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Maintenance Therapy in Advanced Non-Small Cell Lung Cancer: Before We Accept This Treatment Paradigm, Let's Critically Evaluate and Interpret the DataNon-small cell lung cancer (NSCLC) remains the leading cause of cancer-related mortality in the United States.
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Why Oncology Can Be a Tough Sell in MaineChimeric antigen receptor T-cell therapy may soon hit the market, and numerous cancer care centers are poised to offer this for what may be the first FDA-approved indication: relapsed/refractory B-cell acute lymphoblastic leukemia.
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Investigators Seek Expanded Use of Checkpoint Inhibitors in RCCIn contrast to the wide array of available therapies in the metastatic setting of renal cell carcinoma, in patients with localized disease, the results of trials investigating adjuvant systemic therapy after nephrectomy have so far been underwhelming.
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Axitinib Nears Approval as Second-Line Therapy for Metastatic Renal Cell CarcinomaAxitinib has shown promising results in phase II and III trials, including the AXIS trial in patients with metastatic clear cell RCC who failed on other treatments.
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Robotic Surgery Is Useful Option for Oral CancerMinimally invasive transoral robotic surgery, used alone or combined with adjuvant therapy, provides good functional and oncologic outcomes in patients with oropharyngeal squamous cell carcinoma.
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Therapy of Non-Small Cell Lung Cancer: Past, Present, and FutureNew and relevant studies are examining the role of histology, biomarkers, and growth factor receptor inhibitors in the treatment of NSCLC.
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Dr. Saxena on the Importance of Initial Treatment Selection in ALK+ NSCLCAshish Saxena, MD, PhD, discusses the importance of initial therapy selection in ALK-positive non–small cell lung cancer.
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High BMI Linked to Better Immunotherapy Outcomes in NSCLCA high body mass index at baseline may be independently associated with improved survival outcomes in patients with non–small cell lung cancer who receive immune checkpoint inhibitor therapy.
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Researchers Focus on Optimizing Radiotherapy for Locally Advanced NSCLCLocally advanced non-small cell lung cancer (NSCLC) remains a challenging disease to treat, with a 5-year survival rate for patients with unresectable stage III disease of approximately 20%, even after definitive radiation therapy and concurrent chemotherapy.
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Adjuvant Therapy for Non-Small Cell Lung Cancer: Impact of Recent Clinical Trials on Community PracticeNon-small cell lung cancer (NSCLC) is diagnosed at an early stage, when it is amenable to surgical resection in approximately 20% to 25% of cases.
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Sequencing VEGFR-Targeted and mTOR-Targeted Therapy in Advanced Renal Cell CarcinomaWith 8 therapies approved by the US Food and Drug Administration (FDA) for the treatment of patients with advanced renal cell carcinoma (RCC), practitioners are faced with the challenge of selecting the most appropriate therapies for their patients within this crowded therapeutic landscape.
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Study Adds Pembrolizumab to Paradigm for Certain Head and Neck CancersA group of researchers at Washington University in St. Louis recently opened a clinical trial to evaluate pembrolizumab as treatment intensification therapy for patients with high-risk locoregionally advanced, previously untreated, HPV-negative head and neck squamous cell carcinomas.
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Autophagy Modulation May Be a Novel Approach to Treatment of Advanced CancersAlthough prolonged autophagy can result in cancer cell death, recent investigations suggest that therapy-induced autophagy is a reversible response that promotes cancer cell survival, and thus may diminish the efficacy of some therapeutic agents.
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Autophagy Modulation May Be a Novel Approach to Treatment of Advanced CancersAlthough prolonged autophagy can result in cancer cell death, recent investigations suggest that therapy-induced autophagy is a reversible response that promotes cancer cell survival, and thus may diminish the efficacy of some therapeutic agents.
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Evolving Strategies Using Hematopoietic Stem Cell Transplantation in Diffuse Large B-Cell Non-Hodgkin LymphomaDiffuse large B-cell non-Hodgkin lymphoma is typically a chemotherapy-sensitive malignancy, justifying dose-intense therapy with hematopoietic stem cell transplantation for patients unlikely to achieve cure with standard-dose regimens.
