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Study shows faster increase in obesity prevalence among cancer survivors
From 1997 to 2014, cancer survivors had a significantly faster increase in obesity prevalence compared with adults without a history of cancer, investigators found.
Furthermore, the elevated annual increase in rates of obesity was more pronounced in women, in breast and colorectal cancer survivors, and in non-Hispanic blacks.
Cancer patients may be at an increased risk for weight gain caused by specific cancer treatments such as chemotherapy, steroid modifications, and various hormone therapies, especially in “hormonally and metabolically driven cancers such as breast and colorectal cancer,” wrote Heather Greenlee, ND, PhD, of Columbia University, New York, and her associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.66.4391). “To better inform future research on obesity and cancer survival and to inform the planning and implementation of weight loss interventions in cancer survivors, we compared trends from 1997 to 2014 in obesity prevalence in U.S. adults with and without a history of cancer,” the researchers explained.
Obesity prevalence and trends were evaluated through the National Health Interview Survey, an ongoing cross-sectional survey of the health status, health care access, and behaviors of the U.S. civilian population conducted by the National Center for Health Statistics.
For the current study, surveys from a total of 538,969 adults aged 18-85 years with (n = 32,447) or without (n = 506,522) a history of cancer were analyzed. Participants provided self-reported height and weight measures from which body mass index was calculated. Obesity was defined as a BMI of 30 kg/m2 or higher for non-Asians and 27.5 kg/m2 or higher for Asians. Participants also self-reported sex, race, and cancer history.
Overall, the prevalence of obesity consistently increased from 1997 to 2014. Among cancer survivors, the prevalence of obesity increased from 22.4% to 31.7% while in adults without a history of cancer, prevalence increased from 20.9% to 29.5%.
The annual increase in the rate of obesity was significantly greater in both women and men with a history of cancer (2.9% and 2.8% respectively) compared with those without a history of cancer (2.3% and 2.4%, P less than .001 for all).
The elevated annual increase in rates of obesity was even higher in colorectal (3.1% in women and 3.7% in men) and breast (3.0%) cancer survivors compared with adults without a history of cancer, but was lower in prostate cancer survivors (2.1%; P = .001 for all).
“These findings call for public health planning of effective and scalable weight management and control programs for cancer survivors, especially for breast and colorectal cancer survivors and for non-Hispanic blacks,” the investigators concluded.
The National Cancer Institute funded the study. Dr. Greenlee and one other investigator reported serving in advisory roles for EHE International.
On Twitter @jessnicolecraig
From 1997 to 2014, cancer survivors had a significantly faster increase in obesity prevalence compared with adults without a history of cancer, investigators found.
Furthermore, the elevated annual increase in rates of obesity was more pronounced in women, in breast and colorectal cancer survivors, and in non-Hispanic blacks.
Cancer patients may be at an increased risk for weight gain caused by specific cancer treatments such as chemotherapy, steroid modifications, and various hormone therapies, especially in “hormonally and metabolically driven cancers such as breast and colorectal cancer,” wrote Heather Greenlee, ND, PhD, of Columbia University, New York, and her associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.66.4391). “To better inform future research on obesity and cancer survival and to inform the planning and implementation of weight loss interventions in cancer survivors, we compared trends from 1997 to 2014 in obesity prevalence in U.S. adults with and without a history of cancer,” the researchers explained.
Obesity prevalence and trends were evaluated through the National Health Interview Survey, an ongoing cross-sectional survey of the health status, health care access, and behaviors of the U.S. civilian population conducted by the National Center for Health Statistics.
For the current study, surveys from a total of 538,969 adults aged 18-85 years with (n = 32,447) or without (n = 506,522) a history of cancer were analyzed. Participants provided self-reported height and weight measures from which body mass index was calculated. Obesity was defined as a BMI of 30 kg/m2 or higher for non-Asians and 27.5 kg/m2 or higher for Asians. Participants also self-reported sex, race, and cancer history.
Overall, the prevalence of obesity consistently increased from 1997 to 2014. Among cancer survivors, the prevalence of obesity increased from 22.4% to 31.7% while in adults without a history of cancer, prevalence increased from 20.9% to 29.5%.
The annual increase in the rate of obesity was significantly greater in both women and men with a history of cancer (2.9% and 2.8% respectively) compared with those without a history of cancer (2.3% and 2.4%, P less than .001 for all).
The elevated annual increase in rates of obesity was even higher in colorectal (3.1% in women and 3.7% in men) and breast (3.0%) cancer survivors compared with adults without a history of cancer, but was lower in prostate cancer survivors (2.1%; P = .001 for all).
“These findings call for public health planning of effective and scalable weight management and control programs for cancer survivors, especially for breast and colorectal cancer survivors and for non-Hispanic blacks,” the investigators concluded.
The National Cancer Institute funded the study. Dr. Greenlee and one other investigator reported serving in advisory roles for EHE International.
On Twitter @jessnicolecraig
From 1997 to 2014, cancer survivors had a significantly faster increase in obesity prevalence compared with adults without a history of cancer, investigators found.
Furthermore, the elevated annual increase in rates of obesity was more pronounced in women, in breast and colorectal cancer survivors, and in non-Hispanic blacks.
Cancer patients may be at an increased risk for weight gain caused by specific cancer treatments such as chemotherapy, steroid modifications, and various hormone therapies, especially in “hormonally and metabolically driven cancers such as breast and colorectal cancer,” wrote Heather Greenlee, ND, PhD, of Columbia University, New York, and her associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.66.4391). “To better inform future research on obesity and cancer survival and to inform the planning and implementation of weight loss interventions in cancer survivors, we compared trends from 1997 to 2014 in obesity prevalence in U.S. adults with and without a history of cancer,” the researchers explained.
Obesity prevalence and trends were evaluated through the National Health Interview Survey, an ongoing cross-sectional survey of the health status, health care access, and behaviors of the U.S. civilian population conducted by the National Center for Health Statistics.
For the current study, surveys from a total of 538,969 adults aged 18-85 years with (n = 32,447) or without (n = 506,522) a history of cancer were analyzed. Participants provided self-reported height and weight measures from which body mass index was calculated. Obesity was defined as a BMI of 30 kg/m2 or higher for non-Asians and 27.5 kg/m2 or higher for Asians. Participants also self-reported sex, race, and cancer history.
Overall, the prevalence of obesity consistently increased from 1997 to 2014. Among cancer survivors, the prevalence of obesity increased from 22.4% to 31.7% while in adults without a history of cancer, prevalence increased from 20.9% to 29.5%.
The annual increase in the rate of obesity was significantly greater in both women and men with a history of cancer (2.9% and 2.8% respectively) compared with those without a history of cancer (2.3% and 2.4%, P less than .001 for all).
The elevated annual increase in rates of obesity was even higher in colorectal (3.1% in women and 3.7% in men) and breast (3.0%) cancer survivors compared with adults without a history of cancer, but was lower in prostate cancer survivors (2.1%; P = .001 for all).
“These findings call for public health planning of effective and scalable weight management and control programs for cancer survivors, especially for breast and colorectal cancer survivors and for non-Hispanic blacks,” the investigators concluded.
The National Cancer Institute funded the study. Dr. Greenlee and one other investigator reported serving in advisory roles for EHE International.
On Twitter @jessnicolecraig
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Cancer survivors had a significantly faster increase in obesity prevalence compared with adults without a history of cancer.
Major finding: The annual increase in the rate of obesity was significantly higher in both women and men with a history of cancer (2.9% and 2.8% respectively) compared with those without a history of cancer (2.3% and 2.4%, P less than .001 for all).
Data source: National Health Interview Survey responses from 538,969 adults aged 18-85 years with (n = 32,447) or without (n = 506,522) a history of cancer.
Disclosures: The National Cancer Institute funded the study. Dr. Greenlee and one other investigator reported serving in advisory roles for EHE International.
