July 2015, Special ASCO Edition

Immunotherapies Steal the Show at ASCO

Oncologists looking to learn about immunotherapy didn’t have to go very far at the American Society of Clinical Oncology Annual Meeting. Many of the highest-impact presentations this year, including a plenary session abstract, the Karnofsky Award, and the Science of Oncology Award, focused on cancer therapy’s most exciting field. Checkpoint [ Read More ]

Immunotherapy

Biomarkers for Nivolumab

Nivolumab appears to be an effective immunotherapy, improving overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) compared with currently available therapies, according to a prospective biomarker study. Moreover, the study found that nivolumab was effective in both programmed death-1 ligand 1 (PD-L1)-positive (PD-L1+) and PD-L1–negative (PD-L1–) patients. [ Read More ]

Immunotherapy

Clues to Patient Selection for Lenvatinib in Thyroid Cancer

Lenvatinib was approved by the FDA in February of this year for the treatment of patients with advanced 131I-refractory differentiated thyroid cancer based on results from the SELECT trial. However, it is important to identify which patients will preferentially benefit from this oral tyrosine kinase inhibitor (TKI). At ASCO, 2 [ Read More ]

Thyroid Cancer

Nivolumab Is Superior to Docetaxel as Second-Line Therapy for Patients with NSCLC

Immunotherapy with the programmed death-1 (PD-1) inhibitor nivolumab as second-line therapy prolonged survival in patients with nonsquamous non–small cell lung cancer (NSCLC) who had experienced disease progression with standard platinum-based therapy. The patients in the nivolumab group lived an average of 3 months longer compared with patients receiving docetaxel in [ Read More ]

Immunotherapy

Sharing the Best of ASCO

Dear Colleague, Each year, we look forward to the American Society of Clinical Oncology (ASCO) Annual Meeting where the oncology community gathers to review the past year and discuss the lessons and successes that will impact the lives of patients. The value in gathering is not only in sharing what [ Read More ]

Letter to Our Readers

Early Data for ANTI–PD-L1 in Urothelial Bladder Cancer

The programmed death-1 ligand 1 (PD-L1) inhibitor atezolizumab (formerly MPDL3280A) had encouraging activity in a cohort of heavily pretreated patients with metastatic urothelial bladder cancer (UBC). PD-L1 status as measured by an SP142 assay appears to be predictive of the benefit of atezolizumab in UBC, but it is not predictive [ Read More ]

Immunotherapy

Pembrolizumab in Colorectal Cancer: Can Benefit Be Predicted?

New to the programmed death-1 (PD-1) inhibitor arena is colo­rectal cancer, and for this tumor it may be possible to predict which patients will benefit from these drugs. In a phase 2 study of patients with colorectal cancer treated with pembrolizumab, the presence of mismatch repair (MMR) deficiency within the [ Read More ]

Immunotherapy

ABCs of Immunotherapy

With the surge in new immunotherapies becoming available for the treatment of melanoma, non–small cell lung cancer, bladder cancer, and other solid tumors, it is important to know how to assess response patterns that differ from those of chemotherapy, manage the unique side effects, and understand the mechanisms of action [ Read More ]

Immunotherapy

Encouraging Results for Pembrolizumab in Head and Neck Cancer

Pembrolizumab achieved “remarkable” results in a phase 1 study of previously treated, recurrent, squamous cell carcinoma of the head and neck. Tumor shrinkage was observed in 57% of these poor-prognosis, heavily pretreated patients, and 24.8% had partial or complete response on treatment with pembrolizumab in an expansion cohort of the [ Read More ]

Immunotherapy

Combination Immunotherapy Superior to Monotherapy in Patients with Melanoma

Combination treatment with the immunotherapies nivolumab and ipilimumab led to a doubling in progression-free survival (PFS) compared with ipilimumab alone in patients with advanced melanoma, investigators from the CheckMate 067 trial reported. The study also suggested promise for programmed death-1 (PD-1) ligand 1 (PD-L1) as a biomarker of response that [ Read More ]

