Medical Cannabis in Oncology: a Valuable Unappreciated Remedy or an Undesirable Risk?
Opinion statementThe use of the cannabis plant by cancer patients has been rising significantly in the past few years worldwide, primarily driven by public demand. There is an obvious need for more reliable scientific data, pharmacology information, a better understanding of its mode of action, and available clinical evidence supporting its robust use. Physicians must complete a thorough medical assessment, screening for potential drugs, or treatment contraindications before allowing its consumption. In light of the growing popularity of cannabis usage, it is highly essential that, in the near future, the medical community...
Source: Current Treatment Options in Oncology - January 13, 2021 Category: Cancer & Oncology Source Type: research

Refining Immuno-Oncology Approaches in Metastatic Prostate Cancer: Transcending Current Limitations
Opinion statementDue to its immunosuppressive tumor microenvironment, prostate cancer has historically been difficult to treat with immuno-oncology approaches. Other than pembrolizumab, which is now regulatory-approved for all microsatellite instability (MSI)-high and tumor mutational burden (TMB)-high advanced solid tumors, sipuleucel-T is the only immunotherapeutic agent approved by the US Food and Drug Administration (FDA) for prostate cancer. However, sipuleucel-T efficacy is optimal for select patients with indolent metastatic castration-resistant prostate cancer. Although manipulation of immune regulation by blocking...
Source: Current Treatment Options in Oncology - January 12, 2021 Category: Cancer & Oncology Source Type: research

Update on First-Line Combination Treatment Approaches in Metastatic Clear-Cell Renal Cell Carcinoma
Opinion statementThe treatment for metastatic renal cell carcinoma (mRCC) has significantly evolved in recent years with a deeper understanding of the molecular make-up of the disease and the clinical development of therapies with novel mechanisms of action. While some patients with more indolent disease may benefit from local therapy such as metastasectomy or cytoreductive nephrectomy, others may safely embark on an active surveillance program or be offered targeted therapy. Yet, a combination regimen including an ICI is the most effective regimen and should be considered in most mRCC cases. Ongoing studies will help dete...
Source: Current Treatment Options in Oncology - January 12, 2021 Category: Cancer & Oncology Source Type: research

A Review of Pharmacologic Management in the Treatment of Mesothelioma
This article provides a review of current pharmacologic treatment options available for mesothelioma and goes into detail about the recommended medication regimens and dosages and the available evidence of efficacy, effectiveness, and/or safety and estimates the annu al cost of treatment for these medications on the U.S. healthcare system per patient. A brief introduction is provided for several promising agents currently under investigation for mesothelioma as well. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - January 12, 2021 Category: Cancer & Oncology Source Type: research

The Importance of Prognostication: Impact of Prognostic Predictions, Disclosures, Awareness, and Acceptance on Patient Outcomes
Opinion StatementIn the advanced cancer setting, patients, families, and clinicians are often confronted with an uncertain future regarding treatment outcomes and survival. Greater certainty on what to expect can enhance decision-making for many personal and healthcare issues. Although 70 –90% of patients with advanced cancer desire open and honest prognostic disclosure, a small proportion do not want to know. Approximately half of patients with advanced cancer have an inaccurate understanding of their illness, which could negatively impact their decision-making. In this review, we use a conceptual framework to highl...
Source: Current Treatment Options in Oncology - January 11, 2021 Category: Cancer & Oncology Source Type: research

Janus Kinase Inhibitors and Non-Melanoma Skin Cancer
Opinion statementJAK (janus kinase) inhibitors are becoming increasingly prescribed for various conditions from dermatologic diseases to graft versus host disease in bone marrow transplant recipients. This class of drugs has been found to be truly life-changing for many, though they are not without potential adverse effects. While JAK inhibitors have not been shown to significantly increase the risk of non-melanoma skin cancer (NMSC) in large scale clinical trials, NMSC is one of the most concerning possible adverse events, and there have been several reported cases of aggressive squamous cell carcinomas, especially in our...
Source: Current Treatment Options in Oncology - January 9, 2021 Category: Cancer & Oncology Source Type: research