Overweight, obesity increase risk of cardiotoxicity from anthracyclines
Being overweight or obese was significantly associated with a greater risk of developing cardiotoxicity among breast cancer patients treated with anthracyclines and/or trastuzumab, investigators found.
Anthracyclines, a class of anticancer agents widely used to treat many cancer types, have a known association with cardiotoxicity. Furthermore, people who are overweight or obese have an increased risk for developing cardiovascular diseases. The purpose of this study was to “explore in greater depth the influence of overweight and obesity as aggravating factors in the development of cardiotoxicity” specifically among patients who received anthracycline and/or trastuzumab as part of their cancer treatment and were therefore at increased risk of experiencing cardiac-related adverse events, wrote Charles Guenancia, MD, PhD, of University Hospital, Dijon Cedex, France, and his associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.67.4846).
These results are from a meta-analysis of 15 published prospective or retrospective cohort studies that investigated or otherwise reported data on the association between overweight and/or obesity and cardiotoxicity resulting from anthracycline and/or trastuzumab use for treating localized or metastatic breast cancer. Together, the 15 studies represented a total of 8,745 breast cancer patients.
Overall, the mean rate of cardiotoxicity was 17% (95% confidence interval, 11%-25%). Patients treated with anthracyclines only (n = 3,898) had a mean rate of cardiotoxicity of 20% (95% CI, 5%-43%) while patients treated with trastuzumab with or without anthracyclines (n = 4,847) had a lower mean rate of cardiotoxicity at 16% (95% CI, 10%-24%).Paired meta-analysis revealed that overweight, defined as a body mass index score of 25 to 29.9, was associated with increased risk of cardiotoxicity with an odds ratio of 1.15 (95% CI, 0.83-1.58). Obesity, defined as a body mass index score of 30 or greater, was associated with a greater risk of cardiotoxicity with an odds ratio of 1.47 (95% CI, 0.95-2.28).
The association between body mass index and the risk of cardiotoxicity did not differ significantly by drug regimen (anthracyclines alone or sequential anthracyclines and trastuzumab).
This study’s funding source was not listed. Dr. Guenancia and one other investigator reported serving in advisory roles and/or receiving financial compensation from various companies.
On Twitter @jessnicolecraig
Being overweight or obese was significantly associated with a greater risk of developing cardiotoxicity among breast cancer patients treated with anthracyclines and/or trastuzumab, investigators found.
Anthracyclines, a class of anticancer agents widely used to treat many cancer types, have a known association with cardiotoxicity. Furthermore, people who are overweight or obese have an increased risk for developing cardiovascular diseases. The purpose of this study was to “explore in greater depth the influence of overweight and obesity as aggravating factors in the development of cardiotoxicity” specifically among patients who received anthracycline and/or trastuzumab as part of their cancer treatment and were therefore at increased risk of experiencing cardiac-related adverse events, wrote Charles Guenancia, MD, PhD, of University Hospital, Dijon Cedex, France, and his associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.67.4846).
These results are from a meta-analysis of 15 published prospective or retrospective cohort studies that investigated or otherwise reported data on the association between overweight and/or obesity and cardiotoxicity resulting from anthracycline and/or trastuzumab use for treating localized or metastatic breast cancer. Together, the 15 studies represented a total of 8,745 breast cancer patients.
Overall, the mean rate of cardiotoxicity was 17% (95% confidence interval, 11%-25%). Patients treated with anthracyclines only (n = 3,898) had a mean rate of cardiotoxicity of 20% (95% CI, 5%-43%) while patients treated with trastuzumab with or without anthracyclines (n = 4,847) had a lower mean rate of cardiotoxicity at 16% (95% CI, 10%-24%).Paired meta-analysis revealed that overweight, defined as a body mass index score of 25 to 29.9, was associated with increased risk of cardiotoxicity with an odds ratio of 1.15 (95% CI, 0.83-1.58). Obesity, defined as a body mass index score of 30 or greater, was associated with a greater risk of cardiotoxicity with an odds ratio of 1.47 (95% CI, 0.95-2.28).
The association between body mass index and the risk of cardiotoxicity did not differ significantly by drug regimen (anthracyclines alone or sequential anthracyclines and trastuzumab).
This study’s funding source was not listed. Dr. Guenancia and one other investigator reported serving in advisory roles and/or receiving financial compensation from various companies.
On Twitter @jessnicolecraig
Being overweight or obese was significantly associated with a greater risk of developing cardiotoxicity among breast cancer patients treated with anthracyclines and/or trastuzumab, investigators found.
Anthracyclines, a class of anticancer agents widely used to treat many cancer types, have a known association with cardiotoxicity. Furthermore, people who are overweight or obese have an increased risk for developing cardiovascular diseases. The purpose of this study was to “explore in greater depth the influence of overweight and obesity as aggravating factors in the development of cardiotoxicity” specifically among patients who received anthracycline and/or trastuzumab as part of their cancer treatment and were therefore at increased risk of experiencing cardiac-related adverse events, wrote Charles Guenancia, MD, PhD, of University Hospital, Dijon Cedex, France, and his associates (J Clin Oncol. 2016 July 25. doi: 10.1200/JCO.2016.67.4846).
These results are from a meta-analysis of 15 published prospective or retrospective cohort studies that investigated or otherwise reported data on the association between overweight and/or obesity and cardiotoxicity resulting from anthracycline and/or trastuzumab use for treating localized or metastatic breast cancer. Together, the 15 studies represented a total of 8,745 breast cancer patients.
Overall, the mean rate of cardiotoxicity was 17% (95% confidence interval, 11%-25%). Patients treated with anthracyclines only (n = 3,898) had a mean rate of cardiotoxicity of 20% (95% CI, 5%-43%) while patients treated with trastuzumab with or without anthracyclines (n = 4,847) had a lower mean rate of cardiotoxicity at 16% (95% CI, 10%-24%).Paired meta-analysis revealed that overweight, defined as a body mass index score of 25 to 29.9, was associated with increased risk of cardiotoxicity with an odds ratio of 1.15 (95% CI, 0.83-1.58). Obesity, defined as a body mass index score of 30 or greater, was associated with a greater risk of cardiotoxicity with an odds ratio of 1.47 (95% CI, 0.95-2.28).
The association between body mass index and the risk of cardiotoxicity did not differ significantly by drug regimen (anthracyclines alone or sequential anthracyclines and trastuzumab).
This study’s funding source was not listed. Dr. Guenancia and one other investigator reported serving in advisory roles and/or receiving financial compensation from various companies.
On Twitter @jessnicolecraig
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Being overweight or obese was significantly associated with a greater risk of developing cardiotoxicity among breast cancer patients treated with anthracycline and/or trastuzumab.
Major finding: Being overweight was associated with increased risk of cardiotoxicity with an odds ratio of 1.15 (95% CI, 0.83-1.58). Obesity was associated with a greater risk of cardiotoxicity with an odds ratio of 1.47 (95% CI, 0.95-2.28).
Data source: A meta-analysis of 15 studies that investigated or otherwise reported data on the association between overweight and/or obesity and cardiotoxicity resulting from anthracyclines and/or trastuzumab use for treating breast cancer.
Disclosures: This study’s funding source was not identified. Dr. Guenancia and one other investigator reported serving in advisory roles and/or receiving financial compensation from various companies.
Disparities in prostate cancer treatment found at both academic and community centers
Academic and community cancer centers demonstrated similarly high rates of sociodemographic disparities in prostate cancer treatment patterns, a study showed.
Specifically, black, Hispanic, and uninsured patients were less likely to receive definitive therapy for high-risk prostate cancer at community and academic cancer centers than were white or privately insured patients. In addition, white patients began receiving therapy earlier than black and Hispanic patients at both community and academic medical centers.
