Well-differentiated thyroid cancer is one of the most common endocrine cancers, and is often treated using radioactive iodine. However, the risk of subsequent cancer development from radioactive iodine treatment has not been previously determined. Remco Molenaar, MD, PhD, from the University of Amsterdam, Amsterdam, Netherlands, discusses the use of this radioisotope, and explains the results of a recent study which suggested that this treatment could increase the risk of patients developing acute myeloid leukemia. This interview was recorded at the European Society for Medical Oncology (ESMO) 2017 conference in Madrid, Spain.
Просмотров: 3136 VJOncology
Georgina V. Long, BSc, PhD, MBBS, FRACP, of the University of Sydney, Australia, gives a summary of the updates on immunotherapies in melanoma, which were presented from the ASCO 2017 meeting. Data presented at ASCO on immunotherapies has shown great results. Prof. Long highlights the combination of nivolumab and ipilimumab for the treatment of active melanoma brain metastases (MBM) with a response of 50% and a progression-free survival (PFS) of 46% at 6 months and 12 months. Another important topic presented at ASCO was how circulating free DNA measurements can help predict whether a patient will respond to immune therapy long before a scan. Prof. Long explains that a drop in circulating free DNA from the tumor suggests a patient will respond well to and can continue treatment. Furthermore, long-term data of immune therapies, such as fom the KEYNOTE-006 Phase III trial, have shown very good results (NCT01866319). Prof. Long further explains that the field is moving forward with new trials for immune therapies in the neoadjuvant setting. Recorded at the American Society of Oncology (ASCO) 2017 Annual Meeting held in Chicago, IL.
Просмотров: 2117 VJOncology
The human papilloma virus (HPV) currently has no cure, with virtually all cases of cervical cancer being caused by HPV. Here, Judith Smith, PharmD, BCOP, CPHQ, FCCP, FISOPP, of UTHealth McGovern Medical School, Houston, TX, discusses her findings looking at the nutritional supplement active hexose correlated compound, more commonly known as AHCC, that has shown promise in eradicating HPV. Dr Smith was speaking from the 2018 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference, held in Denver, CO.
Просмотров: 1007 VJOncology
Mansoor Mirza, MD of Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark discusses clinical trials in ovarian cancer in comparison to the ENGOT-OV16/NOVA Phase III trial of maintenance with PARP-inhibitor niraparib versus placebo in patients with platinum-sensitive ovarian cancer (NCT01847274). According to Dr Mirza, the trials are performed differently. He explains that for a Phase III trial of olaparib, it is only considering the BRCA-mutated population. In the ENGOT-OV16/NOVA trial, the whole population of ovarian cancer patients was included. In the ARIEL series of trials with rucaparib, which is similar to ENGOT-OV16/NOVA, we are still waiting for the results. In Europe, maintenance niraparib therapy is approved for BRCA mutated population but now with the results, he believes all patients can be treated with niraparib regardless of BRCA or HRD mutational status.
Просмотров: 1505 VJOncology
Martin Reck, MD, PhD of LungenClinic Grosshansdorf, Grosshansdorf, Germany gives an overview of the KEYNOTE-024 trial results for non-small cell lung cancer (NSCLC) presented at the 2016 annual meeting of the European Society of Medical Oncology (ESMO), held in Copenhagen, Denmark. They KEYNOTE-024 trial is a Phase III trial of pembrolizumab compared to standard of care (SOC) platinum-based chemotherapies in patients with previously untreated stage IV, programmed cell death ligand 1 (PD-L1) strong expressing NSCLC (NCT02142738). The assumption was that pembrolizumab will be superior to platinum-based chemotherapies in efficacy and this was observed in the trial. The primary endpoint was progression-free survival (PFS), which was in favor of pembrolizumab with a prolongation of median PFS from 6 months to 10.3 months. There was also an improvement in overall survival (OS) as well as an improvement in response. Further, the tolerability was in favor of pembrolizumab.
Просмотров: 1019 VJOncology
Hendrik Van Poppel, MD, PhD, from KU Leuven, Leuven, Belgium, discusses novel approaches in the treatment of metastatic prostate cancer at the European Association of Urology (EAU) in 2017 in London, UK. The STAMPEDE (NCT00268476) has shown that in patients with newly diagnosed bone metastasis, chemotherapy must be offered first. He explains that the promising new treatments being discussed at this congress are immunotherapy and PSMA PET-CT scans. Immunotherapy has shown to be promising in bladder and kidney cancers, however, more research will need to be carried out to determine its efficacy in prostate cancer. PSMA PET-CT scans may prove particularly useful for patients with oligometastatic disease, where after prostatectomy or radiotherapy, PSA levels remain high. PSMA PET-CT would allow for the detection of solitary bone metastases, as well as solitary nodes missed during lymphadenectomy. This would enable more targeted treatment, allowing castration and androgen deprivation therapy to be postponed, while still monitoring PSA levels. He states that even if it doesn’t give a survival benefit, it will give a quality of life benefit.
Просмотров: 1155 VJOncology
Jürgen Wolf, MD, University Hospital of Cologne, Cologne, Germany, talks about strategies to select the patients most likely to benefit from immune checkpoint inhibitors, a class of drugs that activate the immune system against tumour cells. Current selection strategies are based on the expression levels of PD-L1 in the tumour, with higher levels of expression associated with a higher likelihood of response to treatment. However, Prof Wolf points out that PD-L1 expression is not always associated with a good response to immunotherapy. There are cases of PD-L1 positive patients who do not respond to treatment and conversely, cases of PD-L1 negative-patients who benefit from treatment. Therefore, there is a need for better predictive biomarkers to enable more precise treatment decisions. Prof Wolf discusses two strategies for patient selection that go beyond PD-L1 testing. The first is overall mutational burden, the sum of all mutations present in a tumour cell. The higher the mutation burden, the higher the probability of a response to immunotherapy. The second strategy aims to look at the tumour micro-environment and the multiple interactions that take place between the different components of the immune system. Transcriptome analysis looks at the activity of the tumour’s whole genome as opposed to gene mutations. By looking at activity of the whole genome, Prof Wolf’s research aims to identify patterns that differentiate patients who will respond to immunotherapy from those who will not. These strategies are currently under investigation and not yet ready to be translated into clinical practice. Recorded at the 2017 meeting of the British Thoracic Oncology Group (BTOG) in Dublin, Ireland.
