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Perspectives on Salvage Therapy for Non–Small-Cell Lung CancerPlatinum-based chemotherapy offers a modest survival advantage overbest supportive care in chemotherapy-naive patients with a good performancestatus and advanced/metastatic non–small-cell lung cancer(NSCLC). Despite the survival benefit associated with first-line chemotherapy,the majority of patients will experience relapse or disease progression.In clinical practice, an increasing number of patients maintaina good performance status after first-line treatment and are eligible forfurther treatments. Docetaxel (Taxotere) at 75 mg/m2 given once every3 weeks has been the standard of care for second-line chemotherapy sincethe year 2000. Pemetrexed (Alimta) is a novel multitargeted antifolateagent with single-agent activity in first- and second-line treatment ofNSCLC. A large phase III study comparing docetaxel to pemetrexed insecond-line therapy demonstrated that pemetrexed is equally active andless toxic than docetaxel. Based on these results, pemetrexed is a reasonablesecond-line chemotherapy option for patients with recurrent, advancedNSCLC. Progress made in the field of molecular biology has led to theidentification of drugs active against specific cellular targets. Gefitinib(Iressa) and erlotinib (Tarceva) are both orally active tyrosine kinase inhibitorsof the epidermal growth factor receptor. Phase II and III trialshave demonstrated that these agents are active particularly in a subgroupof patients with specific biologic characteristics. Both drugs have beenapproved for the treatment of pretreated NSCLC. Other drugs, such ascetuximab (Erbitux) and bevacizumab (Avastin) have shown promisingactivity in NSCLC and are currently being tested in clinical trials.
Latest:
Perspectives on Salvage Therapy for Non–Small-Cell Lung CancerPlatinum-based chemotherapy offers a modest survival advantage overbest supportive care in chemotherapy-naive patients with a good performancestatus and advanced/metastatic non–small-cell lung cancer(NSCLC). Despite the survival benefit associated with first-line chemotherapy,the majority of patients will experience relapse or disease progression.In clinical practice, an increasing number of patients maintaina good performance status after first-line treatment and are eligible forfurther treatments. Docetaxel (Taxotere) at 75 mg/m2 given once every3 weeks has been the standard of care for second-line chemotherapy sincethe year 2000. Pemetrexed (Alimta) is a novel multitargeted antifolateagent with single-agent activity in first- and second-line treatment ofNSCLC. A large phase III study comparing docetaxel to pemetrexed insecond-line therapy demonstrated that pemetrexed is equally active andless toxic than docetaxel. Based on these results, pemetrexed is a reasonablesecond-line chemotherapy option for patients with recurrent, advancedNSCLC. Progress made in the field of molecular biology has led to theidentification of drugs active against specific cellular targets. Gefitinib(Iressa) and erlotinib (Tarceva) are both orally active tyrosine kinase inhibitorsof the epidermal growth factor receptor. Phase II and III trialshave demonstrated that these agents are active particularly in a subgroupof patients with specific biologic characteristics. Both drugs have beenapproved for the treatment of pretreated NSCLC. Other drugs, such ascetuximab (Erbitux) and bevacizumab (Avastin) have shown promisingactivity in NSCLC and are currently being tested in clinical trials.
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Revisiting Induction Chemotherapy for Head and Neck CancerSquamous cell carcinomas of the head and neck are highly responsiveto induction chemotherapy. However, randomized trials have failedto demonstrate a survival advantage with the addition of induction chemotherapyto locoregional therapy consisting of surgery and/or radiationtherapy. Currently, concomitant radiation and chemotherapy hasemerged as a standard and has optimized locoregional control in headand neck cancer. In this setting, the addition of induction chemotherapymay further improve outcome by enhancing both locoregional and distantcontrol. As interest in induction regimens is renewed, we elected toconduct a systematic review of trials of induction chemotherapy forlocoregionally advanced head and neck cancer. The most studied combination-cisplatin plus fluorouracil (5-FU)-achieves objective responserates of about 80%. In a meta-analysis, induction with platinum/5-FU resulted in a small survival advantage over locoregionaltherapy alone. The introduction of a taxane into induction chemotherapyregimens has produced promising results. Induction chemotherapyshould be the subject of further clinical research in head andneck cancer. Randomized clinical trials in which the control arm isconcurrent chemoradiotherapy and the experimental arm is inductionchemotherapy followed by concurrent chemoradiotherapy are planned.Platinum/taxane combinations are the preferred regimens for furtherstudy in the induction setting and a suitable platform with which toinvestigate the addition of novel targeted agents.