“The finding that disparities exist across cancer care centers, regardless of academic versus community center structure, suggests that there may be something intrinsic about systemic, provider-level, or patient-level issues that may be interfering with treatment,” wrote Brandon Mahal, MD, of Brigham and Women’s Hospital in Boston and his associates (Cancer. July 2016. doi:10.1002/cncr.30205).
Dr. Mahal and associates identified 138,019 patients with high-risk prostate cancer who had a definitive treatment history available through the National Cancer Data Base. Definitive therapy was defined as either prostatectomy or radiation therapy plus androgen-deprivation therapy. High-risk disease was defined as having a prostate-specific antigen score above 20 ng/mL, a Gleason score of 8-10, or a clinical tumor classification of cT3a.
The investigators found black, Hispanic, and uninsured patients were less likely to receive definitive therapy at community cancer centers than were white or privately insured patients (adjusted odds ratios: 0.60, 0.69, and 0.25; 95% confidence intervals: 0.56-0.64, 0.61-0.78, and 0.22-0.30 for black, Hispanic, and uninsured patients; P less than .001). This finding was also true for patients who received treatment at academic cancer centers (AOR: 0.50, 0.56, and 0.31; 95% CI: 0.46-0.54, 0.50-0.64, and 0.28-0.36; P less than .001 for all).
At academic centers, the median time until receipt of definitive treatment was 83 days for white patients, 102 days for black patients, and 94 days for Hispanic patients. At community centers, the median time until receipt of treatment was 77 days for white patients, 92 days for black patients, and 87 days for Hispanic patients.
This study was supported by David and Cynthia Chapin, Hugh Simons, the Campbell Family, the Prostate Cancer Foundation, Fitz’s Cancer Warriors, the Scott Forbes and Gina Ventre Fund, and a grant from an anonymous foundation. Three investigators reported receiving financial compensation from multiple companies.
On Twitter @jessnicolecraig
Academic and community cancer centers demonstrated similarly high rates of sociodemographic disparities in prostate cancer treatment patterns, a study showed.
Specifically, black, Hispanic, and uninsured patients were less likely to receive definitive therapy for high-risk prostate cancer at community and academic cancer centers than were white or privately insured patients. In addition, white patients began receiving therapy earlier than black and Hispanic patients at both community and academic medical centers.
“The finding that disparities exist across cancer care centers, regardless of academic versus community center structure, suggests that there may be something intrinsic about systemic, provider-level, or patient-level issues that may be interfering with treatment,” wrote Brandon Mahal, MD, of Brigham and Women’s Hospital in Boston and his associates (Cancer. July 2016. doi:10.1002/cncr.30205).
Dr. Mahal and associates identified 138,019 patients with high-risk prostate cancer who had a definitive treatment history available through the National Cancer Data Base. Definitive therapy was defined as either prostatectomy or radiation therapy plus androgen-deprivation therapy. High-risk disease was defined as having a prostate-specific antigen score above 20 ng/mL, a Gleason score of 8-10, or a clinical tumor classification of cT3a.
The investigators found black, Hispanic, and uninsured patients were less likely to receive definitive therapy at community cancer centers than were white or privately insured patients (adjusted odds ratios: 0.60, 0.69, and 0.25; 95% confidence intervals: 0.56-0.64, 0.61-0.78, and 0.22-0.30 for black, Hispanic, and uninsured patients; P less than .001). This finding was also true for patients who received treatment at academic cancer centers (AOR: 0.50, 0.56, and 0.31; 95% CI: 0.46-0.54, 0.50-0.64, and 0.28-0.36; P less than .001 for all).
At academic centers, the median time until receipt of definitive treatment was 83 days for white patients, 102 days for black patients, and 94 days for Hispanic patients. At community centers, the median time until receipt of treatment was 77 days for white patients, 92 days for black patients, and 87 days for Hispanic patients.
This study was supported by David and Cynthia Chapin, Hugh Simons, the Campbell Family, the Prostate Cancer Foundation, Fitz’s Cancer Warriors, the Scott Forbes and Gina Ventre Fund, and a grant from an anonymous foundation. Three investigators reported receiving financial compensation from multiple companies.
On Twitter @jessnicolecraig
Academic and community cancer centers demonstrated similarly high rates of sociodemographic disparities in prostate cancer treatment patterns, a study showed.
Specifically, black, Hispanic, and uninsured patients were less likely to receive definitive therapy for high-risk prostate cancer at community and academic cancer centers than were white or privately insured patients. In addition, white patients began receiving therapy earlier than black and Hispanic patients at both community and academic medical centers.
“The finding that disparities exist across cancer care centers, regardless of academic versus community center structure, suggests that there may be something intrinsic about systemic, provider-level, or patient-level issues that may be interfering with treatment,” wrote Brandon Mahal, MD, of Brigham and Women’s Hospital in Boston and his associates (Cancer. July 2016. doi:10.1002/cncr.30205).
Dr. Mahal and associates identified 138,019 patients with high-risk prostate cancer who had a definitive treatment history available through the National Cancer Data Base. Definitive therapy was defined as either prostatectomy or radiation therapy plus androgen-deprivation therapy. High-risk disease was defined as having a prostate-specific antigen score above 20 ng/mL, a Gleason score of 8-10, or a clinical tumor classification of cT3a.
The investigators found black, Hispanic, and uninsured patients were less likely to receive definitive therapy at community cancer centers than were white or privately insured patients (adjusted odds ratios: 0.60, 0.69, and 0.25; 95% confidence intervals: 0.56-0.64, 0.61-0.78, and 0.22-0.30 for black, Hispanic, and uninsured patients; P less than .001). This finding was also true for patients who received treatment at academic cancer centers (AOR: 0.50, 0.56, and 0.31; 95% CI: 0.46-0.54, 0.50-0.64, and 0.28-0.36; P less than .001 for all).
At academic centers, the median time until receipt of definitive treatment was 83 days for white patients, 102 days for black patients, and 94 days for Hispanic patients. At community centers, the median time until receipt of treatment was 77 days for white patients, 92 days for black patients, and 87 days for Hispanic patients.
This study was supported by David and Cynthia Chapin, Hugh Simons, the Campbell Family, the Prostate Cancer Foundation, Fitz’s Cancer Warriors, the Scott Forbes and Gina Ventre Fund, and a grant from an anonymous foundation. Three investigators reported receiving financial compensation from multiple companies.
On Twitter @jessnicolecraig
FROM CANCER
Key clinical point: Academic and community cancer centers demonstrated similarly high rates of sociodemographic disparities in prostate cancer treatment patterns.
Major finding: Black, Hispanic, and uninsured patients were less likely to receive definitive therapy at community cancer centers than were white or privately insured patients (adjusted odds ratios: 0.60, 0.69, and 0.25; 95% confidence intervals: 0.56-0.64, 0.61-0.78, and 0.22-0.30 for black, Hispanic, and uninsured patients; P less than .001), and were less likely to receive definitive therapy at academic cancer centers (AOR: 0.50, 0.56, and 0.31; 95% CI: 0.46-0.54, 0.50-0.64, 0.28-0.36; P less than .001 for all).
Data source: A retrospective analysis of 138,019 patients with high-risk prostate cancer who had a definitive treatment history available in the National Cancer Data Base.
Disclosures: This study was supported by David and Cynthia Chapin, Hugh Simons, the Campbell Family, the Prostate Cancer Foundation, Fitz’s Cancer Warriors, the Scott Forbes and Gina Ventre Fund, and a grant from an anonymous foundation. Three investigators reported receiving financial compensation from multiple companies.
ASTRO updates treatment standard for rectal cancer
The American Society for Radiation Oncology (ASTRO) has issued a new clinical practice statement for neoadjuvant and adjuvant radiation therapy for patients with moderately advanced rectal cancer based on their risk of recurrence. The statement also examines nonoperative therapies for patients who are medically inoperable or refuse surgery.
“Advancements in treatment options over the past three decades – including more refined surgical techniques, more effective systemic agents, and more focal and shorter-course RT options – have drastically lowered recurrence rates, creating situations where one or more modalities may be omitted and the side effects of treatment may be reduced,” ASTRO noted in a written statement.