Mycosis Fungoides and S ézary Syndrome: Updates and Review of Current Therapy
Opinion statementWhile most patients with early-stage mycosis fungoides (MF) follow an indolent course, patients with advanced-stage MF/S ézary syndrome (SS) have a poor prognosis with a median survival of less than 5 years. Although there are a number of treatments currently available, achieving and maintaining a durable response remain challenging, especially in advanced-stage MF/SS. The choice of frontline therapy is dependent on the stage of disease. For early-stage MF, the treatment concept is to control skin lesions mainly by skin-directed therapies, such as topical therapies, phototherapies, and radiothe...
Source: Current Treatment Options in Oncology - January 7, 2021 Category: Cancer & Oncology Source Type: research

Translating Knowledge About the Immune Microenvironment of Gastrointestinal Stromal Tumors into Effective Clinical Strategies
Opinion statementThe role of targeted therapy is firmly established for gastrointestinal stromal tumors (GISTs); other modalities for targeting this disease are necessary for recurrent and refractory disease. There are several lines of evidence pointing to an active role of the immune system in GIST. Preclinical and clinical studies revealed that the most common type of immune cell infiltration in GISTs is tumor-associated macrophages (TAMs). The mechanism of how TAMs sculpt the tumor microenvironment in GIST is not clear, but it seems that the presence of immunosuppressive regulatory T cells (Tregs) is correlated with the...
Source: Current Treatment Options in Oncology - January 5, 2021 Category: Cancer & Oncology Source Type: research

Symptom Management in Pancreatic Cancer
Opinion statementDespite extensive research that has identified new risk factors, genetic mutations, and therapeutic options, pancreatic ductal adenocarcinoma continues to be a leading cause of cancer related death. Patients with pancreatic cancer, along with their clinicians, must balance realistic hope alongside a life-threatening diagnosis. As the search for treatments to reduce the morbidity and mortality continues, symptom management and quality of life remain the focus of our efforts. In addition to side effects of cancer-directed therapy, patients are at risk for malnutrition, pain, and fatigue. These factors are of...
Source: Current Treatment Options in Oncology - January 2, 2021 Category: Cancer & Oncology Source Type: research

Future Strategies Involving Immune Checkpoint Inhibitors in Advanced Urothelial Carcinoma
Opinion statementImmune checkpoint inhibitors have importantly improved the outcome of patients with urothelial carcinoma. Different immune checkpoint inhibitors are currently approved and used in first- and second-line setting. The multiple agents currently approved in these setting make the choice sometimes difficult for clinicians. Furthermore, only a minority of patients present drastic response and long-term benefit with current immunotherapy. In this review, we describe the current use of immunotherapy in urothelial carcinoma but we also highlight the new strategies of treatment involving immune checkpoint inhibitors...
Source: Current Treatment Options in Oncology - December 2, 2020 Category: Cancer & Oncology Source Type: research

Drug Repurposing in Medulloblastoma: Challenges and Recommendations
Opinion statementMedulloblastoma is the most frequently diagnosed primary malignant brain tumor among children. Currently available therapeutic strategies are based on surgical resection, chemotherapy, and/or radiotherapy. However, majority of patients quickly develop therapeutic resistance and are often left with long-term therapy-related side effects and sequelae. Therefore, there remains a dire need to develop more effective therapeutics to overcome the acquired resistance to currently available therapies. Unfortunately, the process of developing novel anti-neoplastic drugs from bench to bedside is highly time-consuming...
Source: Current Treatment Options in Oncology - November 27, 2020 Category: Cancer & Oncology Source Type: research

The Benefits of Olanzapine in Palliating Symptoms
Opinion StatementOlanzapine has become a major drug in the management of chemotherapy-induced nausea and vomiting as a prophylactic agent. In addition, a recent randomized trial has demonstrated its benefits in treating nausea and vomiting associated with advanced cancer. The added benefit to olanzapine is that it also stimulates appetite. As a result, since it treats multiple symptoms associated with advanced cancer, it is likely to become the antiemetic of choice in palliative care at least in the USA. The added benefit of treating insomnia and the avoidance of benzodiazepines should place olanzapine in at the top of the...
Source: Current Treatment Options in Oncology - November 26, 2020 Category: Cancer & Oncology Source Type: research

