Cellular Immunotherapy in Lymphoma: Beyond CART Cells
Opinion statementCellular immunotherapy has been rapidly evolving and increasingly utilized in the management of relapsed and refractory lymphoma. CD19-specific chimeric antigen receptor T cells (CARTs) have achieved impressive results in pivotal clinical trials. Although CART development continues, these products have fundamental limitations that may make them less desirable in particular settings. For example, CARTs can only target cell surface antigens and thus are incapable of targeting intracellular tumor-associated proteins. In contrast to CARTs, conventional T cell receptors (TCR) allow T cells to target any cellula...
Source: Current Treatment Options in Oncology - February 11, 2020 Category: Cancer & Oncology Source Type: research

Evolving Definitions of Palliative Care: Upstream Migration or Confusion?
Opinion statementPalliative care has evolved over the decades from its roots in the hospice movement to a much wider approach in which early intervention further “upstream” in the illness is encouraged to improve quality of life for patients and their families. This new definition has a strong evidence base in cancer trials and is supported by major national and international organizations. However, it has proven difficult to convince patients, the publi c, and even healthcare providers, of this upstream migration of palliative care, with many continuing to associate palliative care exclusively with end-of-life...
Source: Current Treatment Options in Oncology - February 11, 2020 Category: Cancer & Oncology Source Type: research

Detection of Gene Mutations in Liquid Biopsy of Melanoma Patients: Overview and Future Perspectives
Opinion statementLiquid biopsies are still far from widely implanted in the clinical arena. Issues related to the added sensitivity of this test beyond conventional methods have not been fully resolved. Additionally, issues related to the specificity of these results especially as many cancers may share common mutation need further investigations. One way to resolve this may include the development and testing of large gene panels to add higher specificity. On the other hand, further studies are needed to support the idea that ctDNA or circulating tumor cells may constitute a better representation of the tumor subpopulatio...
Source: Current Treatment Options in Oncology - February 11, 2020 Category: Cancer & Oncology Source Type: research

Emerging Therapies for Radioactive Iodine Refractory Thyroid Cancer
Opinion statementThe landscape of treatment options for radioactive iodine refractory thyroid cancer is rapidly changing. While there are no curative options in this setting, tyrosine kinase inhibitors (TKIs) have revolutionized the management of radioiodine refractory disease to help delay progression of metastatic and life-threatening disease. Ongoing development of more selective targeted inhibitors will certainly improve medication tolerability and tumor specificity. In this review, we discuss the epidemiology of radioactive iodine refractory thyroid cancer and examine the definition of radioactive iodine refractory di...
Source: Current Treatment Options in Oncology - February 11, 2020 Category: Cancer & Oncology Source Type: research

Neoadjuvant Immunotherapy for Locally Advanced Melanoma
Opinion statementPatients with clinical stage III melanoma, defined as palpable lymph nodes with or without in-transit metastases, have poor prognosis even with recent advances with targeted and checkpoint inhibitor therapy in the adjuvant setting. Neoadjuvant therapy for clinical stage III melanoma is an attractive treatment paradigm as patient outcomes may be improved by earlier introduction to systemic therapy. Additionally, preoperative therapy that shrinks disease has the potential to improve surgical morbidity. Neoadjuvant therapy also provides for pathologic response assessment which can serve as a way to stratify p...
Source: Current Treatment Options in Oncology - February 5, 2020 Category: Cancer & Oncology Source Type: research

Extremity Soft Tissue Sarcoma: Role of Local Control
Opinion statementFor localized extremity soft tissue sarcoma (eSTS), treatment is individualized and each patient needs to be evaluated by a multidisciplinary team at a referral sarcoma center specialized in the care of sarcoma. For a majority of patients, treatment for eSTS involves limb-salvage surgery, with or without the addition of radiation therapy. Surgery should only be performed by surgeons specifically fellowship trained in the resection of eSTS. Surgery alone may be considered for small, low-grade, and superficial tumors as long a wide ( ≥ 2 cm) margin can be achieved. In cases where a less than w...
Source: Current Treatment Options in Oncology - February 5, 2020 Category: Cancer & Oncology Source Type: research