“This statement provides practicing physicians with an idea of how to employ alternative treatment options for rectal cancer patients, such as short-course radiation therapy or nonoperative management approaches. It also lets us identify patients who may be more amenable to different treatment sequencing options, rather than grouping everyone with stage II and III rectal cancer together for a single standard trimodal treatment approach. There are cases where we can achieve the same survival benefit with less treatment,” said Karyn A. Goodman, MD, of the University of Colorado. Dr. Goodman was the lead author of the practice statement’s executive summary.
The clinical practice statement was developed with the RAND/UCLA Appropriateness Method, where oncology, gastroenterology, and internal medicine physicians and experts rate the appropriateness of different treatment approaches for different clinical scenarios based on a systematic review of published research.
Neoadjuvant chemoradiation was rated “appropriate” for all scenarios, neoadjuvant brachytherapy was rated “rarely appropriate” for all scenarios, neoadjuvant chemotherapy was rated “may be appropriate” for intermediate- and moderately-high-risk patients, and “rarely appropriate” for the other scenarios, while forgoing neoadjuvant therapy was rated potentially appropriate only for cases with higher tumors situated far from the mesorectal fascia.
Complete recommendations can be found in the ASTRO Clinical Practice Statement published in the May-June 2016 issue of Practical Radiation Oncology.
On Twitter @jessnicolecraig
The American Society for Radiation Oncology (ASTRO) has issued a new clinical practice statement for neoadjuvant and adjuvant radiation therapy for patients with moderately advanced rectal cancer based on their risk of recurrence. The statement also examines nonoperative therapies for patients who are medically inoperable or refuse surgery.
“Advancements in treatment options over the past three decades – including more refined surgical techniques, more effective systemic agents, and more focal and shorter-course RT options – have drastically lowered recurrence rates, creating situations where one or more modalities may be omitted and the side effects of treatment may be reduced,” ASTRO noted in a written statement.
“This statement provides practicing physicians with an idea of how to employ alternative treatment options for rectal cancer patients, such as short-course radiation therapy or nonoperative management approaches. It also lets us identify patients who may be more amenable to different treatment sequencing options, rather than grouping everyone with stage II and III rectal cancer together for a single standard trimodal treatment approach. There are cases where we can achieve the same survival benefit with less treatment,” said Karyn A. Goodman, MD, of the University of Colorado. Dr. Goodman was the lead author of the practice statement’s executive summary.
The clinical practice statement was developed with the RAND/UCLA Appropriateness Method, where oncology, gastroenterology, and internal medicine physicians and experts rate the appropriateness of different treatment approaches for different clinical scenarios based on a systematic review of published research.
Neoadjuvant chemoradiation was rated “appropriate” for all scenarios, neoadjuvant brachytherapy was rated “rarely appropriate” for all scenarios, neoadjuvant chemotherapy was rated “may be appropriate” for intermediate- and moderately-high-risk patients, and “rarely appropriate” for the other scenarios, while forgoing neoadjuvant therapy was rated potentially appropriate only for cases with higher tumors situated far from the mesorectal fascia.
Complete recommendations can be found in the ASTRO Clinical Practice Statement published in the May-June 2016 issue of Practical Radiation Oncology.
On Twitter @jessnicolecraig
The American Society for Radiation Oncology (ASTRO) has issued a new clinical practice statement for neoadjuvant and adjuvant radiation therapy for patients with moderately advanced rectal cancer based on their risk of recurrence. The statement also examines nonoperative therapies for patients who are medically inoperable or refuse surgery.
“Advancements in treatment options over the past three decades – including more refined surgical techniques, more effective systemic agents, and more focal and shorter-course RT options – have drastically lowered recurrence rates, creating situations where one or more modalities may be omitted and the side effects of treatment may be reduced,” ASTRO noted in a written statement.
“This statement provides practicing physicians with an idea of how to employ alternative treatment options for rectal cancer patients, such as short-course radiation therapy or nonoperative management approaches. It also lets us identify patients who may be more amenable to different treatment sequencing options, rather than grouping everyone with stage II and III rectal cancer together for a single standard trimodal treatment approach. There are cases where we can achieve the same survival benefit with less treatment,” said Karyn A. Goodman, MD, of the University of Colorado. Dr. Goodman was the lead author of the practice statement’s executive summary.
The clinical practice statement was developed with the RAND/UCLA Appropriateness Method, where oncology, gastroenterology, and internal medicine physicians and experts rate the appropriateness of different treatment approaches for different clinical scenarios based on a systematic review of published research.
Neoadjuvant chemoradiation was rated “appropriate” for all scenarios, neoadjuvant brachytherapy was rated “rarely appropriate” for all scenarios, neoadjuvant chemotherapy was rated “may be appropriate” for intermediate- and moderately-high-risk patients, and “rarely appropriate” for the other scenarios, while forgoing neoadjuvant therapy was rated potentially appropriate only for cases with higher tumors situated far from the mesorectal fascia.
Complete recommendations can be found in the ASTRO Clinical Practice Statement published in the May-June 2016 issue of Practical Radiation Oncology.
On Twitter @jessnicolecraig
FDA grants priority review to nivolumab for head and neck cancer
The Food and Drug Administration has granted a priority review for expanded use of nivolumab for patients with previously treated recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN), based on results of Checkmate-141.
CheckMate-141 was stopped early in January 2016 after the study met its primary endpoint of improved overall survival in SCCHN patients receiving nivolumab after platinum-based therapy, compared to investigator’s choice of therapy (methotrexate, docetaxel, or cetuximab).
The FDA is expected to act on the review by Nov. 11, 2016, according to a written statement from Bristol-Myers Squib, makers of nivolumab.
The PD-1 immune checkpoint inhibitor, marketed as Opdivo, was also granted breakthrough therapy designation by the FDA for the treatment of unresectable locally advanced or metastatic urothelial carcinoma that has progressed during or following a platinum-based regimen, according to another written statement from Bristol-Myers Squibb. This is the sixth breakthrough therapy designation for nivolumab.
The breakthrough therapy designation in bladder cancer is based on the results of the phase II CA209-275 trial and other supportive data.
On Twitter @jessnicolecraig
The Food and Drug Administration has granted a priority review for expanded use of nivolumab for patients with previously treated recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN), based on results of Checkmate-141.
CheckMate-141 was stopped early in January 2016 after the study met its primary endpoint of improved overall survival in SCCHN patients receiving nivolumab after platinum-based therapy, compared to investigator’s choice of therapy (methotrexate, docetaxel, or cetuximab).
The FDA is expected to act on the review by Nov. 11, 2016, according to a written statement from Bristol-Myers Squib, makers of nivolumab.
The PD-1 immune checkpoint inhibitor, marketed as Opdivo, was also granted breakthrough therapy designation by the FDA for the treatment of unresectable locally advanced or metastatic urothelial carcinoma that has progressed during or following a platinum-based regimen, according to another written statement from Bristol-Myers Squibb. This is the sixth breakthrough therapy designation for nivolumab.
The breakthrough therapy designation in bladder cancer is based on the results of the phase II CA209-275 trial and other supportive data.
On Twitter @jessnicolecraig
The Food and Drug Administration has granted a priority review for expanded use of nivolumab for patients with previously treated recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN), based on results of Checkmate-141.
CheckMate-141 was stopped early in January 2016 after the study met its primary endpoint of improved overall survival in SCCHN patients receiving nivolumab after platinum-based therapy, compared to investigator’s choice of therapy (methotrexate, docetaxel, or cetuximab).
The FDA is expected to act on the review by Nov. 11, 2016, according to a written statement from Bristol-Myers Squib, makers of nivolumab.