Current Landscape and Future Directions on Bladder Sparing Approaches to Muscle-Invasive Bladder Cancer
Opinion statementAlthough radical cystectomy is considered the gold standard approach for patients with muscle-invasive bladder cancer, tri-modal therapy (TMT) is a well-tolerated and efficacious alternative to radical cystectomy that is underutilized in inoperable patients and rarely offered to cystectomy candidates in the USA. Retrospective data suggest similar outcomes between radical cystectomy and TMT after adjusting for patient selection and other confounding factors. Nearly 70 –80% of patients can keep their native bladder with favorable post-treatment quality of life metrics. Current trials are investigating ...
Source: Current Treatment Options in Oncology - November 23, 2020 Category: Cancer & Oncology Source Type: research

Progress on Management of Penile Cancer in 2020
The objectives of our review are to update clinicians on the advances in the management of penile cancer and to summarize the recent guidelines and recommendations. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - November 23, 2020 Category: Cancer & Oncology Source Type: research

Treatment Options in Oligometastatic Disease in Prostate Cancer: Thinking Outside the Box
Opinion statementDue to its relatively indolent disease course, the sensitivity of PSA testing, and the emergence of novel PET imaging, metastatic prostate cancer is particularly likely to present with a limited volume of disease. Patients with up to five metastatic lesions should be considered for an oligometastatic treatment approach. Systemic therapy remains the cornerstone of treatment for these patients. The optimal type and duration are unknown; however, the addition of a second agent to ADT appears to be beneficial. Multiple recent studies have found significant benefits to the integration of systemic therapy and lo...
Source: Current Treatment Options in Oncology - November 20, 2020 Category: Cancer & Oncology Source Type: research

Exploring the Use of State Medical Cannabis Legislation as a Proxy for Medical Cannabis Use Among Patients Receiving Chemotherapy
Opinion statementThe use of medical cannabis is expanding in the USA. Due to conflicting, low-quality evidence, many oncologists may not feel confident to recommend it to patients. Given the potential for legal and financial risks when conducting clinical trials with medical cannabis, the use of observational data should be explored. Observational data that directly capture medical cannabis use in relation to prescription medications and track the prevalence and patterns of cannabis use is sparse. To gain insights into the role medical cannabis plays in the pharmaceutical landscape, proxies such as cannabis legislation nee...
Source: Current Treatment Options in Oncology - November 19, 2020 Category: Cancer & Oncology Source Type: research

Development of a Patient-Centered Framework for Oncology Clinicians to Address Uncertainty in Cancer Care During the COVID-19 Pandemic
(Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - October 29, 2020 Category: Cancer & Oncology Source Type: research

Current Challenge: Endoscopic Submucosal Dissection of Superficial Non-ampullary Duodenal Epithelial Tumors
This article reviews and highlights the current state of ESD for SNADETs and new challenges towards safe and effective ESD. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - October 26, 2020 Category: Cancer & Oncology Source Type: research

Localized Non-melanoma Skin Cancer: Risk Factors of Post-surgical Relapse and Role of Postoperative Radiotherapy
Opinion statementThe mainstay treatment of localized non-melanoma skin cancer (NMSC) is surgical excision or Mohs surgery. However, approximately 5% of patients with NMSC harbor high-risk clinicopathologic features for loco-regional recurrence, and distant metastasis. Prognostic factors such as close or positive margins, tumor size ≥ 2 cm, poor tumor differentiation, perineural invasion, depth of invasion, and immunosuppression have all been associated with increased loco-regional recurrence and impaired survival rates. In these patients more aggressive treatments are needed and radiotherapy (RT) is often di...
Source: Current Treatment Options in Oncology - October 9, 2020 Category: Cancer & Oncology Source Type: research

Targeted Therapies in the Management of Well-Differentiated Digestive and Lung Neuroendocrine Neoplasms
Opinion statementOngoing advances in our understanding of neuroendocrine tumor (NET) biology, genetics, and immunology, will continue to expand the availability of targeted therapies, thus improving the outcomes of patients. Well-differentiated neuroendocrine tumors (NETs) are grouped into pancreatic and non-pancreatic NETs (includes GI and thoracic NETs) for treatment considerations (Fig.  1). For panNETs, initial therapy is driven by the need of radiographic response, and targeted agents are typically reserved for second and third line based on the toxicity profile. Treatment options for non-pancreatic NETs are also...
Source: Current Treatment Options in Oncology - October 6, 2020 Category: Cancer & Oncology Source Type: research