Dedifferentiated Liposarcoma: Systemic Therapy Options
Opinion statementOver the last several years, the systemic treatment landscape for dedifferentiated liposarcoma (DDLPS) has notably expanded. Historically, systemic therapy options have been limited to cytotoxic chemotherapy agents, including doxorubicin, ifosfamide, gemcitabine, and docetaxel, that were shown to have efficacy in unselected populations of patients with soft tissue sarcomas. More recently, however, there have been phase II and III trials establishing clinical benefit of the cytotoxic agents trabectedin and eribulin along with the tyrosine kinase inhibitor pazopanib in patients with advanced liposarcoma and ...
Source: Current Treatment Options in Oncology - February 5, 2020 Category: Cancer & Oncology Source Type: research

Cancer-Related Fatigue: Causes and Current Treatment Options
Opinion statementCancer-related fatigue (CRF) is a problem for a significant proportion of cancer survivors during and after active cancer treatment. However, CRF is underdiagnosed and undertreated. Interventions are available for CRF although there is no gold standard. Based on current level of evidence, exercise seems to be most effective in preventing or ameliorating CRF during the active- and posttreatment phases. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - February 5, 2020 Category: Cancer & Oncology Source Type: research

Chimeric Antigen Receptor T Cell Therapy for Acute Lymphoblastic Leukemia
Opinion statementChimeric receptor antigen (CAR) T cells are an innovative cellular immunotherapeutic approach that involves genetic modification of T cells to express CAR targeting tumor antigen. Prior to the development of CAR-T, the only potential cure for patients with relapsed or refractory (RR) acute lymphoblastic leukemia (ALL) was allogeneic hematopoietic stem cell transplantation (HSCT). Several CAR-T cell products have been studied in prospective clinical trials which ultimately have resulted in the approval of one anti-CD19 CAR-T cell product in pediatric RR ALL: tisagenlecleucel (CD3 ζ and 41BB). While som...
Source: Current Treatment Options in Oncology - February 5, 2020 Category: Cancer & Oncology Source Type: research

How Effective Is Palliative Care in Improving Patient Outcomes?
Opinion statementAs palliative care (PC) continues its rapid growth, an emerging body of evidence is demonstrating that its approach of interdisciplinary supportive care benefits many patient populations, including in the oncology setting. As studies and data proliferate, however, questions persist about who, what, why, when, and how PC as well as the ideal time for a PC consult and length of involvement. When comparing outcomes from chemotherapy trials, it is important to consider the dosing regimens used in the various studies. In the same way, it is important to account for the “dose” of the PC interventions...
Source: Current Treatment Options in Oncology - February 5, 2020 Category: Cancer & Oncology Source Type: research

Patient Spirituality as a Component of Supportive Care: Assessment and Intervention
Opinion statementNational supportive care guidelines for patients with cancer include recognition of patients ’ spirituality and spiritual needs. Experts differ on how best to address this dimension to our patients’ lives. Some suggest that patients’ medical team should take on spiritual care, and others suggest referral to chaplains or collaboration with outside clergy. In our view, the patient’s m edical team ought to best acknowledge patient spirituality when so desired by the patient, but intervention in the case of serious spiritual crisis ought to be the responsibility of those with specific t...
Source: Current Treatment Options in Oncology - February 5, 2020 Category: Cancer & Oncology Source Type: research

Nausea and Vomiting in Advanced Cancer
Opinion StatementNausea and vomiting is a common clinical issue in the advanced cancer patient. The etiology may be related to treatment (chemotherapy, radiation, surgery) or non-treatment clinical issues related to the advanced cancer. A very detailed initial assessment of nausea/vomiting is indicated including frequency, duration, intensity, associated activities, and the presence of anorexia or cachexia and is necessary in order to determine a specific etiology which may allow a potentially specific successful intervention. Various international antiemetic guidelines have been developed for the successful prevention of ...
Source: Current Treatment Options in Oncology - February 5, 2020 Category: Cancer & Oncology Source Type: research

Epidermal Growth Factor Receptor ’s Function in Cutaneous Squamous Cell Carcinoma and Its Role as a Therapeutic Target in the Age of Immunotherapies
Opinion statementRecent studies have evidenced the potential of combining anti-EGFR therapies with anti-PD-1/PD-L1 checkpoint therapies. Both anti-EGFR and anti-PD-1/PD-L1 have been separately tested in the treatment of cutaneous SCC (cSCC). Here, we review recent data on EGFR in the context of cancer progression, as a prognostic and as a therapeutic target in cSCC. Anti-EGFR/checkpoint immunotherapy and other combination therapy approaches are discussed. With the advent of immunotherapy, EGFR is still a valid cSCC target. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - February 3, 2020 Category: Cancer & Oncology Source Type: research

