Epidemiology of Head and Neck Squamous Cell Carcinomas: Impact on Staging and Prevention Strategies
Opinion statementThe epidemiology of head and neck squamous cell carcinoma (HNSCC) has shifted dramatically over the last 50  years, as smoking-related HNSCCs decrease in incidence while human papillomavirus (HPV)-related cancers rise. The shift in HNSCC risk factors has changed patient demographics, the distribution of affected anatomical subsites, and prognosis of this illness. As such, the medical community has respon ded by devising novel staging systems and prevention strategies. The medical community will require continued vigilance in reducing HNSCC traditional risks factors for HNSCC, such as cigarette use, an...
Source: Current Treatment Options in Oncology - April 22, 2019 Category: Cancer & Oncology Source Type: research

Treatment of Radiation-Induced Cognitive Decline in Adult Brain Tumor Patients
Opinion statementPatients with either primary or metastatic brain tumors quite often have cognitive impairment. Maintaining cognitive function is important to brain tumor patients and a decline in cognitive function is generally accompanied by a decline in functional independence and performance status. Cognitive decline can be a result of tumor progression, depression/anxiety, fatigue/sleep dysfunction, or the treatments they have received. It is our opinion that providers treating brain tumor patients should obtain pre-treatment and serial cognitive testing in their patients and offer mitigating and therapeutic intervent...
Source: Current Treatment Options in Oncology - April 8, 2019 Category: Cancer & Oncology Source Type: research

Survivorship Guidance for Patients with Colorectal Cancer
Opinion statementEffective therapy for treatment of colorectal cancer includes comprehensive and evidence-based therapies that may include a combination of surgery, chemotherapy, targeted therapy, and/or radiation. However, in order to provide patients with the highest quality of care, providers must consider all aspects of survivorship care including: surveillance for recurrence/second primaries, genetic counseling, psychosocial/physical late effects of cancer and its therapies, and preventative lifestyle strategies. Health systems, providers, and researchers need to identify systematic methods of addressing the unique ne...
Source: Current Treatment Options in Oncology - April 1, 2019 Category: Cancer & Oncology Source Type: research

Opioid Prescribing in an Opioid Crisis: What Basic Skills Should an Oncologist Have Regarding Opioid Therapy?
Opinion statementAlthough clinical evidence supports the use of opioids for cancer-related pain, doing so amidst the current opioid crisis remains a challenge. A proportion of opioid-related deaths in the USA are attributable to prescription opioids, which implicates health care providers as one of the major contributors. It is therefore even more important now for all clinicians to follow safe and effective opioid prescribing practices. Oncologists are often in the frontline of cancer pain management. They are encouraged to use validated tools to screen all patients receiving opioids for high risk behaviors. Those identif...
Source: Current Treatment Options in Oncology - April 1, 2019 Category: Cancer & Oncology Source Type: research

The Changing Landscape of Management of Metastatic Renal Cell Carcinoma: Current Treatment Options and Future Directions
Opinion statementFor the practicing clinician, the dilemma becomes how most appropriate to sequence the aforementioned regimens. It is challenging to be dogmatic, as there are no comparative studies juxtaposing novel front-line options directly —all of the available studies utilize a comparator arm of sunitinib. With this in mind, the selection of front-line therapy with a patient with mRCC should involve a thorough discussion of both efficacy and safety of available options. The oncologist must also weigh their ability to manage complex immune-related adverse events that can emerge from checkpoint inhibitors, partic...
Source: Current Treatment Options in Oncology - April 1, 2019 Category: Cancer & Oncology Source Type: research

Optimal Management of Upper Tract Urothelial Carcinoma: an Unmet Need
Opinion statementUpper tract urothelial carcinoma (UTUC) is a rare genitourinary entity of the renal pelvis and the ureter characterized by a more aggressive disease phenotype when compared with urothelial carcinoma of the bladder (UCB) with more than half of UTUC cases presenting with invasive disease at diagnosis compared to 20% for bladder tumors. There is growing evidence suggesting that its distinct natural history from that of bladder cancer can be related to several genetic and epigenetic differences. Treatment of low-risk disease consists of kidney-sparing surgeries such as ureteroscopic and percutaneous treatments...
Source: Current Treatment Options in Oncology - April 1, 2019 Category: Cancer & Oncology Source Type: research

