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solid tumors
issues in oncology
symptom management

NCCN Debuts Three New Sets of Guidelines

THE NATIONAL Comprehensive Cancer Network® (NCCN®) debuted three sets of completely new guidelines for treating patients with uveal melanoma, for treating patients who have cancer and the human immunodeficiency virus (HIV), and for managing immune-related toxicities.  Cancer in People Living With...

skin cancer

Expert Point of View: Antoni Ribas, MD

FOUR RANDOMIZED trials have shown improvements in recurrence-free survival in patients with high-risk melanoma with the administration of adjuvant therapy over the past 3 years, noted formal discussant of the EORTC 1325/KEYNOTE-054 trial, Antoni Ribas, MD, Director of the Tumor Immunology Program...

skin cancer

Adjuvant Pembrolizumab Improves Relapse-Free Survival in High-Risk Stage III Melanoma

ADJUVANT THERAPY with pembrolizumab (Keytruda) significantly prolonged recurrence-free survival compared with placebo for patients with resected high-risk stage III melanoma, according to the results of the EORTC 1325/KEYNOTE-054 trial.1 Patients who received pembrolizumab had a 43% reduction in...

lung cancer

Expert Point of View: Roy S. Herbst, MD, PhD

FORMAL DISCUSSANT of the KEYNOTE-189 trial, Roy S. Herbst, MD, PhD, Chief of Medical Oncology at Smilow Cancer Hospital, Yale Cancer Center, New Haven, heartily endorsed the new triplet combination of pembrolizumab, pemetrexed, and a platinum in advanced nonsquamous non– small cell lung cancer...

lung cancer

Pembrolizumab Plus Standard Chemotherapy Improves Survival in Newly Diagnosed Metastatic Non–Small Cell Lung Cancer

ADDING THE IMMUNE checkpoint inhibitor pembrolizumab (Keytruda) to standard chemotherapy with pemetrexed (Alimta) and a platinum as first-line therapy was superior to chemotherapy alone in the KEYNOTE-189 trial.1 Induction and maintenance therapies with the new triplet therapy improved overall...

hematologic malignancies
leukemia

Fine-Tuning Treatment in Myeloma and Leukemia

It is a difficult task to include every notable presentation from the 2017 American Society of Hematology (ASH) Annual Meeting & Exposition. In addition to our more comprehensive coverage of the news from that meeting over the past several issues, below are summaries of additional key...

Expert Point of View: Marisa Weiss, MD

At a press conference where the findings by Chlebowski et al were presented, Marisa Weiss, MD, Founder and Chief Medical Officer of Breastcancer.org and Director of Radiation Oncology at Lankenau Medical Center in Philadelphia, commended this study. “We could set a goal of losing 5 pounds for our...

breast cancer

Modest Weight Loss Reduces Breast Cancer Risk

Evidence of the numerous health benefits of weight loss continues to mount, and the hope is that doctors and patients are listening. A large observational study presented at the 2017 San Antonio Breast Cancer Symposium showed that weight loss of more than 5% is associated with a significantly lower ...

solid tumors

Expert Point of View: Aaron Richard Hansen, BSc, MBBS (Hon), FRACP

“FOR THIS RARE tumor with a paucity of data, all we have are phase II trials to make treatment selection,” said invited discussant Aaron Richard Hansen, BSc, MBBS (Hon), FRACP, of the Princess Margaret Hospital, Toronto. “For patients with de novo metastatic disease or relapse after definitive...

solid tumors

Vinflunine May Benefit Selected Patients With Penile Cancer

PENILE CANCER is rare, outcomes remain poor, and there are few data from randomized trials to guide treatment decisions. However, in the small phase II VinCaP study, presented at the 2018 Genitourinary Cancers Symposium, 45.5% of patients with advanced or metastatic penile cancer had a clinical...

bladder cancer
kidney cancer
prostate cancer

GU Symposium Focuses on Prognostic Model in Urothelial Cancer, Novel Therapies for Prostate and Kidney Cancers

THE 2018 GENITOURINARY Cancers Symposium hosted an international audience of oncologists and other stakeholders to hear about the latest advances in the field. We have included coverage of many of the top news stories from the meeting in previous issues of The ASCO Post. Here are summaries of a few ...

