Use of Anthracyclines Plus Taxanes Found to be Beneficial in Early, HER2-Negative Breast Cancer

Excerpt:

“Treatment with anthracyclines was proven to be beneficial for patients with high-risk, HER2-negative, early-stage breast cancer, according to a joint analysis of the “ABC” trials presented at the 2016 ASCO Annual Meeting.

“The analysis, which included more than 4000 patients, demonstrated that docetaxel plus cyclophosphamide (TC) was significantly inferior to various taxane-plus-anthracycline-based (TaxAC) chemotherapy regimens.

“ ‘Statistical noninferiority of the non-anthracycline regimen could not be demonstrated,’ said lead investigator Joanne Lorraine Blum, MD, PhD, medical oncologist with Texas Oncology at the Baylor-Sammons Cancer Center in Dallas. ‘In terms of the study’s primary endpoint, invasive disease-free survival, TC x 6 was significantly inferior to TaxAC.’ ”

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Second-Generation AR-Targeting Agent Explored in High-Risk Prostate Cancer

Excerpt:

“Researchers are hoping the results of a late-stage efficacy and safety study of apalutamide (ARN-509) in patients with high-risk, localized, or locally advanced prostate cancer who are receiving primary radiation therapy will demonstrate an improvement in metastasis-free survival, according to global principal investigator, Howard M. Sandler, MD.

“ ‘The patient population that we’re studying are men who are at risk of dying of prostate cancer,’ Sandler, chair of the Department of Radiation Oncology at Cedars-Sinai Medical Center in Los Angeles, told OncologyLive. ‘If we can provide better upfront disease control, we’re hoping to reduce the number of men who enter into the castrate-resistant prostate cancer stage.’ “

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ASCO: Combo Tx Fails in Local High-Risk Prostate Ca

Excerpt:

“Neoadjuvant enzalutamide (ENZA) and abiraterone acetate (AA) plus 5 mg prednisone daily can be given safely for 6 months in men with localized high-risk prostate cancer prior to prostatectomy, a neoadjuvant study showed.

“However, the findings did not favor adding ENZA to augment AA plus leuprolide acetate (LHRHa) efficacy in localized high-risk prostate cancer, Eleni Efstathiou, MD, PhD, of the University of Texas MD Anderson Cancer Center, in Houston, said during a presentation at the American Society of Clinical Oncology.

“Pathologic downstaging (≤ pT2N0) occurred in 30% of patients treated with the combination therapy (AA+ENZA+ LHRHa) versus 52% of patients who received AA plus LHRHa alone (P=0.07), the study showed. Despite universal PSA depletion (≤ 0.1), a wide range of viable tumor was observed (volume 0-8.64 cc, cellularity 0-90%, and a tumor epithelial volume [TEV] 0-5.58 cc). TEV and stage were aligned.”

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Video: Dr. Matthew Cooperberg on Surgery for Aggressive Prostate Cancer

“Matthew Cooperberg, MD, genitourinary cancer specialist, University of California San Francisco, discusses the rise in aggressive management of men with high-risk prostate cancer. Cooperberg says the proportion of men who are receiving hormonal therapy alone had been rising consistently over the course of a 15 year period, up until 2010, to about 50%. Since then, Cooperberg says that number has dropped to about half of what it was, or 25%, which is attributed to more aggressive treatment.

“Cooperberg says local therapy for men with high-risk prostate cancer was normally radiotherapy, with surgery not being nearly as common. He adds that a growing body of evidence dictates that surgery in prostate cancer may be a more effective local therapy than radiation alone. According to the body of evidence, cancer-related survival and overall survival were normally boosted when surgery was involved for these patients.”

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ASCO Recommends Ovarian Suppression for ER-Positive Breast Cancer

“An American Society of Clinical Oncology (ASCO) expert panel issued an updated guideline recommending that higher-risk premenopausal women with estrogen receptor (ER)-positive breast cancer receive ovarian suppression in addition to adjuvant endocrine therapy. Lower-risk patients, however, should not receive ovarian suppression.