Use of Minimal Residual Disease in Acute Myeloid Leukemia Therapy
Opinion statementThe expanding availability of minimal or more precisely measurable residual disease (MRD) assessment in acute myeloid leukemia (AML) with its possible implications for therapeutic decisions is of high interest to clinicians treating AML patients. A variety of mostly retrospective studies have shown that AML patients with a positive MRD test, assessed by different techniques at defined cutoffs and time-points, are at significantly higher risk of relapse and experience shorter overall survival compared to MRD-negative patients. How this valuable information may be adapted in the daily routine of patients &rs...
Source: Current Treatment Options in Oncology - January 30, 2020 Category: Cancer & Oncology Source Type: research

Chemotherapy-Induced Sarcopenia
In conclusion, the treatment of both cancer- or chemotherapy-related sarcopenia represents a challenge for the modern oncologist who must be able to coordinate a new panel of specialists with the same skill necessary to decide the priority of different oncologic treatments within a complex multidisciplinary context. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - January 30, 2020 Category: Cancer & Oncology Source Type: research

Opioids in Cancer Development, Progression and Metastasis: Focus on Colorectal Cancer
Opinion statementSo far, opioids have been successfully used to reduce cancer pain in patients in order to improve their quality of life. However, the use of opioids leads to numerous side effects such as constipation, drowsiness, nausea, itching, increased sweating and hormonal changes. In this review, we described the action of opioids in several molecular pathways significant for maintenance of the intestinal homeostasis including the impact on the intestinal epithelium integrity, changes in microbiome composition, modulation of the immune system or induction of apoptosis and inhibition of angiogenesis. We summed up the...
Source: Current Treatment Options in Oncology - January 22, 2020 Category: Cancer & Oncology Source Type: research

Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill
Opinion statementPatients with advanced cancer and their families commonly seek information about prognosis to aid decision-making in medical (e.g. surrounding treatment), psychological (e.g. saying goodbye), and social (e.g. getting affairs in order) domains. Oncologists therefore have a responsibility to identify and address these requests by formulating and sensitively communicating information about prognosis. Current evidence suggests that clinician predictions are correlated with actual survival but tend to be overestimations. In an attempt to cultivate prognostic skills, it is recommended that clinicians practice fo...
Source: Current Treatment Options in Oncology - January 16, 2020 Category: Cancer & Oncology Source Type: research

Multimodal Therapy for Sinonasal Malignancies: Updates and Review of Current Treatment
Opinion statementSinonasal malignancies pose a significant challenge in management due to their low incidence, biologic diversity, and significant symptom burden. Even though surgery remains the primary therapeutic modality, a multi-modality approach has been shown to benefit a significant proportion of patients and its success depends largely on stage and histologic type. Non-surgical approaches such as novel radiation approaches as well as intensification with systemic therapy hold promise in altering the organ preservation rate as well as overall survival for patients. Practice changing randomized trials to test these n...
Source: Current Treatment Options in Oncology - January 16, 2020 Category: Cancer & Oncology Source Type: research

Current and Future Molecular Targets for Acute Myeloid Leukemia Therapy
Opinion statementAcute myeloid leukemia (AML) disease prognosis is poor and there is a high risk of chemo-resistant relapse for both young and old patients. Thus, there is a demand for alternative and target-specific drugs to improve the 5-year survival rate. Current treatment mainstays include chemotherapy, or mutation-specific targeting molecules including FLT3 inhibitors, IDH inhibitors, and monoclonal antibodies. Efforts to devise new, targeted therapy have included recent advances in methods for high-throughput genomic screening and the availability of computer-assisted techniques for the design of novel agents predic...
Source: Current Treatment Options in Oncology - January 13, 2020 Category: Cancer & Oncology Source Type: research

