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CDK4/6 Inhibition in the Metastatic Setting: Where Are We Headed?
Opinion statementHormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER-2-) metastatic breast cancer (MBC) is the most common subtype of breast cancer. Due to therapeutic advances with molecularly targeted therapies, the prognosis for patients with metastatic disease has improved significantly. The advent of CDK4/6 inhibitors (CDK4/6i) has changed the treatment paradigm for patients with HR+HER2-MBC. CDK4/6i allowed for marked improvement in overall survival, delaying the time to chemotherapy initiation, and improved quality of life for our patients. Efforts are now focused on the best appr...
Source: Current Treatment Options in Oncology - June 14, 2023 Category: Cancer & Oncology Source Type: research

Proposals for Clinical Trials in Chronic Myelomonocytic Leukemia
Opinion statementChronic myelomonocytic leukemia (CMML) is a clonal hematologic malignancy of mostly older individuals that exhibits both myelodysplastic and myeloproliferative features. CMML presentation and outcome are variable, reflecting genetic and clinical heterogeneity. Hypomethylating agents are the mainstay of therapy but induce complete remissions in less than 20% of patients and do not prolong survival compared to hydroxyurea. Allogeneic stem cell transplant (ASCT) is potentially curative, but few patients qualify due to advanced age and/or comorbidities. Work of the past several years has identified key molecul...
Source: Current Treatment Options in Oncology - June 10, 2023 Category: Cancer & Oncology Source Type: research

Cardio-oncology for Pediatric and Adolescent/Young Adult Patients
Opinion statementAs chemotherapy continues to improve the lives of patients with cancer, understanding the effects of these drugs on other organ systems, and the cardiovascular system in particular, has become increasingly important. The effects of chemotherapy on the cardiovascular system are a major determinant of morbidity and mortality in these survivors. Although echocardiography continues to be the most widely used modality for assessing cardiotoxicity, newer imaging modalities and biomarker concentrations may detect subclinical cardiotoxicity earlier. Dexrazoxane continues to be the most effective therapy for preven...
Source: Current Treatment Options in Oncology - June 10, 2023 Category: Cancer & Oncology Source Type: research

Treatment of Adult T-Cell Leukemia/Lymphoma: Established Paradigms and Emerging Directions
Opinion StatementAdult T-cell leukemia/lymphoma (ATL) is a rare, aggressive subtype of peripheral T-cell lymphoma developing after many years of chronic, asymptomatic infection with the retrovirus human T-cell lymphotropic virus type 1 (HTLV-1). HTLV-1 is endemic to certain geographic areas of the world, and primary infection generally occurs in infancy through mother-to-child transmission via breastfeeding. In less than 5% of infected individuals, a decades-long pathogenic process culminates in the development of ATL. Aggressive subtypes of ATL are life-threatening and challenging to treat, with median overall survival ty...
Source: Current Treatment Options in Oncology - June 10, 2023 Category: Cancer & Oncology Source Type: research

Interventional Cardio-Oncology: Unique Challenges and Considerations in a High-Risk Population
Opinion StatementPatients with cancer are at risk of developing cardiovascular disease (CVD) including atherosclerotic heart disease (AHD), valvular heart disease (VHD), and atrial fibrillation (AF). Advances in percutaneous catheter-based treatments, including percutaneous coronary intervention (PCI) for AHD, percutaneous valve replacement or repair for VHD, and ablation and left atrial appendage occlusion devices (LAAODs) for AF, have provided patients with CVD significant benefit in the recent decades. However, trials and registries investigating outcomes of these procedures often exclude patients with cancer. As a resu...
Source: Current Treatment Options in Oncology - June 10, 2023 Category: Cancer & Oncology Source Type: research

RAS and Other Molecular Targets in Pancreatic Cancer: The Next Wave Is Coming
Opinion statementSince the discovery of oncogenes in the 1970s, cancer doctors and researchers alike have understood the promise of discovering drugs to block the dominantly acting function of mutated signaling proteins in cancer. This promise was delivered, first slowly, with early signals inhibiting HER2 and BCR-Abl in the 1990s and 2000s, and then quickly, with kinase inhibitors being approved hand over fist in non-small cell lung cancer, melanoma, and many other malignancies. The RAS proteins, however, remained recalcitrant to chemical inhibition for decades, despite being, by far, the most frequently mutated oncogenes...
Source: Current Treatment Options in Oncology - June 10, 2023 Category: Cancer & Oncology Source Type: research

Utility of Measurable Residual Disease (MRD) Assessment in Mantle Cell Lymphoma
This article reviews existing techniques used in MRD assessment for MCL and describes novel methods which may overcome existing limitations, including next-generation sequencing modalities. The use of circulating tumour DNA is explored, with techniques such as CAPP-Seq and PhasED-Seq demonstrating promise in B-lymphoproliferative disorders, though application in MCL requires further study. The other aspect of practice using MRD is identifying therapeutic options which can address a subclinical molecular relapse. Developing suitable interventions that can alter the disease trajectory based o n longitudinal MRD kinetics are...
Source: Current Treatment Options in Oncology - May 30, 2023 Category: Cancer & Oncology Source Type: research

