The Oncologist - Wiley Online Library

Time 2020-09-14 20:03:54

Web Name: The Oncologist - Wiley Online Library

WebSite: http://theoncologist.alphamedpress.org

ID:46620

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The Oncologist is committed to helping physicians excel in the constantly changing fields of oncology and hematology through the publication of timely reviews, original studies, and commentaries on important developments. Can Oncologists Predict the Efficacy of Treatments in Randomized Trials?The effectiveness of decisions regarding approval of clinical trials relies partly on the ability of approvers to assess accurately the promise of treatments and prioritize those most promising. This study measured the ability of oncologists to predict whether cancer treatments would demonstrate efficacy in randomized trials. New Verse for a Familiar Song: Small Molecule Inhibitors for MET exon 14 Skipping Non‐Small Cell Lung CancerThis commentary evaluates the evidence that established MET exon 14 skipping as an actionable driver oncogene in NSCLC, the unique patient population defined by MET exon 14 skipping alterations, and the clinical challenges to care for this elderly patient population. Use of Companion Diagnostics in Advanced NSCLCImproved diagnostic and treatment approaches are needed for patients with non‐small cell lung cancer. This article evaluates the testing patterns and outcomes associated with overall companion diagnostic testing in real‐world clinical practice. Treating Patients with Cancer Fairly During PandemicsThe COVID-19 pandemic has stressed the health care system, prompting the need for guidance on the most equitable steps to follow for the emergency allocation of critical care resources. It is important that such guidelines treat all patients fairly during the pandemic, including patients with cancer, whose diagnosis need not be considered terminal. Racism and Cancer Care: A Call for Recognition and ReformBruce Chabner announces a forthcoming special series investigating the impact of systemic racism on the health outcomes of minority communities in the United States. Concurrent chemo radiotherapy (CCRT) has been the standard of care in locally advanced nasopharyngeal carcinoma (LA‐NPC) for many years. The role of induction chemotherapy (ICT) has always been controversial. This systematic review and meta‐analysis investigates the value of adding ICT to CCRT in LA‐NPC. Two reviewers independently assessed the eligibility of randomized controlled‐trials (RCTs) comparing ICT followed by CCRT versus CCRT alone, including treatment naïve adult patients with histologically proven non‐metastatic LA‐NPC. Eight RCTs with in total 2384 randomized patients, of whom 69% had N2‐N3 disease, were selected. ICT was the allocated treatment in 1200 patients, of whom 1161 actually received this. Treatment compliance varied, with a median rate of 92% [range: 86–100%] of patients receiving all cycles of ICT. The percentage of patients completing radiotherapy was 96% and 95% [(Combined Risk difference (CRD)= 0.004; 95%CI ‐0.001–0.01; p=0.14)] in the ICT group and CCRT group, respectively, while chemotherapy during radiotherapy could be completed only in 28% of the ICT group versus 61% in the CCRT group (CRD=‐0.243; 95%CI‐0.403‐‐0.083; p=0.003). Grade 3–4 acute toxicity was mostly hematologic during the ICT phase (496 events versus 191 non‐hematologic) and was predominant in the ICT group (1596 events versus 1073 in the CCRT alone group) during the CCRT. Adding ICT to CCRT provided a significant benefit in overall survival (hazard ratio (HR) = 0.680; 95%CI 0.511 to 0.905; p=0.001) and progression‐free survival (HR=0.657; 95%CI 0.568 to 0.760; p 0.001). Although ICT followed by CCRT is associated with more acute toxicity and a lower compliance of the chemotherapy during the CCRT phase, this association resulted in a clinically meaningful survival benefit. ICT should be considered as a standard option in patients with LA‐NPC, but further study on optimal patient selection for this treatment is warranted. Locally advanced nasopharyngeal carcinoma is a relatively common disease in some parts of the world, with a rather poor prognosis due to its high metastatic potential. The role of induction chemotherapy (ICT) has always been controversial. Our meta‐analysis demonstrates that ICT followed by concurrent chemo radiotherapy (CCRT) in LANPC is associated with a significant clinical improvement in both overall survival and progression‐free survival compared to CCRT alone. ICT should be considered as a standard option in patients with LANPC. Desmoid tumours (DT) are rare collagen‐forming tumours which can exhibit locally aggressive patterns of behaviour. The aim of this study was to evaluate the efficacy and safety of treatment of DT with single agent oral vinorelbine. A retrospective review of patients treated with vinorelbine 90mg orally on Days 1, 8 and 15 of a 28‐day cycle from January 2004‐July 2019 was performed. Response was assessed using Response Evaluation Criteria in Solid Tumours version 1.1. Descriptive statistics were employed. 29 patients were included. Response rate was 20.7% (6/29) and clinical benefit rate (response by RECIST 1.1 and/or clinical symptom improvement) was 65.5% (19/29).. No patient experienced grade 3 or above toxicity. Common toxicities were grade 1‐2 nausea (14/26, 48.3%), fatigue (9/26, 31.0%) and diarrhoea (4/26, 13.8%). Single agent oral vinorelbine is an effective, safe and well tolerated treatment for DT. It represents a new oral alternative for management of DT. RAF family protein kinases signal through the MAPK pathway to orchestrate cellular proliferation, survival, and transformation. Identifying BRAF alterations in pediatric cancers is critically important as therapeutic agents targeting BRAF or MEK may be incorporated into the clinical management of these patients. In this study, we performed comprehensive genomic profiling on 3,633 pediatric cancer samples and identified a cohort of 221 (6.1%) cases with known or novel alerations in BRAF or RAF1 detected in extracranial solid tumors, brain tumors, or hematological malignancies. 80% (176/221) of these tumors had a known‐activating SV (98, 55.7%), fusion (72, 40.9%), or indel (6, 3.4%). Among BRAF altered cancers, the most common tumor types were brain tumors (74.4%), solid tumors (10.8%), hematological malignancies (9.1%), sarcomas (3.4%) and extracranial embryonal tumors (2.3%). RAF1 fusions containing intact RAF1 kinase domain (encoded by exons 10‐17) were identified in 7 tumors including two novel fusions TMF1‐RAF1 and SOX6‐RAF1. Additionally, we highlight a subset of brain tumor patients with positive clinical response to BRAF inhibitors, demonstrating the rationale for incorporating precision medicine into pediatric oncology. Precision medicine has not yet gained a strong foothold in pediatric cancers. This study describes the landscape of BRAF and RAF1 genomic alterations across a diverse spectrum of pediatric cancers, primarily brain tumors, but also encompassing melanoma, sarcoma, several types of hematologic malignancy, and others. Given the availability of multiple FDA‐approved BRAF inhibitors, identification of these alterations may assist with treatment decision making, as described here in three cases of pediatric cancer. Please check your email for instructions on resetting your password. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. Can't sign in? Forgot your username? 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