19 June 2017 (Monday) - Oncologist email

The regular email from “The Oncologist” arrived today:


Inflammatory Arthritis: A Newly Recognized Adverse Event of Immune Checkpoint Blockade

Jarushka Naidoo, Laura C. Cappelli, Patrick M. Forde, Kristen A. Marrone, Evan J. Lipson, Hans J. Hammers, William H. Sharfman, Dung T. Le, Alan N. Baer, Ami A. Shah, Jemima Albayda, Rebecca L. Manno, Uzma Haque, Anna Kristina Gutierrez, Clifton O. Bingham Iii, Julie R. Brahmer
This commentary summarizes current knowledge on the clinical presentation, management, and outcomes of the inflammatory arthritis which may occur as an immune-related adverse evet of immune checkpoint inhibitor therapy. Herein, we propose a new algorithm aimed at assisting oncologists in the diagnosis and management of this immune-related adverse event.

Precision Medicine Clinic

Exceptional Response to Nivolumab and Stereotactic Body Radiation Therapy (SBRT) in Neuroendocrine Cervical Carcinoma with High Tumor Mutational Burden: Management Considerations from the Center For Personalized Cancer Therapy at UC San Diego Moores Cancer Center

Andrew Sharabi, Sangwoo Shawn Kim, Shumei Kato, Philip D. Sanders, Sandip Pravin Patel, Parag Sanghvi, Elizabeth Weihe, Razelle Kurzrock
This article reports a patient with a rare metastatic, chemotherapy-refractory neuroendocrine carcinoma who was treated with stereotactic body radiation therapy (SBRT) combined with anti-programmed cell death protein 1 antibody. The novel treatment modality of SBRT combined with a checkpoint inhibitor is discussed, as well as the implications of molecular profiling and tumor mutational burden as potential predictors of response.

Clinical Trial Results

Phase I Dose‐Escalation Study of Ramucirumab in Chinese Patients with Advanced Solid Tumors

Junning Cao, Dongmei Ji, Zhiyu Chen, Weina Shen, Jin Wang, Baoyue Li, Haidong Chi, Amanda Long, Ling Gao, Jin Li

Phase II Study of Modified Carboplatin Plus Weekly Nab‐Paclitaxel in Elderly Patients with Non‐Small Cell Lung Cancer: North Japan Lung Cancer Study Group Trial 1301

Eisaku Miyauchi, Akira Inoue, Kazuhiro Usui, Shunichi Sugawara, Makoto Maemondo, Heisuke Saito, Yuka Fujita, Terufumi Kato, Toshiro Suzuki, Toshiyuki Harada, Hiroshi Watanabe, Taku Nakagawa, Masakazu Ichinose

Breast Cancer

Cardiac Safety of Dual Anti‐HER2 Therapy in the Neoadjuvant Setting for Treatment of HER2‐Positive Breast Cancer

Anthony F. Yu, Jasmeet C. Singh, Rui Wang, Jennifer E. Liu, Anne Eaton, Kevin C. Oeffinger, Richard M. Steingart, Clifford A. Hudis, Chau T. Dang
This article reports the cardiac safety data from a single institutional retrospective cohort study of patients with HER2-positive breast cancer treated with dose-dense doxorubicin and cyclophosphamide (AC) followed by paclitaxel with trastuzumab and pertuzumab in the neoadjuvant setting followed by completion of 1 year of adjuvant anti-HER2 therapy.

Everolimus Plus Exemestane in Advanced Breast Cancer: Safety Results of the BALLET Study on Patients Previously Treated Without and with Chemotherapy in the Metastatic Setting

Daniele Generali, Filippo Montemurro, Roberto Bordonaro, Antonino Mafodda, Sante Romito, Andrea Michelotti, Pierluigi Piovano, Maria Teresa Ionta, Claudia Bighin, Donata Sartori, Antonio Frassoldati, Marina Elena Cazzaniga, Ferdinando Riccardi, Franco Testore, Patrizia Vici, Carlo Antonio Barone, Alessio Schirone, Federico Piacentini, Franco Nolè, Annamaria Molino, Luciano Latini, Edda Lucia Simoncini, Fausto Roila, Francesco Cognetti, Francesco Nuzzo, Jennifer Foglietta, Alessandro Marco Minisini, Francesca Goffredo, Giuseppe Portera, Gilda Ascione, Gabriella Mariani
This study presents results of the BALLET study, which focused on the use of everolimus/exemestane combination in postmenopausal women with ER+ locally advanced or metastatic breast cancer after recurrence or progression after nonsteroidal aromatase inhibitor treatment. Real-life data of the cohort are reported.

