17 August 2018 (Friday) - Oncologist Newsletter

The Oncologist” email arrived in my in-box today. As usual with this one it is what I might describe as “of peripheral interest”. But it is still of interest; still useful material.

Commentaries
 
Ann Chao, Sudha Sivaram

This commentary discusses a recent report on the planning, implementation, and outcomes of a community-based colorectal cancer screening program in Shanghai, China, as well as important components of a successful cancer screening program.
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Tomas G. Neilan, Mace L. Rothenberg, Laleh Amiri‐Kordestani, Ryan J. Sullivan, Richard M. Steingart, William Gregory, Subramanian Hariharan, Tarek A. Hammad, JoAnn Lindenfeld, Martin J. Murphy, Javid J. Moslehi, on behalf of the Checkpoint Inhibitor Safety Working Group

Immune checkpoint inhibitors are a class of drugs that trigger the immune system to recognize and fight cancer cells; however, related immune-related adverse events are a challenge. This commentary describes a workshop convened by Project Data Sphere to determine best approaches in the treatment of myocarditis, with the goal of minimizing the risk of this adverse reaction in patients with cancer who are treated with immune checkpoint inhibitors.
Immune‐Related Adverse Events
 
Sarju Ganatra, Tomas G. Neilan

Recently, several cases of immune checkpoint inhibitor-related cardiotoxicity have been reported, with complications ranging from cardiogenic shock to sudden death. Clear guidelines for surveillance, diagnosis, and management of one such adverse event, myocarditis, are not currently available. This article describes a clinical vignette and discusses the salient features and management strategies for immune checkpoint inhibitor-associated myocarditis.
Clinical Trial Results
 
Jesus Vera Aguilera, Ravi D. Rao, Jacob B. Allred, Vera J. Suman, Harold E. Windschitl, Judith S. Kaur, William J. Maples, Val J. Lowe, Edward T. Creagan, Lori A. Erickson, Svetomir Markovic

Mary Lou Affronti, Jennifer Gamboa Jackman, Frances McSherry, James E. Herndon II, Elwood C. Massey Jr., Eric Lipp, Annick Desjardins, Henry S. Friedman, Gordana Vlahovic, James Vredenburgh, Katherine B. Peters
Academia-Pharma Intersect: Symptom Management and Supportive Care
 
Chia‐Yu Chu, Jennifer Choi, Beth Eaby‐Sandy, Corey J. Langer, Mario E. Lacouture

Although seldom severe or life-threatening, dermatologic toxicities can result in physical and emotional discomfort for patients; therefore, appropriate management of such toxicities is important. This review provides oncologists with an understanding of dermatologic adverse events associated with the third-generation EGFR-TKI osimertinib.
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Breast Cancer
 
Richard Tancredi, Jenny Furlanetto, Sibylle Loibl

This review provides clinicians with an overview of the available data on endocrine treatment in premenopausal women with hormone receptor positive metastatic breast cancer and summarizes the treatment options available in routine clinical practice.
Cancer Diagnostics and Molecular Pathology
 
Zviadi Aburjania, Samuel Jang, Jason Whitt, Renata Jaskula‐Stzul, Herbert Chen, J. Bart Rose

This review article focuses on the Notch3 gene subtype, summarizing its role in cancer, possible mechanisms of its action, and current cancer treatment strategies targeting Notch3 signaling.
Gastrointestinal Cancer
 
Carmine Pinto, Maurizio Di Bisceglie, Francesca Di Fabio, Annamaria Bochicchio, Tiziana Latiano, Stefano Cordio, Gerardo Rosati, Carlo Aschele, Antonella Marino, Francesca Bergamo, Sara Bustreo, Luca Frassineti, Fortunato Ciardiello, Angela Damato, Stefania Giaquinta, Daniela Baldari, Luca Boni

This study evaluated the activity and safety of monoclonal antibody anti-EGFR panitumumab single agent without chemotherapy in low-risk LARC preoperative treatment. The use of anti-EGFR monoclonal antibodies in combination with radiotherapy in preoperative treatment in patients with KRAS wild type and low-risk LARC did not reach the pCR primary endpoint; however, this study showed a good toxicity profile and compliance to combination treatment.

