February 2016, Vol. 5, No. 1

On the Cutting Edge of Personalizing Care:
From Molecular Tumor Boards to Cancer Stem Cell Research

Dear Colleague, It is with great enthusiasm that we present this, our first issue of 2016, to you. You will find that we are adapting our presentations to meet the learning needs of our reading community. Specifically, we are expanding our case study presentations to reflect trends in academia as [ Read More ]

Al B. Benson III, MD, FACP, FASCO

Letter to Our Readers

Cancer Stem Cell Research: A New Frontier in the Fight Against Cancer:

An Interview with Stanton L. Gerson, MD, Case Comprehensive Cancer Center, and Zev A. Wainberg, MD, University of California, Los Angeles

Dr. Gerson is Director of the Case Comprehensive Cancer Center and the Shiverick Professor of Hematological Oncology and Founding Director of the Ohio Wright Center for Stem Cell and Regenerative Medicine, now called the National Center for Regenerative Medicine.Dr. Wainberg is Assistant Professor of Medicine at the University of California, [ Read More ]

Cancer Stem Cell Research: A New Frontier in the Fight Against Cancer:

An Interview with Stanton L. Gerson, MD, Case Comprehensive Cancer Center, and Zev A. Wainberg, MD, University of California, Los Angeles

Interview with the Innovators

BRAF Mutation in Colorectal Cancer

Anita Turk, MD; Dustin Deming, MD
Division of Hematology and Oncology,Department of Medicine
University of Wisconsin-Madison School of Medicine and Public Health
and University of Wisconsin Carbone Cancer Center, Madison, WI

Advances in molecular pathology have allowed for the widespread use of sequencing technologies to improve our ability to better understand the biology of each individual patient’s cancer. This allows for the personalization of treatment strategies depending on the molecular profile of the cancer. In colorectal cancer (CRC), mutations in KRAS [ Read More ]

BRAF Mutation in Colorectal Cancer

Anita Turk, MD; Dustin Deming, MD
Division of Hematology and Oncology,Department of Medicine
University of Wisconsin-Madison School of Medicine and Public Health
and University of Wisconsin Carbone Cancer Center, Madison, WI

Colorectal Cancer

Human Epidermal Growth Factor Receptor Type 2 Therapy in Gastrointestinal Tumors

Federico Longo, MD; Alfredo Carrato, MD, PhD
Medical Oncology Department, Ramon y Cajal University Hospital
Madrid, Spain

Case ReportA 64-year-old woman was examined at our emergency department after a 6-month period of suffering from progressive fatigue, anorexia, significant weight loss, and abdominal pain. She had a medical history of active smoking and mixed anxiety-depressive disorder treated with bromazepam and escitalopram. The patient had a performance status of [ Read More ]

Human Epidermal Growth Factor Receptor Type 2 Therapy in Gastrointestinal Tumors

Federico Longo, MD; Alfredo Carrato, MD, PhD
Medical Oncology Department, Ramon y Cajal University Hospital
Madrid, Spain

Gastrointestinal Cancer

Case: Clinically Node-Negative Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare and aggressive cancer with a case fatality rate of 33%. Delayed diagnoses of MCC are common, which results in patients often presenting at advanced stages, said Manisha Thakuria, MD, at the 2015 World Cutaneous Malignancies Congress. The optimal care of MCC is debated. [ Read More ]

WCMC

Inherited Prostate Cancer

Prostate cancer is the most common nondermatologic cancer in males in the United States. Incidence and mortality rates vary significantly between countries. In the United States, the lifetime risk of developing prostate cancer is approximately 1 in 7, with an incidence similar to that of breast cancer. In 2015, it [ Read More ]

Cristi Radford, MS, CGC

Genetic Counseling

Another Study Shows Benefit with a Pediatric Regimen in Young Adults with ALL

A pediatric regimen achieves superior outcomes compared with adult regimens in adolescents and young adults with acute lymphoblastic leukemia (ALL). Several studies have already shown this outcome, and a multicenter phase 2 study presented at the meeting adds further confirmatory evidence in support of this approach. The multicenter phase 2 [ Read More ]