“ ‘In the past year, randomized trials with robust methodological designs have analyzed the effect of ovarian suppression among premenopausal women with ER-positive breast cancers treated with tamoxifen,’ wrote the panel, led by ASCO expert Harold J. Burstein, MD, PhD, of Dana-Farber Cancer Institute in Boston. In the past, studies of this therapy have suffered from problems such as selection criteria confounding.

“The guideline update is based on four randomized controlled trials. These include the Eastern Cooperative Oncology Group 3193 (E-3193) trial, the Suppression of Ovarian Function Trial (SOFT), the Tamoxifen and Exemestane Trial (TEXT), and the Austrian Breast Cancer Study Group (ABCSG)-12 trial. Overall, the studies did not find a significant difference with regard to overall survival between tamoxifen alone, tamoxifen plus ovarian suppression, or aromatase inhibitors (AIs) plus ovarian suppression. The guideline update was published in the Journal of Clinical Oncology.”


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.”


Prostate Cancer: Optimism, Caution for Active Surveillance

“Two-thirds of men with newly diagnosed prostate cancer met criteria for active surveillance, including a subset of higher-risk patients, data from the National Cancer Institute (NCI) suggest.

“Overall, 187 of 281 (67%) patients qualified for active surveillance. Two-thirds of the men qualified by standard assessment criteria, but 64 of the 187 qualified by expanded criteria for higher risk patients: four or fewer biopsy cores with Gleason grade 3+3 cancer and no more than one core of Gleason 3+4 cancer and 15% or less of the core with Gleason 3+4 cancer.

” ‘In comparing the restricted group of men eligible for active surveillance with the less restricted group [expanded criteria], positive margins and upstaging were more common in the less restricted group,’ Ian M. Thompson III, MD, of the University of Texas Health Science Center at San Antonio, and colleagues reported in the September issue of the Journal of Urology.

” ‘However, if upstaging or upgrading were combined as an outcome, there was no difference in the risk of this outcome between the two active surveillance groups of patients,’ they wrote.”


Multigene Assay Validated for Risk Assessment in Prostate Cancer

“There has been a preponderance in the healthcare industry to overtreat early-stage, slow-progressing prostate cancer, often subjecting patients to unwarranted, life-altering treatments. According to Genomic Health Inc, provider of genomic-based diagnostic tests, increased surveillance should be the primary outcome in patients with clinically localized prostate cancer (PC). To prevent overtreatment in such patients, they have developed the Oncotype DX test that allows clinical risk assessment for differentiating between high-risk and low-risk patients with prostate cancer (PC).

“Oncotype DX prostate cancer assay is a multigene RT-PCR expression assay compatible with fixed paraffin-embedded diagnostic prostate needle biopsies. The assay measures expression of 12 cancer-related genes (AZGP1, KLK2, SRD5A2, FAM13c, FLNC, GSN, TPM2, GSTM2, TPX2, BGN, COL1A1, and SFRP4) and five reference genes that are algorithmically combined to calculate the Genomic Prostate Score (GPS) ranging from 0 (low) to 100 (high). This 17-gene biopsy-based assay has been analytically and subsequently validated as a predictor of aggressive PC.”


For Prostate Cancer Patients, Risk-Specific Therapies Now More the Norm

“After decades of overtreatment for low-risk prostate cancer and inadequate management of its more aggressive forms, patients are now more likely to receive medical care matched to level of risk, according to a study by researchers at UC San Francisco.

“In the first study to document updated treatment trends, researchers found that from 2010 to 2013, 40 percent of men with low-risk prostate cancer opted for active surveillance, in which the disease is monitored closely with blood tests, imaging studies and biopsies. Treatment is deferred unless these tests show evidence of progression.

“In contrast, less than 10 percent overall of low-risk prostate cancer patients pursued active surveillance in the years from 1990 through 2009. Rates for radiation therapy for this low-risk group have also slipped since 1995, the authors noted in the study published in JAMA earlier this month.”