Approach to the Patient with Unknown Primary Squamous Cell Carcinoma of the Head and Neck
Opinion statementHead and neck cancer of unknown primary (HNCUP) is increasingly encountered in both community otolaryngology practice and the academic head and neck cancer program. A stepwise diagnostic evaluation will identify many primary sites. However, true HNCUP remains common in high-volume practices after appropriate examination, imaging, and biopsies. The prognosis for the majority of the patients is good, owing to the common association with high-risk HPV, and putative oropharyngeal primary origin. With high oncologic control rates, judicious treatment selection is essential to optimize functional outcomes. (Sour...
Source: Current Treatment Options in Oncology - October 5, 2020 Category: Cancer & Oncology Source Type: research

The Role of Oncoplastic Surgery for Breast Cancer
Opinion statementOncoplastic surgery (OPS) expands the indications and possibilities of breast-conserving surgery (BCS) by allowing for a wider cancer resection than lumpectomy. Ongoing investigation and reporting of OPS outcomes along with improvements in comprehensive training in breast surgical oncology will impact on awareness and lead to increased adoption of these techniques. Indications for OPS include concern about clear margins, poor tumor location (upper inner pole and lower quadrant), multifocality, need for skin excision, and poor candidacy for mastectomy and reconstruction. OPS has been proven to be oncologica...
Source: Current Treatment Options in Oncology - October 5, 2020 Category: Cancer & Oncology Source Type: research

The Potential of Immune Checkpoint Blockade in Cervical Cancer: Can Combinatorial Regimens Maximize Response? A Review of the Literature
Opinion statementCervical cancer (CC) is most often caused by the human papillomavirus (HPV). In principle, these ties to the virus should make HPV tumors a relatively easy target for clearance by the immune system. However, these HPV-associated tumors have evolved strategies to escape immune attack. Checkpoint inhibition immunotherapy, which has had remarkable success in cancer treatment, has the potential to overcome the immune escape in CC by harnessing the patient ’s own immune system and priming it to recognize and kill tumors. Recent work involving PD-1/PD-L1 inhibitors in CC lends credence to this belief, as p...
Source: Current Treatment Options in Oncology - October 5, 2020 Category: Cancer & Oncology Source Type: research

Late and Long-Term Treatment-Related Effects and Survivorship for Head and Neck Cancer Patients
Opinion statementThe demographics of head and neck cancer (HNC) survivors are changing, contributing to a growing number of survivors and a greater length of survivorship. Curative treatment involves intense multimodal therapy, which contributes to both short-term toxicities and long-term treatment-related effects. Delivering high-quality, relevant cancer survivorship care is a growing national priority. Various survivorship models and tools, such as survivorship care plans, have been utilized in an attempt to enhance care and optimize outcomes. However, an essential, yet understudied, component of high-quality survivorshi...
Source: Current Treatment Options in Oncology - October 2, 2020 Category: Cancer & Oncology Source Type: research

Correction to: Immunotherapy Alone or in Combination with Chemotherapy as First-Line Treatment of Non-Small Cell Lung Cancer
The original version of this article unfortunately contained mistakes. In Table 2, under the column 'Lead to death' in Row 5 [CheckMate-026], the figures should read as '0.7' for Experimental Arm and '1.1' for Comparator. Right now, these are printed as 0.007 and 0.011 respectively. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - September 11, 2020 Category: Cancer & Oncology Source Type: research

Small Round Blue Cell Sarcoma Other Than Ewing Sarcoma: What Should an Oncologist Know?
Opinion statementThe diagnosis of round cell sarcomas has changed rapidly over the last decade, causing much diagnostic confusion for pathologists and oncologists. The advances in diagnosis are largely due to the advent of next-generation sequencing techniques, which allowed the recognition of novel gene fusions in round cell sarcomas. The new 5th edition of the WHO Classification of Tumors of Soft Tissue and Bone recognizes four subgroups of undifferentiated round cell sarcomas: Ewing sarcoma,CIC-rearranged sarcomas,BCOR-altered sarcomas, and sarcomas withEWSR1-non-ETS fusions, in addition to desmoplastic small round cell...
Source: Current Treatment Options in Oncology - August 31, 2020 Category: Cancer & Oncology Source Type: research