Targeting Glutamine Metabolism as an Attractive Therapeutic Strategy for Acute Myeloid Leukemia
Opinion statementRelapse after chemotherapy and hematopoietic stem cell transplantation leads to adverse prognosis for acute myeloid leukemia (AML) patients. As a “conditionally essential amino acid,” glutamine contributes to the growth and proliferation of AML cells. Glutamine-target strategies as new treatment approaches have been widely explored in AML treatment to improve outcome. Glutamine-target strategies including depletion of systemic glutamine a nd application of glutamine uptake inhibitors, glutamine antagonists/analogues, and glutaminase inhibitors. Because glutamine metabolism involved in multiple pathways...
Source: Current Treatment Options in Oncology - May 30, 2023 Category: Cancer & Oncology Source Type: research

Immunotherapy in Early-Stage Triple-Negative Breast Cancer: Where Are We Now and Where Are We Headed?
In conclusion, the addition of neoadjuvant ICI to chemotherapy significantly improves both the quality and quantity of the anti-tumour T cell response, suggesting that improvements in recurrence-free survival occur through better immune protection from cancer. In the future, development of ICI agents that target tumour-specific T cells may favourably alter the toxicity profile, improving the risk –benefit ratio for survivors. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - May 24, 2023 Category: Cancer & Oncology Source Type: research

New Developments in Treating RAS-Mutated Metastatic Colorectal Cancer
Opinion statementOne of the great challenges in digestive oncology is choosing the optimal therapy forRAS-mutated metastatic colorectal cancer (mCRC). Even though theRAS genes and accompanying pathway were identified decades ago and extensive knowledge exists on their role in carcinogenesis, it has proven challenging to translate these insights into new therapies and clinical benefit for patients. However, recently, new drugs targeting this pathway (for example,KRASG12C inhibitors) have shown promising results in clinical trials, as monotherapy or in combination regimens. Although resistance remains an important issue, mor...
Source: Current Treatment Options in Oncology - May 22, 2023 Category: Cancer & Oncology Source Type: research

Critical Appraisal of Proton Therapy for Patients with Central Nervous System (CNS) Malignancies
Opinion statementAs more hospital-based proton treatment centres become operational, the indications for proton beam therapy (PBT) are being evaluated. Recent advances in PBT technology are expanding the indications for the use of protons in the treatment of central nervous system (CNS) tumours. Prospective trials that assess the late toxicity of different radiation therapy (RT) techniques are needed to confirm any expected reduction in long-term side effects with PBT. The ASTRO Model Policy on proton beam therapy currently supports the reasonable use of protons in the treatment of specific CNS tumour types. Specifically, ...
Source: Current Treatment Options in Oncology - May 22, 2023 Category: Cancer & Oncology Source Type: research

Update on Small Molecule Targeted Therapies for Acute Myeloid Leukemia
Opinion statementThe search for effective therapies for the highly heterogenous disease acute myeloid leukemia (AML) has remained elusive. While cytotoxic therapies can induce complete remission and even, at times, long-term survival, this approach is associated with significant toxic effects to visceral organs and worsening of immune dysfunction and marrow suppression leading to death. Sophisticated molecular studies have revealed defects within the AML cell that can be exploited by utilizing small molecule agents to target these defects, often dubbed “target therapy.” Several medications have already established new ...
Source: Current Treatment Options in Oncology - May 17, 2023 Category: Cancer & Oncology Source Type: research

Essential Thrombocythemia in Adolescents and Young Adults: Clinical Aspects, Treatment Options and Unmet Medical Needs
Opinion statementCurrent treatment of essential thrombocythemia (ET) should primarily prevent thrombo-hemorrhagic events, without increasing the rate of fibrotic progression or leukemic evolution, and secondarily control microvascular symptoms. Unlike other classicBCR::ABL1-negative myeloproliferative neoplasms, ET is frequently diagnosed in adolescents and young adults (AYA), defined as individuals aged 15 to 39  years, in up to 20% of patients. However, since the current risk stratification of this disease is based on models, including that of ELN, IPSET-Thrombosis and its revised version, mainly applied to an older pat...
Source: Current Treatment Options in Oncology - May 17, 2023 Category: Cancer & Oncology Source Type: research

Measurable Residual Disease in Chronic Lymphocytic Leukemia: Current Understanding and Evolving Role in Clinical Practice
Opinion statementTreatment of chronic lymphocytic leukemia (CLL) has evolved dramatically during the last decade, from chemoimmunotherapy (CIT)-based therapies to newer B-cell receptor (BCR) signaling targeting agents, which are sometimes given as continuous schemes. Response to treatment was traditionally defined according to clinical variables designed to assign a response category. Interest in assessing for deeper responses in CLL by the means of measurable residual disease (MRD) testing has been the subject of research during the last several years. Analyses and sub-analyses of clinical trials have shown that achieving...
Source: Current Treatment Options in Oncology - May 17, 2023 Category: Cancer & Oncology Source Type: research

The Intersection of Prostate Cancer and Hypertension: a Call to Action
Opinion statementWith improvements in treatment and survival from prostate cancer, comorbid cardiac conditions will significantly impact overall morbidity and mortality from prostate cancer. Hypertension is a well-established cardiovascular risk factor that increases the risk of heart failure, myocardial infarction, and stroke. Therapies used in the treatment of prostate cancer, including GnRH agonists, GnRH antagonists, enzalutamide, abiraterone, and others, can directly or indirectly increase the risk of hypertension. In this paper, we review the evidence available on the incidence and mechanism of hypertension in prosta...
Source: Current Treatment Options in Oncology - May 16, 2023 Category: Cancer & Oncology Source Type: research