Systemic Treatment Strategies for Patients with Hereditary Breast Cancer Syndromes

Amanda Parkes, Banu K. Arun, Jennifer K. Litton
This article is a review of systemic treatment strategies for patients with hereditary breast cancer syndromes involving germline mutations, including the most common hereditary breast cancer syndromes: BRCA-related breast cancer syndrome, Li-Fraumeni syndrome, Cowden syndrome, Peutz-Jeghers syndrome, and hereditary diffuse gastric cancer syndrome.

Community Outreach

Accessibility, Availability, and Potential Benefits of Psycho‐Oncology Services: The Perspective of Community‐Based Physicians Providing Cancer Survivorship Care

Verena Zimmermann‐Schlegel, Mechthild Hartmann, Halina Sklenarova, Wolfgang Herzog, Markus W. Haun
By applying an exploratory cross-sectional survey, this study evaluates current referral practices of a large sample of community-based physicians caring for post-treatment cancer survivors. The accessibility, availability, and benefits of psycho-oncology services are explored, as well as who provides psychosocial support and predictors for impeded referral to services.

Gastrointestinal Cancer

Systemic Chemotherapy as Salvage Treatment for Locally Advanced Rectal Cancer Patients Who Fail to Respond to Standard Neoadjuvant Chemoradiotherapy

Francesco Sclafani, Gina Brown, David Cunningham, Sheela Rao, Paris Tekkis, Diana Tait, Federica Morano, Chiara Baratelli, Eleftheria Kalaitzaki, Shahnawaz Rasheed, David Watkins, Naureen Starling, Andrew Wotherspoon, Ian Chau
This study assesses the impact of salvage systemic chemotherapy on the surgical approach and outcome of high-risk locally advanced rectal cancer patients who are inoperable or candidates for extensive surgical procedures after standard long-course chemoradiotherapy.

Genitourinary Cancer

Current Clinical Practice Guidelines for the Treatment of Renal Cell Carcinoma: A Systematic Review and Critical Evaluation

Aristotle Bamias, Bernard Escudier, Cora N. Sternberg, Flora Zagouri, Athanasios Dellis, Bob Djavan, Kimon Tzannis, Loukas Kontovinis, Konstantinos Stravodimos, Athanasios Papatsoris, Dionysios Mitropoulos, Charalampos Deliveliotis, Meletios‐Athanasios Dimopoulos, Constantine A. Constantinides
Therapy options for renal cell carcinoma are developing rapidly. This systematic review focuses on the current guidelines for treatment of renal cell carcinoma.

Head and Neck Cancer

Immunotherapy for Head and Neck Squamous Cell Carcinoma: A Review of Current and Emerging Therapeutic Options

Jessica M. Moskovitz, Jennifer Moy, Tanguy Y. Seiwert, Robert L. Ferris
The use of combination immunotherapies has shown profound synergy and may lead to further treatment advances compared with use as a monotherapy or with current cytotoxic regimens. This review focuses on recently completed checkpoint receptor inhibitor immunotherapy trials, emerging trials in head and neck squamous cell carcinoma, and the background for the development of these trials.

Health Outcomes and Economics of Cancer Care

Bevacizumab for Metastatic Colorectal Cancer: A Global Cost‐Effectiveness Analysis

Daniel A. Goldstein, Qiushi Chen, Turgay Ayer, Kelvin K. W. Chan, Kiran Virik, Ariel Hammerman, Baruch Brenner, Christopher R. Flowers, Peter S. Hall
The cost and value of cancer treatment is under scrutiny worldwide. The objective of this study was to evaluate the cost-effectiveness of bevacizumab in the first-line treatment of metastatic colorectal cancer (mCRC) from the perspective of payers across five selected countries, namely the U.S., U.K., Canada, Australia, and Israel.