Precision Medicine for Breast Cancer Utilizing Circulating Tumor DNA: It Is in the Blood
Opinion statementLiquid biopsy using blood components to assess circulating tumor DNA (ctDNA) is rapidly becoming a new standard-of-care technology in many tumor types, including breast cancer, due to the potential to provide predictive and prognostic information. The minimally invasive and repeatable nature of plasma based mutational testing is appealing for patients and facilitates enhanced disease monitoring. It is important for the clinician to understand the benefits and limitations of this emerging assay and the potential applications in breast cancer. Multiple technologies have been employed to assess breast cancer ...
Source: Current Treatment Options in Oncology - August 31, 2020 Category: Cancer & Oncology Source Type: research

Emerging Treatments for Advanced/Metastatic Pheochromocytoma and Paraganglioma
Opinion statementThe incidence of metastatic pheochromocytoma (PHEO) and paraganglioma (PGL) may occur in as many as 35% of patients particularly with PGL and even more frequently in those with specific mutations. Biochemical, morphological, and molecular markers have been investigated for use in the distinction of benign from malignant PHEO/PGL. PHEO/PGL metastasizes via hematogenous or lymphatic routes and shows differences based on mutational status. The most common sites of involvement in patients that have an SDHB mutation are the bone (78%), lungs (45%), lymph nodes (36%), and liver (35%). In patients with sporadic P...
Source: Current Treatment Options in Oncology - August 28, 2020 Category: Cancer & Oncology Source Type: research

Health-Related Quality of Life and Patient-Reported Outcomes in Radiation Oncology Clinical Trials
Opinion statementThe importance of assessing health-related quality of life (HRQoL) and patient-reported outcomes (PROs) is now well recognized as an essential measure when evaluating the effectiveness of new cancer therapies. Quality of life measures provide for a multi-dimensional understanding of the impact of cancer treatment on measures ranging from functional, psychological, and social aspects of a patient ’s health. Patient-reported outcomes provide for an assessment of physical and functional symptoms that are directly elicited from patients. Collection of PROs and HRQoL data has been shown to not only be fea...
Source: Current Treatment Options in Oncology - August 28, 2020 Category: Cancer & Oncology Source Type: research

Surgical Principles in the Management of Small Bowel Neuroendocrine Tumors
Opinion statementSmall bowel neuroendocrine tumors (SB NETs) are increasing in frequency and becoming more common in surgical practice. It is often difficult to make the diagnosis of a SB NET at an early stage, as the primary tumor tends to be small and patients are asymptomatic until there is regional or distant metastasis, when they develop abdominal pain, partial obstruction, or bleeding and/or develop carcinoid syndrome. Despite this advanced presentation at the time of diagnosis, patients with metastatic SB NETs, as compared to other gastrointestinal malignancies, have favorable survival, which can be improved by appr...
Source: Current Treatment Options in Oncology - August 28, 2020 Category: Cancer & Oncology Source Type: research

Pulmonary Neuroendocrine Tumors: Adjuvant and Systemic Treatments
Opinion statementBronchial carcinoids are uncommon tumors accounting for 20 to 30% of all neuroendocrine tumors and about 1 –2% of all cancers of pulmonary origin. Bronchial carcinoids are well-differentiated neuroendocrine tumors and have a favorable survival outcome when compared with other subtypes of lung cancers. Treatment of bronchial carcinoids is not simple owing to intricacy of symptom presentation and heterog eneity of disease biology. Successful treatment of patients requires a multimodality approach. Resection is curative in the majority of patients with localized tumors and adjuvant treatment is not rout...
Source: Current Treatment Options in Oncology - August 28, 2020 Category: Cancer & Oncology Source Type: research

