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How Genetics Can Drive Initial Therapy Choices for Older Patients with Acute Myeloid Leukemia
Opinion statementTreatment of older adults with acute myeloid leukemia (AML) is challenging. Therapy decisions must be guided by multiple factors including aging-related conditions (e.g., comorbidities, functional impairment), therapy benefits and risks, patient preferences, and disease characteristics. Balancing these factors requires understanding the unique, and frequently higher-risk cytogenetic and molecular characteristics of AML in older adult populations, which should caution providers not to reduce therapy intensity on the basis of age alone. Instead, geriatric assessments should be employed to determine fitness f...
Source: Current Treatment Options in Oncology - June 10, 2022 Category: Cancer & Oncology Source Type: research

Where Are We Now and Where Might We Be Headed in Understanding and Managing Brain Metastases in Colorectal Cancer Patients?
This article reviews the pioneering strategies aiming at understanding, diagnosing, and managing this disease, and discusses future directions, challenges, and potential innovations in each of these domains.Highlights• With the increasing survival in CRC, brain and other rare/late-onset metastases are rising.• Distal colon/rectal primary location, long-standing progressive lung metastases, and longer survival are risk factors for BM development in CRC.• Late diagnosis and lack of consensus treatment strategies make BM-CRC diagnosis very dismal.• Liquid biopsies using circulating tumor cells might offer excellent op...
Source: Current Treatment Options in Oncology - June 7, 2022 Category: Cancer & Oncology Source Type: research

The Role of Immunotherapy in the Treatment of Anal Cancer and Future Strategies
Opinion statementDespite being markedly sensitive to chemoradiotherapy, patients with locally advanced (T3-4 and/or node-positive) squamous cell carcinoma of the anal canal (SCCA) still present high rates of disease recurrence, which is characterized by meaningful morbidity and mortality. Abdominoperineal resection as salvage surgery may be considered for patients with local recurrence, but with an important negative impact in the quality of life. Systemic therapy of advanced SCCA is an unmet clinical need. Palliative chemotherapy for the management of unresectable or metastatic disease yields approximately 60% of objectiv...
Source: Current Treatment Options in Oncology - June 6, 2022 Category: Cancer & Oncology Source Type: research

Immunotherapy in AL Amyloidosis
Opinion StatementLight-chain amyloidosis is a rare disorder where a small clone of plasma cells is producing excess toxic light chains that deposit in various organs and cause dysfunction. Cardiac involvement is a major determinant of survival and rapid reduction of light chain is critical for recovery of organ function and overall survival. Immunotherapy targeting the clonal plasma cells and amyloid fibrils has emerged as a promising candidate. Daratumumab, both alone and in combinations with other anti-myeloma agents, is able to achieve deep hematologic responses and has greatly improved outcomes. Isatuximab, elotuzumab,...
Source: Current Treatment Options in Oncology - May 30, 2022 Category: Cancer & Oncology Source Type: research

The Dilemma of Treating Delirium: the Conundrum of Drug Management
Opinion statementDelirium is a common medical complication in people living with cancer, particularly with more advanced disease. Delirium is associated with significant symptom burden which causes distress and impacts quality of life. As recommended by international guidelines, a high degree of suspicion is needed to ensure delirium is detected early. Attention to collateral history can provide clues to changes in cognition and attention. Non-pharmacological approaches that can be considered essential elements of care are effective in reducing the risk of delirium. Delirium screening using a validated measure is recommend...
Source: Current Treatment Options in Oncology - May 11, 2022 Category: Cancer & Oncology Source Type: research

Approach to Resectable Gastric Cancer: Evolving Paradigm of Neoadjuvant and Adjuvant Treatment
Opinion statementRecent therapeutic advances have prolonged survival in patients with metastatic gastric cancer, though the prognosis for patients with locally advanced resectable gastric cancer remains poor. Long-term survival after resection of locally advanced gastric adenocarcinoma is dependent on early eradication of micrometastatic disease and optimal surgical resection. Preoperative therapy with a docetaxel-containing three-drug regimen has recently been shown to be superior to an anthracycline-containing three-drug regimen or two-drug therapy with a fluoropyrimidine and platinum. Chemoradiation is not essential and...
Source: Current Treatment Options in Oncology - May 7, 2022 Category: Cancer & Oncology Source Type: research

State of the Art in Endoscopic Therapy for the Management of Gastroenteropancreatic Neuroendocrine Tumors
In conclusion, this review of endoscopic therapies for localized NENs may be a useful guide for NEN clinicians and endoscopists who are considering these therapeutic options for the management of focal GEP NENs. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - May 5, 2022 Category: Cancer & Oncology Source Type: research

Immune Checkpoint Inhibitors for the Treatment of Gestational Trophoblastic Neoplasia: Rationale, Effectiveness, and Future Fertility
Opinion statementMost individuals with gestational trophoblastic neoplasia (GTN) are cured with chemotherapy; however, about 5% of them will develop chemotherapy-resistant disease and will die of disease progression. Most GTN tissues express programmed death ligand-1 (PDL-1), making immune checkpoint inhibitors (ICIs) targeting this pathway an attractive treatment option for individuals with GTN. There is increasing evidence to support the use of ICIs for individuals with recurrent or resistant GTN, but available data are derived from case reports and small single arm trials. As promising as it seems, not all individuals w...
Source: Current Treatment Options in Oncology - May 5, 2022 Category: Cancer & Oncology Source Type: research

