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Contemporary Use of Hormonal Therapy in Endometrial Cancer: a Literature Review
Opinion statementMost endometrial cancers are estrogen receptor and progesterone receptor positive. Hormonal therapy in endometrial cancer is best used in patients with low-grade disease and hormone receptor positivity. Though not standard of care, hormonal treatment can be considered in endometrial cancer treatment in both the early-stage upfront setting for patients who are not surgical candidates and in advanced and recurrent endometrial cancer. In patients who desire fertility preservation or who are not surgical candidates, levonorgestrel intrauterine device and oral progesterone are preferred treatment options. In pa...
Source: Current Treatment Options in Oncology - November 22, 2022 Category: Cancer & Oncology Source Type: research

Current Practice in Carcinoid Heart Disease and Burgeoning Opportunities
Opinion statementCardiac surgery with tricuspid valve and potentially pulmonic valve replacement at an experienced center is currently the most effective strategy available for the treatment of carcinoid heart disease. Cardiac surgery for carcinoid heart disease requires a multidisciplinary team including cardiology, medical oncology, cardiothoracic anesthesia, and cardiac surgery. Without cardiac surgery, morbidity and mortality from carcinoid heart disease is high. Aggressive management of carcinoid before and after cardiac surgery is critical. Over time, though, circulating carcinoid hormones can lead to destruction of ...
Source: Current Treatment Options in Oncology - November 22, 2022 Category: Cancer & Oncology Source Type: research

Targeting KRASp.G12C Mutation in Advanced Non-Small Cell Lung Cancer: a New Era Has Begun
Opinion statementKRASp.G12C mutation occurs in 12% of newly diagnosed advanced NSCLC and has recently emerged as a positive predictive biomarker for the selection of advanced NSCLC patients who may respond to novel KRASp.G12C inhibitors. The recent discovery of a new binding pocket under the effector region of KRAS G12C oncoprotein has made direct pharmacological inhibition of the KRASp.G12 mutation possible, leading to the clinical development of a new series of direct selective inhibitors, with a potential major impact on patients ’ survival and quality of life. Promising efficacy and tolerability data emerging from th...
Source: Current Treatment Options in Oncology - November 17, 2022 Category: Cancer & Oncology Source Type: research

Combinations of Chemotherapy and PD-1/PD-L1 Inhibitors in Sarcoma
Opinion statementWhile no PD-1 inhibitor has been FDA approved for use in sarcoma or proven efficacious in a randomized trial, the use of single agent PD-1 inhibitors is standard-of-care and recommended by the NCCN guidelines in certain specific subtypes and situations. Even while the role of immunotherapy is still being defined in sarcoma, there is rising interest in combinations of PD-1 inhibitors with standard-of-care treatments, especially chemotherapy. Recently, several early phase trials have suggested potential benefits for chemotherapy in combination with PD-1 inhibitors. Although some physicians are already combin...
Source: Current Treatment Options in Oncology - November 16, 2022 Category: Cancer & Oncology Source Type: research

Approach to Stereotactic Body Radiotherapy for the Treatment of Advanced Hepatocellular Carcinoma in Patients with Child-Pugh B-7 Cirrhosis
Opinion statementPatients with hepatocellular carcinoma (HCC) with underlying Child-Pugh B-7 cirrhosis benefit from management from an experienced, multidisciplinary team. In patients with localized disease who meet criteria for liver transplant, establishing care at a liver transplant center is crucial. For those awaiting transplant, local bridge therapies have emerged as a strategy to maintain priority status and eligibility. Multiple liver-directed therapies exist to provide locoregional tumor control. The careful selection of locoregional therapy is a multidisciplinary endeavor that takes into account patient factors i...
Source: Current Treatment Options in Oncology - November 5, 2022 Category: Cancer & Oncology Source Type: research

Cancer Immunotherapy: Fecal Microbiota Transplantation Brings Light
Opinion statementImmunotherapy is revolutionizing tumor treatment by activating the immune response to tumors. Among them, immunotherapy represented by immune checkpoint inhibitors is considered to be a milestone in tumor treatment. It has revolutionized the management of advanced malignant tumors by activating T cells, promoting cytotoxic signaling pathways, and killing tumor cells, effectively improving the overall survival of patients. However, resistance to immunotherapy and immune-related adverse events remain challenges for immunotherapy. It has been demonstrated in previous studies that modulating intestinal microbi...
Source: Current Treatment Options in Oncology - October 24, 2022 Category: Cancer & Oncology Source Type: research

Optimal First-Line Therapy for Metastatic Adenocarcinoma of the Esophagus
Opinion statementTreatment strategies for esophageal adenocarcinoma patients continue to advance with the generation of more data from clinical trials that are permitting us to refine the use of immunotherapy in combination with other treatment modalities. While the frontline therapy for metastatic esophageal adenocarcinoma has become more complicated with the approval of combination regimens, it is also yielding better outcomes. These treatment strategies can now be individualized to fit patient circumstances and goals as well as the biomarker profile of their individual tumors leading to an increased likelihood of treatm...
Source: Current Treatment Options in Oncology - October 22, 2022 Category: Cancer & Oncology Source Type: research