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Therapy for Peripheral T-Cell Lymphomas: Where We Are and Where We Hope to BeOur standard therapies for peripheral T-cell lymphoma may cure a subset of patients, and thus far novel agents have not changed the outcomes for the majority.
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Optimizing Radiotherapy With Immunotherapy in Lung Cancer TreatmentThis video examines how the use of radiation therapy in patients on immunotherapy can trigger immunogenic cell death, and reviews some of the challenges related to unwanted immune responses from radiotherapy.
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Reassessment of Anti-CD20 Therapy in Lymphoid Malignancies: Impact, Limitations, and New DirectionsThis review will highlight the survival impact that rituximab therapy has had on major lymphoid malignancies, such as diffuse large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, and mantle cell lymphoma. We will also discuss alternative anti-CD20 monoclonal antibodies.
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Prophylactic Cranial Irradiation for Patients With Locally Advanced Non–Small-Cell Lung CancerThis review by Dr. Gore emphasizesthe significance of theproblem of brain metastases inpatients with locally advanced non–small-cell lung cancer (NSCLC). Thearticle should prompt medical and radiationoncologists to consider enrollingpatients in the ambitious study ofprophylactic cranial irradiation (PCI)led by the Radiation Therapy OncologyGroup (RTOG L-0214). Statisticsfrom the ongoing RTOG study arecomplicated, but essentially, the researchersare looking for a 20% increasein median survival for patientsreceiving PCI. This would make theimpact of PCI in NSCLC comparableto that observed in limited small-celllung cancer (SCLC).
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Induction Chemotherapy for Resectable Non–Small-Cell Lung CancerLung cancer remains the leading cause of cancer death in Americanmen and women. Non–small-cell lung cancer (NSCLC) accountsfor 85% of these cases. Although surgery is the best curative approachfor resectable NSCLC, long-term survival for patients with operabledisease remains poor. More than half of patients who initially presentwith stage I to IIIA disease experience relapse of metastatic disease.Postoperative adjuvant therapy has been evaluated in several randomizedtrials, and provides a survival benefit. It appears reasonable tolook to induction chemotherapy, or preoperative chemotherapy, to providea similar improvement in survival with early treatment ofmicrometastatic disease. Multiple trials of induction therapy have beencarried out with encouraging results. The use of various induction regimenswith chemotherapy alone or chemotherapy combined with radiotherapyfor stage IIIA NSCLC is under investigation. Randomized trialsare under way to better define the role of induction therapy in themultimodality treatment of NSCLC.
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Commentary (Giles/Kantarjian): Biology and Treatment of Chronic Myelogenous LeukemiaDrs. Enright and McGlave succinctly review the biology of chronic myelogenous leukemia (CML) and highlight the therapeutic role of allogeneic stem-cell transplantation. Two points, however, warrant further discussion. The first is that a regimen containing interferon-alfa (Intron A, Roferon-A) is optimal front-line therapy for the great majority of CML patients.[1] The second is that use of an interferon-alfa-based regimen prior to allogeneic stem-cell transplantation does not adversely affect post-transplant mortality, morbidity, or anti-CML efficacy.
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Role for Proton Therapy in Locally Advanced Non–Small-Cell Lung Cancer?This video reviews results of a randomized trial comparing intensity modulated radiation therapy vs passively scattered proton therapy for locally advanced non–small-cell lung cancer.
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Targeted Therapy for Mutation-Driven Metastatic Non–Small-Cell Lung Cancer: Considerations for ALK-Rearranged TumorsIn this article, important concepts in the molecular testing of non–small-cell lung cancer are highlighted.
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Targeted Therapy for Mutation-Driven Metastatic Non–Small-Cell Lung Cancer: Considerations for ALK-Rearranged TumorsIn this article, important concepts in the molecular testing of non–small-cell lung cancer are highlighted.