Просмотров: 710 VJOncology
David Hui, MD, MSc of MD Anderson Cancer Center, Houston, TX discusses hydration and nutrition in end-of-life patients. Hydration is associated with limited side effects, even though there is some potential for swelling and fluid build-up in the body. It should be considered as a part of the treatment to reassure patient’s family. However, artificial nutrition would not be advised in this population as the risks significantly outweigh the benefits. Moreover, Dr Hui mentions physical signs of death in end-of-life patients, which may include respiration with mandibular movement, and drooping of nasolabial fold. However, the absence of these signs cannot completely rule out impending death. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016 Annual Meeting on Supportive Care in Cancer held in Adelaide, Australia.
Просмотров: 1130 VJOncology
David Gandara, MD, from the University of California,Sacramento, CA discusses the current treatment options for squamous cell lung cancer (SCLC), at the annual meeting of the European Lung Cancer Conference (ELCC) 2017, Geneva, Switzerland. Up until recently, the treatment choice for SCLC has been limited but with the development of immunotherapy there has been an improvement in the quality and standard of treatment options. However, relative to adenocarcinomas, there is a lack of PD-L1 expression in SCLC, and current immunotherapy options are tailored to high-expressing tumors only. Other first-line therapies for SCLC include EGFR-monoclonal antibodies such as necitumumab combined successfully with platinum chemotherapy. Second-line therapies include EGFR tyrosine kinase inhibitors such as afatinib and erlotinib. New agents and drugs are being developed every day to refine current therapies for SCLC.
Просмотров: 531 VJOncology
David Currow, BMed, PhD, MPH, FRACP, FAChPM, FAHMS, GAICD of Flinders University, Adelaide, Australia, discusses delirium in cancer patients. Patients, who are acutely unwell are at a much higher risk of being acutely confused. This is observed more frequently late in life, however, all patients being treated for cancer or living with the disease are at a greater risk than the population at large. A high index of suspicion is needed when people’s cognition changes. The majority of patients experience a hyperactive delirium, but hypoactive delirium can also occur. Vivid recollections of delirium, including hallucinations are common. Dr Currow highlights the importance of treating infections, and metabolic changes, as many of the causes can be reversed. Urinary tract infections in patients treated with chemotherapy may cause neutropenia and should be treated early and aggressively to create a supportive environment for patients experiencing symptoms like hallucinations. Dr Currow mentions that the bottom line for delirium is having index of suspicion, and thinking about patients who are very sick and at a higher risk of delirium. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016 Annual Meeting on Supportive Care in Cancer held in Adelaide, Australia.
Просмотров: 552 VJOncology
Mark Schubert, DDS, MSD of Seattle Care Alliance, Seattle, WA provides an overview of his journey through plasmacytoma treatment. With symptoms beginning in 2007, he mentions experiencing fatigue, peripheral neuropathies and weight loss, before officially being diagnosed with plasmacytoma in his left ilium. He then provides a brief overview of the various forms of treatment received: 5 courses of radiation, a treatment with lenalidomide and dexamethasone for a number of years, a switch to bortezomib and dexamethasone and then preceded to an autologous transplant in March 2014. Following that process, he was maintained with bortezomib and is now taking ixazomib. He reports feeling optimistic with the progress so far. Being a dentist, Dr. Schubert explains his experience working in supportive care, for oral oncology. He mentions knowledge surrounding the issues of bad oral complications side effects and a recurrence of disease that patients may experience. This had led to him feeling a sense of panic as a first reaction to his own diagnosis. However, he emphasizes that with the reassurance and support of family and a great oncology team, he was able to better understand and endure treatment. Having access to the literature, as well as care providers who would provide him with the latest up to date research, Dr. Schubert expresses feeling reassured, however at times a level of confusion with regards to making decisions on how he would like to be treated. Dr. Schubert concludes the interview with a takeaway message he plans to raise in his presentation being that patients have to build hope and confidence in their care providers, if they are going to be able to proceed on their treatment journey. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016 Annual Meeting on Supportive Care in Cancer held in Adelaide, Australia.
Просмотров: 929 VJOncology
Ovarian cancer research is moving forwards, as displayed at the European Society for Medical Oncology (ESMO) 2018 Congress, in Munich, Germany. Kathleen Moore, MD, MS, of the Stephenson Cancer Center, Oklahoma City, OK, gave an update on the SOLO-1 trial (NCT01844986) of olaparib maintenance monotherapy for BRCA-mutated ovarian cancer after first-line platinum-based chemotherapy.
Просмотров: 814 VJOncology
Robotic surgery equipment is notoriously expensive, limiting the number of hospitals and surgeons who can utilize this beneficial technology. In this interview, Joel Dunning, PhD, FRCS, of South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK, gives us a practical demonstration of an innovative piece of tech, which is aiming to bring robotic-assisted surgery to the masses. This video was recorded at the British Thoracic Oncology Group (BTOG) Annual Conference 2018, held in Dublin, Ireland.
Просмотров: 534 VJOncology
This an exciting time for cancer research as recent breakthroughs are improving the landscape of cancer treatment. John Bell, PhD, from the University of Ottawa, Ottawa, Canada, presents an exciting oncolytic virus approach to treating cancer being investigated in trials. Dr Bell speaks at the 2018 National Cancer Research Institute (NCRI) Cancer Conference, held in Glasgow, UK on oncolytic viruses, their potential applications, benefits, challenges, and implications in cancer treatment.
