Shorter Radiation Course Recommended for Early-Stage Breast Cancer Patients

Excerpt:

“Early-stage breast cancer patients receiving a shorter course of whole breast radiation with higher radiation doses per fraction reported equivalent cosmetic, functional and pain outcomes over time as those receiving a longer, lower-dose per fraction course of treatment, according to researchers from The University of Texas MD Anderson Cancer Center.

“Their study, published in Cancer, found patient-reported functional status and breast pain improved significantly following both radiation schedules, and there were no significant differences in physician-reported cosmetic evaluations. With a more convenient treatment schedule and equivalent outcomes, the authors suggest the shorter course as the preferred option for patients.”

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Increased Radiation Dose Offers No Survival Benefit for Patients with Low-Risk Prostate Cancer, Penn Study Finds

“Increased radiation dose is associated with higher survival rates in men with medium- and high-risk prostate cancer, but not men with low-risk prostate cancer, according to a new study from Penn Medicine published this week in JAMA Oncology. Already-high survival rates for men with low-risk prostate cancer were unaffected by higher radiation dosages compared to lower radiation dosages.

“In 2014, low-risk prostate cancer was the most common type of prostate cancer diagnosed in the United States, affecting about 150,000 patients, many of whom undergo aggressive treatment, either complete removal of the prostate or radiation.

“ ‘Our study raises the provocative question of whether radiation dose reduction for patients with low-risk prostate cancer could achieve similar cure rates while avoiding the increased risk of side effects associated with higher radiation doses,’ said the study’s lead author, Anusha Kalbasi, MD, a resident in the department of Radiation Oncology at the Perelman School of Medicine at the University of Pennsylvania.”


Eribulin Dose-Modification May Allow for Better Outcomes

“Women with breast cancer who received first-line treatment with the nontaxane microtubule dynamics inhibitor eribulin mesylate were able to stay on treatment longer and had better clinical outcomes when they received dose modifications during their treatment, according to the results of a poster presented at the 32nd Annual Miami Breast Cancer Conference, held February 26–March 1 in Miami Beach, Florida.

“According to the researchers, led by Joyce O’Shaughnessy, MD, of the Texas Oncology–Baylor Charles A. Sammons Cancer Center, and US Oncology, Dallas, Texas, these results suggests that ‘the use of dose modification to manage adverse events may allow patients to achieve a longer duration of eribulin therapy, which in turn may result in improved outcomes.’

“Eribulin mesylate is currently approved for the treatment of metastatic breast cancer in patients who have previously received at least two prior lines of chemotherapy, including a taxane and an anthracycline. Recently though, two phase II studies looked at eribulin as a first-line treatment and showed that the drug had clinical activity with an acceptable toxicity profile.

“The first, Study 206, included 56 patients with HER2-negative breast cancer. The second, Study 208, included 52 patients with HER2-positive disease. All patients were assigned to eribulin 1.4 mg/m2 on days 1 and 8 of a 21-day cycle. Patients enrolled in Study 208 also received trastuzumab on day 1 of each cycle.”


Radiation Oncologist Advocates for Shorter Treatment with Higher Doses of Radiation in Early Breast Cancer

The gist: This is an opinion article written by a radiation oncologist. He believes that early-stage breast cancer patients should have shorter radiation treatments with higher doses of radiation.

“As healthcare professionals, we play an important role in evaluating oncology patients and providing information on the relevant treatment options. For women with early-stage breast disease, there are a variety of decisions to make regarding these options. For example, some women may be eligible for breast-conserving surgery, which typically includes a lumpectomy followed by radiation. Radiation treatment after a lumpectomy has traditionally involved irradiation of the entire breast with an external beam over 6 weeks. However, recent data suggest it may be time to break tradition.

“A recent study analyzed the frequency of hypofractionated whole-breast irradiation (WBI) versus conventional WBI after breast-conserving surgery in the U.S. from 2008 through 2013. Researchers defined hypofractionated treatments as those spanning 11 to 24 fractions over approximately 3 weeks and conventional fractionation as 25 to 40 treatments over approximately 6 weeks. It is important to address a common misconception about radiation treatments analyzed in this 5-year study. The radiation volume for patients undergoing hypofractionated and conventional whole breast irradiation are the same. However, the dosage per treatment is higher for hypofractionated, allowing a patient to receive the same total amount of radiation in a shorter time period. Both treatment types have the same effect on a cancer cell.

“The researchers found that the percentage of patients treated with hypofractionation increased from 10.3% to 34.5% over 5 years. Even so, a majority of eligible women still did not receive the shorter, more intense course of radiation therapy. This means that a majority of the women who were eligible to receive the same amount of radiation in just 3 weeks unnecessarily received a longer course of treatment. Besides the inconvenience of a lengthier regimen, many women must travel some distance to receive radiation. The additional 3 weeks of radiation can put additional stress on patients with work and family responsibilities.”


Briefer Biochemotherapy Yields Better Relapse-Free Survival but Greater Toxicity vs 1-Year High-Dose Interferon in High-Risk Melanoma

The gist: Compared to a standard treatment, an alternative, shorter treatment for stage III melanoma may lengthen the amount of time patients go without their cancer returning. However, it has more toxic side effects. And compared to the standard, it doesn’t lengthen life. The alternative treatment uses the drugs cisplatin, vinblastine, dacarbazine, interleukin-2, and interferon alfa-2b. In a clinical trial with volunteer patients, it was compared to longer (1-year), high-dose treatment with the drug interferon alfa-2b. The trial involved people aged 10 years and older with stage IIIA-N2a through IIIC-N3 melanoma.