The Microbiota in Hematologic Malignancies
Opinion statementThere are approximately 1.2 million new hematologic malignancy cases resulting in ~  690,000 deaths each year worldwide, and hematologic malignancies remain the most commonly occurring cancer in children. Even though advances in anticancer treatment regimens in recent decades have considerably improved survival rates, their cytotoxic effects and the resulting long-term complicati ons pose a significant burden on the patients and the health care system. Therefore, non-toxic treatment modalities are needed to decrease side effects. The human body is the host to approximately 40 trillion microbes, know...
Source: Current Treatment Options in Oncology - January 11, 2020 Category: Cancer & Oncology Source Type: research

Locally Advanced Rectal Cancer: Treatment Approach in Elderly Patients
AbstractIndependently of age, evidence-based guidelines recommend a multidisciplinary treatment approach in patients with locally advanced rectal cancer (LARC). But actually, elderly patients are grossly underrepresented in clinical trials, accounting
Source: Current Treatment Options in Oncology - January 11, 2020 Category: Cancer & Oncology Source Type: research

Opioid-Induced Constipation in Oncological Patients: New Strategies of Management
This article will review prevalent, clinical presentation and recommendations for the treatment of OIC. An independent literature search was carried out by the authors. We reviewed the literature for randomized controlled trials that studied the efficacy of laxatives, naloxone, and naloxegol in treating OIC. Newer strategies addressing the causal pathophysiology of OIC are needed for a more effective assessment and management of OIC. Finally, traditional recommended therapies are appraised and compared with the latest pharmacological developments. Future research should address whether naloxegol is more efficacious by its ...
Source: Current Treatment Options in Oncology - December 19, 2019 Category: Cancer & Oncology Source Type: research

Marginal Zone Lymphoma: State-of-the-Art Treatment
Opinion statementDespite being the second most common indolent non-Hodgkin ’s lymphoma (iNHL), marginal zone lymphoma (MZL) remains largely understudied, and given its underlying disease heterogeneity, it is challenging to define a single treatment approach for these patients. For localized disease, local therapy is recommended such as triple therapy forH.pylori in gastric extranodal MZL, splenectomy for splenic MZL, and radiotherapy for nodal MZL. For disseminated disease with low tumor burden, a watch and wait or single-agent rituximab can be used. However, for symptomatic disease, a similar approach to follicular ...
Source: Current Treatment Options in Oncology - December 5, 2019 Category: Cancer & Oncology Source Type: research

Current Standards for Organ Preservation in Locoregionally Advanced Non-nasopharyngeal Head and Neck Cancer and Evolving Strategies for Favorable-Risk and Platinum-Ineligible Populations
Opinion statementStandard-of-care treatment for the majority of patients with locoregionally advanced squamous cell carcinoma of the head and neck (SCCHN) is either upfront surgery followed by adjuvant treatment as indicated by intraoperative or pathologic findings or concurrent chemoradiation reserving surgical salvage for non-responsive disease. An attempt at upfront complete resection should be pursued if feasible in patients with oral cavity or paranasal sinus primary tumors. Given multimodality treatment paradigms, patients with locoregionally advanced SCCHN should be managed in a multidisciplinary setting. Modern rad...
Source: Current Treatment Options in Oncology - December 4, 2019 Category: Cancer & Oncology Source Type: research

Current Advances and Future Perspectives of Cerebrospinal Fluid Biopsy in Midline Brain Malignancies
Opinion statementMalignancies arising in midline brain structures, including lymphomas, teratomas, germinomas, diffuse midline gliomas, and medulloblastomas typically respond to systemic therapies, and excessive surgical excision can result in serious complications, so that total surgical removal is not routinely performed. Identifying tumor specific biomarkers that can facilitate diagnosis at early stage and allow for dynamic surveillance of the tumor is of great clinical importance. However, existing standard methods for biopsy of these brain neoplasms are high risk, time consuming, and costly. Thus, less invasive and mo...
Source: Current Treatment Options in Oncology - November 29, 2019 Category: Cancer & Oncology Source Type: research

Diagnosis and Treatment of Breast Cancer in Young Women
Opinion statementDespite the increase of breast cancer incidence with age, approximately 7 to 10% ofwomen diagnosed with breast cancer are younger than the age 40. This subgroup ofpatients has different risk factors, tumour biology, clinical outcomes, and specific psy- chosocial issues, such as fertility preservation, family planning, and job reintegration. However, age alone should not be the main consideration when choosing the aggressive- ness of the treatment, as other factors must be considered, including the biologic aggressiveness of the tumour, potential long-term toxicities, and the preferences of the patient. Fer...
Source: Current Treatment Options in Oncology - November 27, 2019 Category: Cancer & Oncology Source Type: research

