August 2015, Vol 4, No 4

Showcasing the Success of Precision Medicine

Dear Colleague, In this issue of Personalized Medicine in Oncology (PMO), we are pleased to offer a wealth of information showcasing the success of precision medicine. Breakthroughs in screening, diagnosing, and treating patients based on the specific biology of individuals and their tumors have impacted our ability to turn some [ Read More ]

Letter to Our Readers

Challenges in Treating Multiple Myeloma and the Impact of New Oral Oncolytics

An Interview with Dixie-Lee Esseltine, MD, and George Mulligan, PhD, of Takeda Pharmaceuticals Multiple myeloma (MM) is a difficult cancer to treat as it is heterogeneous in nature. Each line of therapy pre­sents many choices for physicians and their patients, making it challenging to know which treatment is best for [ Read More ]

Interview with the Innovators

A Genetic-Based Approach to Individualized Prostate Cancer Screening and Treatment

Since its introduction as an aid to the early detection of prostate cancer (PC) in the 1990s, routine prostate-specific antigen (PSA) testing has been associated with a stage migration toward increased diagnoses of organ-confined, low-grade PC.1-4 The result has been a significant decrease in both the percentage and absolute number [ Read More ]

Charles B. Brendler, MD

Prostate Cancer

Genetic Drivers Identified in Premalignancy; Next Step Is Targeting Them for Prevention

Targeting genetic markers in premalignancy is an emerging concept. In speaking at PMO Live 2015, Scott M. Lippman, MD, said that genetic drivers can identify premalignant conditions and even certain benign conditions, and genetic drivers can aid in identifying higher-risk populations and populations most likely to respond to targeted agents. [ Read More ]

PMO Live - Global Biomarkers Consortium

New Methods for Surveillance and Preclinical Modeling Highlight Cancer Biomarker Research

Several cancer biomarkers are in preclinical development and on the verge of commercialization, including an inexpensive method to transport blood that preserves RNA stability and a mouse avatar model for translational cancer, said presenters at PMO Live 2015. In the case of the patient-derived xenograft (PDX), or mouse avatar, the [ Read More ]

PMO Live - Global Biomarkers Consortium

Molecular Pathways in Cancer Are Increasingly Being Exploited

Molecular pathways in cancer can be exploited for therapy, and sensitizing genetic aberrations are the ideal targets, said Alex Adjei, MD, PhD, at PMO Live 2015. Cancer cells have to evade a number of stresses to grow. They are complex and live in a toxic environment, but somehow they manage [ Read More ]

Mechanism of Action/Pathway Profiles, PMO Live - Global Biomarkers Consortium

Predictive Potential of Molecular Biomarkers Promises to Enhance Precision Medicine in Oncology

Recent advances in predictive and prognostic molecular biomarkers promise to enhance precision medicine in oncology. A rundown of the progress being made in bioinformatics, genetics, and proteomics for this purpose was delivered by several speakers at PMO Live 2015. In discussing bioinformatics, Michael Kattan, PhD, argued for a deemphasis of [ Read More ]

PMO Live - Global Biomarkers Consortium

Regulatory Processes Slow Application of Genetic Tests

Research into molecular biomarkers is bringing powerful insights to the identification of disease with considerable potential for prevention and treatment, but current regulatory paradigms may not be adequate to address this new potential, said Andrew Stainthorpe, PhD, at PMO Live 2015. Stainthorpe, head of the National Health Services Research Development [ Read More ]

PMO Live - Global Biomarkers Consortium

Case Presentation: Targeted Therapy in Metastatic Melanoma

The management of melanoma has entered an era of biomarker-driven targeted therapy and immunotherapy. The following case, presented by Sanjiv S. Agarwala, MD, at PMO Live 2015, illustrates the 2015 approach to the management of metastatic melanoma. Case: Metastatic Melanoma A 56-year-old female with a history of T2N2b melanoma and [ Read More ]

Mechanism of Action/Pathway Profiles, PMO Live - Global Biomarkers Consortium

Sonidegib Responses Improve by Use of Less Stringent Assessment Criteria in BCC

Using less stringent evaluation criteria for sonidegib for the treatment of locally advanced basal cell carcinoma (BCC) improved the complete response (CR) rate observed in the registration trial known as BOLT. These data, presented in poster format, were reported by Michael R. Migden, MD, at the 2015 World Cutaneous Malignancies [ Read More ]

