12 October 2018 (Friday) - BTLP Frustrations

In one of my favourite episodes of “South Park”, the anti-hero Eric Cartman is approached by a camp counsellor…

     Rick: “Hello Cartman, how are you today?”

     Cartman: “Well I'm pissed off Rick, how are you?”

I feel just like Eric right now. I’ve just done a BTLP TACT exercise. I am *not* happy with it. To be precise, it was an interesting scenario. I did *exactly* the right things given the limitations of the software, but it has wound me up because

• Finding myself presented with an indeterminate Rh group on a patient supposedly going for stem cell transplant there was no opportunity to review the history.
• Given an antibody (anti-Fyb) there was not sufficient units to meet the request.
• And to add insult to injury the thing told me I’d put the ABO group as indeterminate which I did not !!!

This isn’t the first problem I’ve had with it. Recently I watched a colleague also have similar problems. Am I to be judged by this….

12 October 2018 (Friday) - The Oncologist

The nice people at “The Oncologist” sent their update today:

 

Precision Medicine Clinic: Molecular Tumor Board EML4-ALK Rearrangement and Its Therapeutic Implications in Inflammatory Myofibroblastic Tumors Fernando Vargas-Madueno, Edwin Gould, Raul Valor, Nhu Ngo, Linsheng Zhang, Miguel A. Villalona-Calero A case of a patient who was successfully treated with crizotinib for a recurrent ALK-rearranged pulmonary inflammatory myofibroblastic tumor is reported.

Clinical Trial Results NGR‐hTNF and Doxorubicin as Second‐Line Treatment of Patients with Small Cell Lung Cancer Vanesa Gregorc, Raffaele Cavina, Sivia Novello, Francesco Grossi, Chiara Lazzari, Enrica Capelletto, Carlo Genova, Giulia Salini, Antonio Lambiase, Armando Santoro Selection of Protein Kinase Inhibitors Based on Tumor Tissue Kinase Activity Profiles in Patients with Refractory Solid Malignancies: An Interventional Molecular Profiling Study Mariette Labots, Johannes C. Van der Mijn, Henk Dekker, Rita Ruijter, Thang V. Pham, Hans J. Van der Vliet, Jacobus J.M. Van der Hoeven, Gerrit A. Meijer, Henk M.W. Verheul

Breast Cancer Adjuvant Subcutaneous Trastuzumab for HER2-Positive Early Breast Cancer: Subgroup Analyses of Safety and Active Medical Conditions by Body Weight in the SafeHer Phase III Study Kyung Hae Jung, Beyhan Ataseven, Mark Verrill, Xavier Pivot, Michelino De Laurentiis, Nedal Al-Sakaff, Sabine Lauer, Mona Shing, Joseph Gligorov, Hamdy A. Azim This article reports results of the SafeHer subgroup analysis, which assessed the safety of fixed-dose subcutaneous trastuzumab as an adjuvant therapy in HER2-positive early breast cancer by body weight. Pretreatment 18F‐FDG Uptake Heterogeneity Predicts Treatment Outcome of First‐Line Chemotherapy in Patients with Metastatic Triple‐Negative Breast Cancer Chengcheng Gong, Guang Ma, Xichun Hu, Yingjian Zhang, Zhonghua Wang, Jian Zhang, Yannan Zhao, Yi Li, Yizhao Xie, Zhongyi Yang, Biyun Wang A novel quantitative index to represent the heterogenetic characteristics of metastatic disease is proposed, and the value of heterogeneity among metastatic lesions on pretreatment PET/CT in predicting treatment outcome of patients with mTNBC is evaluated. Adjuvant Anthracyclines in Breast Cancer: What Is Their Role? Ami N. Shah, William J. Gradishar This article provides context for the value and risks of adjuvant anthracyclines, focusing on recently reported evidence of disease and patient characteristics that influences decision making regarding the use of adjuvant anthracyclines.

Advertisement Cancer Diagnostics and Molecular Pathology Developing a Roadmap for Interventional Oncology Stefan O. Schoenberg, Ulrike I. Attenberger, Stephen B. Solomon, Ralph Weissleder Interventional oncology uses image-guided procedures to enhance cancer care. This article reviews challenges and opportunities for growth within interventional oncology.