The PD-1 immune checkpoint inhibitor, marketed as Opdivo, was also granted breakthrough therapy designation by the FDA for the treatment of unresectable locally advanced or metastatic urothelial carcinoma that has progressed during or following a platinum-based regimen, according to another written statement from Bristol-Myers Squibb. This is the sixth breakthrough therapy designation for nivolumab.
The breakthrough therapy designation in bladder cancer is based on the results of the phase II CA209-275 trial and other supportive data.
On Twitter @jessnicolecraig
Cabozantinib improves overall survival in renal cell carcinoma
CHICAGO – The oral multitargeted tyrosine kinase inhibitor cabozantinib confers an overall survival benefit to patients with previously treated renal cell carcinoma, compared with everolimus, according to the final survival analysis of the phase III METEOR trial.
An analysis of the 658 patients enrolled in the study revealed that “treatment with cabozantinib significantly improved overall survival, compared to everolimus. The median overall survival was 21.4 months in the cabozantinib group, compared to 16.5 months in the everolimus group,” Toni Choueiri, M.D., of the Dana-Farber Cancer Institute in Boston reported at the annual meeting of the American Society of Clinical Oncology.
”The hazard ratio of 0.66 does represent a 34% reduction in the rate of deaths,” he said.
An overall survival benefit associated with cabozantinib was consistently observed in all prespecified groups including the groups stratified by Memorial Sloan Kettering Cancer Center (MSKCC) risk criteria, the number and duration of prior vascular endothelial growth factor receptor tyrosine kinase inhibitor therapies, and tumor MET status.
An analysis of the same 658 patients enrolled in the METEOR trial, presented at the Genitourinary Cancers Symposium in early 2016, indicated cabozantinib improved progression-free survival, compared with everolimus (7.4 months vs. 3.9 months, HR, 0.52; P less than .001).
Cabozantinib is the only agent to demonstrate a significant benefit in overall survival, progression-free survival, and overall response rate in a phase III trial in previously treated patients with advanced renal cell carcinoma, according to Dr. Choueiri. “Cabozantinib is an important new treatment option for these patients,” he said.
This study was funded by Exelixis. Dr. Choueiri reported serving in advisory roles and receiving research funding and honoraria from multiple companies.
On Twitter @jessicolecraig
CHICAGO – The oral multitargeted tyrosine kinase inhibitor cabozantinib confers an overall survival benefit to patients with previously treated renal cell carcinoma, compared with everolimus, according to the final survival analysis of the phase III METEOR trial.
An analysis of the 658 patients enrolled in the study revealed that “treatment with cabozantinib significantly improved overall survival, compared to everolimus. The median overall survival was 21.4 months in the cabozantinib group, compared to 16.5 months in the everolimus group,” Toni Choueiri, M.D., of the Dana-Farber Cancer Institute in Boston reported at the annual meeting of the American Society of Clinical Oncology.
”The hazard ratio of 0.66 does represent a 34% reduction in the rate of deaths,” he said.
An overall survival benefit associated with cabozantinib was consistently observed in all prespecified groups including the groups stratified by Memorial Sloan Kettering Cancer Center (MSKCC) risk criteria, the number and duration of prior vascular endothelial growth factor receptor tyrosine kinase inhibitor therapies, and tumor MET status.
An analysis of the same 658 patients enrolled in the METEOR trial, presented at the Genitourinary Cancers Symposium in early 2016, indicated cabozantinib improved progression-free survival, compared with everolimus (7.4 months vs. 3.9 months, HR, 0.52; P less than .001).
Cabozantinib is the only agent to demonstrate a significant benefit in overall survival, progression-free survival, and overall response rate in a phase III trial in previously treated patients with advanced renal cell carcinoma, according to Dr. Choueiri. “Cabozantinib is an important new treatment option for these patients,” he said.
This study was funded by Exelixis. Dr. Choueiri reported serving in advisory roles and receiving research funding and honoraria from multiple companies.
On Twitter @jessicolecraig
CHICAGO – The oral multitargeted tyrosine kinase inhibitor cabozantinib confers an overall survival benefit to patients with previously treated renal cell carcinoma, compared with everolimus, according to the final survival analysis of the phase III METEOR trial.
An analysis of the 658 patients enrolled in the study revealed that “treatment with cabozantinib significantly improved overall survival, compared to everolimus. The median overall survival was 21.4 months in the cabozantinib group, compared to 16.5 months in the everolimus group,” Toni Choueiri, M.D., of the Dana-Farber Cancer Institute in Boston reported at the annual meeting of the American Society of Clinical Oncology.
”The hazard ratio of 0.66 does represent a 34% reduction in the rate of deaths,” he said.
An overall survival benefit associated with cabozantinib was consistently observed in all prespecified groups including the groups stratified by Memorial Sloan Kettering Cancer Center (MSKCC) risk criteria, the number and duration of prior vascular endothelial growth factor receptor tyrosine kinase inhibitor therapies, and tumor MET status.
An analysis of the same 658 patients enrolled in the METEOR trial, presented at the Genitourinary Cancers Symposium in early 2016, indicated cabozantinib improved progression-free survival, compared with everolimus (7.4 months vs. 3.9 months, HR, 0.52; P less than .001).
Cabozantinib is the only agent to demonstrate a significant benefit in overall survival, progression-free survival, and overall response rate in a phase III trial in previously treated patients with advanced renal cell carcinoma, according to Dr. Choueiri. “Cabozantinib is an important new treatment option for these patients,” he said.
This study was funded by Exelixis. Dr. Choueiri reported serving in advisory roles and receiving research funding and honoraria from multiple companies.
On Twitter @jessicolecraig
FROM 2016 ASCO ANNUAL MEETING
Key clinical point: Cabozantinib significantly improved overall survival, compared with everolimus in patients with renal cell carcinoma.
Major finding: For cabozantinib the median overall survival was 21.4 months, compared with 16.5 months in the everolimus group (HR, 0.66; 95% CI, 0.53-0.83; P = .0003).
Data source: A survival analysis of 658 patients with previously treated advanced renal cell carcinoma enrolled in the randomized phase III METEOR trial.
Disclosures: This study was funded by Exelixis. Dr. Choueiri reported serving in advisory roles and receiving research funding and honoraria from multiple companies.
Delaying surgery for 11 weeks after RCT does not increase pCR rates for rectal cancer
Among patients with rectal cancer, delaying surgery for 11 weeks after the end of radiochemotherapy does not improve pathologic complete response rates, investigators reported.
Previously, the Lyon trial, the only randomized controlled study to investigate the effects of delaying surgery following the end of radiochemotherapy (RCT), found that compared with a 2-week delay, a 6-week delay significantly increased the number of patients who experienced complete response (53.1% vs. 71.7%, P = .007). The purpose of the current study was to evaluate the effect of a longer interval between RCT and surgery on pathologic complete response (pCR) rates.
For the phase III, multicenter, randomized trial, 265 patients with mid or lower rectal cancer were randomized to receive surgery at 7 weeks (n = 133) or 11 weeks (n = 132) following the end of RCT.
Baseline tumor characteristics and patient demographics were similar between the two study arms; the majority of patients had stage cT3 rectal cancer (82%).
There was no significant difference in pathologic complete response rate between the study arms (15% for 7-week group vs. 17.4% for 11-week group, P = .5983), reported Jeremie Lefevre, MD, of Hopital Saint-Antoine, Paris, and his associates (J Clin Oncol. 2016 July. doi: 10.1200/JCO.2016.67.6049).
Overall morbidity was significantly increased in the 11-week group (44.5% v 32%; P = .04), primarily explained by an increase in medical complications (32.8% vs. 19.2%; P = .01), the investigators wrote.
The French Ministry of Health funded the study. Dr. Lefevre and seven of his associates reported serving in advisory roles, receiving financial compensation, or participating in the speakers bureau for multiple companies.
On Twitter @jessnicolecraig
Among patients with rectal cancer, delaying surgery for 11 weeks after the end of radiochemotherapy does not improve pathologic complete response rates, investigators reported.
