Postprostatectomy Radiation Therapy Yields Low Toxicity and Favorable Patient-Reported Quality of Life

“A prospective study of guideline-based, postoperative, image-guided intensity-modulated radiation therapy in patients with prostate cancer found low toxicity profiles and favorable patient-reported quality of life following treatment, with researchers concluding that toxicity and health-related quality of life should not impact the recommendation of radiation therapy following prostatectomy. The research was published by Berlin et al in Practical Radiation Oncology.

“Postprostatectomy radiation therapy has been reported as underutilized, with randomized trials showing the benefit of adjuvant radiation therapy, but only about 10% of patients receiving the treatment. One potential reason for underutilization could be concern over side effects or a negative impact on health-related quality of life.”

NSCLC Survival Not Improved By Adjuvant Bevacizumab

“When bevacizumab (Avastin) was added to adjuvant chemotherapy, overall survival (OS) did not improve in patients with surgically resected early-stage non-small cell lung cancer (NSCLC), according to findings of the phase III E1505 trial presented during a press conference at the 2015 World Conference on Lung Cancer.

“The phase III trial randomized 1501 patients with NSCLC in a 1:1 ratio to chemotherapy with bevacizumab (n = 752) or without (n = 749). Data revealed that OS did not differ between the two arms (hazard ratio [HR], 0.99; 95% CI, 0.81-1.21; P = .93); median OS was more than 72 months in both cohorts. Similar data was reported with disease-free survival, a secondary endpoint, between the two arms (HR, 0.98; 95% CI, 0.84-1.14; P = .75).”

Will Adjuvant Pembrolizumab Improve Recurrence-Free Survival for Patients with High-Risk Stage III Melanoma?

“A recently opened double- blind phase III EORTC trial 1325 will prospectively assess whether post-operative adjuvant therapy with pembrolizumab, an anti-PD-1 monoclonal antibody, improves recurrence-free survival as compared to placebo in patients with high-risk stage III melanoma.

“A unique feature of the study is that in case of relapse all patients will have guaranteed access to pembrolizumab. This allows the study to assess a second question: is there a difference in benefit between early or late access to pembrolizumab.”

Cardiac Toxicity Low Among Patients Treated with Adjuvant Trastuzumab

“Incidence of cardiac toxicity appeared low among patients with early HER-2–positive breast cancer who received adjuvant treatment with trastuzumab, according to results of the randomized phase 3 PHARE trial.

“Most cardiac events appeared reversible after discontinuation of trastuzumab (Herceptin, Genentech), researchers wrote.

“Trastuzumab improves outcomes for women with early HER-2–positive breast cancer, but prior studies have shown cardiotoxicity rates between 2% and 7%.

“The French National Cancer Institute sponsored the PHARE trial, which included 3,380 patients with early HER-2–positive breast cancer randomly assigned 1:1 to the standard 12-month trastuzumab regimen or a 6-month regimen.”

Adjuvant Chemo-Immunotherapy May Improve NSCLC Survival

“Postsurgical chemo-immunotherapy offers improved survival rates for patients with non–small-cell lung cancer (NSCLC), compared to adjuvant chemotherapy alone, according to the final analysis and long-term results from a small randomized, controlled phase III study in Japan. The findings were presented at the 2015 World Conference on Lung Cancer in Denver, Colorado (abstract 04.01).

“Immunotherapy in the trial consisted of adoptive transfer of autologous activated killer T cells and dendritic cells from patients’ regional lymph nodes, explained lead study author Hideki Kimura, MD, PhD, of Saiseikai Narashino Hospital in Narashino City, Japan.

“ ‘The final results of the statistical and immunological analysis of the study confirmed the efficacy of immunotherapy in adjuvant treatment of lung cancer patients,’ reported Dr. Kimura. A large-scale multi-institutional randomized controlled trial is needed and ‘inevitable’ for the study’s findings to see clinical application, he said.”

Genetic Test Impacts Chemo Choices In Surprising Ways

“In the new era of personalized medicine, having more information on hand is considered the ideal situation for making more customized, and ideally, effective decisions about medical care.

“And in a new study of breast cancer patients, researchers show that a relatively new genetic test for evaluating tumors is doing just that. It’s just that the test isn’t necessarily leading to the decisions that experts expected.

“The Oncotype DX Breast Cancer Assay is a test approved by the U.S. Food and Drug Administration to help women decide how likely their breast cancer is to recur. The score, from zero to 100, is for women with breast tumors that have not spread to the lymph nodes. It places women on a scale of probability, based on an analysis of 21 genes in her tumor. Most doctors and patients use the score to decide, in part, whether the woman should receive chemotherapy following surgery.”

Early Initiation of Chemotherapy May Prolong DFS for Early Breast Cancer

“Shorter time to initiation of adjuvant chemotherapy may reduce relapse and improve outcomes in patients with rapidly proliferating early breast cancer, according results of a phase 3 study.

“Earlier chemotherapy may improve OS and DFS in patients with certain subtypes of breast cancer that are rapidly proliferating and aggressive, such as triple-negative or HER-2–positive disease.

“Alberto Farolfi, a medical oncologist in training at the Scientific Institute of Romagna for the Study and Treatment of Cancer in Meldola, Italy, and colleagues sought to examine the influence of time to chemotherapy on the outcome of these patients and to set a threshold value for time to chemotherapy to better define the clinical outcome.”

Tumor Histology Is Factor in Determining Need for Lobectomy

“Limited resection is not equivalent to lobectomy when used to treat older patients with stage IA lung cancer of invasive cell types, namely invasive adenocarcinoma and squamous cell carcinoma, a population-based study has now determined.

“Instead, these patients may be considered for completion lobectomy or for adjuvant treatments, Rajwanth R. Veluswamy, MD, at Icahn School of Medicine at Mount Sinai, New York, NY, and colleagues report online in the Journal of Clinical Oncology.

” ‘Tumor histology in early-stage lung cancer is an important predictor of survival and has therapeutic implications,’ Veluswamy said in an interview. ‘Patients with relatively indolent tumors such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) have excellent survival following resection and are therefore likely to benefit from parenchymal sparing provided by limited surgical approaches.’ “

Post-Op Radiation Therapy for Lung Ca Boosts Patient Survival

“Post-operative radiation therapy (PORT) is associated with improved overall survival in patients with incompletely resected stage II or III non-small cell lung cancer (NSCLC,) a review of a large population-based cohort from the National Cancer Data Base indicated.

“In the Journal of Clinical Oncology, Byunghoon Yu, MD, Therapeutic Radiology, Yale School of Medicine, and colleagues reported that although the use of PORT has been on the decline, “our findings strongly support the delivery of PORT in patients with incompletely resected NSCLC.”

“They noted the absence of randomized trials evaluating the use of PORT for this patient population and said that unknown confounders, such as surgical quality and patient motivation, may also be present. ‘As such, our analysis, although robust, should be confirmed using other data sets,’ said Yu.

“In the retrospective survival analysis, 3,395 patients with pathologic stage N0-N2, overall American Joint Committee on Cancer stage II or II NSCLC from 2003 to 2011 were identified. All had undergone a lobectomy or pneumonectomy with positive surgical margins.”