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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...

Expert Point of View: Taofeek Kunle Owonikoko, MD

Formal discussant Taofeek Kunle Owonikoko, MD, of Emory University School of Medicine, Atlanta, commented that this preliminary study looks promising for a new antibody-drug conjugate. “To me, what is intriguing about these data is the efficacy signal in the third-line setting, especially for the ...

lung cancer

Impressive Early Data for Rovalpituzumab Tesirine in Small Cell Lung Cancer

Initial encouraging news from a first-in-human trial suggests that the antibody-drug conjugate rovalpituzumab tesirine (Rova-T) may turn out to be a new option for patients with small cell lung cancer (SCLC) whose tumors overexpress delta-like protein 3 (DLL3). Study results were presented at the...

Expert Point of View: Taofeek Kunle Owonikoko, MD

Formal discussant Taofeek Kunle Owonikoko, MD, of Winship Cancer Institute of Emory University, Atlanta, said it has been controversial whether to use once-daily or twice-daily radiation therapy in this patient population. “CONVERT is one of two studies trying to step into this gap, and it failed...

lung cancer

Once-Daily Radiation (66 Gy) Appears No Better Than Twice-Daily Radiation (45 Gy) for Small Cell Lung Cancer

A schedule of once-daily radiation therapy (66 Gy) was no better than a twice-daily schedule (45 Gy) for optimization of chemoradiotherapy in patients with limited-stage small cell lung cancer (SCLC), according to the eagerly anticipated results of the phase III ­CONVERT trial, presented at the...

Expert Point of View: Sumanta K. Pal, MD, and Richard L. Schilsky, MD

“This study harnesses a specific biologic marker in cancer patients and treats them accordingly using a ‘tumor-agnostic’ approach, so a patient with pancreatic cancer may get a breast cancer drug,” said Sumanta K. Pal, MD, ASCO spokesperson. Dr. Pal moderated the press conference where these data ...

bladder cancer
colorectal cancer
hepatobiliary cancer
lung cancer

Matching Treatment to Tumor Abnormalities Seems to Pay Off

A strategy of matching molecular abnormalities in patients’ tumors to therapies targeted to those abnormalities is gaining ground, according to preliminary results of the phase IIb MyPathway study presented at the 2016 ASCO Annual Meeting.1 These are still early days for this “matching” strategy,...

Expert Point of View: Patricia Ganz, MD

Moderating a press conference where Dr. Chen presented his study findings, Patricia Ganz, MD, Director of Cancer Prevention and Control Research at the University of California Los Angeles (UCLA) Jonsson Comprehensive Cancer Center, called this study “interesting and ­important.” She continued:...

palliative care
issues in oncology

Aggressive Treatment at the End of Life Continues to Be Common

Oncologists in the United States may need to improve their efforts to reduce unnecessary care for younger patients with terminal cancer over the last 30 days of life, based on the findings of a study reported at the 2016 ASCO Annual Meeting.1 Contrary to recommendations, aggressive care is still...

Expert Point of View: Don Dizon, MD

Don Dizon, MD, Chair of ­ASCO’s Cancer Communications Committee, congratulated the authors of the OV21/PETROC study. “This is another example of international collaboration. The authors looked at the role of IP therapy in women who got primary chemotherapy before surgery, and at least in this...

gynecologic cancers

In the Neoadjuvant Era, Intraperitoneal Chemotherapy Is of Benefit in Advanced Ovarian Cancer

The role of intraperitoneal (IP) chemotherapy in the treatment of advanced ovarian cancer has been debated for a long time. According to a new study presented at the 2016 ASCO Annual Meeting, a combination of IP and intravenous (IV) chemotherapy appears more effective than IV chemotherapy alone in...

breast cancer

Trastuzumab Biosimilar Shows Efficacy and Safety Comparable to Reference Product in Phase III HERITAGE Trial

A new biosimilar version of the monoclonal antibody trastuzu­mab (Herceptin) is getting close to the finish line in the race to develop biosimilars in oncology. The new antibody, MYL-1401O, demonstrated comparable efficacy and safety compared with trastuzumab as front-line treatment of women with...