Expert Point of View: Kathryn Ruddy, MD

  “This is a very exciting study. Acupuncture is another tool to address arthralgias associated with aromatase inhibitor therapy,” said Kathryn Ruddy, MD, of the Mayo Clinic, Rochester, Minnesota. “I don’t think every patient with joint pain will opt for this for a variety of reasons, including...

symptom management
supportive care
solid tumors
breast cancer

Acupuncture for Joint Pain Associated With Aromatase Inhibition

Although aromatase inhibitors are highly effective as adjuvant therapy in metastatic breast cancer and for prevention of breast cancer, the side effects can be difficult to tolerate and often lead to discontinuation of therapy. A phase III randomized trial has found that acupuncture may relieve...

multiple myeloma

EXPERT POINT OF VIEW: Kenneth C. Anderson, MD, and S. Vincent Rajkumar, MD

AT A PREMEETING webinar, American Society of Hematology then President Kenneth C. Anderson, MD, Director of the Lebow Institute for Myeloma Therapeutics and Jerome Lipper Myeloma Center at Dana-Farber Cancer Institute, Boston, commented: “This study demonstrates this new treatment has good...

multiple myeloma

Unique CAR T-Cell Construct Studied in Multiple Myeloma

CD19-DIRECTED chimeric antigen receptor (CAR) T-cell therapy has been approved by the U.S. Food and Drug Administration for the treatment of leukemia (tisagenlecleucel [Kymriah]) and lymphoma (axicabtagene ciloleucel [Yescarta]), but another type of CAR T-cell therapy is generating interest as a...

Expert Point of View: Robert Bruce Montgomery, MD

Formal discussant of this trial, Robert Bruce Montgomery, MD, Clinical Director of Genitourinary Medical Oncology, Seattle Cancer Alliance, said, “The rationale for checkpoint inhibition and [poly ADP--ribose polymerase (PARP)] inhibitors is strong in patients with underlying homologous...

prostate cancer

Small Study Evaluates Novel Combination in Metastatic Prostate Cancer

The combination of the poly ADP-ribose polymerase (PARP) inhibitor olaparib (Lynparza) and the programmed cell death ligand 1 (PD-L1) inhibitor durvalumab (Imfinzi) produced positive preliminary results in men with metastatic, castration-resistant prostate cancer previously treated with...

Expert Point of View: Sumanta K. Pal, MD

Over the past 12 years, “the debates in kidney cancer have gotten more exciting. Combination therapy with a programmed cell death protein 1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitor is an area of intense study,” said formal discussant and ASCO Expert Sumanta K. Pal, MD, of City of...

solid tumors
kidney cancer

Positive Preliminary Data Seen for Axitinib Plus Pembrolizumab in Renal Cell Carcinoma

The combination of axitinib (Inlyta) plus pembrolizumab (Keytruda) can be added to the list of combination therapies that look promising in advanced renal cell carcinoma. In a phase Ib trial, almost three-quarters of patients with newly diagnosed advanced renal cell carcinoma treated with the...

Expert Point of View: Robert Jones, MD, PhD

Formal discussant of this trial, Robert Jones, MD, PhD, of the University of Glasgow, Beatson West of Scotland Cancer Center, Glasgow, Scotland, said: “I think it is clear that programmed cell death protein 1/programmed cell death ligand 1 (PD-1/PD-L1)–targeted immunotherapy now has a role for...

solid tumors

Pembrolizumab Survival Advantage Upheld in Advanced Urothelial Carcinoma

Patients with recurrent urothelial cancer had sustained improvement in overall survival at 2 years after they received second-line treatment with pembrolizumab (Keytruda) vs chemotherapy, according to an updated survival analysis of the phase III KEYNOTE-045 trial presented at the 2018...

breast cancer

EXPERT POINT OF VIEW: Aditya Bardia, MD

ADITYA BARDIA, MD, Director of Precision Medicine at the Center for Breast Cancer, Massachusetts General Hospital, Harvard Medical School, Boston, said: “This large, well-powered trial that included 181 centers and more than 2,600 patients unfortunately failed to show that celecoxib improved...

breast cancer

No Evidence of Celecoxib Benefit Reported in Patients With Early Breast Cancer

TWO YEARS of treatment with celecoxib had no observed effect on 5-year outcomes of patients with early breast cancer in the large REACT trial presented at the 2017 San Antonio Breast Cancer Symposium.1 “There was no overall benefit observed in disease-free survival or overall survival for...

bladder cancer

EXPERT POINT OF VIEW: Timothy Gilligan, MD

“POUT IS an impressive study, given that the authors were able to complete a trial in this relatively rare cancer. We still need overall survival data to determine the role of adjuvant chemotherapy for upper tract urothelial cancer. We need to know if it makes people live longer or have a better...

bladder cancer

Adjuvant Chemotherapy for Upper Tract Urothelial Cancer

ADJUVANT CHEMOTHERAPY achieved robust improvements in disease-free survival and metastasis-free survival compared with surveillance in the phase III POUT study of patients with upper tract urothelial cancer.1 Further, there was an early trend toward improved overall survival with adjuvant...

