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Victor T.G. Lin, Lisle M. Nabell, Sharon A. Spencer, William R. Carroll, Shuko Harada and Eddy S. Yang

Salivary duct carcinoma (SDC) is a rare and aggressive malignancy for which limited data exist to guide treatment decisions. With the advent of advanced molecular testing and tumor genomic profiling, clinicians now have the ability to identify potential therapeutic targets in difficult-to-treat cancers such as SDC. This report presents a male patient with widely metastatic SDC found on targeted next-generation sequencing to have a BRAF p.V600E mutation. He experienced a prolonged and robust response to first-line systemic chemotherapy with dabrafenib and trametinib. During his response interval, new data emerged to justify subsequent treatment with both an immune checkpoint inhibitor and androgen blockade after his disease progressed. To our knowledge, this is the first report of frontline BRAF-directed therapy eliciting a response in metastatic SDC.

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Cesar A. Santa-Maria and Rita Nanda

Initial studies investigating single-agent activity of immune checkpoint inhibitors (ICIs) serve as proof of principle that harnessing the immune system can have anticancer activity in a variety of human malignancies. Although breast cancer was historically believed to be immunogenically silent, early studies indicate overall response rates with ICIs are similar to those observed with many other solid malignancies. Overall response rates in advanced breast cancer are low, but the responses are remarkably durable. A deeper understanding of the biology of the interaction between cancer and immune cells is required to both develop biomarkers that more accurately predict response to therapy and identify effective immunotherapy-based combination strategies that can enhance the immunogenicity of biologically “cold” tumors. Breast cancer encompasses a variety of diseases defined by the presence or absence of central oncogenic drivers, and early data suggest that the distinct subtypes may have unique immune phenotypes. Breast cancer represents an ideal disease in which to investigate immunotherapeutic strategies given the prevalence of the disease, unique clinical trial design opportunities, and immunophenotypic diversity.

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Gregory P. Kalemkerian, Billy W. Loo Jr, Wallace Akerley, Albert Attia, Michael Bassetti, Yanis Boumber, Roy Decker, M. Chris Dobelbower, Afshin Dowlati, Robert J. Downey, Charles Florsheim, Apar Kishor P. Ganti, John C. Grecula, Matthew A. Gubens, Christine L. Hann, James A. Hayman, Rebecca Suk Heist, Marianna Koczywas, Robert E. Merritt, Nisha Mohindra, Julian Molina, Cesar A. Moran, Daniel Morgensztern, Saraswati Pokharel, David C. Portnoy, Deborah Rhodes, Chad Rusthoven, Rafael Santana-Davila, Charles C. Williams Jr, Karin G. Hoffmann and Miranda Hughes

The NCCN Guidelines for Small Cell Lung Cancer (SCLC) address all aspects of disease management. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for SCLC regarding immunotherapy, systemic therapy, and radiation therapy. For the 2018 update, new sections were added on “Signs and Symptoms of SCLC” and “Principles of Pathologic Review.”

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Margaret Tempero

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Linda S. Overholser and Carlin Callaway

Individuals with a history of cancer, often referred to as cancer survivors, may experience late and long-term effects of their treatment. Because these individuals live longer in the survivorship phase, some of these late effects may also be considered risk factors for other chronic conditions. With cancer and cardiovascular disease now the top 2 leading causes of death in the United States and with common risk factors for both, as well as the morbidity that can occur after cancer treatment, preventive health is becoming an important issue in cancer survivorship care. Multimorbidity is also becoming increasingly commonplace. Along with an ever-expanding number of guidelines available to help guide care and treatment in the noncancer population comes the need to consider where these guidelines overlap or intersect when considering preventive health recommendations specific to cancer survivors. Counseling for health promotion in survivors is lacking. Many currently available guidelines may not apply to this population, and an evidence base is building to help supplement clinical judgement. An interdisciplinary approach will be necessary to help implement preventive care decision-making early in the survivorship trajectory and to ensure that cancer survivors are receiving consistent messages, and patient preferences and priorities should be taken into account when doing so. Incorporating preventive health into collaborative survivorship care can help maintain a high quality of life for individuals living after a cancer diagnosis.

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Zhong Ye, Chun Wang, Limin Guo, Juan P. Palazzo, Zhixing Han, Yinzhi Lai, Jing Jiang, James A. Posey, Atrayee Basu Mallick, Bingshan Li, Li Jiang and Hushan Yang

Background: Use of chemotherapy in stage II colorectal cancer (CRC) is controversial because it improves survival only in some patients. We aimed to develop a statistical model using routine and readily available blood tests to predict the prognosis of patients with stage II CRC and to identify which patients are likely to benefit from chemotherapy. Methods: We divided 422 patients with stage II CRC into a training and a testing set. The association of routine laboratory variables and disease-free survival (DFS) was analyzed. A prognostic model was developed incorporating clinically relevant laboratory variables with demographic and tumor characteristics. A prognostic score was derived by calculating the sum of each variable weighted by its regression coefficient in the model. Model performance was evaluated by constructing receiver operating characteristic curves and calculating the area under the curve (AUC). Results: Significant associations were seen between 5 laboratory variables and patient DFS in univariate analyses. After stepwise selection, 3 variables (carcinoembryonic antigen, hemoglobin, creatinine) were retained in the multivariate model with an AUC of 0.75. Compared with patients with a low prognostic score, those with a medium and high prognostic score had a 1.99- and 4.78-fold increased risk of recurrence, respectively. The results from the training set were validated in the testing set. Moreover, chemotherapy significantly improved DFS in high-risk patients, but not in low- and medium-risk patients. Conclusions: A routine laboratory variable–based model may help predict DFS of patients with stage II CRC and identify high-risk patients more likely to benefit from chemotherapy.

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Elyse R. Park, Jeffrey Peppercorn and Areej El-Jawahri