“In a phase III trial (Southwest Oncology Group Intergroup S0008) reported in the Journal of Clinical Oncology, Flaherty et al found that a shorter course of biochemotherapy consisting of cisplatin, vinblastine, dacarbazine, interleukin-2, and interferon alfa-2b produced better relapse-free survival, but not overall survival, and was associated with greater toxicity compared with a 1-year high-dose interferon alfa-2b regimen in patients with high-risk melanoma. The trial is a Cancer and Leukemia Group B, Children’s Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group Intergroup study…

“In the trial, 402 patients aged ≥ 10 years with stage IIIA-N2a through IIIC-N3 melanoma were randomly assigned between September 2000 and November 2007 to receive biochemotherapy plus granulocyte colony-stimulating factor given every 21 days for three cycles (n = 199) or high-dose interferon alfa-2b intravenously 5 days per week for 4 weeks and subcutaneously three times per week for 48 weeks (n = 203). The coprimary endpoints were relapse-free survival and overall survival.

“The high-dose interferon and biochemotherapy groups were generally balanced for age (median, 48 and 46 years), sex (69% and 71% male), race/ethnicity (96% and 95% white), number of involved nodes (1–3 or satellite/in-transit only in 76% in both), nodal involvement (micrometasteses only in 43% and 44%), and ulceration (41% in both)…

“The investigators concluded: ‘Biochemotherapy is a shorter, alternative adjuvant treatment for patients with high-risk melanoma that provides statistically significant improvement in [relapse-free survival] but no difference in [overall survival] and more toxicity compared with [high-dose interferon].’ ”


Emesis Combo Quells CINV in Three Trials (CME/CE)

The gist: Some cancer patients who are treated with chemotherapy experience nausea and vomiting as side effects. Researchers recently conducted three clinical trials with volunteer patients to test a treatment for chemotherapy-induced nausea and vomiting (CINV). The trials compared two different dosing schedules of a treatment that combines the drugs netupitant and palonosetron (aka Aloxi). The researchers reported that a single-dose schedule solved the CINV problem for more patients than a multidose schedule.

“A single-dose antiemetic regimen provided superior control of chemotherapy-induced nausea and vomiting (CINV) as compared with a standard multidose regimen, according to results of three randomized trials.

“In each trial, the fixed-dose combination of netupitant and palonosetron (Aloxi) led to a significantly higher rate of complete response during the delayed phase of the first cycle of chemotherapy versus control regimens. Complete response rates with netupitant-palonosetron (NEPA) regimen ranged from 76% to 89%, representing absolute differences of 5% to 14% versus the control groups.

“Taken together, results of the three trials suggest a ‘winning team’ in the search for optimal management of CINV, reported Matti Aapro, MD, of the Multidisciplinary Oncology Institute in Genolier, Switzerland, and colleagues in the July issue of Annals of Oncology.

” ‘If the present registration trial results are replicated in the “real” clinical world, then the NEPA formulation appears to be an advance in terms of overall efficacy and simplicity of dosing regime with the maintenance of efficacy over multiple cycles of chemotherapy being particularly encouraging,’ Paul L.R. Andrews, PhD, of St George’s University of London, said in an accompanying editorial.”


Rash from Tarceva May Herald Drug Effectiveness

Skin rash is a common side effect of the lung cancer drug erlotinib (Tarceva). However, a clinical trial suggests that this rash can be a good sign and can be used to guide dosing. One hundred twenty-four patients with advanced non-small cell lung cancer (NSCLC) received first-line treatment with Tarceva. The drug dose was gradually increased until patients developed a skin rash or other side effects that prevented further dose increases. Seventy percent of patients developed a skin rash. Patients who developed a skin rash survived longer than those who did not (6.8 months longer on average), even though they did not differ in how much the treatment reduced the growth of their tumors.


New Software Quickly Maps Tumors for Radiotherapy

To help protect healthy tissues from the radioactive drugs that target tumors, oncologists laboriously map the tumors by hand from sections of 3-D images. But now researchers have developed a faster way. Based on computed tomography (CT) imaging data from a patient, 3-D graphic design software creates a model of the tumor in just an hour or two. When combined with a test that simulates the fate of therapeutic radioactivity in the body, the tumor model also lets oncologists personalize the radiotherapy dose. A study of several patients showed that this fast new method maps organs and radiotherapy doses as accurately as conventional methods. The new software is expected to be used in a clinical trial of a tumor-targeted radiotherapy, and a commercial version is scheduled for release to other cancer centers next year.


New Software Quickly Maps Tumors for Radiotherapy

To help protect healthy tissues from the radioactive drugs that target tumors, oncologists laboriously map the tumors by hand from sections of three-dimensional (3-D) images. But now researchers have developed a faster way. Based on computed tomography (CT) imaging data from a patient, 3-D graphic design software creates a model of the tumor in just an hour or two. When combined with a test that simulates the fate of therapeutic radioactivity in the body, the tumor model also lets oncologists personalize the radiotherapy dose. A study of several patients showed that this fast, new method maps organs and radiotherapy doses as accurately as conventional methods. The new software is expected to be used in a clinical trial of a tumor-targeted radiotherapy; a commercial version is scheduled for release to other cancer centers next year.