Gastrointestinal Cancer News
Is Surgery Always Necessary in Metastatic Colorectal Cancer?
The Particulars: Surgical removal of primary metastatic colorectal cancer tumors at diagnosis was once standard practice and is still common. Surgery is performed to prevent future complications (eg, intestinal blockage, bowel perforation, and severe bleeding) rather than to extend life.
Data Breakdown: A retrospective study assessed 233 patients with metastatic colorectal cancer who were treated with chemotherapy but had no serious symptoms to prompt immediate surgery. Patients received one of three triple-drug chemotherapy combinations as initial treatment and/or bevacizumab. About 93% of patients never developed complications that required removal of the tumor. Of the 7% who eventually needed surgery, the vast majority had successful operations.
Take Home Pearl: Patients who are newly diagnosed with metastatic, surgically incurable colorectal cancer do not appear to need immediate surgery to remove primary tumors unless they are causing complications and should begin chemotherapy first.
Lung Cancer News
Maintenance Therapy Improves Survival in Advanced NSCLC
The Particulars: Pemetrexed has been approved as a first-line treatment for advanced non-squamous non-small cell lung cancer (NSCLC) in combination with cisplatin and as a single agent in patients with recurrent disease. Previous data demonstrated that maintenance therapy with pemetrexed delayed disease progression.
Data Breakdown: A phase III study administered pemetrexed or placebo to patients with advanced or metastatic NSCLC, along with the best supportive care. Patients who received pemetrexed had an overall survival (OS) of 13.4 months compared with just 10.6 months for patients in the placebo group. For the non-squamous subgroup, OS was 15.5 months for the pemetrexed group and 10.3 months for the placebo group. Patients with the squamous subtype did not seem to benefit with pemetrexed.
Take Home Pearl: Use of pemetrexed as maintenance therapy following standard treatment improves OS for patients with advanced NSCLC, but this benefit is limited to those with the non-squamous subtype.
Combination Approach Improves Maintenance Therapy
The Particulars: Previous research has shown that bevacizumab along with chemotherapy improves progression-free survival (PFS) and overall survival in patients with advanced, metastatic, or recurrent non-squamous non-small cell lung cancer (NSCLC) when compared with chemotherapy alone. A new study was conducted to determine if progression could be further delayed by the addition of erlotinib.
Data Breakdown: A phase III trial randomized patients with NSCLC to receive bevacizumab plus erlotinib or bevacizumab plus placebo. Patients in the erlotinib group experienced a 29% reduced risk of disease progression. Median PFS was 4.8 months in the erlotinib plus bevacizumab group compared with 3.7 months for patients in the bevacizumab-placebo group. The trial was stopped early based on findings.
Take Home Pearl: Adding erlotinib to bevacizumab maintenance therapy after initial treatment with chemotherapy and bevacizumab in patients with advanced NSCLC appears to delay disease progression better than bevacizumab alone.
Personalized Cancer Medicine News
Vaccine Yields Benefits in Metastatic Melanoma
The Particulars: Metastatic melanoma has historically been difficult to treat and is resistant to many therapies. A phase III study was conducted in which a novel vaccine—the gp100:209-217(210M) peptide—was administered with interleukin-2 (IL-2). The comparator group received IL-2 alone.
Data Breakdown: More than twice as many patients in the vaccine group experienced tumor shrinkage (22.1% vs 9.7%) than the IL-2 only group. Progression-free survival (2.9 months) and overall survival (17.6 months) were also longer in the vaccine group than the IL-2 only group (1.6 months and 12.8 months, respectively). A trend toward improved overall survival was observed in patients receiving the vaccine along with standard therapy; they lived nearly 5 months longer than those receiving IL-2 alone. The vaccine was well tolerated, causing no significant side effects.
Take Home Pearl: Adding the gp100:209-217(210M) peptide to standard therapy appears to double response rates and extend progression-free survival in patients with metastatic melanoma.
Improving Survival in HER2-Positive Gastric Cancer
The Particulars: Trastuzumab, a targeted cancer therapy, has demonstrated efficacy in the treatment of HER2-positive breast cancer. Previous reports note that high amounts of HER2 have been found in gastric cancer cases.
Data Breakdown: A phase III study involving 3,807 gastric cancer patients found that 22.1% had high amounts of HER2 in their tumors. Patients were randomized to receive standard chemotherapy (5-fluorouracil or capecitabine and cisplatin) plus trastuzumab or standard chemotherapy alone. The median overall survival was 13.8 months for the trastuzumab group and 11.1 months for the standard chemotherapy group. The combination approach correlated with a 26% reduction in risk of death.
Take Home Pearl: Patients with gastric cancer who receive trastuzumab plus standard chemotherapy appear to live significantly longer than patients who receive standard chemotherapy alone.
Quality of Care News
Wanted: Better Adherence to Fertility Preservation Guidelines
The Particulars: In 2006, the American Society of Clinical Oncology (ASCO) issued guidelines recommending that oncologists address infertility risks with patients treated during their reproductive years and be prepared to discuss fertility preservation options or refer patients to reproductive specialists. A survey was administered to oncologists to assess trends in addressing fertility issues with patients of childbearing age.
Data Breakdown: Of the 613 oncologists who completed the survey, 79% reported that they address fertility issues, but discussions varied widely. Gynecological or medical/hematological oncologists were 2.1 times more likely than other specialists to feel comfortable discussing fertility preservation. Less than 25% of physicians reported referring patients to fertility specialists or distributing educational materials on fertility preservation. Only 38% of physicians were aware of ASCO’s guidelines regarding infertility.
Take Home Pearl: Although most oncologists report discussing fertility preservation with patients of childbearing age, too few are referring them to reproductive specialists or distributing educational materials.
Women’s Cancer News
The Role of CA125 in Recurrent Ovarian Cancer
The Particulars: CA125, a marker of growth for ovarian cancer, is measured by a blood test. Women who have undergone treatment for ovarian cancer may have their CA125 levels tested frequently for several years after initial treatment.
Data Breakdown: Investigators compared overall survival (OS) data in women with ovarian cancer in remission after initial chemotherapy that began second-line chemotherapy after their CA125 levels increased and in women with rising CA125 levels whose treatment was delayed until symptoms of relapse appeared. The early treatment group started second-line chemotherapy 5 months before the delayed treatment group, but OS (41 months) was the same between both groups.
Take Home Pearl: Starting treatment early for ovarian cancer relapses based on CA125 blood levels alone does not appear to improve OS when compared with delaying treatment until symptoms arise, and it may be safe to delay treatment until symptoms develop.
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