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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

Treatment Options for Recurrent Primary CNS Lymphoma
Opinion statementPrimary CNS lymphoma (PCNSL) constitutes a rare extranodal variant of non-Hodgkin lymphoma (NHL) with an annual incidence of 0.45/100,000. Given the paucity of large prospective clinical trials, there is no consensus treatment for refractory or relapsed (r/r) PCNSL, and available strategies are largely based on retrospective analyses. Patient age, performance status, previously administered treatment, duration of response, and molecular characteristics guide selection of salvage therapy. Patients with a good performance status (KPS>70), particularly ≤65 years, and adequate organ function should be con...
Source: Current Treatment Options in Oncology - October 7, 2022 Category: Cancer & Oncology Source Type: research

The Role of Autophagy in Childhood Central Nervous System Tumors
Opinion statementAutophagy is a physiological process that occurs in normal tissues. Under external environmental pressure or internal environmental changes, cells can digest part of their contents through autophagy in order to reduce metabolic pressure or remove damaged organelles. In cancer, autophagy plays a paradoxical role, acting as a tumor suppressor —by removing damaged organelles and inhibiting inflammation or by promoting genome stability and the tumor-adaptive responses—as a pro-survival mechanism to protect cells from stress. In this article, we review the autophagy-dependent mechanisms driving childhood ce...
Source: Current Treatment Options in Oncology - October 5, 2022 Category: Cancer & Oncology Source Type: research

Pathogenic Mechanisms in Acute Myeloid Leukemia
Opinion statementAcute myeloid leukemia (AML) is the most common form of leukemia in adults, leading to the highest number of annual leukemia-associated deaths in the USA. Although most AML patients initially enter remission following induction therapy, most eventually relapse, underscoring the unmet need for more effective therapies. In recent years, novel high-throughput sequencing techniques, and mouse and human models of disease have increased our understanding of the molecular mechanisms that lead to AML. Leukemogenic mechanisms can be broadly classified into two types —cell-intrinsic and cell-extrinsic. Cell-intrin...
Source: Current Treatment Options in Oncology - October 3, 2022 Category: Cancer & Oncology Source Type: research

BRAF Inhibitor Resistance in Melanoma: Mechanisms and Alternative Therapeutic Strategies
Opinion statementMelanoma is caused by a variety of somatic mutations, and among these mutations, BRAF mutation occurs most frequently and has routinely been evaluated as a critical diagnostic biomarker in clinical practice. The introduction of targeted agents for BRAF-mutant melanoma has significantly improved overall survival in a large proportion of patients. However, there is BRAF inhibitor resistance in most patients, and its mechanisms are complicated and need further clarification. Additionally, treatment approaches to overcome resistance have evolved rapidly, shifting from monotherapy to multimodality treatment, wh...
Source: Current Treatment Options in Oncology - October 1, 2022 Category: Cancer & Oncology Source Type: research

Regorafenib for the Treatment of Sarcoma
Opinion statementSarcomas are a rare group of tumors with many subtypes, conventionally classified into soft-tissue sarcomas and bone sarcomas. Chemotherapeutic regimens form the mainstay of systemic therapy but are not well defined beyond the first-line setting and clinical outcomes are variable. Tyrosine kinase inhibitors (TKIs), with a broad inhibition profile which have been shown to target tumor angiogenesis, have an established role in the treatment of sarcomas without characteristic driver alterations. One such TKI, regorafenib, has been evaluated in sarcomas and clinical data are discussed in this review. An overvi...
Source: Current Treatment Options in Oncology - September 30, 2022 Category: Cancer & Oncology Source Type: research

Systemic Therapy Approaches for Breast Cancer Brain and Leptomeningeal Metastases
Opinion statementBrain metastasis arising from breast cancer is associated with a poor prognosis. Various systemic chemotherapy and targeted therapies which are effective against breast cancer often fail to provide benefits against brain metastasis. This is mainly due to limited penetration of the therapies across the blood-brain barrier, and divergent evolution of brain metastasis compared to the primary tumor. Thus, brain metastasis is typically treated upfront with local therapies, such as surgery and radiation, followed by systemic therapies. Systemic therapies with CNS permeability are favored in patients with brain m...
Source: Current Treatment Options in Oncology - September 22, 2022 Category: Cancer & Oncology Source Type: research