Immunotherapy

Elotuzumab, a First-in-Class Monoclonal Antibody Immunotherapy, Improves Outcomes in Patients with Multiple Myeloma

The addition of the novel monoclonal antibody elotuzumab to dexamethasone plus lenalidomide resulted in a 30% reduction in the risk for disease progression and death in patients with relapsed or refractory multiple myeloma. These interim results from the ELOQUENT-2 phase 3 trial, the largest study of a monoclonal antibody in [ Read More ]

Immunotherapy

Lenvatinib Warrants Further Study in mRCC

Lenvatinib added to everolimus extended overall survival (OS) significantly compared with everoli­mus alone in patients with metastatic renal cell carcinoma (mRCC). This phase 2 study also demonstrated improved progression-free survival (PFS) with lenvatinib alone and in combination with everolimus compared with everolimus alone. The OS finding was a secondary end [ Read More ]

RENAL CELL CARCINOMA

Genetic Abnormality Pinpointed for Intensive Therapy in Wilms Tumor

In children with favorable-risk Wilms tumor, the presence of a rare genetic abnormality identifies children who can have a survival benefit from the augmentation or intensification of therapy. The abnormality—loss of heterozygosity on chromosomes 1p and 16q (LOH 1p, 16q)—is associated with worse prognosis in children with Wilms tumor. Two [ Read More ]

Genetics

Activating KIR Genes Implicated in Development of MDS

Evidence from a case-control study implicates the number of activating killer-cell immunoglobulin-like receptor (KIR) genes in the risk of developing myelodysplastic syndrome (MDS) as well as being able to distinguish between high-risk and low-risk MDS once the disease is present. Specifically, patients with high-risk MDS had significantly lower numbers of [ Read More ]

Genetics

Ibrutinib Reduces Risk of Progression in Previously Treated CLL

The combination of ibrutinib plus standard therapy with bendamustine/rituximab (IBR) significantly reduced the risk of progression or death by 80% compared with BR alone in previously treated patients with chronic lymphocytic leukemia (CLL)/small lymphocytic leukemia (SLL), according to results from HELIOS, one of the largest phase 3 trials in this [ Read More ]

Hematological Malignancies

Oral Nicotinamide Prevents Common Skin Cancers

Prevention of common skin cancers and precancers is possible by taking an inexpensive, widely available oral pill twice a day. The pill, a vitamin B3 supplement called nicotinamide, cut the rate of new squamous and basal cell skin cancers by 23% compared with placebo after 1 year. Nicotinamide also reduced [ Read More ]

Prevention

T-DM1 Not Superior to Standard of Care in First-Line Metastatic Breast Cancer

The standard of care for previously untreated HER2-positive metastatic breast cancer remains taxane/trastuzumab/pertuzumab, according to results from the MARIANNE trial, which evaluated trastuzumab emtansine (T-DM1) in this setting. While T-DM1 was not inferior to trastuzumab/taxane (HT), it did not improve outcomes over the control arm and, therefore, does not merit [ Read More ]

Breast Cancer

Adding Radiation to First-Line FOLFOX Reduces Progression of Liver Metastases in Patients with Metastatic Colorectal Cancer

In patients with metastatic colorectal cancer (mCRC) with liver-dominant metastases who received first-line FOLFOX (leucovorin, fluorouracil, and oxaliplatin) with or without bevacizu­mab plus selective internal radiation therapy (SIRT) compared with FOLFOX with or without bevacizumab, progression-free survival (PFS) in the liver was extended by 7.9 months, according to the results [ Read More ]

Gastrointestinal Cancer

Bevacizumab Wins Cost-Effectiveness Analysis in First-Line Metastatic Colorectal Cancer

An economic analysis of the landmark CALGB/SWOG 80405 study, which compared bevaciz­umab versus cetuximab in patients with metastatic colorectal cancer, declares bevacizumab the clear winner, as its total cost is $39,000 less than cetuximab. “Chemotherapy plus bevacizumab costs less and achieves very similar survival and quality-adjusted survival as chemotherapy plus [ Read More ]