High-Dose Somatostatin Analogs for the Treatment of Neuroendocrine Neoplasms: where are we Now?
Opinion statementNeuroendocrine tumors (NET) represent a complex and heterogeneous group of malignancies arising from the diffuse endocrine cells and other cells derived from the neural crest. Advanced disease is observed at diagnosis in more than one-third of patients. Somatostatin analogs (SSA) are the cornerstone in advanced well-differentiated NET treatment. Unfortunately, most patients will eventually develop resistance to SSA treatment by different mechanisms that are not fully understood. In some cases of refractory carcinoid syndrome or progressive disease, the increase of SSA dose may help to reach out a symptomat...
Source: Current Treatment Options in Oncology - May 1, 2022 Category: Cancer & Oncology Source Type: research

Constipation in Cancer Patients — an Update of Clinical Evidence
Opinion StatementConstipation is one of the most frequent problems in cancer patients, and its etiology is multifactorial. It leads to decreased quality of life and impedes optimal pain treatment. Despite the high prevalence, constipation is frequently underdiagnosed mainly because of lack of validated diagnostic criteria or widely accepted definition of constipation in cancer patients. All cancer patients should be evaluated regularly for constipation, and concomitant causes and risk factors were assessed. Opioids are responsible for a much of the secondary constipation in cancer patients. The management of constipation i...
Source: Current Treatment Options in Oncology - April 20, 2022 Category: Cancer & Oncology Source Type: research

Robotic Surgery in Rectal Cancer: Potential, Challenges, and Opportunities
Opinion statementThe current standard treatment for locally advanced rectal cancer is based on a multimodal comprehensive treatment combined with preoperative neoadjuvant chemoradiation and complete surgical resection of the entire mesorectal cancer. For ultra-low cases and cases with lateral lymph node metastasis, due to limitations in laparoscopic technology, the difficulties of operation and incidence of intraoperative complications are always difficult to overcome. Robotic surgery for the treatment of rectal cancer is an emerging technique that can overcome some of the technical drawbacks posed by conventional laparosc...
Source: Current Treatment Options in Oncology - April 18, 2022 Category: Cancer & Oncology Source Type: research

Chronic Lymphocytic Leukemia: Chemotherapy Free and Other Novel Therapies Including CAR T
Opinion statementChronic lymphocytic leukemia (CLL) is the most common leukemia in adults. Most individuals diagnosed with CLL will not need treatment immediately but over time the clonal B cells infiltrate the bone marrow, lymph nodes, liver, and spleen, causing anemia, thrombocytopenia, systemic symptoms, and increased risk for infections. When clonal B cells begin adversely affecting other organs, treatment is warranted. Therapy for CLL has undergone a paradigm shift away from chemotherapy-based regimens to targeted therapy with small-molecule inhibitors. B-cell receptor (BCR) signaling plays a key role in CLL. BCR sign...
Source: Current Treatment Options in Oncology - April 18, 2022 Category: Cancer & Oncology Source Type: research

Complex Persistent Opioid Dependence —an Opioid-induced Chronic Pain Syndrome
Opinion statementLong-term opioid therapy (LTOT) for chronic cancer and non-cancer pain is commonly ineffective in providing its stated goal of improving function through good control of pain. Opioid tapering (slow dose reduction and/or discontinuation), the logical solution, also appears to be ineffective among many patients on LTOT as it often leads to even worse pain control and function, leaving the patients and providers managing LTOT in a clinical conundrum with little treatment choices. Complex persistent opioid dependence (CPOD) was recently offered as a heuristic to explain this clinical conundrum exemplified by t...
Source: Current Treatment Options in Oncology - April 18, 2022 Category: Cancer & Oncology Source Type: research

Targeting Angiogenic Factors for the Treatment of Medulloblastoma
We describe their contribution to MB tumorigenesis and angiogenesis and the potential therapeutic targeting of these factors. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - April 12, 2022 Category: Cancer & Oncology Source Type: research

Appropriate Selection of PARP Inhibitors in Ovarian Cancer
Opinion statementPoly-ADP-ribose polymerase inhibitors (PARPi) are a class of anti-cancer drugs that target DNA repair pathways and have shown promising efficacy in patients with ovarian cancer in recent clinical trials. To date, there have been 9 FDA PARPi approvals/indications in ovarian cancer since 2014, highlighting the importance of this class of agents in the treatment of ovarian cancer.BRCA1/2-mutated tumors or other forms of homologous recombination deficient (HRD) tumors are particularly susceptible to PARP inhibition and have seen the greatest benefits of improvement in response rate and progression-free surviva...
Source: Current Treatment Options in Oncology - April 12, 2022 Category: Cancer & Oncology Source Type: research