Antibody-Drug Conjugates in Breast Cancer: a Comprehensive Review
Opinion StatementAntibody-drug conjugates are an elegant approach to cancer treatment that couples the specificity of monoclonal antibodies to the cytotoxicity of classic chemotherapy agents, permitting, at least in theory, increased activity and reduced toxicity. In breast cancer, the early success of trastuzumab-emtansine (T-DM1) in the HER2-positive metastatic setting led to great hopes, later dashed by results in the early setting (KRISTINE trial) and in combination with pertuzumab (MARIANNE trial). Parallel to this, development of ADCs in breast cancer has suffered other setbacks, including the recent failure of other...
Source: Current Treatment Options in Oncology - April 1, 2019 Category: Cancer & Oncology Source Type: research

Surgical Options for Locally Advanced Oropharyngeal Cancer
Opinion statementOropharyngeal squamous cell carcinoma (OPSCC) incidence rates have been steadily increasing over the past several decades, and this has been largely attributed to human papillomavirus (HPV)-related OPSCC. The rise of HPV-related OPSCC and the observed distinct survival advantage it offers compared to HPV-unrelated OPSCC have resulted in the development of a new staging system specifically for OPSCC in the eighth edition of the AJCC Staging Manual for head and neck cancer. The observations on HPV-related OPSCC and its prognostic implications have coincided with increasing utilization of transoral surgical a...
Source: Current Treatment Options in Oncology - April 1, 2019 Category: Cancer & Oncology Source Type: research

Checkpoint Blockade Strategies in the Treatment of Breast Cancer: Where We Are and Where We Are Heading
Opinion StatementImmunotherapy has become one of the greatest advances in medical oncology over the last century; however, the optimal application for the treatment of breast cancer remains an active area of investigation. Modern immunotherapy strategies augment the immune system and ideally, permit durable tumor-specific immune memory. In fact, several monoclonal antibodies that mediate the immune checkpoint receptors have provided the most clinically meaningful improvement for breast cancer patients to date, particularly for the triple negative subtype. Checkpoint blockade as monotherapy has demonstrated some encouraging...
Source: Current Treatment Options in Oncology - March 28, 2019 Category: Cancer & Oncology Source Type: research

Symptoms of and Palliative Treatment for Unresectable Skin Cancer
Opinion statementThe symptom prevalence in patients with advanced cancer depends on the type of primary cancer, and the palliative treatment varies according to the nature of the primary cancer. Palliative treatment for unresectable skin cancer has not been fully discussed. Patients with unresectable skin cancer sometimes show the primary lesion in the skin and metastases to the lung, skin, liver, and bone. Pain, anorexia, and dyspnea commonly occur in such patients, and bleeding, exudate, and offensive odor are characteristically observed. For the last three symptoms, surgery and radiation are effective therapeutic option...
Source: Current Treatment Options in Oncology - March 27, 2019 Category: Cancer & Oncology Source Type: research

The Need to Prioritize and Re-prioritize Palliative Care Options: Smoking Cessation as a Case-in-Point
Opinion statementPalliative care in cancer patients requires a continuous reprioritization of effort. This review describes the need for this reprioritization and uses smoking cessation as a case-in-point. The treatment of patients with metastatic non-small cell lung cancer has changed dramatically in the past few years. Interestingly, patients who had previously smoked now have an improved prognosis —for a variety of reasons. This review discusses this last observation in detail and raises the question of how forcefully we should advise smoking cessation in patients with incurable metastatic non-small cell lung canc...
Source: Current Treatment Options in Oncology - March 22, 2019 Category: Cancer & Oncology Source Type: research

Immunotherapy Approaches Beyond PD-1 Inhibition: the Future of Cellular Therapy for Head and Neck Squamous Cell Carcinoma
Opinion statementIn a span of a few years, the surprising early successes of programmed cell death 1 (PD-1) inhibitors across a vast range of tumor types have transformed our understanding of cancer immunogenicity and provided proof of principle that T cells, if manipulated, can mediate meaningful tumor regression. In head and neck cancer, only a minority of patients respond to PD-1 therapy, but these small outcomes have fueled the enthusiasm for the next generation of immunotherapy —adoptive cell therapy—which employs recent advances in genetic engineering and cell culturing methods to generate T cells with en...
Source: Current Treatment Options in Oncology - March 14, 2019 Category: Cancer & Oncology Source Type: research