Endocrinology Incidence of Thyroid Function Test Abnormalities in Patients Receiving Immune-Checkpoint Inhibitors for Cancer Treatment Nisha Subhash Patel, Anais Oury, Gregory A. Daniels, Lyudmila Bazhenova, Sandip Pravin Patel This article reports the incidence of new-onset thyroid function test abnormalities in patients undergoing treatment with ipilimumab, nivolumab, pembrolizumab, and combined therapy with ipilimumab and nivolumab and describes the clinical course of these patients.

Gastrointestinal Cancer Immuno-Oncology Biomarkers for Gastric and Gastroesophageal Junction Adenocarcinoma: Why PD-L1 Testing May Not Be Enough Benjamin A. Weinberg, Joanne Xiu, Jimmy J. Hwang, Anthony F. Shields, Mohamed E. Salem, John L. Marshall Although PD-L1 is an important predictive biomarker for response to immune checkpoint inhibition in gastric and gastroesophageal junction adenocarcinoma, high microsatellite instability (MSI), mismatch repair deficient, and high tumor mutational load (TML) have a potential role as positive predictive biomarkers for immune checkpoint inhibition in other tumor types. This study aimed to identify more patients with gastric and gastroesophageal junction adenocarcinoma that have these positive biomarkers and to delineate the overlap between PD-L1, MSI, and TML. Trifluridine/Tipiracil (TAS-102) in Refractory Metastatic Colorectal Cancer: A Multicenter Register in the Frame of the Italian Compassionate Use Program Chiara Cremolini, Daniele Rossini, Erika Martinelli, Filippo Pietrantonio, Sara Lonardi, Silvia Noventa, Emiliano Tamburini, Giovanni Luca Frassineti, Stefania Mosconi, Federico Nichetti, Sabina Murgioni, Teresa Troiani, Beatrice Borelli, Gemma Zucchelli, Alessandro Dal Maso, Vincenzo Sforza, Gianluca Masi, Carlotta Antoniotti, Maria Di Bartolomeo, Rosalba Miceli, Fortunato Ciardiello, Alfredo Falcone A new fluoropyrimidine recently entered the scene of metastatic colorectal cancer (mCRC): trifluridine/tipiracil, also known as TAS-102. Improving the cost/efficacy ratio of TAS-102 in mCRC is needed to avoid toxicities in a definitely palliative setting. ECOG performance score, LDH levels, and time from diagnosis of metastatic disease may help identify patients most likely to benefit. Properly designed prognostic tools, such as the "ColonLife" nomogram, may allow for better treatment decisions for patients with limited life expectancy.

Global Health and Cancer Global Acceptance of Biosimilars: Importance of Regulatory Consistency, Education, and Trust Eduardo Cazap, Ira Jacobs, Ali McBride, Robert Popovian, Karol Sikora This article reviews the evolution of the global biosimilar landscape and provides examples of current discrepancies among biosimilar regulatory frameworks in different regions. In addition, efforts to address regulatory inconsistencies are reviewed, and the importance of healthcare professional and patient education in acceptance of biosimilars is highlighted.

Health Outcomes and Economics of Cancer Care At What Cost to Clinical Trial Enrollment? A Retrospective Study of Patient Travel Burden in Cancer Clinical Trials Hala T. Borno, Li Zhang, Adam Siegel, Emily Chang, Charles J. Ryan Several barriers to clinical trial participation exist; however, the burden of cost and time associated with travel to visits may contribute to disparities in care. This analysis may inform ways that health care payers and systems can reduce the burden to encourage equitable recruitment and retention in cancer clinical trials.

Lung Cancer Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors for Central Nervous System Metastases from Non-Small Cell Lung Cancer Manmeet S. Ahluwalia, Kevin Becker, Benjamin P. Levy This review article discusses preclinical and clinical evidence for EGFR tyrosine kinase inhibitors in the treatment of central nervous system metastases, within the context of current treatment options. Prognostic Factors and Efficacy of First-Line Chemotherapy in Patients with Advanced Thymic Carcinoma: A Retrospective Analysis of 286 Patients from NEJ023 Study Ryo Ko, Takehito Shukuya, Yusuke Okuma, Kazunari Tateishi, Hisao Imai, Shunichiro Iwasawa, Eisaku Miyauchi, Akiko Fujiwara, Tomohide Sugiyama, Keisuke Azuma, Keiko Muraki, Masahiro Yamasaki, Hisashi Tanaka, Yuta Takashima, Sayo Soda, Osamu Ishimoto, Nobuyuki Koyama, Satoshi Morita, Kunihiko Kobayashi, Toshihiro Nukiwa, Kazuhisa Takahashi; North East Japan Study Group This article evaluates the efficacy of chemotherapy in advanced thymic carcinoma, comparing chemotherapy regimens and identifying the patients most likely to benefit from chemotherapeutic regimens.