Systemic Therapies for Metastatic Pancreatic Neuroendocrine Tumors
Opinion statementOver the years, there have been significant advances in systemic treatments for metastatic pancreatic neuroendocrine tumors (panNETs). Despite these advancements, uncertainty remains regarding how to best sequence available therapies. For well-differentiated and metastatic panNETs that are somatostatin receptor (SSTR) avid on functional imaging, first-line therapy typically consists of somatostatin analogs (SSAs), given their favorable toxicity profile and overall low burden for patients. When progression of disease is observed on an SSA, multiple treatment options are available, including the targeted age...
Source: Current Treatment Options in Oncology - November 27, 2019 Category: Cancer & Oncology Source Type: research

Leukemic Non-nodal Mantle Cell Lymphoma: Diagnosis and Treatment
Opinion statementMantle cell lymphoma (MCL) encompasses nearly 6% of all the non-Hodgkin lymphomas. It is considered an incurable neoplastic process arising from B cells. The cytogenetic abnormality t(11;14) (q13; q32) leading to cyclin D1 overexpression is the sentinel genetic event and provides an exceptional marker for diagnosis. MCL is generally considered to have an aggressive course as compared with other indolent lymphomas with traditionally reported median survival of 3 –5 years. According to the 2016 WHO classification, there are two major known variants of MCL: classical which affects the lymph nodes a...
Source: Current Treatment Options in Oncology - November 27, 2019 Category: Cancer & Oncology Source Type: research

Sonic Hedgehog Pathway Inhibition in the Treatment of Advanced Basal Cell Carcinoma
Opinion statementAdvanced basal cell carcinoma (BCC) represents a small proportion of BCCs that are not amenable to standard therapies due to lack of efficacy, high recurrence risk, and excessive morbidity. Implication of the Sonic hedgehog (Shh) pathway in the development of BCC has led to the development of systemic Shh pathway inhibitors, providing patients with advanced BCCs new treatment options and improved survival. There are currently two Food and Drug Administration (FDA) –approved Shh inhibitors, vismodegib and sonidegib, for advanced basal cell carcinomas. Vismodegib has approval for locally advanced BCCs ...
Source: Current Treatment Options in Oncology - November 26, 2019 Category: Cancer & Oncology Source Type: research

Anti-programmed Death-1 Immunotherapy for Endometrial Cancer with Microsatellite Instability –High Tumors
Opinion statementAmong gynecologic malignancies, mismatch repair –deficient endometrial cancers show the greatest response to anti-programmed cell death-1 (PD-1) antibodies, such as pembrolizumab. Routine immunohistochemical (IHC) and molecular testing should be performed on all endometrial cancers at the time of diagnosis in order to identify endometrial cance rs with mismatch repair deficiency that may show improved response to anti-PD-1 therapy in the progressive or metastatic setting. Institutional effort to enroll patients in clinical trials investigating the use of immune checkpoint inhibitors in endometrial ca...
Source: Current Treatment Options in Oncology - November 21, 2019 Category: Cancer & Oncology Source Type: research

Targeted Therapies for Triple-Negative Breast Cancer
Opinion statementTriple-negative breast cancer (TNBC) is a particularly aggressive subtype of breast cancer. TNBC is a heterogenous subtype of breast cancer that is beginning to be refined by its molecular characteristics and clinical response to a targeted therapeutic approach. Until recently the backbone of therapy against TNBC has been cytotoxic chemotherapy. However, the breast oncology community is now seeing encouraging clinical activity from molecularly targeted approaches to TNBC. Recently, we have seen 3 newly approved targeted therapies for TNBC, including the PARP inhibitors olaparib and talazoparib for germline...
Source: Current Treatment Options in Oncology - November 21, 2019 Category: Cancer & Oncology Source Type: research

Management of V600E and V600K BRAF -Mutant Melanoma
Opinion statementThe optimal management of advanced stageBRAF-mutated melanoma is widely debated and complicated by the availability of several different regimens that significantly improve outcomes but have not been directly compared. While there are many unanswered questions relevant to this patient population, the major uncertainty in current practice is the choice between BRAF/MEK inhibitors or immunotherapy for those with previously untreated metastatic or high-risk disease. Decisions regarding first line therapy should include consideration of patient preference as well as the presence of symptomatic metastatic disea...
Source: Current Treatment Options in Oncology - November 18, 2019 Category: Cancer & Oncology Source Type: research

