Guidelines Establish Minimum Negative Margins in DCIS

Excerpt:

“Three medical organizations including the American Society of Clinical Oncology (ASCO) have issued a guideline on margins in breast conserving surgery for patients with ductal carcinoma in situ (DCIS). The new recommendations are published online ahead of print in the Journal of Clinical Oncology.

“The panel of experts from ASCO, the Society of Surgical Oncology (SSO), and the American Society for Radiation Oncology (ASTRO) recommend the use of 2-mm margins as a standard in breast conserving surgery for DCIS treated with whole-breast irradiation. Margins of 2 mm are ‘associated with low rates of ipsilateral breast tumor recurrence and has the potential to decrease re-excision rates, improve cosmetic outcome, and decrease health care costs,’ wrote Monica Morrow, MD, of the department of surgery at the Memorial Sloan Kettering Cancer Center in New York, and coauthors. ‘Clinical judgment should be used in determining the need for further surgery in patients with negative margins less than 2 mm. Margins more widely clear than 2 mm do not further reduce the rates of recurrence of cancer in the breast and their routine use is not supported by evidence.’ ”

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6 Kinds Of Breast Lumps That Aren't Cancer

Excerpt:

“In January, I found a grape-sized lump in my left breast. It wasn’t brought to my attention at the gyno’s office, but rather during a mundane and medically irrelevant event: a hug.

“As my boyfriend and I stood on the subway platform, he pulled me into a tight squeeze, and in that normal gesture, I felt an abnormal pang of pain on the left side of my chest. I shifted my stance to see if maybe it was a ‘bad angle’ — but nope, that spot was tender no matter what direction the pressure came from.

“When I got home, I did a more thorough exam of the area, tracing my breast until I came across a small lump at the tender spot. Then, I did what any modern hypochondriac would do: I burst into tears and hopped online for a diagnosis.”

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Excitement Continues to Build for Advances in Neuroendocrine Tumor Field

Excerpt:

“It’s been an exciting year thus far for patients with neuroendocrine tumors (NETs), with the FDA approving a new treatment regimen and more advancements on the horizon, according to James C. Yao, MD, a professor in the Department of Gastrointestinal (GI) Medical Oncology at The University of Texas MD Anderson Cancer Center.

“In February, the FDA approved everolimus (Afinitor) as a treatment for patients with progressive, well-differentiated, non-functional NETs of GI or lung origin with unresectable, locally advanced or metastatic disease. The mTOR inhibitor has been approved since 2011 for unresectable or advanced pancreatic NETs.

“Meanwhile, the agency is evaluating Lutathera (177Lutetium DOTA-octreotate), a peptide receptor radionuclide therapy (PRRT), for patients with gastroenteropancreatic NETs under its priority review program. Similarly, telotristat etiprate, a small-molecule tryptophan hydroxylase inhibitor, also is being considered under the FDA’s priority review program for carcinoid syndrome in patients with metastatic NETs.”

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Incidence of PD-1 Inhibitor–Related Pneumonitis Highest in NSCLC, Renal Cell Carcinoma

Excerpt:

“PD-1 inhibitor–related pneumonitis occurred most frequently among patients with non–small cell lung cancer or renal cell carcinoma, according to results of a meta-analysis.

“The incidence of this adverse event also appeared greater during treatment with combination therapy.

“PD-1 inhibitors — including FDA–approved nivolumab (Opdivo, Bristol-Myers Squibb) and pembrolizumab (Keytruda, Merck) — are associated with unique toxicities known as immune-related adverse events. Pneumonitis is one such adverse event that, although rare, can be serious and life threatening.”

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Chance Collaboration Yields an Advance in Cancer Treatment

Excerpt:

“A collaboration between an immunologist helping his stepmother fight cancer and the oncologist who treated her led to a discovery that could help many more patients benefit from a transformative new therapy.

“A new class of drugs called checkpoint inhibitors works by releasing a molecular brake that stops the immune system from attacking tumors. So-called immunotherapy has been approved for several types of cancers and found to extend lives of patients with advanced disease for many years. The problem is that for most patients immunotherapy doesn’t work.

“The researchers, from University of California, San Francisco, said they identified a unique type of immune-system cell that ‘robustly’ predicts whether patients will respond to one of the medicines—an achievement has the potential to significantly expand the number of cancer patients who benefit from checkpoint inhibitors.”

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Custirsen Combo Falls Short in Phase III mCRPC Trial

Excerpt:

“Adding custirsen to cabazitaxel (Jevtana) and prednisone in the second-line setting failed to improve overall survival (OS) in men with metastatic castration-resistant prostate cancer (mCRPC) in the phase III AFFINITY trial, according to OncoGenex, the company developing the drug.

“The open-label AFFINITY trial included 634 men with mCRPC who progressed on docetaxel. Patients were randomized to cabazitaxel plus prednisone with or without weekly custirsen. Treatment was administered until progression, unacceptable toxicity, or the completion of 10 cycles. The study was conducted at 95 locations in North America, Europe, Russia, and Australia.”

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ADT Decreases Survival Among Black Men With Favorable-Risk Prostate Cancer

Excerpt:

“Definitive treatment with androgen deprivation therapy increased the risk for death among black men with low- or favorable-risk prostate cancer, according to study results published in Cancer.

“ADT should be reserved for black men with high-risk disease, according to the researchers.

“ADT is frequently combined with radiation therapy for the treatment of men with intermediate- or high-risk prostate cancer. No evidence suggests that this treatment platform benefits patients with low- or favorable-risk disease.”

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The Best Ways to Prevent Breast Cancer

Excerpt:

“As both a breast cancer specialist and a survivor of the disease, I know well that all women are at risk for breast cancer – no matter their family history of the disease.

“Only about 10 percent of breast cancers are associated with an inherited gene, such as the BRCA1 and BRCA2 genetic mutations. The other 90 percent of breast cancers are mostly due to lifestyle causes, reproductive choices and environmental exposures.

“While some of these factors are beyond our control, there are a number of things we can do to substantially lower our risk of developing breast cancer. In fact, half of all breast cancers could be prevented through a combination of lifestyle changes, starting as late as age 50 – and there’s a number of ways you can lower your risk.”

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Leptomeningeal Metastases Are More Common in NSCLC Patients With EGFR Mutations

Excerpt:

“Leptomeningeal metastases (LM), a devastating complication and predictor of poor survival in lung cancer patients, was found to be more prevalent in non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations. Patients receiving tyrosine kinase inhibitors (TKIs) targeting EGFR mutations had a longer overall survival (OS) than those who did not receive TKIs, demonstrating the effectiveness of TKIs for LM therapy.

“The leptomeninges are the membranes that surround the brain, including the arachnoid mater and pia mater, and ensue when cancer cells metastasize to intracranial structures and the cerebrospinal fluid (CSF). LM occurs in 10-26% of  and the presence of LM is a devastating complication for patients and often associated with poor survival. Treatment strategies for LM include epidermal growth factor receptor  (EGFR-TKIs), chemotherapy, whole brain radiotherapy (WBRT), intrathecal chemotherapy (ITC), surgery, and ventriculoperitoneal (VP) shunt operations. However, therapeutic options for treating LM are challenging with no standard treatment. The use of EGFR-TKIs markedly prolong survival in patients with EGFR mutations and frequent EGFR mutations.”

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