prostate cancer

EXPERT POINT OF VIEW: Philip Kantoff, MD

  PHILIP KANTOFF, MD, of Memorial Sloan Kettering Cancer Center, New York, was the formal discussant of both trials. “At first glance, these are two positive trials,” Dr. Kantoff said. Although he praised the results, he said that overall survival is the best demonstration of clinical benefit, and ...

prostate cancer

Apalutamide, Enzalutamide Improve Metastasis-Free Survival in Nonmetastatic Castrate-Resistant Prostate Cancer

IN TWO SEPARATE TRIALS presented at the 2018 Genitourinary Cancers Symposium, apalutamide and enzalutamide (Xtandi), respectively, reduced the risk of metastasis and prolonged metastasis-free survival in men with high-risk nonmetastatic castrate-resistant prostate cancer. In the SPARTAN trial,1,2...

kidney cancer

EXPERT POINT OF VIEW: Sumanta K. Pal, MD

ASCO EXPERT Sumanta K. Pal, MD, of City of Hope, Duarte, California, commented, “IMmotion 151 is a positive trial and represents an important breakthrough. We have debated combination treatment strategies for advanced kidney cancer. This study looks at the combination of a programmed cell death...

kidney cancer

Atezolizumab Plus Bevacizumab Improves Progression-Free Survival in First-Line Treatment of Advanced Renal Cell Carcinoma

THE TYROSINE KINASE inhibitor sunitinib (Sutent) has been the mainstay of treatment for first-line treatment of advanced renal cell carcinoma for about a decade. The IMmotion151 study reported at the 2018 Genitourinary Cancers Symposium found that the combination of the immune checkpoint inhibitor...

EXPERT POINT OF VIEW: Amir T. Fathi, MD

“As of now, there is no standard of care for a maintenance strategy in acute myeloid leukemia (AML),” said Amir T. Fathi, MD, Director of the Leukemia Program at Massachusetts General Hospital and Assistant Professor of Medicine at Harvard Medical School, Boston. “Maintenance therapy is being...

hematologic malignancies
leukemia

Data Favoring Maintenance Therapy in Older Patients With AML Accumulate

The use of maintenance therapy in older patients with acute myeloid leukemia (AML) is theoretically sensible, but its clinical value remains uncertain. The phase III HOVON97 randomized study demonstrated that maintenance therapy with the hypomethylating agent azacitidine may improve disease-free...

hematologic malignancies
symptom management

EXPERT POINT OF VIEW: Robert Brodsky, MD

“THE RESULTS of these two trials are more similar than different. I think the best conclusion would be that we now have two trials with consistent results and can probably, in most cases, replace low–molecular-weight heparin with direct oral anticoagulants,” said Dr. Raskob, lead investigator of...

hematologic malignancies
symptom management

Use of Direct Oral Anticoagulants in Preventing VTE in Patients With Cancer

THE FIRST TWO randomized trials to directly compare direct oral anticoagulants vs low–molecular-weight heparin for management of venous thromboembolism (VTE) in patients with cancer suggest that direct oral anticoagulants may become the new standard of care.1,2 Direct oral anticoagulants appear to...

EXPERT POINT OF VIEW: Ann H. Partridge, MD, MPH, FASCO

“The simple questions are whether ovarian function suppression adds clinical benefit in premenopausal women, and is ovarian function suppression better with an aromatase inhibitor or tamoxifen,” said formal discussant of these trials, Ann H. Partridge, MD, MPH, FASCO, Professor of Medicine at...

solid tumors
breast cancer

Ovarian Function Suppression During and After Chemotherapy Valid for Some Patients With Early Breast Cancer

Temporary ovarian suppression during chemotherapy as a means of preserving ovarian function and fertility in young women with early breast cancer is controversial. An eagerly awaited meta-analysis including individual patient data from five randomized controlled trials found that the use of...

solid tumors
breast cancer

SABCS Highlights Focus on Predicting Residual Tumor Burden, Therapy-Related Arm Morbidity, Lifestyle and Cancer Risk

We have covered many of the important presentations from the 2017 San Antonio Breast Cancer Symposium in the pages of The ASCO Post and in our online Evening News. Here are summaries of additional noteworthy studies presented at the meeting. We hope you will find them of interest. Predicting...

breast cancer

EXPERT POINT OF VIEW: C. Kent Osborne, MD, and Joseph Sparano, MD

“ONCOLOGISTS WANT to find drugs that will delay the use of chemotherapy, and cyclin-dependent kinase (CDK) 4/6 inhibitors provide that. These agents work better than chemotherapy and with less toxicity,” said press conference moderator C. Kent Osborne, MD, Director of the Duncan Cancer Center at...

breast cancer

CDK 4/6 Inhibitors May Be Effective but More Toxic in Older Women

OLDER WOMEN with breast cancer derive benefit from treatment with cyclin-dependent kinase (CDK) 4/6 inhibitors as part of initial endocrine-based therapy for hormone receptor–positive, HER2-negative, metastatic breast cancer, according to a retrospective pooled subgroup analysis of women aged 70 or ...

