Accuracy and Precision Define Radiation Oncology

A Q&A with Eddy Yang, MD, PhD, Professor and Vice Chair of Translational Sciences Department of Radiation Oncology; Deputy Director, Associate Director of Precision Oncology at the Hugh Kaul Precision Medicine Institute; Birmingham, AL; shyang@uabmc.edu

Originally published December 5, 2017

Q: You are a radiation oncologist with a particular interest in cancer of the prostate. How does the molecular study of prostate, as well as other cancers, including Next Generation Sequencing (NGS), help inform Precision Radiation Oncology?

A: Radiation oncology is a specialty where the accuracy and precision of treatment delivery is vital to the safety and outcomes of our patients. Many specialized techniques are utilized to enhance this precision, including intensity modulated radiation therapy, image-guided radiation therapy, and volumetric arc therapy. Emerging modalities such as proton and carbon therapy take advantage of the physics of heavy ions to potentially minimize normal tissue toxicity. With these methods, we are in essence, performing precision oncology, tailoring radiotherapy to each individual patient. However, precision oncology is much more than that, as novel technologies have expanded our understanding of the drivers of cancer that may be targetable or dictate response to treatment. Currently, emerging evidence has shown the benefits of biomarker-directed systemic treatments, but what about genomic markers to guide radiation therapy? Although the preclinical and retrospective data supports the notion of this possibility, results from prospective studies are not yet available. Continue reading…


What to Expect When Active Surveillance Leads to Prostatectomy

Excerpt:

“A high proportion of men who entered active surveillance for early prostate cancer had one or more high-risk disease characteristics when they subsequently had radical prostatectomy, a Swedish study showed.

“Medical records showed that 52 of 132 men had at least one adverse pathology feature at radical prostatectomy. All the men initially opted for active surveillance, and the median time from enrollment to surgery was 1.9 years.”

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Apalutamide Maintains Health-Related QoL in Nonmetastatic CRPC

Excerpt:

“Treatment with apalutamide (Erleada) was not associated with a significant impact on health-related quality of life (HRQoL) in patients with high-risk nonmetastatic castration-resistant prostate cancer, according to patient-reported outcome (PRO) data from the phase III SPARTAN trial.

“In the study overall, patients treated with the addition of apalutamide to standard hormone therapy also had an improvement in metastasis-free survival (MFS) and longer time to symptomatic progression compared with those who were treated with placebo.”

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ASCO and Friends Submit Recommendations to FDA Aimed at Reducing Barriers to Clinical Trial Participation

Excerpt:

“ASCO and Friends of Cancer Research (Friends) have submitted recommended language to the U.S. Food and Drug Administration (FDA) for five guidance documents on ways to broaden eligibility criteria for cancer clinical trials. The recommendations are part of an ASCO and Friends collaboration to broaden eligibility for participating in clinical trials by addressing five specific areas: minimum age requirements for trial enrollment, HIV/AIDS status, brain metastases, organ dysfunction, and prior and concurrent malignancies.”

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Combo Tx No Help After PSA Progression in mCRPC

Excerpt:

“Adding abiraterone acetate (Zytiga) to enzalutamide (Xtandi) did not improve progression-free survival (PFS) after prostate-specific antigen (PSA) progression in men on enzalutamide monotherapy for chemotherapy-naive metastatic castration-resistant prostate cancer (mCRPC), researchers found.

“In the randomized, double-blind PLATO trial, the median PFS in patients treated with enzalutamide plus abiraterone and prednisone was 5.7 months. By comparison, the PFS was 5.6 months in the control group treated with abiraterone and prednisone plus placebo (hazard ratio [HR] 0.83; P=0.22).”

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Deadly Subtype Makes Up 17% of Metastatic Prostate Cancers

Excerpt:

“Treatment-emergent small cell neuroendocrine prostate cancer, a particularly deadly subtype of the disease, occurs in nearly one-fifth of all cases of metastatic, castration-resistant prostate cancer, study data showed.

“Researchers suggested that the subtype should be treated with novel targeted therapies that are currently in the development or testing phase.”

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High Marks for HIFU in Early Prostate Cancer

Excerpt:

“Men with newly diagnosed, nonmetastatic prostate cancer had a 5-year failure-free survival (FFS) of 88% when treated with focal high-intensity focused ultrasound (HIFU) therapy, results of a multicenter European clinical experience showed.

“The 625-patient cohort had a 5-year overall survival of 99%, and none of the patients died of prostate cancer during a median follow-up of 56 months. In a subgroup of men who submitted questionnaires on patient-reported outcomes, 98% said they did not require absorbent pads for urinary incontinence.”

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FDA Approves Enzalutamide for Nonmetastatic CRPC

Excerpt:

“The FDA has approved enzalutamide (Xtandi) for the treatment of patients with nonmetastatic castration-resistant prostate cancer (CRPC), according to Pfizer and Astellas, the codevelopers of the antiandrogen agent.

“The approval is based on the phase III PROSPER trial, in which the combination of enzalutamide (Xtandi) and androgen deprivation therapy (ADT) reduced the risk of metastases or death by 71% compared with ADT alone for patients with nonmetastatic CRPC. In the double-blind study, the median metastasis-free survival (MFS) was 36.6 months with enzalutamide plus ADT versus 14.7 months with ADT alone (HR, 0.29; 95% CI, 0.24-0.35; P <.0001).”

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New Treatment Lowers Risk for Death from Aggressive Prostate Cancer by Over 70 Percent, Study Finds

Excerpt:

“Some of the 165,000 U.S. men who are estimated to receive a new diagnosis of prostate cancer this year will develop resistance to hormonal therapies for the disease, but a new study by a doctor now at Northwestern Memorial Hospital points to use of an existing drug to help treat them.

“This kind of aggressive cancer has challenged doctors, as effective treatment to improve outcomes for these men hadn’t existed previously. But a clinical trial led by Dr. Maha Hussain, now an oncologist at Northwestern Memorial, showed that taking a drug, enzalutamide, resulted in a 71 percent lower risk of cancer spread or death, compared to those taking a placebo during the three-year trial. The patients involved all had prostate cancer that hadn’t spread but that also had not responded to hormone treatment.”

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