Просмотров: 322 VJOncology
Benjamin Besse, MD, PhD, from the Gustave Roussy Cancer Institute, Paris, France, discusses toxicity associated with immunotherapy at the European Society for Medical Oncology (ESMO) 2017 in Madrid, Spain. Immunotherapies are typically perceived as being less toxic than other systemic treatments, such as chemotherapy, however, this isn’t always the case. The toxicities with immunotherapy tend to be autoimmune related, and therefore can affect any organ in the body. Depending on how severe these side effects are, the therapy might need to be stopped, and the patient referred to a specialist.
Просмотров: 693 VJOncology
Michael Atkins, MD, from the Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, discusses recent trials in the treatment of metastatic kidney cancer at the European Society for Medical Oncology (ESMO) 2017 in Madrid, Spain. The CheckMate 124 study (NCT02231749) compared nivolumab plus ipilimumab with sunitinib. It found that the combination of nivolumab plus ipilimumab led to higher response rates, progression free survival and overall survival compared to sunitinib, especially in patients with poor risk clinical factors relating to their tumor. The IMmotion151 study (NCT02420821) investigated the combination of atezolizumab plus bevacizumab compared with sunitinib. This trial also found sunitinib to be less superior to the combination. These findings were further validated by the CABOSUN study (NCT01835158), a comparison of cabozantinib and sunitinib.
Просмотров: 480 VJOncology
New and exciting developments on urothelial cancer were presented at the 2018 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference, held in Denver, CO. In this detailed interview, Kirollos Hanna, PharmD, BCOP, BCPS of the University of Minnesota Medical Center, Minneapolis, MN, discusses PD-L1 expression and covers the latest updates on immunotherapy options for metastatic urothelial carcinoma.
Просмотров: 369 VJOncology
Reuben Harris, PhD of University of Minnesota, Minneapolis, MN gives an overview of his talk focused on APOBEC enzymes. Dr Harris is interested in defining processes which cause cancer mutations in order to stop tumor evolvability. Existing therapies often fail due to drug-resistant mutations. APOBEC is a family of enzymes contributing to cancer mutagenesis. APOBEC signature mutations are defined as cytosine to thymine, or cytosine to guanine changes that happen within specific motifs, usually TCA, TCG or TCT. In some cancers, like cervical cancer it is 90% of all mutations. Recorded at the 2016 National Cancer Research Institute (NCRI) Conference in Liverpool, UK.
Просмотров: 344 VJOncology
ATM and ATR have exciting potential as therapeutic targets for the treatment of cancer. In this interview Melinda L. Telli, MD, from Stanford University Medical Center, Stanford, CA, discusses the role of ATM and ATR in the DNA damage response and regulating cell cycle checkpoints, as well as their druggability. This interview was recorded at the 2017 European Society for Medical Oncology (ESMO) conference held in Madrid, Spain.
Просмотров: 397 VJOncology
Barbara Melosky, MD, FRCPC, of the University of British Columbia, Vancouver, BC discusses how the world of epidermal growth factor receptor (EGFR) mutating lung cancers has changed in terms of management, understanding, and the choices which are available. Research is investigating which patients might benefit from certain medications, as choice is expanding with each generation of drugs. There are first-generation EGFR tyrosine kinase inhibitors (TKIs); gefitinib, and erlotinib, second generation EGFR TKIs; afatinib, dacomitinib, and third generation; osimertinib. Dr Melosky is most excited about AURA3 data for osimertinib (NCT02151981). The choices today in the first-line setting for patients depend on the type of EGFR mutation. Mutation types are broken up into 3 categories; exon 19 deletion, exon 21 L858R, and an uncommon mutation. Following determining mutation type, it is important to communicate and educate the patient on, for example, survival rates. LUX-Lung 3 and 6 trial data has shown that exon 19 deletion has an overall significant survival benefit (NCT00949650 and NCT01121393) and in young patients, it is important to communicate this. From the LUX-Lung 7 Phase II trial, there was an observed improvement in progression-free survival (PFS), time to treatment failure, and interestingly, a 30% improvement in response rate by RECIST criteria for the exon 21 L858R mutation (NCT01466660). Another lesson to learn is that for patients with exon 21 L858R mutation needing a robust response, the best choice of drug is afatinib. For patients who are elderly, live far away from a cancer center, or where communication is poor, gefitinib may be a good choice according to Dr Melosky. AURA3 data might show that patients who develop an exon 20 T790M mutation are suited to osimertinib. From LUX-Lung 7 data, in patients either on gefitinib or afatinib that went on to osimertinib, survival is approaching 4-5 years. In conclusion, the future is looking bright for EGFR mutation patients, and hopefully this is becoming a chronic disease. Recorded at the 2016 World Conference of Lung Cancer (WCLC) of the International Association for the Study of Lung Cancer (IASLC) in Vienna, Austria.
Просмотров: 746 VJOncology
Beth Eaby-Sandy MSN, CRNP, OCN, of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA explains the different toxicities seen with immunotherapy compared to chemotherapy. Toxicities associated with immunotherapy are generally uncommon, but can be life threatening if they progress. It important for nurses to understand why these patients are having these toxicities, and how they differ from chemotherapy. Nurses must tell patients when to get in contact. Three of the most common severe immune-mediated toxicities from immunotherapies used in lung cancer are: pneumonitis, colitis, and rash/dermatitis. Pneumonitis and colitis are the two that can be life-threatening. Patients with pneumonitis may develop sudden in shortness of breath, chest tightness, or coughing. Such toxicities are reversible with high doses of steroids followed by about a months’ worth of a taper. Patients with colitis often confuse symptoms with diarrhea. The difference is that in diarrhea frequent and loose stools are seen. In colitis abdominal pain, cramping, with bloody or mucousy stools are seen. Colitis without treatment with high-dose steroids can rapidly become worse. It is important for HCPs to realize the greater concern of pneumonitis in lung cancer patients when compared to melanoma patients. The rash/dermatitis is not necessarily life-threatening. But it is important to evaluate with pictures, and possibly biopsy the skin lesion. This tends to be rare with lung cancer drugs, but more common and severe in melanoma with combinations of ipilimumab and nivolumab. Another wide range of common toxicities are endocrinopathies. Hypothyroidism causes TSH levels to go up meaning a need to supplement with levothyroxines (treatment of choice). Hyperthyroidism is less common and more difficult to treat. Hypophysitis, or pituitary or adrenal disorders, can also occur but are rare and treated accordingly with hormones or cortisol therapies. There are many other rare toxicities, for example ocular toxicities, neuromuscular toxicities. Hepatitis and nephritis are slightly more common but are ‘paper toxicities’, which patients don’t feel and can be managed. Recorded at the 2016 World Conference of Lung Cancer (WCLC) of the International Association for the Study of Lung Cancer (IASLC) in Vienna, Austria.
