“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.”
“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 breast cancer 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.”
“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 cancer 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 survival benefit with concurrent versus sequential CRT (median overall survival, 17.0 versus 15.4 months; log-rank P = 0.01).”
“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.”
“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.”
“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 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.’ “
“A phase III study showed that APF530, a delayed release formulation of granisetron, could improve control of emesis in cancer patients receiving highly emetogenic chemotherapy (HEC). The results were presented at the 2015 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium in San Francisco (abstract 68).
“Ian D. Schnadig, MD, of Compass Oncology in Portland, Oregon, presented the study, and said that with regards to supportive care, ‘we still have a ways to go to move the ball down the field in this important domain of cancer care.’ Specifically, managing delayed-phase chemotherapy-induced nausea and vomiting (CINV) is an unmet medical need, he said.
“The MAGIC trial was a phase III, prospective, randomized, placebo-controlled, double-dummy, double-blind trial including 942 patients receiving an HEC regimen. In one arm, patients received ondansetron and a placebo injection; in the other, they received an ondansetron placebo and a APF530 injection. Both groups received fosaprepitant and dexamethasone. The most common chemotherapy regimens were doxorubicin/cyclophosphamide-based and cisplatin-based.”
“The explosion of new drugs for the treatment of castration-resistant prostate cancer (CRPC) is a welcome advance, but raises questions about how best to sequence these drugs with standard docetaxel chemotherapy. A subanalysis of the ALSYMPCA trial suggests that chemotherapy can be safely administered after treatment with radium-223—one of the newer agents approved in this setting—in patients with metastatic CRPC and bone metastasis.
“The study, presented at the 18th ESMO-40th ECCO 2015 European Cancer Congress, was a post-hoc analysis of patients enrolled in ALSYMPCA who received chemotherapy post treatment with radium-223 and post treatment with placebo. Follow-up was 3 years.
“ ‘This study has some limitations, including the fact that it represents a subset of patients based on post-randomization factors, including study drug treatment with radium-223 or placebo, and randomization of the original study does not ensure comparability of the treatment arms,’ said lead author Oliver Sartor, MD, Tulane Cancer Center, New Orleans, LA.”