Gastrointestinal Cancer

Docetaxel Boosts Survival in Hormone-Naive Metastatic Prostate Cancer

Adding docetaxel to standard hormone therapy extends overall survival (OS) by a median of 10 months versus hormone therapy alone in men with newly diagnosed, advanced hormone therapy–naive prostate cancer according to results from the STAMPEDE trial. The survival benefits were more pronounced in metastatic disease and were less certain [ Read More ]

Prostate Cancer

Urine Assays Detect Early Mutations in Patients with Advanced Cancers

An assay that measures circulating tumor DNA (ctDNA) in the urine can detect mutations in patients with advanced cancers. In one study, tracking cell-free DNA mutations in the urine from patients with refractory cancers found that low-frequency KRAS mutations were present in about 80%, said Filip Janku, MD, PhD. “We [ Read More ]

Cancer Screening

Cost-Effectiveness of T-DM1 Examined

For the treatment of advanced HER2-positive breast cancer, the use of trastuzumab emtansine (T-DM1) is not cost-effective when compared with lapatinib plus capecitabine from both a societal and a payer’s perspective, according to an analysis conducted at Western University of Health Sciences College of Pharmacy in Pomona, CA. From a [ Read More ]

Value-Based Cancer Care

Enhanced Reimbursement for Oncology Services Pays for Patient-Centered Care

Payment models that align reimbursement to support treatment planning and care coordination encourage oncology care providers to adhere to cancer treatment pathways, said Jennifer Malin, MD, PhD. Anthem has a Cancer Care Quality Program that aligns practice patterns of physicians through enhanced reimbursement mechanisms. The providers qualify for enhanced reimbursement [ Read More ]

Value-Based Cancer Care

Aetna Examines Cost by Site of Service

Contrary to the notion that chemotherapy infusion has largely become a hospital-based procedure, analysts from Aetna found that three-quarters of their patients still receive chemotherapy in the community. They also found tremendous variability, by site of service, in the cost of caring for cancer patients. “There’s been much discussion about [ Read More ]

Value-Based Cancer Care

ASCO’s Value Initiative: A Case-Based Approach

Recent advances in medical technology have led to remarkable breakthroughs in cancer treatments. Unfortunately, new cancer drugs come with enormous price tags, and patients are forced to make difficult decisions about very high out-of-pocket costs for expensive treatments with measurable but sometimes modest health benefits. The chair of the ASCO [ Read More ]

Value-Based Cancer Care

Searching for the Tipping Point in Drug Pricing

Leonard Saltz, MD, Chief of Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York City, was given a prominent soapbox from which to voice his concerns about the rising cost of cancer care. At the plenary session, Saltz was asked to share his perspective on the rising costs of [ Read More ]

Value-Based Cancer Care

Treating with Checkpoint Inhibitors—Figure $1 Million per Patient

Leonard Saltz, MD, Chief of Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York City, wants the new checkpoint inhibitors to be available to his patients, but he questions how society will pay for them. Offering his perspective on value during the plenary session presentation, Saltz estimated that [ Read More ]

Value-Based Cancer Care

Targeted and Immunologic Approaches to Brain Metastases

Targeted agents and immunotherapeutic approaches hold promise for the treatment of patients with brain metastases, which occur in up to 30% of adults with cancer. Given that most cancer patients die of metastases rather than their primary tumor, and the potentially devastating effects of central nervous system (CNS) impairment due [ Read More ]

Brain Metastases

Immunotherapy Makes Headwinds into Liver Cancer

Immunotherapy with nivolumab resulted in durable responses and promising overall survival (OS) in a dose-escalation and -expansion trial of patients with advanced liver cancer. The 12-month OS rate exceeded 60% in patients in whom sorafenib had failed, and responses occurred in patients with the hepatitis B virus (HBV) or hepatitis [ Read More ]

Immunotherapy