Previously, the Lyon trial, the only randomized controlled study to investigate the effects of delaying surgery following the end of radiochemotherapy (RCT), found that compared with a 2-week delay, a 6-week delay significantly increased the number of patients who experienced complete response (53.1% vs. 71.7%, P = .007). The purpose of the current study was to evaluate the effect of a longer interval between RCT and surgery on pathologic complete response (pCR) rates.
For the phase III, multicenter, randomized trial, 265 patients with mid or lower rectal cancer were randomized to receive surgery at 7 weeks (n = 133) or 11 weeks (n = 132) following the end of RCT.
Baseline tumor characteristics and patient demographics were similar between the two study arms; the majority of patients had stage cT3 rectal cancer (82%).
There was no significant difference in pathologic complete response rate between the study arms (15% for 7-week group vs. 17.4% for 11-week group, P = .5983), reported Jeremie Lefevre, MD, of Hopital Saint-Antoine, Paris, and his associates (J Clin Oncol. 2016 July. doi: 10.1200/JCO.2016.67.6049).
Overall morbidity was significantly increased in the 11-week group (44.5% v 32%; P = .04), primarily explained by an increase in medical complications (32.8% vs. 19.2%; P = .01), the investigators wrote.
The French Ministry of Health funded the study. Dr. Lefevre and seven of his associates reported serving in advisory roles, receiving financial compensation, or participating in the speakers bureau for multiple companies.
On Twitter @jessnicolecraig
Among patients with rectal cancer, delaying surgery for 11 weeks after the end of radiochemotherapy does not improve pathologic complete response rates, investigators reported.
Previously, the Lyon trial, the only randomized controlled study to investigate the effects of delaying surgery following the end of radiochemotherapy (RCT), found that compared with a 2-week delay, a 6-week delay significantly increased the number of patients who experienced complete response (53.1% vs. 71.7%, P = .007). The purpose of the current study was to evaluate the effect of a longer interval between RCT and surgery on pathologic complete response (pCR) rates.
For the phase III, multicenter, randomized trial, 265 patients with mid or lower rectal cancer were randomized to receive surgery at 7 weeks (n = 133) or 11 weeks (n = 132) following the end of RCT.
Baseline tumor characteristics and patient demographics were similar between the two study arms; the majority of patients had stage cT3 rectal cancer (82%).
There was no significant difference in pathologic complete response rate between the study arms (15% for 7-week group vs. 17.4% for 11-week group, P = .5983), reported Jeremie Lefevre, MD, of Hopital Saint-Antoine, Paris, and his associates (J Clin Oncol. 2016 July. doi: 10.1200/JCO.2016.67.6049).
Overall morbidity was significantly increased in the 11-week group (44.5% v 32%; P = .04), primarily explained by an increase in medical complications (32.8% vs. 19.2%; P = .01), the investigators wrote.
The French Ministry of Health funded the study. Dr. Lefevre and seven of his associates reported serving in advisory roles, receiving financial compensation, or participating in the speakers bureau for multiple companies.
On Twitter @jessnicolecraig
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Delaying surgery for 11 weeks after the end of radiochemotherapy does not improve pathologic complete response rates in patients with rectal cancer, compared with a delay of 7 weeks.
Major finding: There was no significant difference in pathologic complete response rate between the study arms (15% for 7-week group vs. 17.4% for 11-week group, P = .5983).
Data source: A phase III, multicenter, randomized trial involving 265 patients with varying stages of rectal cancer.
Disclosures: The French Ministry of Health funded the study. Dr. Lefevre and seven of his associates reported serving in advisory roles, receiving financial compensation, or participating in the speakers bureau for multiple companies.
Olanzapine helps prevent nausea in patients on chemo
Olanzapine is more effective than placebo, in combination with a 5-HT3-receptor antagonist and an NK1-receptor antagonist, in preventing nausea in patients undergoing chemotherapy, according to investigators.
“This large, randomized, double-blind, placebo-controlled, phase III trial showed that it is more effective to combine olanzapine than placebo with an NK1-receptor antagonist, a 5-HT3–receptor antagonist, and dexamethasone for the prevention of nausea and vomiting in patients who have not received previous chemotherapy but are currently receiving highly emetogenic chemotherapy,” reported Rudolph Navari, MD, PhD, of the World Health Organization, Geneva, and his associates (N Engl J Med. 2016;375:134-42).
Patients were randomized to receive olanzapine or the placebo, along with a 5-HT3-receptor antagonist (either palonosetron intravenously, granisetron intravenously or orally, or ondansetron intravenously or orally) and an NK1-receptor antagonist (fosaprepitant intravenously or aprepitant orally). The olanzapine (n = 192) and placebo (n = 188) groups were balanced with respect to age, race, sex, and chemotherapy administered.
Patients kept daily records of nausea and episodes of vomiting. The proportion of patients who reported no nausea or who experienced no clinically significant nausea was significantly greater in the olanzapine group than in the placebo group (37% vs. 22%, P = .002 and 67% vs. 49%, P = .001).
Patients receiving olanzapine had significantly increased sedation (severe in 5%) on day 2 compared with baseline, Dr. Navari and his associates reported. The sedation resolved on days 3, 4, and 5 even though patients continued to receive the drug on days 3 and 4. No patients discontinued the study because of sedation.
The National Cancer Institute funded the study. One investigator reported receiving financial support from Merck and Co. The other investigators reported having no disclosures.
On Twitter @jessnicolecraig
Olanzapine is more effective than placebo, in combination with a 5-HT3-receptor antagonist and an NK1-receptor antagonist, in preventing nausea in patients undergoing chemotherapy, according to investigators.
“This large, randomized, double-blind, placebo-controlled, phase III trial showed that it is more effective to combine olanzapine than placebo with an NK1-receptor antagonist, a 5-HT3–receptor antagonist, and dexamethasone for the prevention of nausea and vomiting in patients who have not received previous chemotherapy but are currently receiving highly emetogenic chemotherapy,” reported Rudolph Navari, MD, PhD, of the World Health Organization, Geneva, and his associates (N Engl J Med. 2016;375:134-42).
Patients were randomized to receive olanzapine or the placebo, along with a 5-HT3-receptor antagonist (either palonosetron intravenously, granisetron intravenously or orally, or ondansetron intravenously or orally) and an NK1-receptor antagonist (fosaprepitant intravenously or aprepitant orally). The olanzapine (n = 192) and placebo (n = 188) groups were balanced with respect to age, race, sex, and chemotherapy administered.
Patients kept daily records of nausea and episodes of vomiting. The proportion of patients who reported no nausea or who experienced no clinically significant nausea was significantly greater in the olanzapine group than in the placebo group (37% vs. 22%, P = .002 and 67% vs. 49%, P = .001).
Patients receiving olanzapine had significantly increased sedation (severe in 5%) on day 2 compared with baseline, Dr. Navari and his associates reported. The sedation resolved on days 3, 4, and 5 even though patients continued to receive the drug on days 3 and 4. No patients discontinued the study because of sedation.
The National Cancer Institute funded the study. One investigator reported receiving financial support from Merck and Co. The other investigators reported having no disclosures.
On Twitter @jessnicolecraig
Olanzapine is more effective than placebo, in combination with a 5-HT3-receptor antagonist and an NK1-receptor antagonist, in preventing nausea in patients undergoing chemotherapy, according to investigators.
“This large, randomized, double-blind, placebo-controlled, phase III trial showed that it is more effective to combine olanzapine than placebo with an NK1-receptor antagonist, a 5-HT3–receptor antagonist, and dexamethasone for the prevention of nausea and vomiting in patients who have not received previous chemotherapy but are currently receiving highly emetogenic chemotherapy,” reported Rudolph Navari, MD, PhD, of the World Health Organization, Geneva, and his associates (N Engl J Med. 2016;375:134-42).
