Groups Endorse Shorter RT for Prostate Cancer

Excerpt:

“Hypofractionated external beam radiation therapy (EBRT) for early prostate cancer represents a reasonable alternative to standard treatment protocols involving lower doses of radiation administered over a longer period of time, according to a new clinical guideline.

” ‘Moderately hypofractionated’ EBRT regimens result in similar disease control and side effects as compared with conventional protocols, although the shortened regimens confer a small risk of more short-term gastrointestinal toxicity. Additionally, physicians should counsel patients about the limited data on oncologic outcomes beyond 5 years of follow-up, according to a panel representing the American Society for Radiation Oncology, American Society of Clinical Oncology, and American Urological Association.”

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Can Trastuzumab Duration Be Shortened in HER2-Positive Breast Cancer?

Excerpt:

“Adding to a growing list of similar results, the Short-HER study was unable to show noninferiority of 9 weeks of trastuzumab compared with the standard 1 year when given along with chemotherapy in women with HER2-positive breast cancer. Shorter administration does, however, reduce the risk of cardiotoxicity.

” ‘Adjuvant pivotal trials with 1-year trastuzumab have significantly improved the prognosis of HER2-positive early breast cancer,’ wrote study authors led by Pierfranco Conte, MD, of the Istituto Oncologico Veneto in Italy. Several studies have attempted to reduce the duration of trastuzumab, though most have failed to show noninferiority.”

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Does Sequential vs Concurrent Treatment Change Outcomes in HER2+ Breast Cancer?

Excerpt:

“Outcomes for patients with HER2-positive breast cancer did not differ when treated with sequential chemotherapy plus trastuzumab compared with a concurrent approach, according to a new phase III trial.

” ‘The effectiveness of trastuzumab with chemotherapy in the neoadjuvant setting is evident; however, the cardiac safety of trastuzumab combined with anthracyclines has been questioned,’ wrote study authors led by Kelly K. Hunt, MD, of the University of Texas MD Anderson Cancer Center in Houston.”

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Accelerated WBI Should be the Norm for Most Breast Cancers

Excerpt:

“Most women with breast cancer should receive accelerated whole-breast irradiation (WBI) as the standard of care, according to a new guideline from the American Society for Radiation Oncology (ASTRO).

“Accelerated, or hypofractionated, WBI is the preferred form of radiotherapy for breast cancer, regardless of a patient’s age, tumor stage, or whether the patient has received chemotherapy. The guideline replaces an ASTRO guideline published in 2011, which recommended hypofractionated WBI for selected patients: primarily older patients and those with less advanced disease.”

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Neoadjuvant Endocrine Therapy Ideal for Some Breast Cancer Patients

Excerpt:

“Endocrine therapy can achieve tumor reduction for patients with ER-positive breast cancer, possibly avoiding the need for chemotherapy or even surgery in some patients; however, deciding how long to continue this therapy can be tricky, said Hyman B. Muss, MD, who presented at the 2018 Miami Breast Cancer Conference.

” ‘It can improve the probability of breast preservation for women who would appropriately fit in [related] studies and don’t have very high-grade or aggressive tumors,’ said Muss, of the Lineberger Comprehensive Cancer Center, University of North Carolina, and a 2017 Giants of Cancer Care® winner. ‘The optimal duration is 3 to 6 months. I think it’s [also] worth considering this in postmenopausal women with larger tumors.’ ”

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Shorter Course of Treatment May Provide Better Outcome for Intermediate-Risk Prostate Cancer

Excerpt:

“Prostate cancer is the most common cancer among males in the United States. Approximately, 180,000 men are diagnosed each year, and approximately 95 percent of these men have localized disease that is potentially curable. Previously, studies have consistently demonstrated that conventionally fractionated high dose external beam radiation therapy (CRT), consisting of daily treatment for two months, decreases prostate cancer recurrence, and improves metastasis-free survival. Previous studies also demonstrate that moderate hypo-fractionated radiation therapy (HRT), consisting of daily treatment for one month using a larger dose per treatment, provides a similar low risk of recurrence, and may even be lower with HRT than CRT.”

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Intermittent Extended Letrozole Fails in Postmenopausal Breast Cancer

Excerpt:

“An intermittent dosing schedule with extended adjuvant letrozole did not improve disease-free survival (DFS) over continuous treatment with the agent in postmenopausal women with hormone receptor–positive breast cancer, according to the randomized phase III SOLE trial.

” ‘The magnitude of the beneficial effect of 5 years of extended letrozole use in postmenopausal women who have previously received an aromatase inhibitor for 5 years is low,’ wrote study authors led by Marco Colleoni, MD, of the European Institute of Oncology in Milan, Italy. That small effect may be partially due to acquired resistance, and animal studies suggest that such resistance can be reversed by discontinuing treatment.”

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New Study Provides BRCA Mutation Carriers Guidance for When Surgery Has Greatest Impact

Excerpt:

“Of the women who carry the mutated BRCA1/2 genes, 45-65 percent will develop breast cancer, and 15-39 percent will develop ovarian cancer in their lifetimes. Many women, especially those who have experienced the death of family members to these cancers, elect to undergo preventive surgeries that can significantly increase life expectancy, but require extensive recovery time and can impact later fertility and quality-of-life. However, few guidelines exist that shed light on the optimal age to undergo these procedures, and in what sequence. A new study in the INFORMS journal Decision Analysis provides insight to help enable physicians and patients make better-informed choices.

“The study, ‘Was Angelina Jolie Right? Optimizing Cancer Prevention Strategies Among BRCA Mutation Carriers,’ was conducted by Eike Nohdurft and Stefan Spinler of the Otto Beisheim School of Management, and Elisa Long, of the UCLA Anderson School of Management.”

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Radiation Prior to Surgery Reduces Risk of Secondary Tumors in Early-Stage Breast Cancer

Excerpt:

“Moffitt Cancer Center researchers launched a first of its kind study comparing the long-term benefits of radiation therapy in women with breast cancer either before surgery (neoadjuvant) or after surgery (adjuvant). Their study, published in the June 30 issue of Breast Cancer Research, found that patients who have neoadjuvant radiation therapy have a significantly lower risk of developing a second primary tumor at any site.

“The majority of patients who have early stage breast cancer have surgery to remove their tumor or a complete mastectomy. Surgery is commonly followed by radiation therapy, which has been shown to increase relapse-free survival. However, in some cases, patients may require neoadjuvant radiation therapy to decrease the size of the tumor before surgery. Currently, there are no studies that have analyzed the long-term effects of neoadjuvant radiation therapy on breast cancer patients.”

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