, interferon alfa (IFN-α) and interleukin (IL)-2 comprised the available systemic treatment options. Since then, 7 new agents have been approved by the FDA for treatment of RCC: sorafenib, sunitinib, temsirolimus, bevacizumab, everolimus, pazopanib, and
Matthew P. Banegas, Linda C. Harlan, Bhupinder Mann and K. Robin Yabroff
By 2020, pancreatic cancer is expected to be the second most common cause of cancer-related death, exceeded only by lung cancer. During her presentation at the NCCN 22nd Annual Conference, Dr. Margaret Tempero offered an update on the current state of systemic treatment of pancreatic cancer, focusing on resectable/borderline resectable, locally advanced, and metastatic disease.
A. Dimitrios Colevas
clear that a significant minority of patients experience unquestionable benefit from systemic treatments for their recurrent or metastatic disease. Until better predictors for who will benefit become available, clinicians and patients must often make
Rahel Demisse, Neha Damle, Edward Kim, Jun Gong, Marwan Fakih, Cathy Eng, Leslie Oesterich, Madison McKenny, Jingran Ji, James Liu, Ryan Louie, Kit Tam, Sepideh Gholami, Wissam Halabi, Arta Monjazeb, Farshid Dayyani and May Cho
Treatment options for locally advanced rectal cancer have continued to consist largely of chemotherapy, chemoradiation, and/or surgical resection. For patients who are unable to undergo these therapeutic modalities or who do not to experience a response to them, treatment options are limited. We report 3 cases of mismatch repair–deficient (dMMR) locally advanced adenocarcinoma of the rectum that showed significant response with neoadjuvant immunotherapy–based systemic treatment. The first patient was not eligible for standard therapy because of a history of radiotherapy to the prostate with concurrent comorbidities and therefore received single-agent pembrolizumab. The second patient did not respond to total neoadjuvant chemoradiation and subsequently received combined nivolumab and ipilimumab. The third patient had a known family history of Lynch syndrome and presented with locally advanced rectal cancer and a baseline carcinoembryonic antigen level of 1,566 ng/mL. She was treated using neoadjuvant pembrolizumab and FOLFOX (folinic acid, fluorouracil, oxaliplatin). In this small series, we suggest that single-agent and combined-modality neoadjuvant immunotherapy/chemotherapy appear to be safe and effective treatment options for patients with (dMMR) locally advanced rectal cancer. Our findings encourage further studies to investigate the role of neoadjuvant immunotherapy as a viable treatment strategy in this population.
Eli Rosenbaum, Alan Partin and Mario A. Eisenberger
After local treatment, a substantial proportion of patients with prostate cancer present with rising prostate specific antigen (PSA) serum levels as the only indication of disease activity. Evolving data derived from large databases that were predominantly retrospectively evaluated show that the natural history of these patients is quite variable. Various clinical and pathologic parameters have been shown to predict for the probability of development of distant metastasis, including the surgical Gleason score, time of PSA relapse after primary treatment, and PSA doubling time (PSADT). The PSADT appears to be the most important predictor of development of distant metastasis and prostate cancer-specific mortality. At present, no data support a standard management approach for these patients, and clinical trials pose a major challenge in view of the methodologic complexities involved. Patients and treating physicians should make major efforts to participate in clinical trials in this patient population.
Nikolaos A. Trikalinos, Amy Zhou, Maria B. Majella Doyle, Kathryn J. Fowler, Ashley Morton, Neeta Vachharajani, Manik Amin, Jesse W. Keller, William C. Chapman, Elizabeth M. Brunt and Benjamin R. Tan
patients with metastatic or unresectable tumors, we offer systemic treatment with platinum and gemcitabine, and send the tumor samples for genomic analysis in an attempt to identify actionable mutations, including mismatch repair (MMR) protein status, IDH1
Michael Karass, Rohan Bareja, Ethan Shelkey, Panagiotis J. Vlachostergios, Brian D. Robinson, Francesca Khani, Juan Miguel Mosquera, Douglas S. Scherr, Andrea Sboner, Scott T. Tagawa, Ana M. Molina, Olivier Elemento, David M. Nanus and Bishoy M. Faltas
of the inguinal lymph nodes revealed metastatic UC. Figure 1. Patient’s clinical course. (A) Clinical events in chronologic order, including the diagnosis of noninvasive, invasive, and metastatic disease; local and systemic treatments at each stage
Robert Torrey, Philippe E. Spiess, Sumanta K. Pal and David Josephson
retroperitoneum, and occasionally to those with limited metastatic disease. However, significant strides toward improved systemic treatments have been made. Although many of these approaches are not curative for patients with metastatic disease, they have been
Presenter : William J. Gradishar
simplistic,” he said. The choice of systemic treatment now takes into account certain characteristics that can be exploited, in particular, germline BRCA1/2 mutations, which can be targeted by inhibitors of PARP and expression of PD-L1, a biomarker for
Christopher K. Bichakjian, Thomas Olencki, Sumaira Z. Aasi, Murad Alam, James S. Andersen, Daniel Berg, Glen M. Bowen, Richard T. Cheney, Gregory A. Daniels, L. Frank Glass, Roy C. Grekin, Kenneth Grossman, Susan A. Higgins, Alan L. Ho, Karl D. Lewis, Daniel D. Lydiatt, Kishwer S. Nehal, Paul Nghiem, Elise A. Olsen, Chrysalyne D. Schmults, Aleksandar Sekulic, Ashok R. Shaha, Wade L. Thorstad, Malika Tuli, Marshall M. Urist, Timothy S. Wang, Sandra L. Wong, John A. Zic, Karin G. Hoffmann and Anita Engh
consider multidisciplinary consultation to determine whether the patient should be offered systemic treatment with a hedgehog pathway inhibitor or treatment in the context of a clinical trial. Recurrence and Metastasis Systemic Therapy Recent