Patients were randomized to receive olanzapine or the placebo, along with a 5-HT3-receptor antagonist (either palonosetron intravenously, granisetron intravenously or orally, or ondansetron intravenously or orally) and an NK1-receptor antagonist (fosaprepitant intravenously or aprepitant orally). The olanzapine (n = 192) and placebo (n = 188) groups were balanced with respect to age, race, sex, and chemotherapy administered.
Patients kept daily records of nausea and episodes of vomiting. The proportion of patients who reported no nausea or who experienced no clinically significant nausea was significantly greater in the olanzapine group than in the placebo group (37% vs. 22%, P = .002 and 67% vs. 49%, P = .001).
Patients receiving olanzapine had significantly increased sedation (severe in 5%) on day 2 compared with baseline, Dr. Navari and his associates reported. The sedation resolved on days 3, 4, and 5 even though patients continued to receive the drug on days 3 and 4. No patients discontinued the study because of sedation.
The National Cancer Institute funded the study. One investigator reported receiving financial support from Merck and Co. The other investigators reported having no disclosures.
On Twitter @jessnicolecraig
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Key clinical point: Olanzapine significantly reduced episodes of nausea, compared with placebo.
Major finding: The proportion of patients who experienced no clinically significant nausea was significantly greater in the olanzapine group than in the placebo group (67% vs. 49%, P = .001).
Data source: A randomized, double-blind phase III trial of 380 patients receiving chemotherapy for malignant cancer.
Disclosures: The National Cancer Institute funded the study. One investigator reported receiving financial support from Merck and Co. The other investigators reported having no disclosures.
No difference between chemo regimens for ovarian clear cell carcinoma
Irinotecan plus cisplatin is no better than paclitaxel plus carboplatin for women with ovarian clear cell carcinoma, according to an international study led by Japanese investigators.
Clear cell carcinoma (CCC) accounts for approximately 10% of epithelial ovarian cancers (EOCs) in Europe and the United States, but is more prevalent in Asia; In Japan CCC accounts for 24% of all EOCs.
In the first phase III, CCC-specific clinical trial, 667 women with stage I to IV CCC were randomized to receive one of two treatment regimens: irinotecan at a dose of 60 mg/m2 on days 1, 8, and 15 plus cisplatin at 60 mg/m2 on day 1 every 4 weeks for six cycles (n = 332) or paclitaxel at a dose of 175 mg/m2 plus carboplatin on day 1 every 3 weeks for six cycles (n = 335).
Japanese women made up 93.5% of the study population, the median age was 53 years, and 6.4% of patients had stage I cancer. Median follow-up time was 44.3 months.
No difference was found between the groups in progression-free or overall survival, Toru Sugiyama, MD, of Iwate Medical University, Morioka, Japan, and associates reported (J Clin Oncol. 2016 July 11. doi: 10.1200/JCO.2016.66.9010).
Both regimens were well tolerated, though the toxicity profiles were different, investigators wrote.
Overall, 72% of patients received all six cycles of their respective chemotherapy treatments. Two-year progression-free survival rates were 73.0% (95% confidence interval, 67.7%-77.5%) among patients receiving irinotecan plus cisplatin, 77.6% (95% CI, 72.4%-81.9%) among patients receiving paclitaxel plus carboplatin, and were not significantly different (HR, 1.17; 95% CI, 0.87-1.58; P = .30).
There was also no significant difference in overall survival between the two treatment arms.
In subgroup analyses, there was no significant difference in progression-free or overall survival by disease stage or tumor size.
Grade 3 or 4 anorexia, diarrhea, nausea, vomiting, and febrile neutropenia were the most common adverse events among women receiving irinotecan plus cisplatin. Grade 3 or 4 leukopenia, neutropenia, thrombocytopenia, peripheral sensory neuropathy, and joint pain were the most common adverse events among women receiving paclitaxel plus carboplatin. No treatment-related deaths occurred in either treatment arm.
This study was funded by the Japanese Gynecologic Oncology Group. Dr. Sugiyama and 18 other investigators had no disclosures to report. Six investigators reported serving in advisory roles for or receiving financial compensation or honoraria from multiple companies.
On Twitter @jessnicolecraig
Irinotecan plus cisplatin is no better than paclitaxel plus carboplatin for women with ovarian clear cell carcinoma, according to an international study led by Japanese investigators.
Clear cell carcinoma (CCC) accounts for approximately 10% of epithelial ovarian cancers (EOCs) in Europe and the United States, but is more prevalent in Asia; In Japan CCC accounts for 24% of all EOCs.
In the first phase III, CCC-specific clinical trial, 667 women with stage I to IV CCC were randomized to receive one of two treatment regimens: irinotecan at a dose of 60 mg/m2 on days 1, 8, and 15 plus cisplatin at 60 mg/m2 on day 1 every 4 weeks for six cycles (n = 332) or paclitaxel at a dose of 175 mg/m2 plus carboplatin on day 1 every 3 weeks for six cycles (n = 335).
Japanese women made up 93.5% of the study population, the median age was 53 years, and 6.4% of patients had stage I cancer. Median follow-up time was 44.3 months.
No difference was found between the groups in progression-free or overall survival, Toru Sugiyama, MD, of Iwate Medical University, Morioka, Japan, and associates reported (J Clin Oncol. 2016 July 11. doi: 10.1200/JCO.2016.66.9010).
Both regimens were well tolerated, though the toxicity profiles were different, investigators wrote.
Overall, 72% of patients received all six cycles of their respective chemotherapy treatments. Two-year progression-free survival rates were 73.0% (95% confidence interval, 67.7%-77.5%) among patients receiving irinotecan plus cisplatin, 77.6% (95% CI, 72.4%-81.9%) among patients receiving paclitaxel plus carboplatin, and were not significantly different (HR, 1.17; 95% CI, 0.87-1.58; P = .30).
There was also no significant difference in overall survival between the two treatment arms.
In subgroup analyses, there was no significant difference in progression-free or overall survival by disease stage or tumor size.
Grade 3 or 4 anorexia, diarrhea, nausea, vomiting, and febrile neutropenia were the most common adverse events among women receiving irinotecan plus cisplatin. Grade 3 or 4 leukopenia, neutropenia, thrombocytopenia, peripheral sensory neuropathy, and joint pain were the most common adverse events among women receiving paclitaxel plus carboplatin. No treatment-related deaths occurred in either treatment arm.
This study was funded by the Japanese Gynecologic Oncology Group. Dr. Sugiyama and 18 other investigators had no disclosures to report. Six investigators reported serving in advisory roles for or receiving financial compensation or honoraria from multiple companies.
On Twitter @jessnicolecraig
Irinotecan plus cisplatin is no better than paclitaxel plus carboplatin for women with ovarian clear cell carcinoma, according to an international study led by Japanese investigators.
Clear cell carcinoma (CCC) accounts for approximately 10% of epithelial ovarian cancers (EOCs) in Europe and the United States, but is more prevalent in Asia; In Japan CCC accounts for 24% of all EOCs.
In the first phase III, CCC-specific clinical trial, 667 women with stage I to IV CCC were randomized to receive one of two treatment regimens: irinotecan at a dose of 60 mg/m2 on days 1, 8, and 15 plus cisplatin at 60 mg/m2 on day 1 every 4 weeks for six cycles (n = 332) or paclitaxel at a dose of 175 mg/m2 plus carboplatin on day 1 every 3 weeks for six cycles (n = 335).
Japanese women made up 93.5% of the study population, the median age was 53 years, and 6.4% of patients had stage I cancer. Median follow-up time was 44.3 months.
No difference was found between the groups in progression-free or overall survival, Toru Sugiyama, MD, of Iwate Medical University, Morioka, Japan, and associates reported (J Clin Oncol. 2016 July 11. doi: 10.1200/JCO.2016.66.9010).
Both regimens were well tolerated, though the toxicity profiles were different, investigators wrote.