Daniel DeAngelo, MD, PhD

ASH 2015, ASH Highlights

Venetoclax: Strong Showing in CLL

Venetoclax, an oral, investigational, small molecule Bcl-2 inhibitor, achieved excellent and durable responses in patients with relapsed/refractory chronic lymphocytic leukemia (RR CLL). All patients in the trial harbored a 17p deletion, signaling poor prognosis.In a pivotal phase 2 trial reported at the meeting, nearly 80% of patients with high-risk RR [ Read More ]

Stephan Stilgenbauer, MD

ASH 2015, ASH Highlights

CAR T-Cell Therapy Highly Active in Various Hematologic Malignancies

CAR T cells demonstrated consistent activity in advanced hematologic malignancies evaluated in multiple small clinical trials reported at the meeting.Disease remission persisting for as long as 36 months occurred in 8 of the first 20 patients treated at the National Cancer Institute. The 40% overall response rate included 4 of [ Read More ]

James Kochenderfer, MD

ASH 2015, ASH Highlights

Checkpoint Inhibitors in Lymphoma: A New Universe

Immunotherapy is generating great excitement in melanoma and non–small cell lung cancer (NSCLC). FDA approvals of checkpoint inhibitors in these tumor types, as well as encouraging preliminary results in other solid tumors, have paved the way for studying them in hematologic cancers.Philippe Armand, MD, Dana-Farber Cancer Institute, Boston, MA, discussed [ Read More ]

Philippe Armand, MD

ASH 2015, ASH Highlights

Idelalisib Combined with Bendamustine/Rituximab Boosts Survival in CLL

Idelalisib combined with bendamustine/rituximab (BR) reduced the risk of disease progression and death versus BR alone in patients with relapsed/refractory (RR) chronic lymphocytic leukemia (CLL), according to results from a randomized, double-blind, placebo-controlled, phase 3 late-breaking trial presented at the meeting.Lead investigator Andrew Zelenetz, MD, Memorial Sloan Kettering Cancer Center, [ Read More ]

Andrew Zelenetz, MD

ASH 2015, ASH Highlights

Ibrutinib a New Standard of Care for Elderly CLL Patients

Ibrutinib significantly reduced the risk of disease progression and death compared with standard treatment with chlorambucil in older treatment-naive patients with chronic lymphocytic leukemia (CLL). Ibrutinib achieved a 91% reduction in risk of disease progression and an 84% reduction in the risk of death compared with chlorambucil. These results from [ Read More ]

ASH 2015, ASH Highlights

In Newly Diagnosed Myeloma Patients, Triplets Preferred

While the cost of treating newly diagnosed patients is greatly increased with the use of 3 drugs, doublets should not be considered adequate, and triplets should be the standard of care, according to results from a randomized trial.The use of triplets—including a proteasome inhibitor, immunomodulatory drug (IMiD), and steroid—has been [ Read More ]

Brian G.M. Durie, MD

ASH 2015, ASH Highlights

Midostaurin: First Targeted Therapy in AML Is Potentially Practice Changing

Midostaurin is the first FLT3 inhibitor to improve overall survival in FLT3-mutated acute myeloid leukemia (AML). Midostaurin plus standard chemotherapy improved survival compared with placebo plus chemotherapy as up-front treatment for high-risk patients with AML and FLT3 mutations. Patients and physicians have waited for new drugs for AML since the [ Read More ]

ASH 2015, ASH Highlights

Nilotinib Yields Better Rates of Molecular Response Than Imatinib in the Frontline Setting

Dose-optimized nilotinib increased the rates of major molecular response (MMR) in patients with newly diagnosed chronic myeloid leukemia in chronic phase (CML-CP) in the ENESTxtnd study. According to final results from this study, the cumulative MMR rate was 78.8% by 12 months and 81.0% by 24 months in patients managed [ Read More ]