Просмотров: 790 VJOncology
Isaac Brownell, MD, PhD of the National Cancer Institute, Bethesda, MD discusses the virus associated with Merkel cell carcinoma and ongoing research into a potential vaccine for the disease during his attendance at the 2016 World Congress on Cancers of the Skin (WCCS) and the Congress of the European Association of Dermato-Oncology (EADO) in Vienna, Austria. Unlike in other skin cancers, Dr Brownell explains that Merkel cell carcinoma is associated with a virus, which may explain why the immune system is able to target so many of the tumors. Viruses express proteins which are not usually expressed in the body, which gives a natural target for the immune system. Because these tumors are driven by a virus and it is necessary for the viral proteins to be expressed, the tumor needs to figure out a way to protect itself from the immune detection of that viral protein, which may be another reason that checkpoint inhibitors are effective in Merkel cell carcinoma. The virus associated with Merkel cell carcinoma is abundant in the environment and can be found on most people’s skin and does not appear to cause any issues. During cancer, the virus is integrated into the host DNA and the virus proteins become mutated which drives tumor formation. Dr Brownell believes developing a vaccine against this virus would not likely be effective as there is not a strong correlation between infection and tumor formation. However, research into vaccines against the tumor formation are ongoing, with the aim to develop a vaccine specifically for patients with Merkel cell carcinoma, which would augment the immune response.
Просмотров: 321 VJOncology
With exciting data from the Phase III SPARTAN (NCT01946204) and PROSPER (NCT02003924) trials of apalutamide and enzalutamide, respectively, for the treatment of nonmetastatic castration-resistant prostate cancer (nmCRPC), a question arising is which drug is better. Speaking from the 2018 Genitourinary Cancers Symposium, in San Francisco, CA, Eric Small, MD, of the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, discusses this question.
Просмотров: 600 VJOncology
Dr Mansoor Mirza, chief oncologist at Copenhagen University Hospital, Denmark and medical director of the Nordic Society of Gynaecological Oncology (NSGO) describes the results of the NOVA trial, evaluating the efficacy and safety of the PARP inhibitor, niraparib, as maintenance therapy in patients with recurrent ovarian cancer, who respond to platinum-based chemotherapy. Patients were assigned to cohorts by BRCA mutation status and randomised 2:1 to receive niraparib 300 mg or placebo once daily. The trial included 553 patients, of whom 203 had the germline BRCA mutation and 350 did not. Niraparib significantly improved the primary endpoint of progression-free survival compared to placebo in both cohorts, as well as in all subgroups. Other significant reports are that patients on niraparib maintained symptom control and had a quality of life comparable to those on placebo. There are limited treatment options for patients with recurrent ovarian cancer; according to Dr Mirza, “This is a breakthrough for patients… we have never seen such large benefits in progression-free survival in recurrent ovarian cancer. These landmark results could change the way we treat this disease.” He concluded that, “Once it is approved by the regulatory authorities, I’ll consider niraparib for all my patients with recurrent ovarian cancer who respond to platinum regardless of BRCA status.”
Просмотров: 706 VJOncology
Prof Jürgen Wolf, MD, University Hospital of Cologne, Cologne, Germany, discusses methods of measuring whole mutation burden, i.e. the sum of all mutations present in a tumour. Whole mutation burden is currently investigated as a predictive biomarker for response to immunotherapy, with the hypothesis that the higher the mutation burden, the higher the probability of a response to immunotherapy. Prof Wolf compares two methods: Whole exome sequencing and next generation sequencing (NGS) diagnostic panels. Whole exome sequencing, which looks at the sequence of transcribed genes, is expensive, requires fresh biopsy samples and is difficult to implement in a clinical setting. In contrast, next generation sequencing (NGS) diagnostic panels focus on a certain set of genes, are faster, cheaper and can be applied to paraffin-embedded tissue to measure the mutation load in a tumour. Several retrospective studies have shown that NGS diagnostic panels provide comparable results to whole exome sequencing. Prof Wolf and other investigators are now working to validate these data with prospective studies. Recorded at the 2017 meeting of the British Thoracic Oncology Group (BTOG) in Dublin, Ireland.
Просмотров: 302 VJOncology
Eva Lehner-Baumgartner, PhD of Vienna General Hospital, Vienna, Austria, speaks about the role of clinical psychologists and therapists in patient care at the 2016 World Congress on Cancers of the Skin (WCCS) and the Congress of the European Association of Dermato-Oncology (EADO) in Vienna, Austria. Dr Lehner-Baumgartner provides the example of how it can be difficult for a patient to believe that a treatment is making them better when it is actually making them feel worse than they did before the treatment. This is when clinical psychologists and therapists can help by explaining such issues to patients and teaching them coping strategies. Introducing coping strategies to patients early on in their disease is beneficial for the patient in handling their illness. Dr Lehner-Baumgartner believes it is important for clinical psychologist and therapists to cooperate with physicians so that when a patient is confronted with their diagnosis, they can give support to not only the patient but also the physician.