Surgical Principles in the Management of Lung Neuroendocrine Tumors: Open Questions and Controversial Technical Issues
Opinion statementPrimary neuroendocrine tumors (NETs) of the lung represent a heterogeneous group of malignancies arising from the endocrine cells, involving different entities, from well differentiated to highly undifferentiated neoplasms. Because of the predominance of poorly differentiated tumors, advanced disease is observed at diagnosis in more than one third of patients making chemo- or chemoradiotherapy the only possible treatment. Complete surgical resection, as defined as anatomical resection plus systematic lymphadenectomy, becomes a reliable curative option only for that little percentage of patients presenting ...
Source: Current Treatment Options in Oncology - October 21, 2022 Category: Cancer & Oncology Source Type: research

Management and Treatment of Non-small Cell Lung Cancer with MET Alteration and Mechanisms of Resistance
Opinion statementMET-driven tumors are a heterogenous group of non-small cell lung cancers (NSCLC) with activating mutations. Pathologic activation of MET can be achieved with increased number of gene copies overexpression, or decreased protein degradation through several mechanisms, including mutations, amplifications, or fusions. Besides its role as primary driver, MET activation might also mediate resistance to kinase inhibitors in NSCLC with various other actionable alterations. While checkpoint inhibitors have modest efficacy in MET-driven tumors, several approaches of targeted blockade are available. Among them the m...
Source: Current Treatment Options in Oncology - October 21, 2022 Category: Cancer & Oncology Source Type: research

Understanding Cancer Cachexia and Its Implications in Upper Gastrointestinal Cancers
Opinion statementConsiderable advances in the investigation and management of oesophagogastric cancer have occurred over the last few decades. While the historically dismal prognosis associated with these diseases has improved, outcomes remain very poor. Cancer cachexia is an often neglected, yet critical, factor for this patient group. There is a persuasive argument that a lack of assessment and treatment of cachexia has limited progress in oesophagogastric cancer care. In the curative setting, the stage of the host (based on factors such as body composition, function, and inflammatory status), alongside tumour stage, has...
Source: Current Treatment Options in Oncology - October 21, 2022 Category: Cancer & Oncology Source Type: research

Therapeutic Options for Brain Metastases in Gynecologic Cancers
Opinion statementBrain metastases (BM) are rare in gynecologic cancers. Overall BM confers a poor prognosis but other factors such as number of brain lesions, patient age, the presence of extracranial metastasis, the Karnofsky Performance Status (KPS) score, and the type of primary cancer also impact prognosis. Taking a patient ’s whole picture into perspective is crucial in deciding the appropriate management strategy. The management of BM requires an interdisciplinary approach that frequently includes oncology, neurosurgery, radiation oncology and palliative care. Treatment includes both direct targeted therapies to th...
Source: Current Treatment Options in Oncology - October 18, 2022 Category: Cancer & Oncology Source Type: research

The Role of PARP Inhibitors in Patients with Primary Malignant Central Nervous System Tumors
Opinion statementPrimary malignant central nervous (CNS) tumors are a devastating group of diseases with urgent need for improved treatment options. Surgery, radiation, and cytotoxic chemotherapy remain the primary standard treatment modalities, with molecularly targeted therapies having proven efficacy in only small subsets of cases. Poly(ADP-ribose) polymerase (PARP) inhibitors, which have had immense success in the treatment of extracranial cancers with homologous recombination deficiency (HRD), are emerging as a potential targeted treatment for various CNS tumors. Although few primary CNS tumors display canonical BRCA ...
Source: Current Treatment Options in Oncology - October 15, 2022 Category: Cancer & Oncology Source Type: research

New Strategies and Novel Combinations in EGFR TKI-Resistant Non-small Cell Lung Cancer
Discussion at a molecular tumor board for assessment for enrollment in clinical trials/expanded access program if available with innovative drugs or possible off-label use of available targeted agents, based on the results of molecular profiling, -If no mechanism of resistance identified, administration of platinum-based chemotherapy with antiangiogenic agents. The role of immunotherapy will also be addressed given the uncertain benefit. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - October 15, 2022 Category: Cancer & Oncology Source Type: research

Is There Still a Role for Transplant for Patients with Mantle Cell Lymphoma (MCL) in the Era of CAR-T Cell Therapy?
Opinion statementFor years, upfront autologous hematopoietic cell transplant (auto-HCT) has been the standard of care for younger and physically fit mantle cell lymphoma (MCL) patients after chemoimmunotherapy (CIT) induction. Bruton ’s tyrosine kinase (BTK) inhibitors have proven to be excellent salvage therapies, but their durability remains a question, especially in high-risk (HR) MCL. Allogeneic HCT (allo-HCT) was the only option for long-term remission and possibly cure for MCL relapse after auto-HCT and sometime as upfro nt consolidation for a young patient with HR MCL (debatable). We have seen a paradigm shift sin...
Source: Current Treatment Options in Oncology - October 13, 2022 Category: Cancer & Oncology Source Type: research

Beyond Serous: Treatment Options for Rare Endometrial Cancers
Opinion statementRare endometrial cancers are high-grade, aggressive malignancies which are often diagnosed at an advanced stage, and account for disproportionately more deaths than their more common low-grade counterparts. Standard of care includes a combination of surgery, radiation, and chemotherapy. Surgery consists of complete hysterectomy, and more recent evidence supports replacing a full lymphadenectomy with sentinel node mapping. Paclitaxel and carboplatin remain the mainstays of chemotherapy, while current studies incorporating immunotherapy will inform future practice. Whether and how to incorporate radiation re...
Source: Current Treatment Options in Oncology - October 7, 2022 Category: Cancer & Oncology Source Type: research