Survivorship and Caregiver Issues in Neuro-oncology
Opinion statementAs cancer care has evolved so has the awareness of the issues cancer patients, their caregivers and families face during and after treatment, giving rise to the cancer survivorship care initiative. The body of research pertaining to quality of life, health-related quality of life, and multidimensional symptom burden of neuro-oncology patients and their caregivers has grown significantly, yielding a wealth of data and information indicating interventions and actions targeting symptoms and needs are both warranted and desired. The provision of survivorship care aiming to deliver care in a patient-centered, w...
Source: Current Treatment Options in Oncology - November 13, 2019 Category: Cancer & Oncology Source Type: research

Diagnosis and Treatment of ALK Aberrations in Metastatic NSCLC
Opinion statementThere has been rapid progress in the use of targeted therapies for ALK-positive which has led to improve dramatically PFS and OS in the metastatic ALK-rearranged NSCLC patients. There are several molecules now available (crizotinib, ceritinib, brigatinib, alectinib, and lorlatinib) and others in development. Such an improvement in treatment efficacy has even more highlighted the importance of an adequate identification of ALK alterations. Efficient and easily accessible testing tools are required to identify eligible patients in a timely fashion. Different methods for detecting ALK+ NSCLC patients are now ...
Source: Current Treatment Options in Oncology - September 4, 2019 Category: Cancer & Oncology Source Type: research

Molecular Imaging and Therapy for Neuroendocrine Tumors
Opinion statementNeuroendocrine tumors (NETs) are relatively rare, with 12,000 –15,000 new cases diagnosed annually in the USA. Although NETs are a diverse group of neoplasms, they share common molecular targets that can be exploited using nuclear medicine techniques for both imaging and therapy. NETs have traditionally been imaged with SPECT imaging using111In-labeled octreotide analogs to detect neoplasms with somatostatin receptors. In addition, certain NETs (pheochromocytomas, paragangliomas, and neuroblastomas) are also effectively imaged using123I- or131I-labeled metaiodobenzylguanidine (MIBG), an analog of gua...
Source: Current Treatment Options in Oncology - August 29, 2019 Category: Cancer & Oncology Source Type: research

Peptide Receptor Radiotherapy: Current Approaches and Future Directions
Opinion statementNeuroendocrine neoplasia (NEN) represents a heterogenous group of tumours. Guidelines regarding treatment choice and sequencing remain complex given varied primary sites, hormone-secretory status, tumour grade, disease heterogeneity, and paucity of rigorous comparative trials due to rarity of this condition. However, there is increasing evidence that peptide receptor radionuclide therapy (PRRT) is an effective treatment, especially for grade 1 and 2 NEN. Primary indications for treatment include oncologic control in patients with progressive disease and symptomatic control in the context of hormone-secreto...
Source: Current Treatment Options in Oncology - August 29, 2019 Category: Cancer & Oncology Source Type: research

Correction to: Sentinel Lymph Node Biopsy and Completion Lymph Node Dissection for Melanoma
The original version of this article, which published inCurrent Treatment Options in Oncology, Volume 19, Issue 11, November 2018, contained an error within the Conflict of Interest statements. It was originally stated that “Norma E. Farrow received support from an NIH T32 grant (T32-CA009111.” (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - August 29, 2019 Category: Cancer & Oncology Source Type: research

Immunotherapy: Checkpoint Inhibitors in Lynch-Associated Gynecologic Cancers
Opinion statementResearch into novel therapies for gynecologic cancers is underfunded, and as a result, we are still playing catchup with other solid tumors in the realm of immune checkpoint inhibition. This is despite the fact that two of the most common gynecologic cancers in the USA have strong biologic rationales for response to these agents. Work is now underway to demonstrate safe and effective therapies for our patients. As we better understand the immune system, and more specifically the tumor microenvironment, we will be able to achieve complete responses. The immune system can learn, adapt, and provide ongoing su...
Source: Current Treatment Options in Oncology - August 23, 2019 Category: Cancer & Oncology Source Type: research