Role of Bisphosphonates in Breast Cancer Therapy
Opinion statementBisphosphonates are utilized routinely in breast cancer. In metastatic disease with bone involvement, bisphosphonates prevent or delay skeletal-related events and can improve pain control. Different agents have shown benefit compared with placebo or no treatment. While in unselected patients, comparison between zoledronic acid and pamidronate did not show a significant difference, exploratory analyses showed that in patients with osteolytic lesions or hypercalcemia, zoledronic acid is superior to pamidronate. De-escalating treatment with zoledronic acid from every 4 to every 12  weeks has been shown t...
Source: Current Treatment Options in Oncology - March 14, 2019 Category: Cancer & Oncology Source Type: research

Current Update on the Molecular Biology of Cutaneous Sarcoma: Dermatofibrosarcoma Protuberans
Opinion statementCutaneous sarcoma is a group of malignant mesenchymal tumors primarily involving the dermis, and it is characterized by extreme clinicopathological heterogeneity. Although its occurrence rate is rare, dermatofibrosarcoma protuberans (DFSP) is one of the most common types of dermal sarcoma. DFSP grows slowly and tends to relapse locally after inadequate resection. There are various histological variants of DFSP tumors and it often mimics benign lesions such as dermatofibroma and scar, which make accurate diagnosis difficult and delayed, and some cases progress to the stage where the tumor is unresectable. R...
Source: Current Treatment Options in Oncology - March 14, 2019 Category: Cancer & Oncology Source Type: research

Controversies in the Therapy of Low-Grade Gliomas
Opinion statementIn the context of the new WHO classification system, all low-grade gliomas must have an IDH mutation, with or without 1p/19q codeletion. Upon discovery of the tumor, maximal safe surgical resection is the most appropriate first step due to the current inability to differentiate between IDH mutant and IDH wild –type tumors by imaging alone. In the postoperative setting, based on the synthesis and interpretation of the available data, we recommend utilizing conventional radiation therapy and PCV in all high-risk–low-grade gliomas. For patients felt to be in a low risk category, we recommend maint...
Source: Current Treatment Options in Oncology - March 14, 2019 Category: Cancer & Oncology Source Type: research

Clinical Use of Measurable Residual Disease in Acute Myeloid Leukemia
In conclusion, MRD testing during treatment is a superb prognosticator and a major tool when choosing whether a patient should be transplanted or not. The exact use of MRD testing after treatment is less well defined but evidence is mounting for the instigation of treatment upon rising MRD levels (pre-emptive treatment) before morphologically detectable relapse. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - March 14, 2019 Category: Cancer & Oncology Source Type: research

Contemporary Treatment of Locally Advanced Oral Cancer
Opinion statementAt our institution, locally advanced oral cancer is most commonly treated with surgical resection, immediate reconstruction, and adjuvant radiotherapy with or without concurrent systemic therapy depending on final surgical pathologic analysis. There are patients with markedly advanced local or regional disease who unfortunately will have a low probability of cure. We counsel these patients on induction chemotherapy, emphasizing that this is unlikely to result in a smaller volume of surgical resection. In these patients, a good response to induction chemotherapy is more frequently followed by concurrent che...
Source: Current Treatment Options in Oncology - March 14, 2019 Category: Cancer & Oncology Source Type: research

The Role of Surgery in Management of Locally Advanced Non-Small Cell Lung Cancer
Opinion statementPatients with locally advanced non-small cell lung cancer (NSCLC) are treated for cure, but treatment decisions are not straightforward. Chemotherapy is essential due to the high risk of systemic relapse, but local therapy is also required for cure. In the small subset of stage III patients with N0 or N1 disease, surgery is typically the initial therapy and extended resections are frequent. The majority of IIIA patients present with N2 disease and treatment paradigms for these patients are controversial, particularly concerning the role of resection. Surgery has a limited role in bulky IIIA, IIIB, and IIIC...
Source: Current Treatment Options in Oncology - March 14, 2019 Category: Cancer & Oncology Source Type: research

Systemic Immunotherapy for Advanced Cutaneous Squamous Cell Carcinoma
Opinion statementAdvanced (i.e., unresectable) cutaneous squamous cell carcinoma (cSCC) is a rare condition with a dismal prognosis. Although less than 5% of cSCC patients develop metastases or local recurrence after complete excision, advanced cSCC is difficult to treat. These conditions tend to develop in elderly patients, although, at times, metastases are noted in middle-aged patients. Once metastasis occurs in cSCC, the 10-year survival rates fall to less than 20% for patients with regional lymph node involvement and less than 10% for patients with distant metastases, indicating that cSCC can be difficult to treat eff...
Source: Current Treatment Options in Oncology - March 14, 2019 Category: Cancer & Oncology Source Type: research

