Phase III Results Support Novel Focal Therapy for Low-Risk Prostate Cancer

Excerpt:

“Padeliporfin vascular-targeted photodynamic therapy, a novel tissue-preserving treatment, may offer men with low-risk prostate cancer a safe and effective alternative to either active surveillance or radical therapy, according to the results of a phase III trial published in The Lancet Oncology.

“Among treatment-naïve patients with low-risk, localized prostate cancer, disease progression at 24 months was 28% among patients receiving padeliporfin vascular-targeted photodynamic therapy versus 58% in those receiving active surveillance (HR, 0.34; 95% CI, 0.24-0.46; P <.0001). The median time to progression was 28.3 months (95% CI, 26.0-30.6) versus 14.1 months (95% CI, 12.9-23.8; P <.0001), respectively.”

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Less Treatment May Show Greater Benefit in Low-Risk Breast Cancer

Excerpt:

“Although there has been in increase in promising novel regimens available for patients with breast cancer in recent years, oncologists should carefully consider whether each agent would provide a significant enough benefit to offset its associated toxicities, cost, and the time and commitment by the patient it requires, explained Hope S. Rugo, MD.

“ ‘We have built very successful treatments that have improved survival in patients with breast cancer. The challenge we have now is to not keep adding more and more treatments as we look for better therapies to cure that group of patients who will have a recurrence,’ Rugo said during the 2016 International Congress on the Future of Breast Cancer. ‘At the same time, we also need to understand that, for the majority of patients, we are doing a pretty good job. We don’t need to add more toxicities and costs by giving them additional therapies.’ ”

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A Treatment Vaccine for Low-Risk Prostate Cancer

Excerpt:

“A Louisiana-based biopharmaceutical company is betting that its experimental immunotherapeutic vaccine can keep previously untreated prostate cancer in check.

“The company, OncBioMune Pharnaceuticals, Inc, in Baton Rouge, is planning to test the vaccine, dubbed ProscaVax, in a phase 2 trial for patients with previously untreated prostate cancer and in a second trial for patients with recurrent or hormone-refractory disease.

“The trial of a treatment vaccine in untreated, low-risk prostate cancer patients is novel.”

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Hypofractionation Is Ready for Prime Time in Prostate Cancer, but Will It Be Adopted?

“Separate phase III trials presented at the 2016 Genitourinary Cancers Symposium demonstrated that modest hypofractionated radiotherapy is noninferior to conventional radiotherapy for men with intermediate- and low-risk prostate cancer and should be considered a new standard of care.1,2 However, it is not clear how widely adopted hypofractionation schedules will be.

“NRG Oncology RTOG 0415 was a randomized, phase III, noninferiority study comparing two fractionation schedules in men with low-risk prostate cancer: conventional radiotherapy (73 Gy in 41 fractions over 8.3 weeks) vs hypofractionation (70 Gy in 28 fractions over 5.6 weeks).1

“The study enrolled 1,115 patients with low-risk prostate cancer. No androgen suppression was given. Patients were stratified according to Gleason score 2–4 and Gleason score 5–6.”


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.”


Women with Luminal A Subtype of Breast Cancer Did Not Benefit from Adjuvant Chemotherapy

“Premenopausal women whose invasive breast cancers were of the luminal A subtype had comparable 10-year disease-free survival rates regardless of whether or not they received adjuvant chemotherapy, according to data from the phase III DBCG77B clinical trial presented at the 2015 San Antonio Breast Cancer Symposium, held Dec. 8-12.

” ‘Luminal A is a relatively common subtype of breast cancer, and is defined by high expression of hormone receptors [estrogen receptor (ER) and progesterone receptor (PR)], and low expression of the cell-growth marker Ki67 and the oncoprotein HER2. It is the form of breast cancer with the best prognosis,’ said Torsten Nielsen, MD, PhD, professor of pathology at the University of British Columbia in Vancouver, Canada.

” ‘We wanted to address the clinical question of whether or not women with molecularly low-risk luminal A breast cancer actually benefit from chemotherapy,’ added Nielsen. ‘Instead of starting a new trial and waiting for 10 years to find answers, we used an older, completed trial that had saved tissue samples for future studies.’ “


Men Who Forgo Aggressive Treatment for Prostate Cancer Don't Receive Appropriate Monitoring

“An increasing number of men diagnosed with low-risk prostate cancer are opting for active surveillance – closely monitoring their cancer – rather than aggressive treatment to avoid the debilitating potential side effects of surgery and radiation, such as erectile and urinary dysfunction.

“However, a new study by UCLA researchers has found that less than 5 percent of men who chose to forgo aggressive treatment are being monitored as closely as they should be, putting them in danger of their cancer progressing or metastasizing without their knowledge.

“The study, published today in the peer-reviewed journal Cancer, examined the records of 37,687 men diagnosed with prostate cancer from 2004 to 2007 who were followed through 2009. They found that of the 3,656 men diagnosed with prostate cancer who did not undergo aggressive treatment, only 166 men, or 4.5 percent, were being monitored appropriately, said Dr. Karim Chamie, the study’s first author and an assistant professor of urology at UCLA.”


Shorter-Course Radiation Non-Inferior to Conventional Therapy for Low-Risk Prostate Cancer

“Hypofractionated radiation therapy yielded a similar rate of DFS and toxicity profile as conventional radiotherapy among men with low-risk prostate cancer, according to results of a randomized phase 3 non-inferiority study presented at the ASTRO Annual Meeting.

“Given in larger doses over a shorter period, hypofractionated radiation therapy is being studied as a possible improved treatment option for some patients.

“Howard Sandler, MD, MS, FASTRO, professor and chair of the department of radiation oncology at Cedars Sinai Medical Center in New York, and colleagues sought to evaluate whether the hypofractionated therapy schedule — or 70 Gy in 28 fractions over 5.6 weeks — resulted in a 5-year DFS that was not lower than that of the conventional schedule, or 73.8 Gy in 41 fractions over 8.2 weeks, by more than 7%.”


Prostate Cancer Study Shows Hypofractionation Comparable to Standard Radiation in Low-risk Patients

“Hypofractionated radiotherapy can achieve similar cure rates with similar side effects compared with conventional radiotherapy for men with low-risk, early prostate cancer, according to follow-up RTOG 0415 study data presented October 20, 2015, during a scientific session at the 2015 ASTRO Annual Meeting.

“Hypofractionated radiotherapy is delivered in larger doses over 5.5 weeks whereas conventional radiotherapy requires 8 weeks of treatment. ‘Results of our study demonstrate that for men with low-risk prostate cancer, hypofractionated radiotherapy offers a shorter, more convenient treatment schedule without compromising cure or causing additional side effects,’ said lead author W. Robert Lee, MD, professor of radiation oncology at Duke University School of Medicine, Durham, NC.”