Expert Point of View: Robert Brodsky, MD and Henry Fung, MD, FACP, FRCPE

“Several new drugs that have been approved for the treatment of chronic lymphocytic leukemia (CLL) are changing the landscape of this disease. CLL is associated with a long survival, so we will need longer follow-up to see how deep the responses are,” said Robert Brodsky, MD, Director of...

hematologic malignancies
leukemia

Venetoclax Plus Rituximab Outperforms Standard Bendamustine Plus Rituximab in CLL

  Venetoclax (Venclexta) plus rituximab (Rituxan)—a non–chemotherapy-containing regimen—was superior to standard-of-care bendamustine plus rituximab for patients with relapsed or refractory chronic lymphocytic leukemia (CLL), according to a final analysis of the phase III MURANO study reported at...

Expert Point of View: Renier J. Brentjens, MD, PhD

“The JULIET study, along with ZUMA-1, shows striking responses that are remarkably similar, even though there are differences in the signaling domains of both chimeric antigen receptor (CAR) T-cell products [tisagenlecleucel (Kymriah) and axicabtagene ciloleucel (Yescarta)],” said Renier J....

hematologic malignancies
lymphoma

Update on CAR T-Cell ‘Breakthrough’ Therapy in Lymphoma

Primary analysis of the JULIET trial adds to mounting evidence that chimeric antigen receptor (CAR) T-cell therapy is effective for the treatment of lymphoma in patients with no other good treatment options. A single infusion of CAR T cells (CTL019) achieved durable remissions in almost 40% of...

Expert Point of View: Jennifer Amengual, MD

“Patients diagnosed with Hodgkin lymphoma who are more than 60 years old have unacceptably low progression-free survival rates compared with younger patients. Dr. Evens and colleagues were interested in improving outcomes for this group of patients,” said Jennifer Amengual, MD, Assistant Professor ...

hematologic malignancies
lymphoma

Best Outcomes to Date in Older Patients With Hodgkin Lymphoma

  Older patients with Hodgkin lymphoma typically do not fare as well as younger patients on standard regimens. A phase II study reported the best outcomes to date in older patients with Hodgkin lymphoma who were treated with sequential brentuximab vedotin (Adcetris) before and after a regimen of...

Expert Point of View: Virginia Kaklamani, MD

“This study provides proof of concept in the advanced HER2-positive, trastuzu-mab-resistant setting. The presence of tumor--infiltrating lymphocytes was predictive of response. We don’t know if the addition of chemotherapy would help the tumor microenvironment,” said press conference moderator...

solid tumors
breast cancer

Proof-of-Principle Study of Combination Checkpoint Inhibitor Plus Trastuzumab in HER2-Positive Advanced Breast Cancer

  The combination of pembrolizumab (Keytruda) plus trastuzumab (Herceptin) may turn out to be a good treatment option for patients with trastuzumab-resistant advanced HER2-positive breast cancer, according to the results of an early study presented at the 2017 San Antonio Breast Cancer Symposium...

breast cancer

Dose-Dense Chemotherapy in Early Breast Cancer: A ‘Win-Win’ Treatment Approach

INCREASING THE DOSE density of chemotherapy lowers the risk of recurrence and breast cancer death by about 15% in women with early breast cancer, according to a large, meticulously conducted meta-analysis by the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG).1 The trials included in...

breast cancer

Expert Point of View: Marisa Weiss, MD; Carlos Arteaga, MD; and Kathryn Ruddy, MD

COMMENTING ON THIS STUDY, Marisa Weiss, MD, Founder and Chief Executive Officer of Breastcancer.org, said: “It is great to see a compliance rate of 80% at 2 years. When you talk to a patient about extending adjuvant therapy for 2 years instead of 5 extra years, it may be this will encourage...

breast cancer

Extended Endocrine Therapy in Postmenopausal Women With Breast Cancer: 2 Years as Effective as 5 Years

An additional 5 years of aromatase inhibitor therapy after 5 years of adjuvant endocrine therapy failed to improve disease-free survival compared with an additional 2 years of aromatase inhibitor therapy in postmenopausal women with hormone receptor–positive breast cancer, according to the results ...

lymphoma

Front-Line Brentuximab Plus AVD vs Standard ABVD in Advanced Hodgkin Lymphoma

FRONT-LINE TREATMENT of advanced Hodgkin lymphoma with brentuximab vedotin (Adcetris) plus doxorubicin/ vinblastine/dacarbazine (A+AVD) achieved superior outcomes compared with the standard four-drug regimen of doxorubicin/bleomycin/vinblastine/dacarbazine (ABVD). The substitution of brentuximab...

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