Current State of Immunotherapy for Treatment of Glioblastoma
Opinion statementAt this time, there are no FDA-approved immune therapies for glioblastoma (GBM) despite many unique therapies currently in clinical trials. GBM is a highly immunosuppressive tumor and there are limitations to a safe immune response in the central nervous system. To date, there have been several failures of phase 3 immune therapy clinical trials in GBM. These trials have targeted single components of an antitumor immune response. Learning from these failures, the future of immunotherapy for GBM appears most hopeful for combination of immune therapies to overcome the profound immunosuppression of this diseas...
Source: Current Treatment Options in Oncology - February 21, 2019 Category: Cancer & Oncology Source Type: research

Malignant Pleural Mesothelioma: Is Tailoring the Second-Line Therapy Really “Raising the Bar?”
Opinion statementUnresectable or relapsed malignant pleural mesothelioma (MPM) has dismal prognosis. First-line combination therapy with pemetrexed and a platinum analog allows a modest survival benefit, while no clear therapeutic options exist for the second-line therapy. In this setting, pemetrexed seems to be the most active drug; however, the inclusion in front-line treatment limits its use in further lines. Nevertheless, rechallenge with one or both drugs used in first-line remains a feasible strategy for responder patients. Alternatively, only few cytotoxic drugs have demonstrated a mild activity in refractory MPM. A...
Source: Current Treatment Options in Oncology - February 21, 2019 Category: Cancer & Oncology Source Type: research

The Role of Angiogenesis Inhibitors in the Era of Immune Checkpoint Inhibitors and Targeted Therapy in Metastatic Non-Small Cell Lung Cancer
Opinion statementThe treatment of advanced non-small cell lung cancer (NSCLC) has evolved to include targeted therapy, immunotherapy as well as chemotherapy for selected patients in the first-line setting. Angiogenesis inhibitors have been used in combination with chemotherapy in the first-line and maintenance settings providing improved progression-free survival (PFS) and objective response rate (ORR), as well as overall survival (OS) in selected studies. Biologic rationale exists for combining anti-angiogenic agents with immunotherapy and targeted kinase inhibitors (TKIs). A recent study has demonstrated improved surviva...
Source: Current Treatment Options in Oncology - February 18, 2019 Category: Cancer & Oncology Source Type: research

The Potential of Targeting P53 and HSP90 Overcoming Acquired MAPKi-Resistant Melanoma
Opinion StatementMelanoma is the deadliest form of skin cancer worldwide. The rising melanoma incidence and mortality, along with its high propensity for metastasis highlights the urgency to identify more effective therapeutic targets. Approximately, one half of advanced melanoma bears a mutation in the BRAF gene that makes BRAF as an important therapeutic target. Significant clinical benefit is associated with BRAF and MEK inhibitors (MAPKi) on targeting patients with BRAF V600 mutations. However, the frequent and rapid development of acquired resistance still is the major challenge facing the melanoma. Several mechanisms...
Source: Current Treatment Options in Oncology - February 18, 2019 Category: Cancer & Oncology Source Type: research

Current Treatment Options for Breast Cancer Brain Metastases
Opinion statementIn the past, the standard of care for treatment of BM was whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and surgery. There has been a greater role for medical therapies in the last two decades due to the discovery of driver mutations and corresponding targeted therapies. These innovations have dramatically altered the approach to treating these patients. Some of the important mutations include epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations in small cell lung cancer, human epidermal growth factor receptor (HER2) mutation in breast cancer, and ...
Source: Current Treatment Options in Oncology - February 15, 2019 Category: Cancer & Oncology Source Type: research

Postoperative Treatment of Oropharyngeal Cancer in the Era of Human Papillomavirus
Opinion statementDespite an overall decline in the incidence of tobacco-related cancers, human papillomavirus (HPV) –related head and neck squamous cell carcinoma (HNSCC) of the oropharynx is on the rise. The prognosis of HPV-related oropharynx cancer (HPV-OPC) is generally favorable even in locoregionally advanced disease, and a variety of treatment options are available. Though the primary treatment modality of choice remains definitive radiation (RT), surgical resection followed by appropriate adjuvant therapy remains an option, especially in those patients who may not be favorable candidates for definitive radiot...
Source: Current Treatment Options in Oncology - February 15, 2019 Category: Cancer & Oncology Source Type: research