Secondary Central Nervous System Lymphoma: Updates in Treatment and Prophylaxis Strategies
Opinion statementReferring to any central nervous system (CNS) involvement with preceding or concurrent systemic disease, secondary CNS lymphoma (SCNSL) lacks a clear standard of care and historically carries a very poor prognosis. Aggressive histologies predominate, most notably diffuse large B cell lymphoma (DLBCL), with higher relative frequency in Burkitt lymphoma but lower absolute incidence. Therapeutic strategies commonly feature intensive CNS-penetrant chemotherapy, including methotrexate, cytarabine, and others. Combination regimens, novel targeted agents, and cellular therapy considerations are reviewed, noting t...
Source: Current Treatment Options in Oncology - September 21, 2022 Category: Cancer & Oncology Source Type: research

Advanced Acral Melanoma Therapies: Current Status and Future Directions
Opinion statementMelanoma is one of the deadliest malignancies. Its incidence has been significantly increasing in most countries in recent decades. Acral melanoma (AM), a peculiar subgroup of melanoma occurring on the palms, soles, and nails, is the main subtype of melanoma in people of color and is extremely rare in Caucasians. Although great progress has been made in melanoma treatment in recent years, patients with AM have shown limited benefit from current therapies and thus consequently have worse overall survival rates. Achieving durable therapeutic responses in this high-risk melanoma subtype represents one of the ...
Source: Current Treatment Options in Oncology - September 20, 2022 Category: Cancer & Oncology Source Type: research

Antibody-Drug Conjugates for Melanoma and Other Skin Malignancies
Opinion statementWhile most skin malignancies are successfully treated with surgical excision, advanced and metastatic skin malignancies still often have poor long-term outcomes despite therapeutic advances. Antibody-drug conjugates (ADCs) serve as a potentially promising novel therapeutic approach to treat advanced skin cancers as they combine antibody-associated antigen specificity with cytotoxic anti-tumor effects, thereby maximizing efficacy and minimizing systemic toxicity. While no ADCs have gained regulatory approval for advanced skin cancers, several promising agents are undergoing preclinical and clinical investig...
Source: Current Treatment Options in Oncology - September 20, 2022 Category: Cancer & Oncology Source Type: research

Radiation-Induced Cardiovascular Toxicities
Opinion statementSeveral seminal papers over the last decade have furthered our recognition of radiation-induced heart disease (RIHD) as an important potential toxicity following radiation therapy (RT) to the chest. Investigators continue to evaluate the subacute and long-term effects of RT. In addition, studies are determining whether certain cardiac substructures are more sensitive to radiation, working to identify risk factors for the development of RIHD, and testing screening and mitigation strategies for RIHD. Multiple groups and expert consensus guidelines have published whole-heart and cardiac substructure dose cons...
Source: Current Treatment Options in Oncology - September 10, 2022 Category: Cancer & Oncology Source Type: research

Approach to Localized Squamous Cell Cancer of the Esophagus
Opinion statementEsophageal cancer is a leading cause of cancer deaths worldwide, with an increasing incidence in recent decades. The majority of esophageal cancers are squamous cell carcinoma. The 5-year survival rate of esophageal squamous cell carcinoma (ESCC) is poor, and there remains globally a pressing need for novel treatments that improve patient outcomes and quality of life. In this review, we discuss management of localized ESCC with an update on relevant newly published literature, including targeted therapy and novel biomarkers. The standard treatment approach for locally advanced, resectable ESCC is currently...
Source: Current Treatment Options in Oncology - August 31, 2022 Category: Cancer & Oncology Source Type: research

The Role of Pharmacogenomics in Opioid Prescribing
Opinion statementPharmacogenomics is increasingly important to guide objective, safe, and effective individualised prescribing. Personalised prescribing has revolutionised treatments in the past decade, allowing clinicians to maximise drug efficacy and minimise adverse effects based on a person ’s genetic profile. Opioids, the gold standard for cancer pain relief, are among the commonest medications prescribed in palliative care practice. This narrative review examines the literature surrounding opioid pharmacogenomics and its applicability to the palliative care cancer population. There is currently limited intersection...
Source: Current Treatment Options in Oncology - August 24, 2022 Category: Cancer & Oncology Source Type: research

Perioperative Chemotherapy for Liver Metastasis of Colorectal Cancer: Lessons Learned and Future Perspectives
Opinion statementColorectal cancer (CRC) is a major public health problem and the 2nd leading-cause of cancer-related death worldwide. Around 30% of patients present with metastatic disease and 50% of those with early disease will eventually relapse. The metastatic spread occurs mainly to the liver, which is the exclusive site in 30 –40% of the cases. Surgery is the main curative option for liver recurrence, but only one out of five patients are eligible for resection. Moreover, even if surgery is feasible, recurrence rate is high, occurring in up to 75% of patients. Therefore, additional treatment to improve these disap...
Source: Current Treatment Options in Oncology - August 18, 2022 Category: Cancer & Oncology Source Type: research