Lung Cancer

Treatment Paradigms for Advanced Non‐Small Cell Lung Cancer at Academic Medical Centers: Involvement in Clinical Trial Endpoint Design

Charu Aggarwal, Hossein Borghaei
Selection of appropriate clinical endpoints for examining the efficacy of investigational agents for non-small cell lung cancer is of vital importance in clinical trial design. This review provides an overview of the study designs of clinical trials for approved agents in non-small cell lung cancer and focuses on the validity of alternative endpoints for such trials.

Neutrophil‐Lymphocyte Ratio Is a Prognostic Marker in Patients with Locally Advanced (Stage IIIA and IIIB) Non‐Small Cell Lung Cancer Treated with Combined Modality Therapy

Katherine A. Scilla, Søren M. Bentzen, Vincent K. Lam, Pranshu Mohindra, Elizabeth M. Nichols, Melissa A. Vyfhuis, Neha Bhooshan, Steven J. Feigenberg, Martin J. Edelman, Josephine L. Feliciano
Neutrophil-lymphocyte ratio is a measure of systemic inflammation that appears prognostic in localized and advanced non-small cell lung cancer. Increased systemic inflammation portends a poorer prognosis in cancer patients. This study explores whether low neutrophil-lymphocyte ratio at diagnosis is associated with improved overall survival in patients with locally advanced non-small cell lung cancer.

Melanoma and Cutaneous Malignancies

Neurologic Serious Adverse Events Associated with Nivolumab Plus Ipilimumab or Nivolumab Alone in Advanced Melanoma, Including a Case Series of Encephalitis

James Larkin, Bartosz Chmielowski, Christopher D. Lao, F. Stephen Hodi, William Sharfman, Jeffrey Weber, Karijn P. M. Suijkerbuijk, Sergio Azevedo, Hewei Li, Daniel Reshef, Alexandre Avila, David A. Reardon
Melanoma is a particularly immunogenic cancer, and immune checkpoint inhibitors have been extensively studied in this tumor type. This review focuses on the incidence of serious neurologic immune-related adverse events, specifically encephalitis, in patients with advanced melanoma treated with nivolumab alone or in sequence or combination with ipilimumab. Practical guidance is provided for the diagnosis and management of treatment-related encephalitis associated with nivolumab and ipilimumab.

Regulatory Issues: FDA

FDA Approval Summary: Atezolizumab for the Treatment of Patients with Progressive Advanced Urothelial Carcinoma after Platinum‐Containing Chemotherapy

Yang‐Min Ning, Daniel Suzman, V. Ellen Maher, Lijun Zhang, Shenghui Tang, Tiffany Ricks, Todd Palmby, Wentao Fu, Qi Liu, Kirsten B. Goldberg, Geoffrey Kim, Richard Pazdur
On May 18, 2016, the U.S. Food and Drug Administration approved atezolizumab for the treatment of patients with locally advanced or metastatic urothelial carcinoma whose disease progressed during or following platinum-containing chemotherapy or within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy. This article summarizes key review findings that supported this approval.

Brief Communications

Case Report: Encephalitis, with Brainstem Involvement, Following Checkpoint Inhibitor Therapy in Metastatic Melanoma

Simon Bossart, Selina Thurneysen, Elisabeth Rushing, Karl Frontzek, Henning Leske, Daniela Mihic‐Probst, Hannes W. Nagel, Johanna Mangana, Simone M. Goldinger, Reinhard Dummer
A unique case of brainstem encephalitis, in a patient with malignant melanoma being treated with ipilimumab and pembrolizumab, is reported.

Letters to the Editor

Safety Analysis of Premenopausal Breast Cancer Patients in PALOMA‐3 Study: Is It Worth Mentioning?

Kadri Altundag
This letter reflects on the PALOMA-3 study, as related to the safety analysis of premenopausal breast cancer patients.

In Reply

Sunil Verma
This letter describes preliminary results of a follow-up study that was performed to assess the safety profile of palbociclib in premenopausal women with metastatic breast cancer.
 

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