Use of Immune Checkpoint Inhibitors in Mesothelioma
Opinion statementRecent advances in immunology have extended into the mesothelioma field. To date, only Japan has given regulatory approval to salvage nivolumab in chemo-refractory mesothelioma patients. The USA has included in the NCCN guidelines that pembrolizumab (in programmed death ligand 1 (PD-L1) immunohistochemistry (IHC) –positive patients) and nivolumab with or without ipilimumab (whatever the PD-L1 status is) are accepted salvage therapies. Based on the growing body of literature, it is anticipated that checkpoint inhibitors will receive regulatory approval in the USA and Europe soon for salvage therapy. A...
Source: Current Treatment Options in Oncology - February 14, 2019 Category: Cancer & Oncology Source Type: research

Diagnosis and Management of Basal Cell Carcinoma
Opinion statementBasal cell carcinomas (BCCs) are common skin cancers that tend to appear on sun-exposed skin. Pathobiologically, activation of the Hedgehog signaling pathway characterizes the majority of cases. In general, BCCs are slow-growing and rarely metastasize. Nevertheless, they are locally invasive and can be destructive. While typical cases are diagnosed based on clinical findings, the clinicopathological manifestations are varied. Consequently, skin biopsy is essential to confirm the diagnosis and evaluate the risk of recurrence. In the treatment of primary lesions, the initial goal is to complete tumor removal...
Source: Current Treatment Options in Oncology - February 11, 2019 Category: Cancer & Oncology Source Type: research

Treatment Approaches for Cisplatin-Ineligible Patients with Invasive Bladder Cancer
Opinion statementCisplatin has been established as an important agent in the neoadjuvant setting prior to radical cystectomy (RC) surgery for muscle-invasive urothelial cancer (MIUC) as well as in the unresectable or metastatic urothelial carcinoma (mUC) setting. Unfortunately, many patients in practice are felt to be “cisplatin-ineligible.” Thus, it is vital that we develop treatment approaches and novel therapeutics for this population. We evaluate therapeutic alternatives to cisplatin-based treatment. For patients undergoing RC, there is no recommended alternative to neoadjuvant cisplatin-based combination t...
Source: Current Treatment Options in Oncology - February 11, 2019 Category: Cancer & Oncology Source Type: research

Palliative Cancer Care in the Outpatient Setting: Which Model Works Best?
Opinion statementMultiple randomized controlled trials have underscored the importance of timely referral to palliative care for patients with advanced cancer. Outpatient palliative care can facilitate timely referral and is increasingly available in many cancer centers. The key question is which model of outpatient palliative care is optimal. There are currently many variations for how palliative care is delivered in the outpatient setting, including (1) Interdisciplinary Specialist Palliative Care in Stand-Alone Clinics, (2) Physician-Only Specialist Palliative Care in Stand-Alone Clinics, (3) Nurse-Led Specialist Pallia...
Source: Current Treatment Options in Oncology - February 11, 2019 Category: Cancer & Oncology Source Type: research

Innovating Cancer Care Delivery: the Example of the 4R Oncology Model for Colorectal Cancer Patients
Opinion statementCare delivery innovation is necessary to address the growing complexity of cancer care across specialties and integrate new diagnostics, treatments, and services into care delivery. Informed by Cancer Care Delivery Research (CCDR), multilevel intervention research, and other disciplines, this article describes the 4-step cancer care delivery innovation cycle. The cycle guides collaborative efforts of cancer clinicians, researchers, patients, and other stakeholders to systematically define care delivery problems and formulate, test, and implement care innovations to effectively address problems. We illustra...
Source: Current Treatment Options in Oncology - February 11, 2019 Category: Cancer & Oncology Source Type: research

Prognostic Significance of Complex Karyotypes in Acute Myeloid Leukemia
Opinion statementAcute myeloid leukemia (AML) patients with a complex karyotype (CK-AML) show at least 3 unrelated clonal cytogenetic abnormalities with notoriously poor outcome. Such cases fall into either AML with myelodysplasia-related changes or therapy-related AML in the current World Health Organization classification of AML. Allogeneic stem cell transplantation is one of the only treatment modalities that can provide a long-term survival benefit and is recommended as a consolidative treatment in patients who are able to achieve complete remission. Unfortunately, transplantation is also associated with a higher relap...
Source: Current Treatment Options in Oncology - February 11, 2019 Category: Cancer & Oncology Source Type: research

