NCI-MATCH to Assess Treatments Based on Genetic Abnormalities, Not Cancer Type

“The ECOG-ACRIN Cancer Research Group has opened the largest precision medicine cancer trial to date.

“The phase 2 National Cancer Institute-Molecular Analysis for Therapy Choice (NCI-MATCH) trial will evaluate the efficacy of targeted therapies in patients whose tumors share specific gene abnormalities. Treatment choice will be made based on these abnormalities rather than the site of origin of the malignancy.

“ ‘The primary underpinning of the trial comes from genetic characterization of various cancer types, which has become increasingly common place but is not yet routine,’ Keith T. Flaherty, MD, an oncologist at Massachusetts General Hospital, associate professor at Harvard Medical School andECOG-ACRIN chair of the NCI-MATCH trial, told HemOnc Today. ‘When looking at cancers as defined by their site of origin, there are threads of continuity across those cancer types. Within a cancer type, there also is heterogeneity, and understanding what this patchwork looks like was really the main motivator for setting up a trial like this.’ “


The Coming Third Wave of Precision Cancer Medicines

“Targeted treatments for cancer have been extending and saving lives for more than 15 years—precision medicine isn’t a new idea in oncology. Now drugs pioneered on select, specific cancers are, one by one, finding new applications.

“The first wave of targeted drug approvals were for cancers associated with specific mutations. Herceptin (traztuzumab) led the way, approved in 1998. It’s a monoclonal antibody deployed against the HER2/neu receptor that is overabundant in some aggressive and early-onset breast cancers. Robert Bazell’s excellent book Her 2 tells the tale.

“In 2001 came the blockbuster Gleevec (imatinib), a small molecule that intercepts signals to divide. Erin Zammett’s My So-Called Normal Life with Cancer relates that story. A very young editor at Glamour magazine when a routine check-up revealed chronic myelogenous leukemia, Erin’s recovery was one of the first of thousands thanks to this now famous drug.”


Scientists Turn to Aspirin to Turbo-Charge Cancer Immunotherapy

Editor’s note: This story describes a study performed in mice. More research is needed to determine whether the results also apply to humans.

“Giving cheap aspirin to cancer patients may turbo-charge the effectiveness of expensive new medicines that help their immune systems fight tumors, experiments on mice suggest.

“Immunotherapy promises to revolutionize cancer care by offering a better, longer-lasting response with fewer adverse side effects than conventional treatment, but the new drugs do not work well in all cases.

“One reason is that cancer cells often produce large amounts of the molecule prostaglandin E2 (PGE2), which turns down the immune system’s normal attack response to tumor cells, according to scientists at London’s new Francis Crick Institute.”


Precision Therapy and a New Kind of Disappointment

“She had come to see me as a second opinion; diagnosed with uterine serous cancer, one of the more aggressive types of uterine cancers. At surgery they found that it had metastasized to her nodes—stage III disease. The surgery was successful, though, and she had been treated with adjuvant chemotherapy with the hope it was curative. Two years later, she developed abdominal pain. A work-up showed that her CA-125 was elevated, which prompted a scan, and a diagnosis of hepatic metastases. Her doctors recommended repeat treatment with chemotherapy—carboplatin and paclitaxel. ‘It didn’t work the first time, so I am not sure doing it all over again makes sense.’ “


FDA Approves New Drug Treatment for Nausea and Vomiting from Chemotherapy

“The U.S. Food and Drug Administration approved Varubi (rolapitant) to prevent delayed phase chemotherapy-induced nausea and vomiting (emesis). Varubi is approved in adults in combination with other drugs (antiemetic agents) that prevent nausea and vomiting associated with initial and repeat courses of vomit-inducing (emetogenic and highly emetogenic) cancer chemotherapy.

“Nausea and vomiting are common side effects experienced by cancer patients undergoing chemotherapy. Symptoms can persist for days after the chemotherapy drugs are administered. Nausea and vomiting that occurs from 24 hours to up to 120 hours after the start of chemotherapy is referred to as delayed phase nausea and vomiting, and it can result in serious health complications. Prolonged nausea and vomiting can lead to weight loss, dehydration and malnutrition in cancer patients leading to hospitalization.”