Sarcomas Outcomes of Elderly Patients with Advanced Soft Tissue Sarcoma Treated with First-Line Chemotherapy: A Pooled Analysis of 12 EORTC Soft Tissue and Bone Sarcoma Group Trials Eugenie Younger, Saskia Litière, Axel Le Cesne, Olivier Mir, Hans Gelderblom, Antoine Italiano, Sandrine Marreaud, Robin Lewis Jones, Alessandro Gronchi, Winette T.A. van der Graaf Despite the large number of elderly patients with cancer, they are often disproportionally underrepresented in clinical research trials. This article reports outcomes of elderly patients treated with first-line chemotherapy within EORTC-STBSG clinical trials.

Symptom Management and Supportive Care Prognostic Understanding at Diagnosis and Associated Factors in Patients with Advanced Lung Cancer and Their Caregivers Takashi Sato, Kenzo Soejima, Daisuke Fujisawa, Mari Takeuchi, Daisuke Arai, Ichiro Nakachi, Katsuhiko Naoki, Ichiro Kawada, Hiroyuki Yasuda, Kota Ishioka, Shigenari Nukaga, Keigo Kobayashi, Katsunori Masaki, Takashi Inoue, Kota Hikima, Morio Nakamura, Keiko Ohgino, Yoshitaka Oyamada, Yohei Funatsu, Takeshi Terashima, Naoki Miyao, Koichi Sayama, Fumitake Saito, Fumio Sakamaki, Tomoko Betsuyaku An accurate understanding of a diagnosis is important for patients with advanced cancer so that the patient can make decisions that align with preferences and values. This study examined the understanding of prognosis and therapy goals in patients with newly diagnosed advanced lung cancer, as well as the understanding of the patients' caregivers. Pattern and Predictors of Outpatient Palliative Care Referral Among Thoracic Medical Oncologists David Hui, Kelly Kilgore, Minjeong Park, Diane Liu, Yu Jung Kim, Ji Chan Park, Frank Fossella, Eduardo Bruera A better understanding of clinician and patient characteristics that are associated with referral for palliative care in a real-world context may help to overcome barriers to timely palliative care access. This article reports patterns of outpatient palliative care referral among thoracic medical oncologists and identifies oncologist characteristics associated with greater referral.

Letters to the Editor Regarding “Improved Detection of Circulating Epithelial Cells in Patients with Intraductal Papillary Mucinous Neoplasms” Go J. Yoshida New treatment strategies for platinum‐resistant recurrent ovarian cancer are needed. Programmed cell death‐1 (PD‐1) signaling is a new target of antitumor therapy that involves immune reactivation; however, its antitumor effect on subsequent chemotherapy is unclear. Two representative cases are described here. In Reply Joseph W. Franses, David T. Ting With this Letter to the Editor, Franses and Ting respond to questions about their recently published article on improved detection of circulating epithelial cells in patients with intraductal papillary mucinous neoplasms.

Immune-Related Adverse Events A Case of Nivolumab-Induced Bullous Pemphigoid: Review of Dermatologic Toxicity Associated with Programmed Cell Death Protein-1/Programmed Death Ligand-1 Inhibitors and Recommendations for Diagnosis and Management Adriana T. Lopez, Larisa Geskin Bullous pemphigoid is an autoimmune subepidermal blistering disease characterized by the development of tense bullae and is most frequently seen in the elderly. PD-1/PD-L1-induced bullous pemphigoid (BP) has emerged as a potentially serious dermatologic toxicity. This article reports a case of a 72-year-old woman who developed BP shortly after initiating treatment with the PD-1 inhibitor nivolumab for metastatic non-small cell lung cancer.

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