ASH 2015, ASH Highlights

Rituximab Boosts Chemotherapy Benefit in B-Cell Precursor ALL

In patients with B-cell precursor acute lymphoblastic leukemia (BCP-ALL), the addition of rituximab to chemotherapy significantly improved event-free survival in a large European study. “Adding rituximab to standard therapy should become a standard of care for these patients,” according to Sébastien Maury, MD, Hôpital Henri Mondor, Créteil, France. The study [ Read More ]

ASH 2015, ASH Highlights

Pembrolizumab Shows Promise in Multiple Myeloma

Monoclonal antibodies targeting programmed death-1 (PD-1) may be effective in multiple myeloma, according to early data on pembrolizumab presented at ASH.In heavily pretreated relapsed/refractory patients, pembrolizumab was combined with lenalidomide/dexamethasone (Rd) in a phase 1 study with 50 patients, where a response rate of 76% was observed (Abstract 505). Pembrolizumab [ Read More ]

Jesus San Miguel, MD

ASH 2015, ASH Highlights

Promising Combo in Elderly Patients with ALL

Elderly patients with acute lymphoblastic leukemia (ALL) are difficult to treat. A new study suggests that frontline treatment with the combination of the investigational antibody-drug conjugate inotuzu­mab ozogamicin plus deintensified chemotherapy is a good option for older patients with this disease. In a phase 2 trial, the combination had impressive [ Read More ]

ASH 2015, ASH Highlights

ESR1 Mutations Portend Worse Survival in ER+ Advanced Breast Cancer

A “liquid biopsy” was able to detect 2 mutations in the estrogen receptor 1 (ESR1) gene that predicted worse overall survival (OS) in women with estrogen receptor–positive (ER+), metastatic breast cancer who were originally enrolled in the BOLERO-2 clinical trial.The presence of a D358G and/or Y537S mutation in the ESR1 [ Read More ]

Sarat Chandarlapaty, MD, PhD

San Antonio Breast Cancer Symposium

Early Results with Immunotherapy in Breast Cancer

Immunotherapy is a hot topic in cancer right now, with approved checkpoint inhibitors for melanoma and non–small cell lung cancer. Checkpoint inhibitors are also making inroads in other solid tumors.Separate preliminary studies of checkpoint inhibitors in the treatment of breast cancer had less impressive results, but these are early studies, [ Read More ]

Hope S. Rugo, MD

San Antonio Breast Cancer Symposium

Omit Chemotherapy for Premenopausal Luminal A Breast Cancer?

Younger patients with luminal A subtype breast cancer may not need chemotherapy, according to a Danish trial presented at the 2015 San Antonio Breast Cancer Symposium. Luminal A biological subtype breast cancer has an excellent prognosis, even in high-risk patients, the study suggests.“A large body of evidence suggests that luminal [ Read More ]

Torsten O. Nielsen, MD, PhD

San Antonio Breast Cancer Symposium

Liquid Biopsy Characterizing CTCs Can Aid in Treatment Selection

A “liquid biopsy” using phlebotomy blood samples can identify phenotypes and genomic characteristics of circulating tumor cells (CTCs) that may help personalize treatment selection for men with advanced prostate cancer.“Hormonal agents prolong the lives of men with castrate-resistant prostate cancer. The optimal sequence of agents to maximize survival is unknown. [ Read More ]

Howard Scher, MD

Genitourinary Cancers Symposium

The Coming Government Takeover of Drug Pricing ObamaCare provides the tools for a unilateral move against the industry the left loves to demonize

Hillary Clinton has plenty of allies as she demonizes drug-company profits and pushes for federal control over how drugs are priced. There’s a drug-pricing task force led by the White House and a similar Democrat-led effort in Congress. Many of the pharma industry’s proponents in Washington and on Wall Street [ Read More ]

Scott Gottlieb, MD

Editorial

Personalized Medicine at FDA: 2015 Progress Report

One year after the initial observation by the Personalized Medicine Coalition (PMC) of an increased rate of personalized medicine approvals at the FDA Center for Drug Evaluation and Research (CDER), the most recent data show that the trend has continued, with oncology leading the way for the field.A new analysis [ Read More ]

Daryl Pritchard, PhD

The Last Word