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Optimizing the Duration of Trastuzumab: A Fresh PerspectiveABSTRACT Prior to the introduction of trastuzumab, the first targeted anti-HER2 agent, in 1998, patients diagnosed with HER2-positive breast cancer felt like they were being handed a death sentence. Despite treatment with aggressive chemotherapy, their tumors recurred faster, more often spread to brain and liver, and were associated with higher rates of death than HER2-negative tumors. However, in the 1980s, cancer researchers and oncologists recognized that HER2 could be targeted by a small molecule that binds to the receptor on the cell surface and blocks the signal telling the cell to divide. This small molecule was called trastuzumab, and it eventually completely changed how HER2-positive breast cancer was treated. The drug was first approved in the metastatic setting, and then the results of 2 pivotal randomized control trials demonstrated that the administration of trastuzumab in the adjuvant setting decreased the risk of breast cancer recurrence by 50%. These trials showed trastuzumab to be unequivocally effective in the adjuvant setting and the HERA trial results led to the adoption of 1 year of adjuvant trastuzumab as the standard of care. Since that time, the field of anti–HER2-targeted therapy has exploded, with the development of multiple targeted agents for use in the advanced and up-front settings. Although trastuzumab significantly improves outcomes for women diagnosed with HER2-positive breast cancer and has few adverse effects (AEs), the disadvantages are that it requires intravenous administration every 3 weeks and can be associated with cardiac AEs. It is also expensive. Given all of these factors, the question of whether a duration of trastuzumab that is shorter than 1 year may be acceptable for some patients with early-stage HER2-positive breast cancer is an important and very relevant one. Here, we will review the studies that have examined this question and evaluate their results.
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Immunotherapy in Advanced Lung CancerABSTRACT Historically, platinum-based chemotherapy was the standard of care for metastatic lung cancer. However, since the success of immune checkpoint inhibitors (ICIs) in melanoma, PD-1/PD-L1 and CTLA-4 immune checkpoint pathways have been established as effective therapies to manage advanced non–small cell lung cancer (NSCLC) and extensive-stage (ES) small cell lung cancer (SCLC). Multiple large-scale randomized clinical trials have analyzed the effects of ICIs in NSCLC, and results of these trials have since translated to the approval of single-agent PD-1/PD-L1 inhibitors, and the combination of PD-1 inhibitors with platinum-based chemotherapy has become the new standard of care for patients with advanced NSCLC. Furthermore, in ES SCLC, in which chemotherapy or chemoradiation has been the standard of care for decades, 2 anti–PD-1/PD-L1 agents have been approved for use in the frontline setting for ES SCLC, in combination with chemotherapy. Despite progressive integration of immunotherapy into treatment regimens, there remains a need for reliable biomarkers to precisely determine therapy candidates.
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Targeted Therapy in Squamous Cell Cancers of the Head and NeckThe 5-year survival of patients with locally advanced squamous cell cancers of the head and neck is still less than 30%. Treatment of these cancers involves significant functional impairment, diminished quality of life, and considerable time and expense. Local recurrence and distant metastases are still fairly common, and the development of second primary cancers has a significant impact on survival in patients with initial early-stage disease. Despite the success of combination chemoradiation in locally advanced head and neck cancers, these facts stress the need for improved treatment of this disease.
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High-Dose Therapy With Stem-Cell Transplantation in the Malignant LymphomasApproximately 35,000 stem (progenitor)-cell transplants are performed annually worldwide, with an estimated yearly growth rate of between 10% and 20%.[1] Non-Hodgkin’s lymphoma remains the second most common indication for stem-cell transplantation, and Hodgkin’s disease ranks approximately seventh overall.[1]
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High-Dose Therapy With Stem-Cell Transplantation in the Malignant LymphomasApproximately 35,000 stem (progenitor)-cell transplants are performed annually worldwide, with an estimated yearly growth rate of between 10% and 20%.[1] Non-Hodgkin’s lymphoma remains the second most common indication for stem-cell transplantation, and Hodgkin’s disease ranks approximately seventh overall.[1]
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Cancer Management Chapter 20: Melanoma and other skin cancersSkin cancer is the single most common form of cancer, accounting for more than 75% of all cancer diagnoses. More than 1 million cases of squamous cell and basal cell carcinomas are diagnosed annually, with a lifetime risk of more than one in five. The vast majority of skin cancers can be cured with surgery alone. Resection is the mainstay of therapy, even for skin cancer involving regional lymph nodes or, in some cases, more distant metastatic sites.