Management of Nonmetastatic Castration-Resistant Prostate Cancer: Recent Advances and Future Direction
Opinion statementNonmetastatic castration-resistant prostate cancer (nmCRPC) comprises a relatively narrow niche of advanced prostate cancer, but the treatment landscape for men with nmCRPC has drastically changed over the past year. Prior to the SPARTAN and PROSPER trials, men with nmCRPC were commonly treated with first-generation androgen receptor antagonists, such as bicalutamide or flutamide, or with estrogens or ketoconazole, none of which were associated with any proven survival benefit. The SPARTAN trial evaluated apalutamide versus placebo for men with nmCRPC and found that apalutamide significantly improved metas...
Source: Current Treatment Options in Oncology - February 11, 2019 Category: Cancer & Oncology Source Type: research

Updates on Minimally Invasive Surgery in Non-Small Cell Lung Cancer
Opinion statementVideo-assisted thoracic surgery (VATS) has become widely used since the 1990s and has become a standard treatment approach mainly for early-stage non-small cell lung cancer. The few randomized controlled trials providing evidence of the effectiveness of VATS lobectomy at present are supported by a large number of propensity-matched studies, several high-quality meta-analyses, and outcome studies. These studies provide comprehensive data demonstrating the lower morbidity, shorter chest tube duration, and shorter hospital stay of VATS than thoracotomy during the postoperative course. Moreover, VATS shows equ...
Source: Current Treatment Options in Oncology - February 11, 2019 Category: Cancer & Oncology Source Type: research

Guidelines for Treatment and Monitoring of Adult Survivors of Pediatric Brain Tumors
Opinion statementPathologies of pediatric brain tumors are more varied than those diagnosed in adults and survival outcomes more optimistic. Therapies for pediatric brain tumors are also diverse and treatment options are expanding. The growing number of adult survivors of childhood brain tumors is quite diverse. Medical management of these adults requires understanding the tumor diagnosis and location, the modalities used to treat the tumor, the age of the survivor at the time of diagnosis and treatment, any complications of treatment, and, most importantly, the baseline medical condition and neurological function of each ...
Source: Current Treatment Options in Oncology - February 9, 2019 Category: Cancer & Oncology Source Type: research

Blastic Plasmacytoid Dendritic Cell Neoplasm
Opinion statementWhile there is a high initial response rate with standard chemotherapeutic regimens for blastic plasmacytoid dendritic cell neoplasm (BPDCN), the responses are typically not durable and this remains a very aggressive disease with generally poor outcomes. For this reason, the standard approach for eligible patients has been high-dose induction chemotherapy preferably with acute lymphoblastic leukemia (ALL)-based regimens followed by consolidation with allogeneic hematopoietic stem cell transplantation (alloHSCT). Unfortunately, many patients with this disease are elderly and/or frail and cannot tolerate thi...
Source: Current Treatment Options in Oncology - February 4, 2019 Category: Cancer & Oncology Source Type: research

The Optimal Duration of Adjuvant Therapy for Stage III Colon Cancer: the European Perspective
Opinion statementThe International Duration Evaluation of Adjuvant Therapy (IDEA) collaboration was created to pool data from different studies worldwide in order to assess whether a shorter duration of adjuvant treatment in colon cancer could maintain the expected benefit while reducing toxicity. The results of the IDEA trials were clinically relevant. They confirmed a two- to sixfold reduction in neurotoxicity for the shorter duration across trials. Overall, the 3-year disease-free survival was very similar: only 0.9% lower for the 3  months group. However, the results were partially unexpected, because they reveale...
Source: Current Treatment Options in Oncology - January 26, 2019 Category: Cancer & Oncology Source Type: research

Targeted Therapy and Immunotherapy for Melanoma in Japan
In conclusion, acral and mucosal melanomas have been treated based on the available medical evidence for the treatment of non-acral c utaneous melanomas. Considering the differences in genetic backgrounds and therapeutic efficacy of immunotherapy, specialized therapeutic strategies for these subtypes of melanoma should be established in the future. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - January 24, 2019 Category: Cancer & Oncology Source Type: research

New Concepts of Treatment for Patients with Myelofibrosis
Opinion statementSeven years after the approval of the Janus kinase 1/2 (JAK1/2) inhibitor ruxolitinib, it remains the only drug licensed for the treatment of myelofibrosis. Patients who discontinue ruxolitinib have a dismal outcome, and this is, therefore, an area of significant unmet need. Given the central role that JAK-signal transducer and activator of transcription (STAT) activation plays in disease pathogenesis, there have been many other JAK inhibitors tested, but most have been abandoned, for a variety of reasons. The JAK2-selective inhibitor fedratinib has recently been resurrected, and there has been a resurgenc...
Source: Current Treatment Options in Oncology - January 24, 2019 Category: Cancer & Oncology Source Type: research