Goro Nakayama, Ayako Mitsuma, Yuki Sunagawa, Kiyoshi Ishigure, Hiroyuki Yokoyama, Takanori Matsui, Hiroshi Nakayama, Kazuhiko Nakata, Akiharu Ishiyama, Takahiro Asada, Shinichi Umeda, Kazuhiro Ezaka, Norifumi Hattori, Hideki Takami, Daisuke Kobayashi, Chie Tanaka, Mitsuro Kanda, Suguru Yamada, Masahiko Koike, Michitaka Fujiwara, Tsutomu Fujii, Kenta Murotani, Yuichi Ando, Yasuhiro Kodera

This article reports the results of a randomized phase II study that investigated the efficacy and safety of CapIRI plus bevacizumab in relation to CapOX plus bevacizumab as a first-line treatment of metastatic colorectal cancer in Japanese patients.
Geriatric Oncology
 
Nina C.A. Vermeer, Yvette H.M. Claassen, Marloes G.M. Derks, Lene H. Iversen, Elizabeth van Eycken, Marianne G. Guren, Pawel Mroczkowski, Anna Martling, Robert Johansson, Tamara Vandendael, Arne Wibe, Bjorn Moller, Hans Lippert, Johanneke E.A. Portielje, Gerrit Jan Liefers, Koen C.M.J. Peeters, Cornelis J.H. van de Velde, Esther Bastiaannet

The aim of this international comparison was to compare treatment strategies and relative survival between countries for older patients with colon cancer, using data from population-based cancer registries across Europe.
Global Health and Cancer
 
Yangming Gong, Peng Peng, Pingping Bao, Weijian Zhong, Yan Shi, Kai Gu, Ying Zheng, Chunxiao Wu, Sanjun Cai, Ye Xu, Jun Sheng, Fan Wu

There is good evidence of the benefits of early detection of cancer and removal of adenomas in asymptomatic individuals; however, the widespread implementation of colorectal screening programs is resource-dependent. Such programs have been widely implemented in high-income regions and countries in North America, Europe, Japan, and South Korea, but such programs are few in low and middle-income countries [35]. This article describes the implementation of a comprehensive approach to colorectal cancer screening in Shanghai, China.
Immuno‐Oncology
 
Matteo Sarocchi, Francesco Grossi, Eleonora Arboscello, Andrea Bellodi, Carlo Genova, Maria Giovanna Dal Bello, Erika Rijavec, Giulia Barletta, Giovanni Rossi, Federica Biello, Giorgio Ghigliotti, Marco Canepa, Michele Mussap, Claudio Brunelli, Paolo Spallarossa

This article explores the potential role of seriated troponin assessments during treatment with nivolumab for advanced non-small cell lung cancer as a biomarker of nivolumab-related cardiac toxicity.
Regulatory Issues: FDA
 
Robert Q. Le, Liang Li, Weishi Yuan, Stacy S. Shord, Lei Nie, Bahru A. Habtemariam, Donna Przepiorka, Ann T. Farrell, Richard Pazdur

This article summarizes key review findings that supported the approval of tocilizumab for treatment of severe or life-threatening CAR T cell-induced cytokine release syndrome.
Sarcomas
 
Loïc Chaigneau, Anna Patrikidou, Isabelle Ray‐Coquard, Thibaud Valentin, Claude Linassier, Jacques Olivier Bay, Laurence Moureau Zabotto, Emmanuelle Bompas, Sophie Piperno‐Neumann, Nicolas Penel, Thierry Alcindor, Maryline Laigre, Cecile Guillemet, Sebastien Salas, Anne Hugli, Julien Domont, Marie Pierre Sunyach, Axel Lecesne, Jean Yves Blay, Virginie Nerich, Nicolas Isambert

This article reports the results of a study conducted within the French Sarcoma Group. The natural history of sarcoma brain metastasis is described, and strategic recommendations are proposed for the management of patients with sarcoma brain metastasis.
Symptom Management and Supportive Care
 
Jai N. Patel, Lauren A. Wiebe, Henry M. Dunnenberger, Howard L. McLeod

Pharmacogenomics can guide clinicians to select the safest and most effective supportive medications for an individual cancer patient from the very first prescription. This review outlines a theoretical patient case and the implications of using pharmacogenetic test results to personalize supportive care throughout the cancer care continuum.