Просмотров: 646 VJOncology
Marc Mureau MD, PhD of Erasmus University Medical Center, Rotterdam, Netherlands gives an overview his talk on breast reconstruction in case of radiotherapy held at the European Cancer Congress of the European Cancer Organisation (ECCO) 2017 in Amsterdam, Netherlands. Around one-third of patients need radiation therapy after breast cancer treatment and approximately one-third of patient receive immediate breast reconstruction. Dr Mureau explains that an increasing number of patients ask for immediate breast reconstruction but they also need radiation. Radiation can have detrimental effects on breast reconstruction as Dr Mureau explains. He further explains that the evidence shows that there is a fairly increased risk of complication and implant failure after immediate implant breast reconstruction and post-mastectomy radiation therapy. Breast reconstruction is also possible with autologous tissue and these cases, the negative effects of radiation therapy on the reconstruction are less clear and can vary more. Overall, for patients who opt for immediate breast reconstruction and who need radiation therapy afterwards, the evidence points toward autologous reconstruction compared to implant reconstruction. Recorded at the European Cancer Congress of the European Cancer Organisation (ECCO) 2017 in Amsterdam, Netherlands.
Просмотров: 857 VJOncology
Lesley Fallowfield, DBE, BSc, DPhil, FMedSci of Brighton & Sussex Medical School, University of Sussex, UK talks about the importance of clearly communicating information to cancer patients. Cancer patients need more information than they are usually given to make informed choice. However, studies have shown that patients often have difficulty understanding the information supplied to them by doctors and nurses. Healthcare professionals do not realise the difficulty patients face in understanding the esoteric and technical language they use. Prof. Fallowfield discusses her involvement in running communication skills programs and providing patients with user friendly content. She concludes that the triumphs of academia and development in cancers drugs have undermined elements of basic care, such as communication, that are so important to cancer patients. Recorded at the 2016 Annual Meeting of the Oncology Nursing Society (ONS), held in Brighton, UK.
Просмотров: 421 VJOncology
Gabriel Hortobagyi, MD, FACP, of the The University of Texas MD Anderson Cancer Center, Houston, TX, gives a summary of the findings of the MONALEESA-2 clinical trial (NCT01958021). The MONALEESA-2 study recruited 668 patients who were post-menopausal, had hormone receptor positive, HER2 negative advanced or metastatic breast cancer who had received no prior therapy for advanced disease. These patients were randomly assigned to either letrozole (a commonly used endocrine therapy) plus placebo, or letrozole plus ribociclib (a CDK46 inhibitor). Adverse events were commonly seen but were mostly uncomplicated changes and very few patients discontinued treatment on the basis of adverse events. The side effects were managed with dose interruptions and dose reductions. On the basis of the results, Dr Hortobagyi explains that it was concluded that patients who received ribociclib with letrozole had a statistically significant and a clinically meaningful increase in progression-free survival (PFS) compared with letrozole plus placebo. The treatment benefit was consistent across patient subgroups and for other secondary endpoints. He explains that in conclusion, this combination represents an important advance for patients with metastatic hormone receptor positive breast cancer. Recorded at the 2016 annual meeting of the European Society of Medical Oncology (ESMO), held in Copenhagen, Denmark. Medicines: Ribociclib
Просмотров: 754 VJOncology
Toni Choueiri, MD of Dana-Farber Cancer Institute, Boston, MA gives a press brief about the results of the CABOSUN trial of cabozantinib compared to sunitinib in treatment naive poor and intermediate risk renal-cell carcinoma (RCC) patients (NCT01835158) at the 2016 annual meeting of the European Society of Medical Oncology (ESMO), held in Copenhagen, Denmark. Dr Choueiri explains that cabozantinib is an oral inhibitor of tyrosine kinases. The primary endpoint of the trial was progression-free survival (PFS) and secondary endpoint was overall survival (OS), objective response rate (ORR) and safety. He explains that treatment with cabozantinib resulted in median PFS of 8.2 months compared to 5.6 arms with the control arm of sunitinib. ORR was 46% for cabozantinib compared to 18% for sunitinib. OS is preliminary; median OS with cabozantinib is 30.3 months compared to 21.8 months for sunitinib. They intend to have an update on OS within the next months. In terms of safety, occurrence of grade 3/4 events was not different and discontinuation around 20% for both drugs. There were no surprises in terms of side effects, which include hypertension, diarrhea, PPE and fatigue. Further, there was a greater exposure in the cabozantinib arm. He then explains the implications; sunitinib is a standard of care therapy in first-line in metastatic RCC and as cabozantinib improved PFS and ORR, he believes that it presents a potential first-line treatment in patients with advanced RCC.
Просмотров: 371 VJOncology
Benjamin Besse, MD, PhD, from the Gustave Roussy Cancer Institute, Paris, France, discusses recent study in the treatment of non-small cell lung cancer (NSCLC) at the European Society for Medical Oncology (ESMO) 2017 in Madrid, Spain. Lorlatinib is a potent third generation ALK and ROS1 inhibitor that is currently being developed. A study investigating lorlatinib in the treatment of ALK-positive or ROS1-positive NSCLC (NCT02927340) found a high response rate, with a large proportion of patients either disease free or progression free after a year, a very positive result.
Просмотров: 273 VJOncology
Neal Shore, MD, FACS of the Carolina Urologic Research Center, Myrtle Beach, SC talks about bone-migrated prostate cancer and Radium-223 therapy. Dr Shore explains that the concept of the bone migratory pathway is very contemporary and he further discusses the bone microenvironment and its importance in prostate cancer. He points out that 90% of patients who die with castration-resistant prostate cancer will have bone metastases. In the symposium, they reviewed imaging and the data from the recent ALSYMPCA trial (NCT00699751), which demonstrated the survival advantage of giving Radium-223. Radium-223 is a novel radiopharmaceutical. Dr Shore explains that it is different from the historical beta/gamma particles, which are much smaller. He explains that there is less penetration into the marrow and less myelosuppression. He highlights that Radium-223 prolongs survival first and foremost. Further, the therapy is well-tolerated. When he started using the therapy, it was mostly after chemotherapy and now, 90% of his patients receive it before chemotherapy. Moreover, he highlights the three Ps and their importance in his clinic: prolonged life, preserve function, prevent complications of therapy. Recorded at the 2016 annual meeting of the European Society of Medical Oncology (ESMO), held in Copenhagen, Denmark.