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Treating Bladder Cancer: Neoadjuvant vs Adjuvant TherapyOccult distant micrometastasis at the time of radical cystectomy leads predominantly to distant failures in patients with locally advanced muscle-invasive transitional cell carcinoma of the bladder. Cisplatin-based combination chemotherapy enhances survival in patients with metastatic urothelial cancer. Studies evaluating adjuvant chemotherapy have been limited by inadequate statistical power. However, randomized clinical trials have demonstrated a survival benefit for neoadjvuant cisplatin-based combination chemotherapy, which should be considered a standard of care. In addition, neoadjuvant therapy may assist in the rapid development of novel systemic therapy regimens, since pathologic complete remission appears to be a powerful prognostic factor for long-term outcomes. Patients who are either unfit for or refuse radical cystectomy may benefit from neoadjuvant chemotherapy with or without radiation to enable bladder preservation.
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Role of Adjuvant Therapy in Resected Stage II/IIIA Non-Small-Cell Lung CancerThe search for effective postoperative adjuvant therapy for patients with resected non-small-cell lung cancer (NSCLC) has been spurred by a high rate of failure after definitive surgery. Except for patients with resected T1, N0, M0 lesions, failure rates exceed 30%. Widespread application of adjuvant therapy has been reined in by a disappointing lack of effectiveness in this setting.
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Current Clinical Trials of Molecularly Targeted Agents in Children With CancerA number of molecularly targeted agents directed at critical pathways involved in cell survival and cell proliferation have recently entered clinical evaluation in children with cancer. These agents offer the potential for more effective anticancer therapy while diminishing acute and long-term toxic effects. Systematic evaluations of agents such as these are essential if continuing improvements in outcome are to be achieved in children with cancer. Brief summaries of the rationale for conducting studies of several agents in children are provided below. Following these summaries is a listing of phase I, phase I/II, phase II, and pilot studies of these agents in pediatric populations
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Current Clinical Trials of Molecularly Targeted Agents in Children With CancerA number of molecularly targeted agents directed at critical pathways involved in cell survival and cell proliferation have recently entered clinical evaluation in children with cancer. These agents offer the potential for more effective anticancer therapy while diminishing acute and long-term toxic effects. Systematic evaluations of agents such as these are essential if continuing improvements in outcome are to be achieved in children with cancer. Brief summaries of the rationale for conducting studies of several agents in children are provided below. Following these summaries is a listing of phase I, phase I/II, phase II, and pilot studies of these agents in pediatric populations
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Is There a Role for Dose-Intensive Chemotherapy With Stem Cell Rescue in Breast Cancer?During the 1990s, perhaps no other therapy for women with breast cancer was more controversial than high-dose chemotherapy with autologous bone marrow and/or peripheral stem cell support. With encouraging results from late phase I and early phase II trials in the early to mid-1990s, high-dose chemotherapy was promoted by its many enthusiastic proponents as a potentially great leap forward for women with high-risk, node-positive or metastatic disease.
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High-Dose Chemotherapy in Poor-Risk Germ-Cell TumorsTesticular cancer is a highly curable cancer. However, 30% of patients are refractory to standard therapy and will need additional therapy. This article focuses on the use of high-dose chemotherapy in germ-cell tumors.
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The Role of Mitoxantrone in Non-Hodgkin’s LymphomaDr. Armitage presents a succinct and thorough review of the role of mitoxantrone (Novantrone) in patients with non-Hodgkin’s lymphoma (NHL). He begins by emphasizing the importance of accurate diagnosis as described in the World Health Organization classification which evolved from the Revised European American Lymphoma classification. Both of these present day classifications are based on the immunologic principles separating lymphomas into B- and T-cell disorders developed in the 1970s by Lennert, Lukes, and Collins.[1,2] His review addresses multiple issues in mitoxantrone therapy, including dose intensity, cardiotoxicity, combination therapy with nucleoside analogs in low-grade lymphomas, the impact of rituximab (Rituxan), therapy for acquired immunodeficiency syndrome (AIDS)-related lymphoma, and the role of high-dose mitoxantrone as part of a preparative regimen for autologous transplants.
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Romidepsin, an HDAC Inhibitor for Cutaneous T-cell LymphomaDrug is indicated for the treatment of patients with cutaneous T-cell lymphoma (CTCL) who have received at least one prior systemic therapy.
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EPOCH-Rituximab Therapy Obviates Need for Radiotherapy in B-Cell LymphomaA dose-adjusted regimen of etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH-R) obviated the need for radiotherapy in patients with primary mediastinal B-cell lymphoma in a single-group, phase II, prospective study.