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Combination Therapy Enhances Stem Cell Mobilization in Patients With Multiple MyelomaA phase III trial evaluated intermediate-dose cytarabine plus granulocyte-colony stimulating factor (G-CSF) vs G-CSF alone prior to autoSCT in multiple myeloma.
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Luca Biavati, MD, on Bone Marrow T-Cells for Adoptive Cell TherapyLuca Biavati, MD, from Johns Hopkins Medicine, discussed bone marrow T-cells and bone marrow infiltrating lymphocytes as a source for adoptive cell therapy at the 34th Annual Meeting & Pre-Conference Programs of the Society for Immunotherapy of Cancer (SITC 2019).
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Diego Villa, MD, FRCPC, Discusses Bendamustine and Rituximab as Induction Therapy in MCLDiego Villa, MD, FRCPC, elaborated on the progress made with bendamustine and rituximab as induction therapy for transplant eligible and ineligible patients with mantle cell lymphoma.
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HPV and the Immune System in Head and Neck Cancers: Therapeutic ConsiderationsA review of the role of immune therapy in HPV-associated head and neck squamous cell carcinoma, along with the evidence and perspective behind differing therapeutic considerations.
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HPV and the Immune System in Head and Neck Cancers: Therapeutic ConsiderationsA review of the role of immune therapy in HPV-associated head and neck squamous cell carcinoma, along with the evidence and perspective behind differing therapeutic considerations.
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Oncology Drug Snapshot: Axitinib (Inlyta)This oncology drug snapshot takes a look at axitinib (Inlyta) for the treatment of advanced renal cell carcinoma (RCC) after failure of one prior systemic therapy.
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Lenalidomide Maintenance Prolongs PFS in Elderly DLBCLFor the first time, a study shows that using an immunomodulatory agent as maintenance therapy prolongs progression-free survival for patients with diffuse large B-cell lymphoma after first-line treatment with rituximab plus CHOP.
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Combination agents target early, late stages of allergyOphthalmic drops that combine immediate antihistamine relief with prophylactic care in the form of mast cell inhibition and eosinophil blockage are the mainstay of therapy for allergic conjunctivitis.
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Combination agents target early, late stages of allergyOphthalmic drops that combine immediate antihistamine relief with prophylactic care in the form of mast cell inhibition and eosinophil blockage are the mainstay of therapy for allergic conjunctivitis.
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Georg Schett, MD, on Exploring CAR-T for Autoimmune DiseaseThe vice president research and chair of internal medicine at the University of Erlangen – Nuremberg discussed findings from 2 early studies of CD19 CAR T-cell therapy.
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Merit Cudkowicz, MD, on Evaluating Mesenchymal Cell Therapy for ALSBrainStorm Cell Therapeutics has decided to submit a BLA for NurOwn in ALS following an erratum to a phase 3 trial.
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Research on CAR T Therapy in Earlier Lines of TreatmentAmit Patel, BSc, MBBS, PhD, discusses currently ongoing clinical trials of CAR T-cell therapy in first- and second-line treatment settings and comments on potential developments on the horizon.
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Phase 2 Study of Combo Therapy Shows Promise for Patients With Mantle Cell LymphomaA phase 2 trial demonstrated that the regimen of rituximab, bortezomib, bendamustine, and dexamethasone is a viable treatment option for older patients with mantle cell lymphoma (MCL), and highlighted the usefulness of using minimal residual disease (MRD) to guide early and late clinical decisions.
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CAR-T Cells: The Next Era in Immuno-OncologyAn update on immunotherapies and the potential impact of chimeric antigen receptor (CAR)-T cells on oncology care.
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CAR-T Cells: The Next Era in Immuno-OncologyAn update on immunotherapies and the potential impact of chimeric antigen receptor (CAR)-T cells on oncology care.
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The Potential Impact of CAR T-Cell Treatment Delays on SocietyTreatment delays limit the social value generated by chimeric antigen receptor (CAR) T-cell therapy for the treatment of pediatric acute lymphoblastic leukemia and diffuse large B-cell lymphoma.
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The Potential Impact of CAR T-Cell Treatment Delays on SocietyTreatment delays limit the social value generated by chimeric antigen receptor (CAR) T-cell therapy for the treatment of pediatric acute lymphoblastic leukemia and diffuse large B-cell lymphoma.
