Checkpoint Inhibitors Show Promise in SCLC, Mesothelioma

“Immune checkpoint inhibitors have demonstrated encouraging results for patients with small cell lung cancer (SCLC) and mesothelioma, two aggressive thoracic malignancies with few options, according to a presentation by M. Catherine Pietanza, MD, at the 10th Annual New York Lung Cancer Symposium.

“ ‘The antibodies to CTLA-4, PD-1, and PD-L1 can be safely given to these patients. Responses are seen and are durable. There is a benefit in both platinum-sensitive and platinum-refractory SCLC,’ said Pietanza, a medical oncologist at Memorial Sloan Kettering Cancer Center.

“Chemotherapy has traditionally been the treatment of choice for most patients with SCLC and mesothelioma beyond the frontline setting. However, outcomes are poor with these therapies, specifically for SCLC, where the median survival following second-line therapy ranges from 6 to 9 months.”


Higher Insulin Is an Independent Prognostic Factor in Advanced Breast Cancer

“Patients with breast cancer that has spread to other parts of the body (metastasised) and who have higher insulin levels than normal, but are not diabetic, have a significantly worse prognosis compared with those with normal insulin levels, a researcher will tell the Advanced Breast Cancer Third International Consensus Conference tomorrow.

“Although the effect of higher insulin levels is already known in early breast cancer patients, it is the first time that insulin resistance, where the body’s inefficient use of insulin leads to the production of an excess, has been shown to lead to a worse outcome for metastatic breast cancer patients.

“Dr Nicoletta Provinciali, MD, an oncologist from the E.O. Ospedali Galliera, Genoa, Italy, will describe to the conference her team’s study, which involved 125 metastatic breast cancer patients. In addition to not being diabetic, all those involved had HER2 negative tumours and were receiving chemotherapy on its own (first line chemotherapy) as part of a clinical trial. The researchers assessed the relationship between insulin resistance and the length of time the patient lived without the disease getting worse (progression-free survival, or PFS) and overall survival (OS), the length of time that the patient remained alive.”


ASCO Updates Guidelines for Antiemetics During Chemo

“For patients receiving chemotherapy, the use of the oral combination of netupitant (a neurokinin 1 receptor antagonist) and palonosetron (a 5-hydroxytryptamine-3 receptor antagonist) is beneficial for prevention of acute and delayed nausea and vomiting, according to a focused guideline update published online Nov. 2 in the Journal of Clinical Oncology.

“Paul J. Hesketh, M.D., from the Lahey Hospital and Medical Center in Burlington, Mass., and colleagues conducted a targeted systematic literature review to update guidelines on use of the oral combination of netupitant and palonosetron for prevention of acute and delayed nausea and vomiting among patients receiving chemotherapy.”


New Study Could Save Breast Cancer Patients Time, Money and Side Effects

“Most breast cancer patients with invasive lobular carcinoma could be treated with hormones alone and not with chemotherapy, according to a study by Virginia Piper Cancer Institute at Abbott Northwestern Hospital, part of Allina Health.

“Researchers reviewed all consecutive cases of invasive lobular carcinoma  diagnosed at the Allina Health Laboratory from the past eight years. Included were 158 patients with invasive lobular carcinoma breast cancer who also had molecular testing with the Oncotype DX gene expression test.

“With Allina Health pathologists, researchers defined a model that included characteristics of a tumor most predictive of the recurrence risk identified on the Oncotype DX gene expression test: progesterone receptor expression, Ki-67 (proliferation index), estrogen receptor expression, patient age and tumor size.”


CRT May Be Preferred Strategy for Elderly with Lung Cancer

“Chemoradiotherapy (CRT) is associated with survival benefit over chemotherapy (CT) alone for elderly patients with limited-stage small-cell lung cancer, according to a study published online Oct. 19 in the Journal of Clinical Oncology.

“Christopher D. Corso, M.D., Ph.D., from the Yale University School of Medicine in New Haven, Conn., and colleagues examined outcomes for elderly patients (≥70 years) treated with CT versus CRT. Data were included for 8,637 patients with limited-stage small-cell lung  in the National Cancer Data Base between 2003 and 2011.