Molecular Assays to Determine Optimal Duration of Adjuvant Endocrine Therapy in Breast Cancer
Opinion statementHormone receptor (HR) positive breast cancer has a high propensity for late recurrences that might be prevented with longer durations of endocrine therapy (ET). However, trials evaluating extended adjuvant ET have produced somewhat conflicting results. Additionally, ET is associated with not only day to day side effects that can impact quality of life, but more detrimental effects that can cause significant morbidity. Although patients with higher stage disease are at greater risk of late recurrences, even patients with stage 1 disease have a significant risk of recurrence after 5  years. Current guid...
Source: Current Treatment Options in Oncology - August 14, 2020 Category: Cancer & Oncology Source Type: research

Leveraging Social Media for Cardio-Oncology
Opinion statementAs the world becomes more connected through online and offline social networking, there has been much discussion of how the rapid rise of social media could be used in ways that can be productive and instructive in various healthcare specialties, such as Cardiology and its subspecialty areas. In this review, the role of social media in the field of Cardio-Oncology is discussed. With an estimated 17 million cancer survivors in the USA in 2019 and 22 million estimated by 2030, more education and awareness are needed. Networking and collaboration are also needed to meet the needs of our patients and healthcar...
Source: Current Treatment Options in Oncology - August 12, 2020 Category: Cancer & Oncology Source Type: research

Use of Robotics in Surgical Treatment of Non-small Cell Lung Cancer
Opinion statementRobotic-assisted videothoracoscopic surgery (R-VATS) has become increasingly popular and widely used since its introduction and is nowadays considered a standard treatment approach in many centres for the treatment of non-small cell lung cancer. R-VATS was initially developed to overcome the drawbacks of VATS by offering surgeons more flexibility and three-dimensional optics during thoracoscopic surgery. The effectiveness of R-VATS lobectomy regarding oncological outcomes, morbidity, mortality, and postoperative quality of life (QoL) has been shown in an increasing number of studies. More recently, these r...
Source: Current Treatment Options in Oncology - August 6, 2020 Category: Cancer & Oncology Source Type: research

The Role of Biomarkers to Evaluate Cardiotoxicity
Opinion statementModerate-level evidence suggests that cardiac troponin and natriuretic peptides are useful for risk stratification and early identification of anthracycline cardiotoxicity; however, many of these studies used older chemotherapy regimens, and thus, the applicability to current anthracycline treatment regimens is uncertain. Further research is needed to determine optimal timing and thresholds for troponin and natriuretic peptides in anthracycline-treated patients and evaluate these and other promising biomarkers for anti-HER2 therapies, thoracic radiation, anti-VEGF therapy, and fluoropyrimidine therapy &nda...
Source: Current Treatment Options in Oncology - August 6, 2020 Category: Cancer & Oncology Source Type: research

Available Therapies for Patients with Neurofibromatosis-Related Nervous System Tumors
This article reviews the currently available data on management of tumors associated with these three syndromes. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - August 6, 2020 Category: Cancer & Oncology Source Type: research

Contemporary Management of Anaplastic Thyroid Cancer
Opinion statementAnaplastic thyroid cancer (ATC) is a rare but very aggressive form of undifferentiated thyroid cancer. Due to its rapid rate of progression and invasive nature, ATC poses significant risks of morbidity and mortality. The cornerstone in the management of ATC remains a prompt diagnosis of the disease and timely management of complications depending on the stage of disease. Surgery continues to offer a higher chance of a cure, although not all patients are candidates for surgical management. Patients with advanced disease may be considered for palliative surgery to reduce morbidity and complications from adva...
Source: Current Treatment Options in Oncology - August 6, 2020 Category: Cancer & Oncology Source Type: research

The Evolving Landscape of HER2-Directed Breast Cancer Therapy
Opinion statementThe management of patients with HER2+ breast cancer has evolved significantly over the preceding decades. HER2 targeting strategies have advanced beyond focusing on the receptor alone to encompass a range of approaches. Current standard of care practices in these patients relies upon dual HER2 blockade with trastuzumab and pertuzumab in the adjuvant and metastatic settings. T-DM1 has proven particularly efficacious in patients with residual disease status post neoadjuvant therapy, with additional therapies approved in the subsequent lines to address recurrent and resistant disease. Advances continue to be ...
Source: Current Treatment Options in Oncology - August 6, 2020 Category: Cancer & Oncology Source Type: research