Expert Point of View: Winald Gerritsen, MD, PhD

“This is a really great study with excellent translational research,” said formal discussant Winald Gerritsen, MD, PhD, Professor of Immunotherapy at Radboud University Medical Center, Nijmegen, The Netherlands. “I consider it practice-changing for Merkel cell carcinoma. The company is going for...

skin cancer

Anti–PD-1 Inhibitor Gains Foothold in Merkel Cell Carcinoma

Immunotherapy marches on! One of the latest frontiers for checkpoint inhibitors is the treatment of Merkel cell carcinoma, a rare but aggressive type of cancer. First-line therapy with pembrolizumab (Keytruda)—an anti–PD-1 (programmed cell death protein 1) inhibitor—achieved an objective response...

Expert Point of View: Stuart A. Grossman, MD, and Deborah Schrag, MD

Formal discussant of this trial Stuart A. Grossman, MD, of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, commented that the trial did not include a best standard-of-care arm. The pivotal trial defined optimal radiotherapy as 60 Gy over 6 weeks, but this...

cns cancers

Chemoradiotherapy Improves Survival in Patients Over Age 65 With Glioblastoma: A New Standard Option?

The combination of short-course radiotherapy and temozolomide followed by maintenance with temozolomide significantly improved survival compared with short-course radiotherapy alone in newly diagnosed elderly patients with glioblastoma, according to the results of a global cooperative group trial...

Expert Point of View: Harold J. Burstein, MD, and Ian Smith, MD

“There is a tremendous interest in longer aromatase inhibitor therapy. The Oxford Overview data, presented at ASCO, show the substantial risk of recurrence in years 5 to 15, despite an initial 5 years of adjuvant endocrine treatment. “Women with lower-risk breast cancer will be less inclined to...

breast cancer

Additional 5 Years of Letrozole May Benefit Some Postmenopausal Women With Early-Stage Breast Cancer

Five years of aromatase inhibitor as upfront therapy or after tamoxifen is the current standard of care for postmenopausal women with early hormone receptor–positive breast cancer. A new trial suggests that extending aromatase inhibitor therapy with letrozole for an additional 5 years may improve...

Expert Point of View: Louis M. Weiner, MD

“These gene fusions that drive malignant processes in certain cancers are good targets for cancer therapy. These targets can be potentially disabled [by targeted therapy],” said Louis M. Weiner, MD, Director of the Georgetown Lombardi Comprehensive Cancer Center in Washington, DC, who moderated a ...

solid tumors

Gene Rearrangements: Attractive Targets in a Variety of Cancers

Entrectinib, a potent investigational tyrosine kinase inhibitor, exhibited promising clinical activity in a pooled analysis of two phase I trials of patients with solid metastatic tumors that harbored any of five specific genetic rearrangements involving NTRK1, NTRK2, NTRK3, ROS1, or ALK....

Expert Point of View: Mayer Fishman, MD, PhD

“This was a difficult study to conduct. It required 13 centers in 8 countries over 3 years to recruit these patients—that’s about 1 patient per site per year,” said Mayer Fishman, MD, PhD, of Moffitt Cancer Center in Tampa, Florida. “It’s an important study, because these patients are typically...

kidney cancer

Crizotinib Active in Orphan Kidney Malignancy

Crizotinib (Xalkori) achieved overall and durable responses in advanced inoperable papillary renal cell carcinoma type 1 characterized by somatic MET mutations, according to an investigator-initiated trial conducted by the European Organization for Research and Treatment of Cancer (EORTC).1 “To...

breast cancer
prostate cancer
hematologic malignancies

Highlights From the 2016 AACR Annual Meeting

This year’s Annual Meeting of the American Association for Cancer Research (AACR) featured outstanding research in the field of cancer, as well as an inspiring talk by Vice President Joe Biden (see the May 10 issue of The ASCO Post). Here are some summaries of studies that warrant attention; they...

gynecologic cancers
multiple myeloma
skin cancer
pancreatic cancer
lung cancer
prostate cancer
breast cancer
survivorship

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): 2016 Guidelines

In 1996, the National Comprehensive Cancer Network (NCCN®) published its first set of Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), covering eight tumor types. The NCCN Guidelines® are now published for more than 60 tumor types and topics. Some of the key updates for 2016 were...

Expert Point of View: Padmanee Sharma, MD, PhD

“When we treat our patients, overall survival is the gold standard. We are all waiting for phase III overall survival data from CheckMate 067,” said formal discussant Padmanee Sharma, MD, PhD, Professor; Scientific Director of the Immunotherapy Platform; and Co-Director of the Parker Institute for ...

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