Living With Cancer: Collateral Damage

“When I was invited to attend a prostate cancer group called ‘Us Too’ in my town, its members were meeting in a private room in our public library. About eight men, some accompanied by their wives, had great difficulty communicating their discomfort about urine leaks and diapers. They wanted to know what strategies my gynecological cancer group used to talk about sexual issues. To alleviate their daily problems, the participants needed professional help that I could not furnish.

“Sexual dysfunction and incontinence in prostate cancer survivors underscore a quandary that shadows oncology. As we all realize, procedures that prolong lives also impair them. Yet cancer patients who must forfeit quality of life to gain quantity of life rarely receive adequate warning before treatment or guidance afterward.”


The Truth behind Three Natural Cancer “Cures”

“The Internet is full of ‘miracle cures’ for cancer and alleged surefire ways to prevent it, and well-meaning people may urge cancer patients to just try them out in hopes of eliminating their disease. Some patients, worried that conventional treatments won’t work or pose significant side effects, seek a treatment whose effectiveness isn’t actually supported by scientific evidence or may even prove dangerous. During a time of uncertainty and anxiety, it’s understandable that any hope for a cure — even if it isn’t medically proven — is tempting.

“ ‘Patients want something “natural” to try to treat their cancer or prevent their cancer from coming back,’ says Memorial Sloan Kettering pharmacist and herbalist K. Simon Yeung. ‘But the people promoting these treatments might not necessarily have a medical or oncology background. In addition, patients who try these therapies may find, when they come back to seek mainstream treatment, that it’s too late and their cancer has already spread.’ “


High Use of Alternative Medicine in Senior Oncology Patients

“Alternative medicines are widely thought to be at least harmless and very often helpful for a wide range of discomforts and illnesses. However, although they’re marketed as ‘natural,’ they often contain active ingredients that can react chemically and biologically with other therapies. Researchers performed a comprehensive review of all of the medications taken by senior oncology patients and found that as 26 percent were using complementary or alternative medicines (CAM), in a report published August 12th, in the Journal of Geriatric Oncology.

“ ‘Currently, few oncologists are aware of the alternative medicines their patients take,’ said Ginah Nightingale, PharmD, an Assistant Professor in the Jefferson College of Pharmacy at Thomas Jefferson University. ‘Patients often fail to disclose the CAMs they take because they think they are safe, natural, nontoxic and not relevant to their cancer care, because they think their doctor will disapprove, or because the doctor doesn’t specifically ask.’ “


Rolapitant Reduced Chemotherapy-Induced Nausea and Vomiting in Patients Receiving Moderately Emetogenic Chemotherapy or Anthracycline/Cyclophosphamide

“In a phase III study reported in The Lancet Oncology, Schwartzberg et al found that the addition of rolapitant to serotonin (5-HT3) receptor antagonist and dexamethasone treatment significantly improved complete response rates in prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy or anthracycline and cyclophosphamide regimens.

“In this double-blind trial, patients from 170 sites in 23 countries were randomly assigned between March 2012 and September 2013 to receive oral rolapitant 180 mg or placebo 1 to 2 hours before the administration of moderately emetogenic chemotherapy. All patients received oral granisetron 2 mg and oral dexamethasone 20 mg on day 1 (except for those receiving taxanes, who received dexamethasone according to the package insert) and granisetron 2 mg on days 2 and 3. Treatment was given for up to six cycles, with a minimum of 14 days…

“The investigators concluded: ‘Rolapitant in combination with a 5-HT3 receptor antagonist and dexamethasone is well tolerated and shows superiority over active control for the prevention of chemotherapy-induced nausea and vomiting during the 5-day (0–120 h) at-risk period after administration of moderately emetogenic chemotherapy or regimens containing an anthracycline and cyclophosphamide.’ “