Просмотров: 300 VJOncology
Hendrik-Tobias Arkenau, MD, PhD of the Sarah Cannon Research Institute, Nashvile, TN, talks about a study presented at ASCO 2017 which investigated how long patients with stage III colon cancer need adjuvant chemotherapy. The current standard of care for patients with stage III colon cancer is adjuvant oxaliplatin based treatment for 6 months. However, the use of oxaliplatin can cause increase neurotoxicity, causing damage to the nerves of hand and feet. Therefore, this study (NCT01150045) aimed to answer the question of whether a shorter time of 3 months for oxaliplatin treatment is better than 6 months. Dr Arkenau explains that the study showed that oxaliplatin related neurotoxicity is reduced after 3 months as compared to 6 months. Recorded at the American Society of Oncology (ASCO) 2017 Annual Meeting held in Chicago, IL
Просмотров: 232 VJOncology
Justin Stebbing, MD, MA, FRCP, FRCPath, PhD from Imperial College Healthcare NHS Trust, London, UK discusses developments in anti-PD-1 and anti-PD-L1 drugs presented at the American Society of Oncology (ASCO) 2016 Annual Meeting held in Chicago, IL. Prof Stebbing discusses a study on nivolumab and ipilimumab in 220 patients with small cell lung cancer and how these drugs might change the outlook for this disease. He further discusses the presentation on the OX40 agonist MOXR0916 and the PD-L1 inhibitor atezolizumab in patients with advanced solid tumors and what this might mean for the future use of chemotherapy.
Просмотров: 664 VJOncology
Gary K. Schwartz, MD of the Columbia University Medical Center, New York, NY discusses the success and potential of immunology as a treatment for sarcomas. Dr Schwartz explains that sarcoma is a complex cancer, representing 60 different cancers; he continues, highlighting that it now poses as a challenge when doctors are trying to develop new therapies directed at the vast scope of tumor subtypes that need to be considered. He then discusses studies on immunotherapy presented at the 2016 Annual Meeting of the American Society of Clinical Oncology (ASCO), held in Chicago, IL. The first Phase II trial he discusses looked at the effect of a PD-1 inhibitor called pembrolizumab (NCT0230103); PD-1 is a immune checkpoint. Results of the study showed low response rates, of around 15% in 85-90 patients. However, certain subtypes of sarcoma had better response rates. For example, pembrolizumab caused a response in 4 out of 6 patients with undifferentiated pleomorphic sarcoma. In patients with liposarcoma, 1 out of 4 responded also. In a Phase II trial of nivolumab in leiomyosarcoma of the uterus (NCT02428192) however, only one patient responded. Further study is now being done into factors that affect response rates (i.e. the influence of biomarkers). Dr Schwartz suggests that despite the overall low response rates, higher response rates in certain sarcoma subtypes are promising to the future of sarcoma immunotherapies.
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Ian Tannock, MD, PhD, DSc, from the University of Toronto, Toronto, Canada, discusses the problems limiting the use of personalized medicine at the European Cancer Congress of the European Cancer Organisation (ECCO) 2017 in Amsterdam, Netherlands. Personalized medicine is currently typically defined as genetic analysis of a patient’s tumor, in order to match treatments to the mutations found. Prof. Tannock points out that for some mutations, such as HER2 in breast cancer, matching of treatments to mutations is very successful. However, for many mutations, no effective targeted agents are available. Furthermore, the targeted agents that can be used show similar toxicity levels as chemotherapy, often precluding the use of these treatments together. An additional problem is tumor heterogeneity, meaning that tens of different mutations can be found within the same patient in different parts of the primary tumor or in metastases. Prof. Tannock describes how because of this heterogeneity, targeted treatments may only work for a while before resistance is developed.
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Neal Navani, MA, MBBS, MRCP, MSc, PhD, University College London, London, UK, explains the need for re-biopsy in non-small cell lung cancer (NSCLC) patients with progressive disease. Approximately 15% of NSCLC patients have tumour-associated EGFR mutations and are usually treated with EGFR Tyrosine Kinase Inhibitors (TKIs) in first-line. However, after 9-12 months, the disease starts to progress again in the majority of patients. Of these patients, those carrying a T790M mutation in the EGFR gene can benefit from treatment with osimertinib (Tagrisso ®), as demonstrated recently in the AURA3 trial. Dr Navani addresses how the T790M mutation can be detected in patients with progressive NSCLC, in order to inform treatment decisions. He discusses ways to test for this mutation: cell-free DNA assays and advanced biopsy techniques. Cell-free DNA assays are performed using blood samples, and therefore, are convenient for patients and relatively fast. However, the test sensitivity is approximately 60-70% and is lower in patients whose disease only progresses within the lungs. In terms of biopsy techniques, two key techniques are used: endobronchial ultrasound (EBUS) and CT-guided biopsies. Dr Navani explains that together, these two techniques allow sampling from virtually anywhere within the thorax in order to obtain tissue to analyse for T790M mutation. Recorded at the 2017 meeting of the British Thoracic Oncology Group (BTOG) in Dublin, Ireland.
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Rosalyn Juergens, MD, PhD of McMaster University, Juravinski Cancer Centre, Canada gives an overview of her presentation of the data from the Canadian Clinical Trials Group Investigational New Drug Committee (IND), trial IND.226 (NCT02537418). This looked at quadruple therapy in lung cancer, which was chemotherapy plus two different forms of immunotherapy, CTLA-4 inhibitor (tremelimumab) and PD-L1 inhibitor (durvalumab). This was a Phase I, dose escalation study looking at safety and tolerability. Combinations of immuno-oncology drugs have been a challenge in the past, so seeing whether patients can sustain the treatment before moving onto quadruple therapy was important. It was found that patients could sustain it, with incremental increases in the manageable side effects to patients. There was an increase in fatigue, a slight increase in diarrhea, as well as pneumonitis, hypothyroidism and hyperthyroidism. Efficacy in terms of response rate was double what would be expected with just chemotherapy alone. It is slightly higher than what has been seen with chemotherapy plus a PD-1 or PD-L1 inhibitor. However, they are awaiting further results and hoping for increased durability. Recorded at the 2016 World Conference of Lung Cancer (WCLC) of the International Association for the Study of Lung Cancer (IASLC) in Vienna, Austria.