Management of Well-Differentiated High-Grade (G3) Neuroendocrine Tumors
Opinion statementIn 2017, the World Health Organization (WHO) classification for pancreatic NET was updated to include a new category of well-differentiated high-grade (Ki 67> 20%) pancreatic tumors (NET G3), distinct from high-grade poorly differentiated neuroendocrine carcinoma (NEC). NET G3 are considered a molecularly, radiologically, and prognostically distinct entity compared to NEC and NET G1/G2. The optimal first-line management in NET G3 and sequencing therapies remains a challenge awaiting future trials taking into consideration the unique characteristics of this category. In this review, we aim to summarize t...
Source: Current Treatment Options in Oncology - August 19, 2019 Category: Cancer & Oncology Source Type: research

Advanced Imaging Modalities to Monitor for Cardiotoxicity
Opinion statementEarly detection and treatment of cardiotoxicity from cancer therapies is key to preventing a rise in adverse cardiovascular outcomes in cancer patients. Over-diagnosis of cardiotoxicity in this context is however equally hazardous, leading to patients receiving suboptimal cancer treatment, thereby impacting cancer outcomes. Accurate screening therefore depends on the widespread availability of sensitive and reproducible biomarkers of cardiotoxicity, which can clearly discriminate early disease. Blood biomarkers are limited in cardiovascular disease and clinicians generally still use generic screening with ...
Source: Current Treatment Options in Oncology - August 8, 2019 Category: Cancer & Oncology Source Type: research

The Role of Cytotoxic Chemotherapy in Well-Differentiated Gastroenteropancreatic and Lung Neuroendocrine Tumors
Opinion StatementThe treatment landscape of well-differentiated neuroendocrine tumors (NETs) has considerably expanded in recent years, and both somatostatin analogs, radiolabeled somatostatin analogs, everolimus, and sunitinib have been incorporated within the therapeutic armamentarium against these malignancies. Even in the context of multiple treatment options available, cytotoxic chemotherapy plays a pivotal role in the management of pancreatic NETs (panNETs), while its activity in midgut carcinoids and lung NETs is still debated. High response rates, ranging from 30 to 70%, have been consistently reported in studies o...
Source: Current Treatment Options in Oncology - July 25, 2019 Category: Cancer & Oncology Source Type: research

A Second Course of Radiotherapy in Patients with Recurrent Malignant Gliomas: Clinical Data on Re-irradiation, Prognostic Factors, and Usefulness of Digital Biomarkers
Opinion StatementThe treatment of malignant gliomas has undergone a significant intensification during the past decade, and the interdisciplinary treatment team has learned that all treatment opportunities, including surgery and radiotherapy (RT), also have a central role in recurrent gliomas. Throughout the decades, re-irradiation (re-RT) has achieved a prominent place in the treatment of recurrent gliomas. A solid body of evidence supports the safety and efficacy of re-RT, especially when modern techniques are used, and justifies the early use of this regimen, especially in the case when macroscopic disease is present. A...
Source: Current Treatment Options in Oncology - July 19, 2019 Category: Cancer & Oncology Source Type: research

Management of Metastatic Hormone-Sensitive Prostate Cancer (mHSPC): an Evolving Treatment Paradigm
Opinion statementCombination systemic therapy is now standard of care for all men with metastatic, hormone-sensitive prostate cancer (mHSPC). Patients with mHSPC should be treated with standard androgen deprivation therapy (ADT) and abiraterone acetate with prednisone or docetaxel (chemohormoanl therapy) unless there are contraindications to combination therapy. Based on the Chemohormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer (CHAARTED) study subgroup analysis, chemohormonal therapy may be most beneficial in men with high-volume disease burden, as men with low-volume met...
Source: Current Treatment Options in Oncology - July 9, 2019 Category: Cancer & Oncology Source Type: research

Carcinoid Syndrome: Updates and Review of Current Therapy
Opinion statementCarcinoid syndrome (CS) is a complex disorder caused by functional neuroendocrine tumors (NETs). This debilitating disease is characterized by hyper-secretion of biologically active substances eliciting major hormonal symptoms burden and fibrotic changes that are often challenging for management. There have been a number of insights that have substantially advanced treatments since the introduction of somatostatin analogs (SSAs). Second-line treatments are needed in a substantial proportion of patients with advanced disease that have uncontrolled hormone secretion on the highest labeled doses of SSAs. Inte...
Source: Current Treatment Options in Oncology - July 9, 2019 Category: Cancer & Oncology Source Type: research

