, MD

Commenting on this talk during the discussion afterward, Youn Kim, MD, of Stanford University School of Medicine, Stanford, California, said: “At our center, we use high-throughput sequencing of T-cell receptors daily in patients with cutaneous T-cell lymphomas, and it is a billable service paid...

lymphoma
skin cancer

High-Throughput Sequencing of T-Cell Receptors May Transform Diagnosis and Treatment of Cutaneous T-Cell Lymphomas

High-throughput sequencing of T-cell receptors may be a solution to some of the challenges confronting oncologists who treat cutaneous T-cell lymphomas. According to experts who presented talks on high-throughput sequencing of T-cell receptors at the 3rd World Congress of Cutaneous Lymphoma...

Expert Point of View: Axel Le Cesne, MD

“The debate about perioperative chemotherapy in localized high-grade soft-tissue sarcoma is never-ending. Can this study resolve the debate?” asked formal discussant Axel Le Cesne, MD, of the Institute de Cancerologie Gustave-Roussy, Villejuif, France. “Surgery remains the standard of care for all ...

sarcoma

Neoadjuvant Chemotherapy in High-Risk Soft-Tissue Sarcoma: A New Standard?

For the first time, a randomized trial has provided good evidence to support the use of neoadjuvant chemotherapy for treatment of high-risk soft-tissue sarcoma of the extremities or trunk wall.1 But the findings of the study were surprising, because neoadjuvant chemotherapy with one-size-fits-all...

Expert Point of View: Sandro Pignata, MD

“This study represents a significant step forward in the treatment of recurrent ovarian cancer,” stated formal discussant Sandro Pignata, MD, of the IRCCS National Cancer Institute “Fondazione G. Pascale,” Naples, Italy. He highlighted some key factors: Patients selected for the study were those...

gynecologic cancers

‘Breakthrough’ in Recurrent Ovarian Cancer: Niraparib Extends Progression-Free Survival in Platinum-Sensitive Disease

A landmark study showed that the investigational PARP (poly ADP-ribose polymerase) 1/2 inhibitor niraparib, when used as maintenance therapy, significantly improves the outcome of platinum-sensitive recurrent ovarian cancer. Specifically, niraparib significantly prolonged progression-free survival ...

Expert Point of View: Anthony T.C. Chan, MD

These results showed nivolumab (Opdivo) to be the clear winner in this trial from the patients’ perspective, according to formal discussant Anthony T.C. Chan, MD, of the Chinese University of Hong Kong. “Taking the positive results of nivolumab in improving survival in these patients, and...

head and neck cancer

Better Quality of Life Reported in Patients With Head and Neck Cancer Receiving Nivolumab vs Chemotherapy

Standard treatment for advanced head and neck cancer—including chemotherapy and radiation—causes painful side effects that impair quality of life, as well as the ability to socialize and engage in daily life activities. A new study of patients with platinum-refractory recurrent, metastatic head...

Expert Point of View: Guido Reifenberger, MD

“Low-grade gliomas are biologically and clinically heterogeneous entities with different genetic drivers,” said formal discussant of this trial, Guido Reifenberger, MD, of Heinrich Heine University, Düsseldorf, ­Germany. “The BRAF V600 mutation is a novel therapeutic target in gliomas occurring in ...

cns cancers

Preliminary Data Indicate Potential Role for Dabrafenib as Part of Therapy for Pediatric Low-Grade Gliomas With BRAF V600 Mutation

About 10% of children with low-grade gliomas have the BRAF V600E mutation, and preliminary studies suggest that the BRAF inhibitor dabrafenib (Tafinlar) may play an important role in treating this group of patients. A phase I/II trial presented at the 2016 European Society for Medical Oncology...

Expert Point of View: Peter Schmid, MD, PhD

Several practice-changing studies have shown that adding a CDK4/6 inhibitor to an aromatase inhibitor improves survival in hormone receptor–positive advanced breast cancer, and those results should also be considered, said formal discussant Peter Schmid, MD, PhD, of Bart’s Cancer Institute, Queen...

breast cancer

Fulvestrant Superior to Anastrozole as Initial Therapy in Advanced Breast Cancer

Fulvestrant (Faslodex) was superior to anastrozole as initial treatment of hormone receptor–positive, endocrine therapy–naive, advanced breast cancer, significantly reducing the risk of disease progression or death, according to the results of the phase III FALCON study presented at the 2016...

Expert Point of View: Jean-Charles ­Soria, MD, PhD

Formal discussant Jean-Charles ­Soria, MD, PhD, of Institut Gustave Roussy, Villejuif, France, and Editor-in-Chief of Annals of Oncology (the official journal of the European Society for Medical Oncology [ESMO]), tried to put these findings into perspective. He pointed out that when applying the...

lung cancer

Pembrolizumab Plus Chemotherapy Improves Outcomes Over Chemotherapy Alone in Advanced NSCLC

Combining immunotherapy with a standard chemotherapy doublet appears to be an attractive option for the front-line treatment of advanced nonsquamous non–small cell lung cancer (NSCLC), according to the results of a phase II study presented at the 2016 European Society for Medical Oncology (ESMO)...