First-Line Therapy for Metastatic Soft Tissue Sarcoma
Opinion statementSoft tissue sarcomas are rare cancers with an expected incidence of about 14,000 new cases in 2018, and account for less than 1% of all cancers. It includes in excess of 75 heterogeneous subtypes with varying biology, molecular aberrations, and variable response to treatment. Because of the rarity of these tumors and the many different subtypes, there is no large-scale data to guide treatment, and hence the need for a multidisciplinary individualized approach to treatment, preferably at a high-volume tertiary referral center. For localized disease, surgery with or without radiation is the preferred treatme...
Source: Current Treatment Options in Oncology - January 24, 2019 Category: Cancer & Oncology Source Type: research

Treatment of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia
Opinion statementWith the introduction of tyrosine kinase inhibitors (TKIs) in the management of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL), the prognosis of patients has improved dramatically. Currently, the standard of care in the frontline setting for fit patients is TKI in combination with chemotherapy. Age-adjusted chemotherapy or corticosteroids alone have been used with TKIs in elderly patients with comorbidities with modest long-term benefit. The primary goal of treatment is the achievement of early deep molecular remission as the achievement of complete molecular remission (CMR) at 3 &...
Source: Current Treatment Options in Oncology - January 24, 2019 Category: Cancer & Oncology Source Type: research

Systemic Therapy for Advanced Hepatocellular Carcinoma in an Evolving Landscape
Opinion statementGlobally, hepatocellular carcinoma (HCC) is a leading cause of cancer-related death and a malignancy with rising incidence. After sorafenib remaining the one and only FDA-approved therapy for the disease for many years, the past 2  years has seen the landscape of available treatments change dramatically. Multiple multi-targeted tyrosine kinases (TKIs) have demonstrated success and garnered FDA approval both in the first- (lenvatinib) and second-line (regorafenib) settings. Now, various questions regarding the sequencing of t hese therapies remain for investigation. Effective positioning of these TKIs ...
Source: Current Treatment Options in Oncology - January 11, 2019 Category: Cancer & Oncology Source Type: research

Therapeutic Intensification and Induction Chemotherapy for High-Risk Locally Advanced Squamous Cell Carcinoma
Opinion statementThe treatment of HNSCC has rapidly evolved over the past 30  years and multidisciplinary management is required, especially for locally advanced disease (LAHNSCC). Concomitant chemoradiation (cCRT) is the standard of care and cetuximab/RT (CET/RT) is an alternative treatment option, especially for patients unfit for concurrent cisplatin. Several intensifica tion strategies have been explored to improve the outcome of the concomitant treatment. The combination of cisplatin plus cetuximab concurrent to RT failed to improve overall survival (OS) in two phase III trials. Induction chemotherapy (IC) has a ...
Source: Current Treatment Options in Oncology - January 11, 2019 Category: Cancer & Oncology Source Type: research

Immunotherapy Advances in Urothelial Carcinoma
Opinion statementCheckpoint inhibitors have monumentally transformed the treatment of metastatic urothelial carcinoma. While the efficacy and safety of the different agents are similar in platinum-refractory metastatic urothelial carcinoma, pembrolizumab is the only agent that was superior to chemotherapy in a randomized phase III trial. Pembrolizumab and atezolizumab are also approved as first-line therapies in cisplatin-ineligible metastatic urothelial carcinoma. Several immunotherapy trials are ongoing in non-metastatic setting to maximize responses upfront. Despite the promising responses with immunotherapy, majority o...
Source: Current Treatment Options in Oncology - December 15, 2018 Category: Cancer & Oncology Source Type: research

Is There Value in Molecular Profiling of Soft-Tissue Sarcoma?
Opinion statementSoft-tissue sarcomas represent a heterogeneous group of diseases accounting for up to 1% of cancer in adults and 15% of cancer in children. Introduction of next-generation sequencing (NGS) technologies has allowed to gain additional insight into the genetic diversity and complexity of sarcomas, including the potential therapeutic implications of some genetic alterations.Two large studies have investigated the role of targeted NGS to identify actionable mutations in patients with soft-tissue sarcomas. In these two studies, actionable alterations were identified in up to 50% of patients. Retrospective data s...
Source: Current Treatment Options in Oncology - December 7, 2018 Category: Cancer & Oncology Source Type: research