Emerging Role of Genomics and Cell-Free DNA in Breast Cancer
Opinion statementPrecision Medicine is gaining momentum as the future gold standard healthcare strategy as it enables treatment optimization and consequently a potential improvement for quality of life and survival. This paradigm shift was possible thanks to new high-throughput genomics technologies, which provide prognostic and predictive information on tumor biology and potential treatment options, as standard pathological procedures are unable to capture both spatial and temporal tumor heterogeneity. As a result of decreasing costs, both solid and liquid-based genomics have an increasingly important role in clinical tri...
Source: Current Treatment Options in Oncology - June 29, 2019 Category: Cancer & Oncology Source Type: research

Role of Targeted Therapies in Management of Metastatic Urothelial Cancer in the Era of Immunotherapy
Opinion statementDespite significant advances and the approval of immune checkpoint inhibitors, metastatic urothelial carcinoma (mUC) is still very hard to treat and has poor outcomes. Deeper understanding of the molecular underpinnings of mUC has identified potential biomarkers, biologic drivers, and relevant therapy targets. However, targeted therapies in mUC have had significant challenges due to molecular heterogeneity, clonal evolution, and genomic instability, and have not improved outcomes so far. Despite that, recent technological developments, clinical utilization of molecular biology, and discovery of new agents ...
Source: Current Treatment Options in Oncology - June 28, 2019 Category: Cancer & Oncology Source Type: research

Cardiac Tumors: Clinical Presentation, Diagnosis, and Management
Opinion statementCardiac masses and tumors are a heterogenous group of disorders and include primary tumors (both benign and malignant), metastatic disease, and numerous masquerades such as thrombus. Clinical presentation ranges from incidental discovery on imaging tests ordered for other reasons to life-threatening presentations such as cardiac tamponade, arrhythmia, obstruction, and systemic embolization. Of the available imaging modalities, cardiac MRI is generally the most useful for assessment and helps to delineate the relevant anatomy. Due to the technical difficulties and risk of biopsy of cardiac masses, a presump...
Source: Current Treatment Options in Oncology - June 27, 2019 Category: Cancer & Oncology Source Type: research

Approach to the Patient with Recurrent/Metastatic Disease
Opinion statementFor most of patients with a recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC), the treatment remains palliative: The main objective is to reduce the symptoms related to the locoregional relapse, prolong life while maintaining quality of life, which is a big challenge. The systemic treatment needs to be adapted to the performance status, comorbidities, and sequelae of patients. For fit patients, the combination of platinum-based chemotherapy and cetuximab (EXTREME) is the standard of care in first-line treatment since 2008, as no other targeted therapy has been approved in this settin...
Source: Current Treatment Options in Oncology - June 25, 2019 Category: Cancer & Oncology Source Type: research

Updates on Management of Adult Medulloblastoma
Opinion statementMedulloblastoma (MB) is a malignant embryonal tumor of the posterior fossa and is the most common type of brain cancer in pediatric patients. In contrast, adult MB is very rare with an incidence of 0.6 per million per year and mostly affects young adults below the age of 40. Recent molecular analyses of pediatric and adult MB have classified these tumors into at least four individual molecular subgroups (SHH, WNT, group 3, and group 4) with distinct demographics, histology, and prognosis. The discrete biological composition of these tumors likely explains the marked heterogeneity in responses seen to conve...
Source: Current Treatment Options in Oncology - June 24, 2019 Category: Cancer & Oncology Source Type: research

Adjuvant Therapy for Melanoma
Opinion statementIn recent years, the number of patients with malignant melanoma has continued to increase globally; surgery remains the first treatment option for patients with resectable melanoma. Adjuvant therapy for patients with stage III and IV melanoma following surgical resection has gradually been approved. After complete resection, these patients can probably derive significant benefit from adjuvant therapy. New treatments that improve the long-term survival of patients with unresectable advanced or metastatic melanoma are currently under evaluation in adjuvant therapy to increase relapse-free survival and overal...
Source: Current Treatment Options in Oncology - June 24, 2019 Category: Cancer & Oncology Source Type: research