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Winston Tan, MD of Mayo Clinic, Jacksonville, FL discusses a treatment of bone metastases in prostate cancer. Dr Tan mentions that addition of bisphosphonates does not increase the overall survival of patients suffering from various cancer types, including breast cancer, prostate cancer, and renal cancer. Cabozantinib, approved for metastatic renal cancer makes the bone metastases disappear, however, it has not been shown to increase survival in patients with a metastatic prostate cancer in a phase III randomised clinical trial. A combination of two or three drugs may be required to achieve better results in patients. The next step would be to look at markers, a combination of targets and drugs which can work together to help improve survival and prevent the consequences of bone metastases. Dr Tan highlights the importance of supportive care for cancer patients, who can benefit from an access to physical therapists, psychologists, and nutritionists. This could mean less bone pain and decreased use of pain medication, which may cause dizziness, constipation, or reduced mobility. Ongoing studies in the metastatic prostate cancer compare the micro-environmental factors, before and after the treatment to better understand which genetic and metabolic factors affect the bone metastases. Dr Tan says that prostate cancer patients with bone pain should be offered Radium 223, which improves survival and long-term can improve the symptomatology, and bisphosphonates, or denosumab, which is known to prevent skeletal-related events. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016 Annual Meeting on Supportive Care in Cancer held in Adelaide, Australia.
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Toni Choueiri, MD of the Dana-Farber Cancer Institute, Boston, MA gives an overview of the CABOSUN trial of cabozantinib compared to sunitinib in treatment naive poor and intermediate risk renal-cell carcinoma (RCC) patients (NCT01835158) presented at the 2016 annual meeting of the European Society of Medical Oncology (ESMO), held in Copenhagen, Denmark. Dr Choueiri first talks about the METEOR trial of cabozantinib in second-line (NCT01865747), which was presented at ESMO last year and published. It showed that cabozantinib provided an improved progression-free survival (PFS) and response rate over everolimus in the second-line setting. Later on they reported at ASCO that cabozantinib in second-line or later is associated with an overall survival (OS) benefit. He explains that the CABOSUN study was sponsored by the National Cancer Institute (NCI) and the Alliance for Clinical Trials in Oncology. It was a smaller study with 157 patients, powered for PFS and for patients who did not have systemic treatment with a focus on intermediate or poor metastatic RCC. PFS was the primary endpoint and they saw a PFS benefit that is clinically relevant and statistically significant. Further, there was a 31% decrease in risk of progression of death. Also, the secondary endpoint, response rate, was higher and more significant with cabozantinib. They had an early look at OS which is not significant yet but trending in the right direction. According to Dr Choueiri, the side effects were similar in both arms. Therefore, the question is if cabozantinib could become the next first-line option after sunitinib, which was the standard and most used first-line agent for 10 years. He believes that cabozantinib could become the next first-line option and therefore CABOSUN could change how we treat frontline RCC.
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Immunotherapy for melanoma has taken off, opening the door to a new era of therapy. Here, Thomas Gajewski, MD, PhD, of the University of Chicago Comprehensive Cancer Center, Chicago, IL, discusses new immuno-oncology strategies to improve therapy further, including potential targets following resistance to PD-1/PD-L1 inhibitors. This interview took place at the European Society for Medical Oncology (ESMO) 2018 Congress, in Munich, Germany.
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David Sebag-Montefiore, MBBS, MRC, FRCR, FRCP from the University of Leeds, Leeds, UK discusses the RAPIDO trial in rectal cancer and the FOxTROT trial in colon cancer (NCT01558921 and NCT00647530 respectively). Prof. Sebag-Montefiore explains that the trials are investigating the role of neoadjuvant chemotherapy. He outlines the design and results of both trials. In the FOxTROT trial, the current results suggest that neoadjuvant therapy is safe. In the RAPIDO trial, there was an increase in the serious adverse events seen in the experimental arm, which was, however, at an acceptable rate for clinical practice. Further, there is no evidence of any difference in surgical morbidity and a low rate of treatment-related mortality from chemotherapy. For both trials, however, we have to wait for the long-term outcome data to determine the significance of these two trials in terms of clinical practice and guidelines. Recorded at the European Cancer Congress of the European Cancer Organisation (ECCO) 2017 in Amsterdam, Netherlands.
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Arlene Siefker-Radtke, MD, of the MD Anderson Cancer Center, Houston, TX, discusses the first results of the primary analysis of the Phase II BLC2001 study (NCT02365597) of erdafitinib in patients with metastatic or unresectable urothelial carcinoma with FGFR alterations. Notably, immune 'cold' patients were observed to respond well to erdafitinib. Dr Siefker-Radtke highlights interesting future directions for this research. This interview was recorded at the American Society of Oncology (ASCO) 2018 Annual Meeting, held in Chicago, IL.
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Highly anticipated data from the Phase III SPARTAN study (NCT01946204), which investigated apalutamide for nonmetastatic castration-resistant prostate cancer (nmCRPC), was presented at the 2018 Genitourinary Cancers Symposium, held in San Francisco, CA. In this interesting interview from the meeting, Eric Small, MD, of the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, discusses the results of the trial. Dr Small highlights the excellent primary and secondary endpoint data, including risk reduction and time to metastasis, as well as results for toxicity. In addition, he covers the doubled-blinded aspect of the study design and how this affected access to abiraterone treatment for patients.