“The researchers found that 43.7 and 56.3 percent of the patients received CT and CRT, respectively. CRT receipt was less likely with increasing age, clinical stage III disease, female sex, and the presence of medical comorbidities (all P < 0.01). Compared with CT, CRT use correlated with increased overall survival on univariate and multivariate analysis (median overall survival, 15.6 versus 9.3 months). Survival benefit associated with CRT was confirmed in a propensity score-matched cohort of 6,856 patients (hazard ratio, 0.52; P < 0.001). In subset analysis, patients who were alive at four months after diagnosis had a  with concurrent versus sequential CRT (median overall survival, 17.0 versus 15.4 months; log-rank P = 0.01).”


For Lung Cancer Patients, IMRT Associated with Lesser Side Effects, Better Tolerance of Chemotherapy, Compared to Conventional Radiation Therapy

“An analysis of an international, cooperative-led trial of patients with locally advanced non-small cell lung cancer (NSCLC) has shown that those who received intensity modulated radiation therapy (IMRT) had less severe lung toxicity and were able to better tolerate their chemotherapy, compared to patients who received 3-dimensional conformal radiation therapy (3-D CRT).

“Stephen Chun, M.D., fellow, Radiation Oncology at The University of Texas MD Anderson Cancer Center, presented the research at the American Society for Radiation Oncology’s 57th Annual Meeting.

“According to the American Cancer Society, in the United States, 221,200 will be diagnosed with lung cancer in 2015 and 158,040 will die from the disease — making it the deadliest of all cancers. About a third of all lung cancers are diagnosed when the cancer is locally advanced, said Chun. The standard of care for locally advanced lung cancer is concurrent chemotherapy and radiation, with most patients receiving either 3-D CRT or IMRT.”


Chemotherapy Use, Survival in SCLC Increased Over 20 Years

“A study looking at trends from 1985 to 2005 found that overall survival has increased in Medicare patients with small-cell lung cancer (SCLC), and that treatment with chemotherapy is associated with improved survival.

“ ‘Although the proportion of cases diagnosed as SCLC has declined from approximately 20% to 13%, this subset is still a major cause of disease burden with close to 30,000 new cases annually,’ wrote study authors led by Madhusmita Behera, PhD, of Emory University in Atlanta. The use of chemotherapy in real-world populations is limited by significant toxicity, they added, and whether recommended therapies are adopted has not been well studied.

“The new study used the SEER database to study trends in outcome and treatment; it included 47,351 eligible patients divided into 5-year intervals, with 1985–1990 used as the baseline. Results were published online ahead of print in Cancer.”


HER2-Positive Breast CA Patients Prosper on Solo Chemo

“Prognosis for human epidermal growth factor receptor 2 (HER2)-positive patients with lymphocyte-predominant breast cancer (LPBC) was significantly better following treatment with chemotherapy alone than it was for their counterparts receiving chemotherapy plus trastuzumab (Herceptin), an exploratory analysis of the North Central Cancer Treatment Group-N9831 trial has shown.

“Among 489 patients from the N9831 trial receiving chemotherapy alone, 10-year Kaplan-Meier estimates for recurrence-free survival (RFS) among participants with high-levels of stromal tumor-infiltrating lymphocytes (STILs) was 90.9% compared with 64.5% for patients with low-levels of STILs.

“In dramatic contrast, 10-year estimates for RFS among 456 patients who received the same chemotherapy regimen followed by weekly paclitaxel plus trastuzumab followed by trastuzumab alone were virtually identical in patients with high- and low-levels of STILs at 80% and 80.1%, respectively (HR 1.26; 95% CI 0.50-3.17; P=0.63).”


Sequential Anthracycline-Cyclophosphamide, Taxane Regimen 'Most Effective' Adjuvant Therapy for Early-Stage Breast Cancer

“Sequential anthracycline-cyclophosphamide and taxane may serve as the best available adjuvant therapy regimen for early-stage breast cancer regardless of hormone receptor status, according to the results of a systemic review and network meta-analysis.

“Many different adjuvant chemotherapy regimens exist for early-stage breast cancer; however, a conventional meta-analysis would not allow for comparison of all of these regimens, according to researchers.

“ ‘It is well established that adjuvant chemotherapy plays an important role in reducing the risk for recurrence and improving the survival of patients with breast cancer,’ Naoto T. Ueno, MD, PhD, chief of the section of translational breast cancer research at The University of Texas MD Anderson Cancer Center, and colleagues wrote. ‘The National Comprehensive Cancer Network guidelines for the treatment of breast cancer describe numerous recommended adjuvant chemotherapy regimens … of them, sequential anthracycline-cyclophosphamide and taxane (AC-T) is the most commonly accepted standard regimen. However, two types of regimens without anthracyclines may have efficacy similar to or greater than that of sequential AC-T.’ “