Optimal Management of Corticosteroids in Patients with Intracranial Malignancies
Opinion statementCorticosteroids have been essential in the management of brain tumor patients for decades, primarily for the treatment of peritumoral cerebral edema and its associated neurologic deficits. Dexamethasone is the drug of choice with standard practice being administration up to four times per day, however, because of its long biologic half-life and high potency, once or twice a day dosing is likely adequate in patients without elevated intracranial pressure. The length of corticosteroid treatment should be limited to the shortest period of time to minimize the risk of potential toxicities that can significantl...
Source: Current Treatment Options in Oncology - July 29, 2020 Category: Cancer & Oncology Source Type: research

Tumor Treating Fields in the Management of Patients with Malignant Gliomas
Opinion statementMalignant gliomas remain a challenging cancer to treat due to limitations in both therapeutic and efficacious options. Tumor treating fields (TTFields) have emerged as a novel, locoregional, antineoplastic treatment modality with favorable efficacy and safety being demonstrated in the most aggressive type of malignant gliomas, glioblastoma (GBM). In 2 large randomized, controlled phase 3 trials, the addition of TTFields was associated with increased overall survival when combined with adjuvant temozolomide (TMZ) chemotherapy in patients with newly diagnosed GBM (ndGBM) and comparable overall survival compa...
Source: Current Treatment Options in Oncology - July 29, 2020 Category: Cancer & Oncology Source Type: research

Anatomic and Functional Imaging of Neuroendocrine Tumors
Opinion statementNeuroendocrine tumors (NETs) can occur in a wide variety of organs and display a spectrum of pathologic behavior. Accurate and effective imaging is paramount to the diagnosis, staging, therapy, and surveillance of patients with NET. There have been continuous advancements in the imaging of NET which includes anatomic and functional techniques. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - July 28, 2020 Category: Cancer & Oncology Source Type: research

Leptomeningeal Metastases in Non-small Cell Lung Cancer: Optimal Systemic Management in NSCLC With and Without Driver Mutations
Opinion statementAs a devastating complication of non-small cell lung cancer (NSCLC), the incidence of leptomeningeal metastasis (LM) is rising, largely due to overall longer survival of NSCLC, especially in patients with targetable molecular driver mutations. There is no clear consensus on the optimal management of LM. This review will cover recent advances in diagnosis, monitoring, and treatment of LM in NSCLC. In LM without oncogene drivers, systemic chemotherapy, intrathecal therapy, and radiation have modestly improved the clinical outcomes. Emerging data have also suggested encouraging activity of immunotherapy. At t...
Source: Current Treatment Options in Oncology - July 27, 2020 Category: Cancer & Oncology Source Type: research

A Head Start: CAR-T Cell Therapy for Primary Malignant Brain Tumors
Opinion statementOncology is the midst of a therapeutic renaissance. The realization of immunotherapy as an efficacious and expanding treatment option has empowered physicians and patients alike. However, despite these remarkable advances, we have only just broached the potential immunotherapy has to offer and have yet to successfully expand these novel modalities to the field of neuro-oncology. In recent years, exciting results in preclinical studies of immune adjuvants, oncolytic viruses, or cell therapy have been met with only fleeting signs of response when taken to early phase trials. Although many have speculated why...
Source: Current Treatment Options in Oncology - July 27, 2020 Category: Cancer & Oncology Source Type: research

Consolidation Therapy in Primary Central Nervous System Lymphoma
Opinion statementPrimary central nervous system lymphoma is a complex disease with no agreed-upon standard-of-care therapy. Induction therapy involves multiagent chemotherapy based on high-dose methotrexate, with several regimens available. We have a preference for a regimen using rituximab, methotrexate (3.5  g/m2), procarbazine, and vincristine (R-MPV) for initial induction therapy, given the favorable balance between toxicities and very high response rates (80–90%), which allow for decreasing disease burden and increasing the effectiveness of consolidation treatments. However, in the absence of con solidation...
Source: Current Treatment Options in Oncology - July 27, 2020 Category: Cancer & Oncology Source Type: research