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Meera Agar, MBBS, MPC, FRACP, PhD of University of Technology Sydney, Sydney, Australia discusses delirium treatment options. The guidelines internationally recommend that delirium symptoms are treated in a targeted way, but there has never been a clinical trial to establish the best approach. Prof Agar in collaboration with the Palliative Care Clinical Studies Collaborative (PaCCSC) undertook a clinical trial to explore the use of antipsychotic drugs: risperidone and haloperidol. The goal of the study was to improve targeted delirium symptoms in palliative care patients. There were three study arms: risperidone, haloperidol, and a placebo solution. Delirium symptoms improved better in the control group, which means lack of evidence supporting antipsychotics as a way to improve delirium outcomes. Non-pharmacological interventions could be used to prevent delirium, but these interventions are much harder to put in place as a part of a health system. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016 Annual Meeting on Supportive Care in Cancer held in Adelaide, Australia.
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Jürgen Becker, MD, PhD from the University Hospital Essen, Essen, Germany discusses the symposium on Merkel cell carcinoma treatment at the 2016 World Congress on Cancers of the Skin (WCCS) and the Congress of the European Association of Dermato-Oncology (EADO) in Vienna, Austria. Merkel cell carcinoma is a rare and aggressive form of skin cancer, for which the standard treatment is chemotherapy following metastasis, however, positive treatment responses tend to be short-lived. The symposium also covered current immunotherapy options for Merkel cell carcinoma, which include PDL-1 and PD-1 blockade. Dr Becker goes on to recall recent clinical trial results that show up to 50% of Merkel cell carcinoma patients responding to PDL-1 axis blocking treatment and these patients also have long-lived responses and disease-ree or non-progressive periods. Dr Becker comments though that more and larger trials need to be conducted to confirm and support these early results.
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David Ross Camidge, MD, PhD of the University of Colorado, Denver, CO, provides an insight into the study (NCT01631552) of a new antibody-drug conjugate (ADC) sacituzumab govitecan (IMMU-132). IMMU-132 targets Trop-2, a very commonly expressed epithelial marker in different cancers, such as in 70-80% of lung cancers. The ADC uses the antibody as a delivery system, where the conjugate is the toxin. In this case, the old-fashioned but effective toxin used is SM38, an active ingredient of irinotecan. Prof. Camidge explains that researchers have previously looked at irinotecan in lung cancer, highlighting its 4% response rate. He further explains that now, through changing its efficacy-to-toxicity ratio, researchers are able to deliver high amounts of irinotecan towards the tumor. He further elaborates, that in a very heavily treated population, where the median is three lines of prior therapy, the treatment is tolerable, at 10 mg/kg at days 1 and 8, on a 21-day cycle, showing roughly a 23–24% grade III/IV neutropenia, which is highly manageable. However, the diarrhea rate is only about 7%, where naked irinotecan shows a 24–25% rate. The duration of response in the patients is however 9 months. He proceeds to explain that studies have shown that they have been able to differentiate between the people who are gaining benefits from this treatment, often in a tolerable way; but since Trop-2 is so common, there does not seem to be a differentiator. Finally, he states that the treatment is probably being delivered to most of the tumors, but now the issue is that not all of them may be sensitive to it. Recorded at the 2016 Annual Meeting of the American Society of Clinical Oncology (ASCO), held in Chicago, IL.
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Sumanta Pal, MD of City of Hope, Duarte, CA, discusses the introduction of new data of the new single-agent cabozantinib for advanced renal cell carcinoma. The agent is a dual MET and VEGFR2 inhibitor, and has been assessed in metastatic renal cell carcinoma and other diseases. Dr Pal highlights his involvement in the Phase I trials of cabozantinib’s development in renal cell carcinoma, where impressive responses were observed. He proceeds to highlight that most recently, cabozantinib was used in a Phase III METEOR trial comparing it to the agent everolimus (NCT01865747). This study identified an improvement in response rate, overall survival (OS) and progression-free survival (PFS) for patients with advanced renal cell carcinoma. According to Dr Pal, these findings make the agent the optimal second-line choice in patients with metastatic renal cell carcinoma. He further adds that data from the CABOSUN study (NCT01835158), a clinical trial that compared sunitinib and cabozantinib in the front-line setting, will hopefully be available shortly. Recorded at the American Society of Oncology (ASCO) 2016 Annual Meeting held in Chicago, IL.
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Only one treatment for malignant mesothelioma has been approved since 2003 and rates of the disease are rising worldwide; thus, new treatments must be found. Here, Dean Fennell, PhD, FRCP, of University Hospitals of Leicester NHS Trust, Leicester, UK, discusses the late phase randomized trials that he is excited about. Prof. Dean highlights CheckpOiNt Blockade For Inhibition of Relapsed Mesothelioma (CONFIRM; NCT03063450) which is investigating nivolumab; the PROMISE-meso study (NCT02991482) of pembrolizumab vs. standard chemotherapy; and the VIM trial (NCT02139904) of vinorelbine in the second-line setting. This video was recorded at the British Thoracic Oncology Group (BTOG) Annual Conference 2018, held in Dublin, Ireland.
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Marcus Butler, MD, from the Princess Margaret Cancer Centre, Toronto, Canada, discusses data on the efficacy of pembrolizumab treatment in advanced mucosal melanoma, which he presented at the European Cancer Congress of the European Cancer Organisation (ECCO) 2017 in Amsterdam, Netherlands. This type of melanoma develops for unknown reasons unrelated to UV light exposure, and historically has a lower response rate and overall survival (OS) following various treatments. The development of new melanoma treatments, particularly immunotherapy, led Dr Butler to investigate the efficacy of these in mucosal melanoma by combining the results from the KEYNOTE-001 (NCT01295827), KEYNOTE-002 (NCT01704287), and KEYNOTE-006 (NCT01866319) studies for patients with advanced mucosal melanoma. He discusses the results, which indicate that mucosal melanoma patients benefit from pembrolizumab treatment. While the response rate is lower than for melanoma patients, Dr Butler argues that the effect is still clinically meaningful, and may be a good choice particularly as anti-PD-1 therapy has very few side effects and is well tolerated by the majority of patients.
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