Overall, 72% of patients received all six cycles of their respective chemotherapy treatments. Two-year progression-free survival rates were 73.0% (95% confidence interval, 67.7%-77.5%) among patients receiving irinotecan plus cisplatin, 77.6% (95% CI, 72.4%-81.9%) among patients receiving paclitaxel plus carboplatin, and were not significantly different (HR, 1.17; 95% CI, 0.87-1.58; P = .30).
There was also no significant difference in overall survival between the two treatment arms.
In subgroup analyses, there was no significant difference in progression-free or overall survival by disease stage or tumor size.
Grade 3 or 4 anorexia, diarrhea, nausea, vomiting, and febrile neutropenia were the most common adverse events among women receiving irinotecan plus cisplatin. Grade 3 or 4 leukopenia, neutropenia, thrombocytopenia, peripheral sensory neuropathy, and joint pain were the most common adverse events among women receiving paclitaxel plus carboplatin. No treatment-related deaths occurred in either treatment arm.
This study was funded by the Japanese Gynecologic Oncology Group. Dr. Sugiyama and 18 other investigators had no disclosures to report. Six investigators reported serving in advisory roles for or receiving financial compensation or honoraria from multiple companies.
On Twitter @jessnicolecraig
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Irinotecan plus cisplatin is no better than paclitaxel plus carboplatin for women with ovarian clear cell carcinoma
Major finding: Among patients receiving irinotecan plus cisplatin, the 2-year progression-free survival rate was 73.0% (95% confidence interval, 67.7%-77.5%), compared with 77.6% (95% CI, 72.4%-81.9%) for patients receiving paclitaxel plus carboplatin (HR, 1.17; 95% CI, 0.87-1.58; P = .30).
Data source: A randomized, multicenter, phase III trial of 667 patients with ovarian clear cell carcinoma.
Disclosures: This study was funded by the Japanese Gynecologic Oncology Group. Dr. Sugiyama and 18 other investigators had no disclosures to report. Six investigators reported serving in advisory roles for or receiving financial compensation or honoraria from multiple companies.
Lack of hematology-specific measures not barrier to quality end of life care
Standard oncology measures are acceptable indicators of good-quality end of life care for hematologic malignancies, investigators report.
Six out of eight standard end of life (EOL) care measures were deemed acceptable (defined as greater than 55% agreement) based on 349 returned surveys from hematologic oncologists. Hospice enrollment more than 7 days before death, no chemotherapy less than 14 days before death, and no CPR and intubation within the last 30 days of life were acceptable measures to more than 75% of those surveyed.
No more than one hospitalization within 30 days of death and no more than one emergency room visit within 30 days of death did not meet the threshold for acceptance by the oncologists.
“These data suggest that the absence of hematology-specific measures is unlikely to be a major barrier to quality care and that more resources should be directed toward addressing barriers to compliance with established EOL quality measures than toward creating new ones,” Oreofe O. Odejide, MD, of the Dana-Farber Cancer Institute, Boston, and her associates reported (J Clin Oncol. 2016 July. doi: 10.1200/JCO.2016.67.8177).
The top barriers to end of life care were unrealistic patient expectations (97.3%), clinician concern about diminishing patient and family hope (71.3%), and unrealistic clinician expectations (59.0%), according to investigators.
Surveyed oncologists also reported that increasing access to palliative care services (93.7%), increasing access to inpatient hospice facilities (92.2%), and allowing hospice enrollment with disease-directed treatment (90.1%) would be the most helpful interventions to improve end of life care.
The Lymphoma Research Foundation, the Conquer Cancer Foundation, and investigators’ respective institutions funded this research. Dr. Odejide and four of her associates had no disclosures to report. Two investigators reported serving in advisory roles, holding patents, or having stock or ownership interest in UnitedHealthcare, UpToDate, or Recap Information Systems.
On Twitter @jessnicolecraig
Standard oncology measures are acceptable indicators of good-quality end of life care for hematologic malignancies, investigators report.
Six out of eight standard end of life (EOL) care measures were deemed acceptable (defined as greater than 55% agreement) based on 349 returned surveys from hematologic oncologists. Hospice enrollment more than 7 days before death, no chemotherapy less than 14 days before death, and no CPR and intubation within the last 30 days of life were acceptable measures to more than 75% of those surveyed.
No more than one hospitalization within 30 days of death and no more than one emergency room visit within 30 days of death did not meet the threshold for acceptance by the oncologists.
“These data suggest that the absence of hematology-specific measures is unlikely to be a major barrier to quality care and that more resources should be directed toward addressing barriers to compliance with established EOL quality measures than toward creating new ones,” Oreofe O. Odejide, MD, of the Dana-Farber Cancer Institute, Boston, and her associates reported (J Clin Oncol. 2016 July. doi: 10.1200/JCO.2016.67.8177).
The top barriers to end of life care were unrealistic patient expectations (97.3%), clinician concern about diminishing patient and family hope (71.3%), and unrealistic clinician expectations (59.0%), according to investigators.
Surveyed oncologists also reported that increasing access to palliative care services (93.7%), increasing access to inpatient hospice facilities (92.2%), and allowing hospice enrollment with disease-directed treatment (90.1%) would be the most helpful interventions to improve end of life care.
The Lymphoma Research Foundation, the Conquer Cancer Foundation, and investigators’ respective institutions funded this research. Dr. Odejide and four of her associates had no disclosures to report. Two investigators reported serving in advisory roles, holding patents, or having stock or ownership interest in UnitedHealthcare, UpToDate, or Recap Information Systems.
On Twitter @jessnicolecraig
Standard oncology measures are acceptable indicators of good-quality end of life care for hematologic malignancies, investigators report.
Six out of eight standard end of life (EOL) care measures were deemed acceptable (defined as greater than 55% agreement) based on 349 returned surveys from hematologic oncologists. Hospice enrollment more than 7 days before death, no chemotherapy less than 14 days before death, and no CPR and intubation within the last 30 days of life were acceptable measures to more than 75% of those surveyed.
No more than one hospitalization within 30 days of death and no more than one emergency room visit within 30 days of death did not meet the threshold for acceptance by the oncologists.
“These data suggest that the absence of hematology-specific measures is unlikely to be a major barrier to quality care and that more resources should be directed toward addressing barriers to compliance with established EOL quality measures than toward creating new ones,” Oreofe O. Odejide, MD, of the Dana-Farber Cancer Institute, Boston, and her associates reported (J Clin Oncol. 2016 July. doi: 10.1200/JCO.2016.67.8177).
The top barriers to end of life care were unrealistic patient expectations (97.3%), clinician concern about diminishing patient and family hope (71.3%), and unrealistic clinician expectations (59.0%), according to investigators.
Surveyed oncologists also reported that increasing access to palliative care services (93.7%), increasing access to inpatient hospice facilities (92.2%), and allowing hospice enrollment with disease-directed treatment (90.1%) would be the most helpful interventions to improve end of life care.
The Lymphoma Research Foundation, the Conquer Cancer Foundation, and investigators’ respective institutions funded this research. Dr. Odejide and four of her associates had no disclosures to report. Two investigators reported serving in advisory roles, holding patents, or having stock or ownership interest in UnitedHealthcare, UpToDate, or Recap Information Systems.
On Twitter @jessnicolecraig
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Standard measures are acceptable indicators of good quality end of life care for patients with hematologic malignancies.
Major finding: All but two standard measures developed for solid tumors were found to be acceptable (defined as greater than 55% agreement) indicators of good quality end of life care for hematologic malignancies.
Data source: A national, pilot-tested survey of 349 hematologic oncologists.
Disclosures: In addition to internal funding, the Lymphoma Research Foundation and the Conquer Cancer Foundation funded this research. Dr. Odejide and four of her associates had no disclosures to report. Two investigators reported serving in advisory roles, holding patents, or having stock or ownership interest in UnitedHealthcare, UpToDate, or Recap Information Systems.