Capecitabine Versus Continuous Infusion Fluorouracil for the Treatment of Advanced or Metastatic Colorectal Cancer: a Meta-analysis
Opinion statementNowadays, systemic chemotherapy with intravenous (IV) 5-fluorouracil (5-FU) remains the most commonly prescribed treatment for metastatic colorectal cancers (CRC), in combination with other cytotoxic drugs. 5-FU can be administered through a bolus injection or continuous infusion (cIV), with the latter becoming the preferred administration method and standard of care in recent years. Oral fluoropyrimidines were developed to overcome challenges associated with the IV administration of 5-FU, among which capecitabine has become the most widely used one. However, although capecitabine and other oral fluoropyri...
Source: Current Treatment Options in Oncology - November 27, 2018 Category: Cancer & Oncology Source Type: research

Proton Therapy in Non-small Cell Lung Cancer
Opinion statementNon-small cell lung cancer (NSCLC) accounts for 85% of new lung cancer cases and has 5-year survival rates ranging from 92% in early-stage disease to as low as 13% in locally advanced cases. Radiation therapy is a key component in the treatment repertoire for NSCLC, where it is currently used alone or in combinations with chemotherapy and surgery. Despite the broad use of modern photon radiation techniques, as many as 25% of patients experience isolated locoregional recurrences, and toxicity has been proven to be a limiting factor in many cases. Proton beam therapy (PBT) has emerged as a potential solution...
Source: Current Treatment Options in Oncology - November 27, 2018 Category: Cancer & Oncology Source Type: research

Radical Trachelectomy for Early Stage Cervical Cancer
Opinion StatementIn patients with early-stage cervical cancer, radical hysterectomy and pelvic lymphadenectomy is the gold standard. However, this disease commonly affects women of childbearing age; thus an option to spare fertility is ideal. This option came to fruition in the early 90s when the Dargent procedure or radical trachelectomy was first reported. The procedure has subsequently been modified as technology has improved and now may be performed via minimally invasive techniques. Additionally, with the advent of the sentinel lymph node procedure, the morbidity in this usually young patient population has continued ...
Source: Current Treatment Options in Oncology - November 19, 2018 Category: Cancer & Oncology Source Type: research

Using PARP Inhibitors in the Treatment of Patients With Ovarian Cancer
Opinion statementUse of poly(ADP-ribose) polymerase (PARP) inhibitors has greatly increased over the past 5  years. With several new Food and Drug Administration (FDA) approvals, three PARP inhibitors have entered into standard of care treatment for epithelial ovarian cancer (including ovarian, fallopian tube, and primary peritoneal cancer). Olaparib and rucaparib currently have indications for treatment of recurrentBRCA mutant ovarian cancer. Olaparib, rucaparib, and niraparib all have indications for maintenance therapy in recurrent platinum-sensitive ovarian cancer after response to platinum-based therapy. In our p...
Source: Current Treatment Options in Oncology - November 15, 2018 Category: Cancer & Oncology Source Type: research

Review of Immune Therapies Targeting Ovarian Cancer
Opinion statementThe rise of immunotherapy is the greatest advance in oncology to occur over the last several years, but applications in gynecologic malignancies lag behind other tumors. The term “immunotherapy” envelops monoclonal antibodies as receptor mediators, including immune checkpoint inhibitors (ICPI), cancer vaccines, and adoptive immunotherapies alone or in combination with other therapeutic approaches. The purpose of this review is to summarize the status of immunotherapy tri als in ovarian cancer and to specifically highlight data published in the last 1–2 years. (Source: Current Treatme...
Source: Current Treatment Options in Oncology - November 14, 2018 Category: Cancer & Oncology Source Type: research

Radiation-Related Alterations of Taste Function in Patients With Head and Neck Cancer: a Systematic Review
Opinion statementTaste sensation is vital for a healthy body as it influences our food intake, acts as a defense mechanism and elicits pleasure. Majority of the head and neck cancer (HNC) patients undergoing radiotherapy suffer from altered taste function and often complain of inability to taste their food, reduced food intake, and weakness. However, there are not many studies conducted to assess this commonly reported side effect. Furthermore, clinical research on radiotherapy-induced taste alterations has proven to be difficult, considering a lack of reliable and validated study tools for assessing objective and subjecti...
Source: Current Treatment Options in Oncology - November 9, 2018 Category: Cancer & Oncology Source Type: research