Expert Point of View: Axel Bex, MD, PhD

The formal discussant of this trial, Axel Bex, MD, PhD, of The Netherlands Cancer Institute in Amsterdam, was cautious in interpreting these results to be practice-changing. “I congratulate the investigators for the first-ever positive trial for adjuvant treatment of renal cell carcinoma,” he...

kidney cancer

Phase III Study of Sunitinib Is First to Show Benefit in Adjuvant Setting for Treatment of Renal Cell Carcinoma

Sunitinib (Sutent) improved disease-free survival by more than 1 year when used as adjuvant treatment for high-risk locoregional renal cell carcinoma following nephrectomy, but with the cost of toxicity. S-TRAC is the first phase III trial showing a benefit for adjuvant therapy in renal cell...

Expert Point of View: Bernard Escudier, MD

Formal discussant of this trial, Bernard Escudier, MD, Chairman of the Renal Cancer Unit at Institut Gustave Roussy, Villejuif, France, said: “The main question is whether this study will change practice.” He is not so sure it will and would like more data. Dr. Escudier told listeners that the...

kidney cancer

Cabozantinib Improves Progression-Free Survival and Response Rates vs Sunitinib in First-Line Treatment of Metastatic Kidney Cancer

Cabozantinib (Cabometyx) improved progression-free survival and response rates in patients with untreated metastatic renal cell carcinoma compared with the standard of care, sunitinib (Sutent), according to the results of a phase II multicenter randomized trial called CABOSUN reported at the 2016...

Expert Point of View: Colleen A. Lawton, MD

“This is very exciting work and is exactly what we need in prostate cancer,” said Colleen A. Lawton, MD, Vice-Chair of the Medical College of Wisconsin, Milwaukee, and moderator of a press conference where the study by Spratt et al was discussed. “The prognostic measures we use are rough and...

prostate cancer

Prognostic and Predictive Molecular Subtypes of Prostate Cancer Identified

Members of the oncology community have long complained that prostate cancer lags behind breast cancer regarding biomarkers for prognosis and treatment, but the good news is that this gap is narrowing. In the largest study of its kind to date, presented at the 58th Annual Meeting of the American...

Expert Point of View: Vinai Gondi, MD

Formal discussant of both trials, Vinai Gondi, MD, Director of CNS Radiation Oncology at Northwestern Medicine Cancer Center in Warrenville, Illinois, offered a somewhat more nuanced take on the data from these studies. To begin, he commended the authors of both studies. “These were both...

cns cancers

Stereotactic Radiosurgery Achieves Better Quality of Life and Improved Cognition Than Whole-Brain Radiotherapy

Two separate randomized trials presented at the 58th Annual Meeting of the American Society of Radiation Oncology (ASTRO) affirmed the value of stereotactic radiosurgery as an option for postoperative treatment of the surgical cavity of resected brain metastases, potentially avoiding the cognitive...

prostate cancer

Safety of Extreme Hypofractionation Reassuring in Intermediate-Risk Prostate Cancer

Giving patients larger fractions of radiation over shorter periods (ie, hypofractionation) is gaining ground in several types of cancers. This approach is attractive for patients’ convenience, shortening treatment and travel times, and also for resource utilization. Several studies have shown that ...

Expert Point of View: Brian Kavanagh, MD

“Lung cancer patients are living longer with stereotactic body radiation therapy. Patients should have access to this care. It would be tragic if we couldn’t give this treatment to patients who need it,” said Brian Kavanagh, MD, President of the American Society for Radiation Oncology (ASTRO) and...

lung cancer

Retrospective Studies Confirm Survival Benefit of Stereotactic Body Radiotherapy in Early-Stage NSCLC

Stereotactic body radiation therapy is becoming more widely adopted for the treatment of early-stage non–small cell lung cancer (NSCLC). Along with its increasing uptake, survival has significantly increased over the past decade, according to two large retrospective studies presented at the 58th...

Expert Point of View: Geraldine M. Jacobson, MD

Geraldine M. Jacobson, MD, of West Virginia University, Morgantown, commented on the study by Moran et al at a press conference held during the American Society of Radiation Oncology (ASTRO) meeting, where the data were presented. “To date evidence has been lacking for a radiation boost following...

breast cancer

Study Shows Strong Evidence Supporting Radiation Boost to Tumor Bed in Ductal Carcinoma in Situ

A radiation boost to the local tumor bed following treatment with breast-conserving therapy (ie, local excision followed by whole-breast radiation therapy) improves local control for patients with ductal carcinoma in situ, according to a study of pooled data from 10 academic centers,1 presented at...

