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Robert W. Carlson, Susan Moench, Arti Hurria, Lodovico Balducci, Harold J. Burstein, Lori J. Goldstein, William J. Gradishar, Kevin S. Hughes, Mohammad Jahanzeb, Stuart M. Lichtman, Lawrence B. Marks, Joan S. McClure, Beryl McCormick, Lisle M. Nabell, Lori J. Pierce, Mary Lou Smith, Neal S. Topham, Tiffany A. Traina, John H. Ward, and Eric P. Winer

. Excellent reviews of breast cancer in older women have been published recently. 4 – 6 This report provides a forum for framing relevant questions on topics that impact older women with early-stage, locally advanced, and metastatic breast cancer. Areas of

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Ghassan K. Abou-Alfa

Sorafenib, a multitargeted anti-VEGF receptor and raf kinase inhibitor, was recently approved by the FDA for treating unresectable hepatocellular carcinoma (HCC) based on 2 randomized phase III studies. In addition, a phase II study evaluating sorafenib in patients with HCC and Child-Pugh A and B and a phase I study evaluating sorafenib in patients with organ dysfunction have provided insight about the safety and efficacy of sorafenib in patients with HCC and more advanced cirrhosis, and any difference in outcome based on etiology of HCC. The lack of objective responses observed in the sorafenib arm in the SHARP study also raises practical issues about how to assess response or efficacy of the therapy and thus how long a patient should receive sorafenib. This article addresses these questions on the use of sorafenib in HCC, both in the locally advanced and metastatic settings, in addition to the potential future applications and uses of sorafenib.

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Jill A. Foster, Maziar Abdolrasulnia, Hamidreza Doroodchi, Joan McClure, and Linda Casebeer

Background

Studies of adherence to breast cancer guidelines have often focused on primary therapies, but concordance with other guideline recommendations has not been examined as extensively. This study assesses the knowledge and practice patterns of medical oncologists in the United States to inform education and quality improvement initiatives that can improve breast cancer care.

Methods

A survey containing case vignettes and related questions was developed to examine oncologists' clinical decision-making in evaluating and treating women with early breast cancer. The instrument was distributed to a random sample of 742 oncologists in the United States and yielded 205 responses (27.6% response rate). Responses from 184 practicing medical oncologists were analyzed relative to the 2007 NCCN Clinical Practice Guidelines in Oncology: Breast Cancer.

Results

Most oncologists made guideline-consistent choices in clarifying indeterminate human epidermal growth factor 2 (HER2) status (85%), initial treatment for early breast cancer (95%), and postsurgical management of locally advanced breast cancer (82%). Guideline-discordant choices were seen in the lack of clip placement before neoadjuvant chemotherapy (36%), unnecessary use of PET scanning for initial assessment (34%), inappropriate assessment of menopausal status (33%), inappropriate use of tumor markers (22%), and use of chest imaging (16%) during posttherapeutic surveillance.

Conclusions

Oncologists often make guideline-consistent choices, but discordant clinical decisions may occur in important aspects of care for early breast cancer. Broadening the diffusion and adoption of guideline recommendations is an important mechanism for addressing these gaps and may substantially improve the quality of breast cancer care.

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Dipesh Uprety and David E. Marinier

trial showing the feasibility of the cisplatin/etoposide combination with radiotherapy in patients with locally advanced NSCLC. Concurrent CRT treatment is superior to a sequential approach, but has the disadvantage of increased toxicity. 4 Up to 10% of

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Courtney Lawhn Heath, Laura J. Esserman, Robert R. Flavell, and Michelle E. Melisko

Re: Groheux D, Hindié E, Espié M, Ulaner GA. Letter to the Editor: PET/CT in Locally Advanced Breast Cancer: Time for a Guideline Change? J Natl Compr Canc Netw 2021;19(8):xxx. The recent articles by Ko et al 1 and our group 2 contribute to

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Joseph M. Herman and Albert C. Koong

, bowel and stomach). SBRT has most often been studied in the setting of locally advanced, unresectable cancer. Although early studies evaluating single-fraction (25 Gy x 1 fraction) SBRT showed excellent local control (>90%), high rates of late grade 2

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Parvin F. Peddi and Andrea Wang-Gillam

disease at diagnosis, whereas approximately 40% have metastatic disease and another 30% to 40% have locally advanced unresectable tumors. 2 The second factor in the lethal nature of pancreatic cancer lies in its complex tumor biology and interaction with

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Benjamin E. Greer and Wui-Jin Koh

for groin lymph node disease. “These patients have a poor outcome, with 2-year survival of 23%, and tend to be elderly with significant medical comorbidities,” he said. Locally Advanced Disease Dr. Koh also discussed treatment for locally

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Margaret A. Tempero

evaluate neoadjuvant chemotherapy with and without radiation, followed by resection. “These studies will give us benchmarking data we have not had before,” she said. Locally Advanced Pancreatic Adenocarcinoma In locally advanced disease, where

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Michael Lux, Alex Niyazov, Katie Lewis, Lucy Massey, Alex Rider, Bhakti Arondekar, and Reshma Mahtani

Background: Recently, PARPi have been approved as targeted treatments for pts with gBRCA1/2 mut HER2- locally advanced and/or metastatic breast cancer in the US and other countries. Limited information is available on the pharmacoeconomic benefit