WCMC

Considerations in Genetic Testing

Now that new tests are changing the landscape of genetic testing, challenges are emerging in communicating results to patients, according to presenters at an education session on “Genetic Testing in 2015: Who Owns the Data, How Do You Return Results, and Other Clinical Dilemmas.” Multigene panels can now be offered [ Read More ]

Genetics

Leukemia Stem Cell Phenotypes Associated with Outcomes

Three distinct, mutually exclusive subtypes of leukemia stem cells (LSCs) have been identified, and these are correlated with specific cytogenetic/molecular risk factors and are also correlated with response and outcomes. LSCs comprise less than 1% of cells at diagnosis of acute myeloid leukemia (AML), and these stem cells are thought [ Read More ]

ASCO 2015

Molecular Subtype-Specific Therapy in DLBCL

Molecular classification of diffuse large B-cell lymphoma (DLBCL), the most common type of non-Hodgkin lymphoma, is beginning to influence treatment selection and hopefully will improve outcomes, according to presenters at an education session. Cell-of-origin (COO) identification by genetic analysis has enabled classification of DLBCL into 2 subtypes that have different [ Read More ]

ASCO 2015

GADOLIN Trial: Obinutuzumab Moves into Indolent Lymphoma

Results from the phase 3 GADOLIN trial provide the first proof of efficacy for obinutuzumab in indolent non-Hodgkin lymphoma (NHL). Obinutuzumab added to standard bendamustine chemotherapy more than doubled progression-free survival (PFS) in patients with rituximab-refractory indolent lymphoma: median PFS was 29.2 months with obinutuzumab/bendamustine versus 14 months with bendamustine [ Read More ]

ASCO 2015

Combination Targeted and Immunotherapy Feasible in Advanced Melanoma

One of the burning questions about the new agents available to treat melanoma is how best to combine and/or sequence them. A phase 1 study showed the feasibility of combining a BRAF inhibitor and a MEK inhibitor plus a programmed death-1 ligand 1 (PD-L1) inhibitor (MEDI4736). These 3 agents can [ Read More ]

ASCO 2015

IDH1 Gene and ATRX Gene Prognostic in Anaplastic Astrocytoma

The IDH1 gene and the ATRX gene appear to be potential prognostic markers for anaplastic astrocytoma, a rare form of brain cancer, according to findings of a phase 3 trial. Patients with a mutated IDH1 gene survived for a mean of 7.9 years after diagnosis versus 2.8 years for patients [ Read More ]

ASCO 2015

New CLL-IPI Scoring System Validated as Clinically Applicable

Traditional staging systems for chronic lymphocytic leukemia (CLL), such as Rai and Binet, need to be updated in the current era of more effective therapies. A group of investigators has developed a CLL-IPI (International Prognostic Index) scoring system that combines genetic risk factors with clinical stage, age, and ?2-microglobulin into [ Read More ]

ASCO 2015

Care Pathway for NSCLC Cuts Chemotherapy Charges

Implementing a clinical pathway for stage IV non–small-cell lung cancer (NSCLC) led to a reduction in chemotherapy drug charges at the Cleveland Clinic, reported James Stevenson, MD. A pathway for the management of patients with nonsquamous EGFR wild-type, ALK-negative stage IV NSCLC was developed between October 2013 and July 2014. [ Read More ]

Lung Cancer

The Fourth Annual World Cutaneous Malignancies Congress

The Fourth Annual World Cutaneous Malignancies Congress (WCMC) took place in Seattle, WA, on July 24-25, 2015. The WCMC is a 2-day congress dedicated to informing, educating, and fostering the exchange of clinically relevant information in the field of cutaneous malignancies on topics in melanoma, basal cell carcinoma, squamous cell [ Read More ]

WCMC Abstracts

Alternative Payment Models and the Future of Personalized Medicine

Alarmed by the escalating price of cancer drugs, the American Society of Clinical Oncology (ASCO) last month published for review a new “value framework” to consider the cost of those drugs to both patients and society. In a radical departure for American medicine, which has, until now, focused predominantly on [ Read More ]

Edward Abrahams, PhD

The Last Word