Targeted Therapies in Advanced Gastric Cancer
Opinion statementDespite a decreasing incidence in the USA, gastric cancer is highly prevalent worldwide. Furthermore, gastric cancer remains highly lethal with median survival of less than 1  year for metastatic disease. The backbone of therapy against metastatic gastric cancer remains cytotoxic chemotherapy, but recent advances in the molecular understanding of gastric cancer have renewed hope within that targeted agents can be leveraged to improve survival and reduce toxicity. For ex ample, in patients with human epidermal growth factor-2 (HER2)-positive gastric cancer, the addition of trastuzumab to frontline chem...
Source: Current Treatment Options in Oncology - July 27, 2020 Category: Cancer & Oncology Source Type: research

Defining and Treating Borderline Resectable Pancreatic Cancer
Opinion statementPatients with borderline resectable pancreatic ductal adenocarcinoma (BR PDAC) should receive preoperative chemotherapy with or without radiation therapy, with the intent to eradicate occult metastatic cancer cells, to select patients with a “locally dominant cancer phenotype” for whom local therapies might be most effective, and to reduce the anatomic extent of tumors to facilitate surgical resection. The administration of preoperative therapy may also be a useful strategy to deliver the maximum load of chemotherapy to patients wit h BR PDAC, since as many as half of patients will never qualif...
Source: Current Treatment Options in Oncology - July 27, 2020 Category: Cancer & Oncology Source Type: research

Immunotherapy Alone or in Combination with Chemotherapy as First-Line Treatment of Non-Small Cell Lung Cancer
Opinion statementImmune checkpoint inhibitors (ICIs) have revolutionized the management of metastatic and selected cases of unresectable advanced non-small cell lung cancer (NSCLC). Importantly for patients, this implies that in the absence of a targetable oncogenic driver [especially epidermal growth factor receptor (EGFR) gene mutations and anaplastic lymphoma kinase (ALK) gene rearrangements] and in the presence of high programmed death-ligand 1 (PD-L1) expression ( ≥ 50%), they are eligible for mono-therapy with pembrolizumab thereby avoiding chemotherapy as the first line of treatment. This mono-immunotherap...
Source: Current Treatment Options in Oncology - July 26, 2020 Category: Cancer & Oncology Source Type: research

Role of (Neo)adjuvant Denosumab for Giant Cell Tumor of Bone
Opinion statementDenosumab is a RANK ligand inhibitor approved for the treatment of giant cell tumor of bone. While the role of denosumab in the setting of advanced and unresectable disease is well established, its role in surgically resectable disease is currently under discussion. Several prospective and retrospective series on neoadjuvant therapy in potentially resectable tumor with high morbidity surgery reported a relapse rate of 10 –20% after resection and 30–40% after curettage. At the same time, less morbid surgery has obvious clinical advantages for the patient, and several studies have shown the effic...
Source: Current Treatment Options in Oncology - July 3, 2020 Category: Cancer & Oncology Source Type: research

Cardiovascular Toxicities of Bruton ’s Tyrosine Kinase Inhibitors
Opinion statementThere has been a significant shift in the management of B cell malignancies over the past decade. Initial strategies involving the use of systemic chemotherapies have been gradually replaced by more targeted therapies to improve survival and overall tolerability. Bruton ’s tyrosine kinase inhibitors are breakthrough drugs that have been approved to treat many B cell malignancies. Despite their demonstrated benefits, unintended events still occur including various cardiotoxicities. In this review, we discuss the rationale behind developing these agents, their comm on cardiovascular toxicities, and ass...
Source: Current Treatment Options in Oncology - June 29, 2020 Category: Cancer & Oncology Source Type: research

Targeting DNA Damage Repair Pathways in Pancreatic Adenocarcinoma
Opinion statementMetastatic (and locally advanced) pancreatic adenocarcinoma (mPDA) represents a major challenge for the oncology community given the rising mortality burden from the disease and the preponderance of patients diagnosed with unresectable disease. Although systemic therapies have become more potent with the development of fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) and gemcitabine plus nab-paclitaxel as first-line treatments, the median overall survival for patients treated with either of these regimens remains just above 1  year. A significant need exists to build upon the effectiveness of fi...
Source: Current Treatment Options in Oncology - June 28, 2020 Category: Cancer & Oncology Source Type: research