Evangelos K. Oikonomou, Sofia G. Athanasopoulou, Polydoros N. Kampaktsis, Damianos G. Kokkinidis, Christos A. Papanastasiou, Attila Feher, Richard M. Steingart, Kevin C. Oeffinger, Dipti Gupta

This article focuses on the challenge of maintaining cardiovascular health in long-term childhood cancer survivors. A simple risk score is proposed, which can be used in clinical practice to identify patients at increased cardiovascular risk.

17 August 2018 (Friday) - D Dimer Calibration


I did a calibration on the D-Dimer assay today. Despite following the instructions things didn’t go according to plan. After a little struggling it turns out that although the device can store multiple reagent lot data,  it only stores one calibration file. When the calibrator expiry date is reached the calibration and assay is automatically invalidated even though the calibration is still acceptable.
Therefore DO NOT have multiple calibrator information stored on-board.


I always say a day when you learn nothing is a day wasted…

16 August 2018 (Thursday) - Wassat?


Here’s an interesting case in the Facebook Hematology Interest Group. What *is* this cell?

The discussion following on from the photo was rather interesting


16 August 2018 (Thursday)- The Oncologist Newsletter


The Oncologist Newsletter appeared in my in-box this morning. Whilst not of immediate relevance to my daily round, it is always good to have a refresher on some of the background stuff…



Featured Content
Practice-Changing Article

Currently, there are no uniform treatment lines for advanced chondrosarcoma patients, which results in a very diverse group of treatment regimens being used. In this study, the data of 112 patients was collected. It was concluded that some treatment regimens seem to have a better progression‐free survival compared with others, and that these results also differ between the chondrosarcoma subtypes. Prospective studies need to be conducted based on preclinical work to develop a uniform regimen to treat advanced chondrosarcoma patients according to the diagnosed histological subtype to improve their survival.
Review Article

This article highlights the importance of monitoring for immune‐mediated adverse events (IMAEs) in patients with Hodgkin lymphoma (HL) who receive anti‐programmed death‐1 (anti‐PD‐1) therapy, with particular attention given to the recognition and management of such events. The risk of individual IMAEs differs between patients with HL and those with solid tumors, as prior treatments may predispose certain organ systems to specific IMAEs. Accurate and prompt diagnosis of IMAEs is essential for optimal management, allowing PD‐1 inhibitor therapy to be restarted in order to maintain disease control. Potential difficulties, such as distinguishing disease progression from pneumonitis, or colitis from diarrhea, are highlighted to raise clinical awareness.
 
 
Clinical Trial Results

Lessons Learned

> The combination of the antiangiogenic agent ziv‐aflibercept and the heat shock protein 90 inhibitor ganetespib was associated with several serious and unexpected adverse events and was not tolerable on the dosing schedule tested.

> Studies such as these emphasize the importance of considering overlapping toxicities when designing novel treatment combination regimens.
 
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In the News
 
CME Activities
Treatment for cancer may lead to development of cognitive difficulties in cancer survivors. This study aimed to evaluate a long-term cognitive functioning (CogF) in germ-cell tumor (GCT) survivors.
High-dose chemotherapy and autologous stem cell transplantation (ASCT) can offer durable remission in many patients with relapsed or high-risk lymphoma. However, elderly patients are often not considered ASCT candidates based on age alone. A retrospective analysis of patients ≥ 70 years of age with a diagnosis of Hodgkin or non-Hodgkin lymphoma receiving ASCT between 2000 and 2016 at two partner institutions was performed.