Expert Point of View: Stephen R.D. Johnston, MD

“These results apply to about two-thirds of women with advanced breast cancer, ie, those with hormone receptor–positive metastatic breast cancer,” noted the formal discussant of this paper, Stephen R.D. Johnston, MD, of the Royal Marsden Hospital, London. “At present with first-line endocrine...

breast cancer

Combination of Ribociclib and Letrozole Improved Progression-Free Survival in Hormone Receptor–Positive Advanced Breast Cancer

The combination of the selective CDK4/6 inhibitor ribociclib plus letrozole significantly improved progression-free survival in hormone receptor–positive advanced breast cancer. When ribociclib was added to letrozole, progression-free survival improved by 44% compared with letrozole alone,...

survivorship
issues in oncology

Improving Management of Sexual Problems for Cancer Survivors

What do up to 60% of cancer survivors have in common? Answer: some type of long-term sexual dysfunction. How many cancer survivors seek professional help for sexual problems? Answer: less than 20%. Even when they do seek help, they may not be successful in finding professionals with expertise in...

Expert Point of View: W. Robert Lee, MD

Formal discussant W. Robert Lee, MD, of Duke University School of Medicine, Durham, North Carolina, placed himself firmly in the camp supporting hypofractionation as a new standard of care. “We now have three large noninferiority trials with different eligibility criteria and different regimens....

prostate cancer

Hypofractionation May Be Poised to Become New Standard of Care for Prostate Cancer

There has been an ongoing debate about which type of radiation therapy is preferable in the treatment of localized prostate cancer: hypofractionation (larger fractions given over 4–5 weeks) or conventional radiotherapy (given over 8–9 weeks). A new study presented at the 2016 ASCO Annual Meeting...

Expert Point of View: Patricia A. Ganz, MD & Gregory A. Masters, MD

“This is a tremendous advance. If we had a drug that could achieve these results we would rush to use it. This is also personalized medicine that alerts the health-care team when symptoms need addressing. And it is very important that using the app led to appropriate use of scans and tests, which...

lung cancer

App Triggers Earlier Detection of Relapse, May Help Improve Survival of Patients With Lung Cancer

Web-based applications have invaded mainstream culture and grabbed the attention of multitudes of people around the world. According to a study presented at the 2016 ASCO Annual Meeting, an app may also contribute to extending the lives of people with cancer and, at the same time, reduce...

Expert Point of View: Marc S. Ernstoff, MD

The field of studies of combination immunotherapies is exploding, and “the future looks bright, with currently 71 trials of combination therapy in melanoma,” said formal discussant of these trials Marc S. Ernstoff, MD, of Roswell Park Cancer Institute, Buffalo, New York. “We now know that...

skin cancer

Studies Suggest Bright Future for Combination Immunotherapy in Advanced Melanoma, but Questions Remain

Two studies presented at the 2016 ASCO Annual Meeting focused on the use of combination immunotherapy in the treatment of patients with advanced melanoma. Updated results from the phase III CheckMate 067 trial centered on the combination of nivolumab (Opdivo) plus ipilimu­mab (Yervoy) compared...

Expert Point of View: Charles Ryan, MD

“These are important data. It is safe to envision a future where atezolizumab [Tecentriq] can be used first-line. These were cisplatin-ineligible patients, and many patients fall into this category, especially the elderly. Platinum-ineligibility is a big problem due to comorbidities,” explained...

bladder cancer

Atezolizumab Promising in Cisplatin-Ineligible Metastatic Bladder Cancer

Atezolizumab (Tecentriq), an anti–programmed cell death ligand 1 (PD-L1) inhibitor, achieved durable responses as first-line treatment in cisplatin-ineligible patients with metastatic urothelial carcinoma in a primary analysis of a phase II trial. These data represent an unmet need, because...

Expert Point of View: Steven M. Devine, MD

Formal discussant of these trials Steven M. Devine, MD, of The Ohio State University Comprehensive Cancer Center, Columbus, was not able to attend the ASCO Meeting, but his slides were presented to the audience. “CAR T-cell therapy was first thought of in the 1980s, but it is only recently that we ...

leukemia

CAR T-Cell Dose Refinement May Reduce Cytokine-Release Syndrome in Patients With Advanced Acute Lymphoblastic Leukemia

Chimeric antigen receptor (CAR) T-cell therapy has been effective in adults and children with advanced acute lymphoblastic leukemia (ALL), but along with efficacy, the treatment can stimulate cytokine-­release syndrome, which can be deadly if it goes unrecognized and untreated. Adjusting the dose...

Expert Point of View: David R. Spigel, MD

“These are outstanding results,” commented formal discussant of this trial David R. Spigel, MD, of the Sarah Cannon Research Institute, Nashville, Tennessee. In melanoma, the combination of nivolumab (Opdivo) plus ipilimumab (Yervoy) vs nivolumab alone vs ipilimumab alone found superior...

lung cancer

Combination of Nivolumab and Ipilimumab Moves Forward in NSCLC

How best to combine new immunotherapies is a burning question in oncology. A new study in the CheckMate series suggests that nivolumab (Opdivo) and ipilimumab (Yervoy) can be safely and effectively combined as first-line treatment of advanced non–small cell lung cancer (NSCLC),1 but further study...

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