Caroline Helwick

The EGFR tyrosine kinase inhibitor gefitinib (Iressa) should be considered a first-line treatment option for nonsmoking Asian patients with adenocarcinoma of the lung, according to results from the large Iressa Pan-Asia Study (IPASS) conducted at the Chinese University of Hong Kong.

SAN FRANCISCO-A number of viable treatments are available for unresectable hepatocellular carcinoma, so a multidisciplinary approach is a must. The panelists at the ASCO GI Cancer Symposium were:

ORLANDO-The ancillary treatment costs of managing side effects can be burdensome to patients, so Harvard Medical School investigators were somewhat surprised when clinical trial patients reported little anxiety about paying for these drugs. But as more people become uninsured or underinsured, and the costs of drugs rise, patient anxiety could increase and adherence to treatment diminish, the lead author predicted.

ORLANDO-Ginger has been used for years to treat gastrointestinal upset, but for the first time, a large double-blind multicenter randomized study has shown ginger supplements can successfully stem chemotherapy-related nausea, University of Rochester in New York investigators reported at ASCO 2009 (abstract 9511). Some 70% of patients experience nausea and vomiting related to chemotherapy. While vomiting can largely be prevented with anti-emetics, nausea is typically more difficult to prevent and treat.

ORLANDO-Results from an international phase III trial in advanced non-small-cell lung cancer could change the standard of care, according to the lead investigator.

New biologics are improving the treatment of advanced colorectal cancer, but their optimal integration into practice remains unclear, and the question of how aggressive treatment should be is still open ended.

A call center in India takes a customer service inquiry from Idaho; an Australian doctor reads an emergency x-ray for a U.S. patient; a professor in Moscow delivers a lecture via satellite to UK-based students-these examples of “going global” no longer seem so novel. Cancer clinical trials are also crossing international datelines. Between 2005 and 2006, international clinical trials initiated in the Asia-Pacific region increased by 50%, while major research initiatives-once the stronghold of U.S. institutions-are now run by EU-based investigators.

Denver—By supporting the growth of blood vessels that absorb nutrients and oxygen, angiogenesis allows tumors to progress from clonal populations to cell masses that can expand and ultimately metastasize. This is a well-established concept, but some of the premises underlying anti-angiogenic drug development are now being revised, according to Luisa Iruela-Arispe, PhD, of the molecular, cell and developmental biology department at the University of California, Los Angeles.

The majority of postmenopausal breast cancer patients have tumors that express hormone receptors, so advances in endocrine therapy are clearly important. The optimal use of an expanding array of agents is the subject of active investigation, and presentations at SABCS 2008 added insight regarding the relative efficacy of the various approaches in hormone-sensitive early breast cancer patients.

Pazopanib reduced tumor volumes in 86% of patients with non-small cell lung cancer when used as a single agent, according to the results of a phase II study. Lead investigator Nasser Altorki, MD, stressed that the most important finding of his group’s work is that the drug can be given safely to patients with early-stage disease without altering their suitability for surgery.

SAN FRANCISCO-Routine KRAS testing in colon cancer patients received a major boost in January when ASCO issued a provisional clinical statement in favor of pretreatment genetic screening in metastatic disease. But KRAS is only the first step toward personalized medicine in colorectal cancer, according to reports presented at the 2009 Gastrointestinal Cancers Symposium. In fact, colon cancer treatment is headed in the same direction as breast cancer, with other genetic polymorphisms emerging as both predictive and prognostic.

SAN FRANCISCO-Two agents dramatically delayed the time to disease progression in metastatic neuroendocrine tumors, according to reports at the 2009 Gastrointestinal Cancers Symposium.

STOCKHOLM-Published data overwhelmingly support the use of trastuzumab (Herceptin) concurrently with chemotherapy, according to John Crown, MD, a consultant oncologist at St. Vincent’s Hospital in Dublin, Ireland. On the other hand, there is no evidence that sequential delivery is less effective than concurrent therapy, and it is definitely less toxic, commented Ian E. Smith, MD, head of the Breast Unit at Royal Marsden Hospital in London.

The clinical trials program in the U.S. is broken and apparently nobody has noticed,” Vincent T. DeVita, Jr., MD, wrote in a recent editorial in Nature Clinical Practice Oncology (5:683, 2008), of which he is editor-in-chief.

STOCKHOLM-For rectal cancer patients, a multidisciplinary team is critical to success because it increases the possibility of a curative resection, Andres Cervantes, MD, associate professor of medicine at University Hospital, Valencia, Spain, said at ESMO 2008. “Every patient should be treated within an expert multidisciplinary team,” he emphasized.

The optimal use of taxanes in the adjuvant treatment of breast cancer continues to inspire debate. Questions remain regarding the relative efficacy of sequential vs concurrent treatment, the most effective doses and schedules, and the best combinations of agents. Key studies presented at SABCS 2008 offered insight into these issues, but no definitive resolutions. In fact, two studies designed to establish optimal scheduling reached conflicting conclusions.

With clinical trial involvement stalled at around 5% for adult cancer patients, there is much room for improvement. Oncology News International spoke with two experts who have found that common sense marketing strategies can boost enrollment.

SAN ANTONIO-Data presented at SABCS 2008 by the ATAC Trialists’ Group extends the value of the Oncotype DX Recurrence Score in assessing risk of distant recurrence in breast cancer patients receiving an aromatase inhibitor.

Lapatinib (Tykerb) plus letrozole (Femara) may delay disease progression in metastatic breast cancer patients, according to an international phase III trial. Patients who benefited from the protocol were those who overexpressed the HER2/neu protein and the epidermal growth factor receptor and were also hormone receptor-positive.

Expression of the microtubule-binding protein Tau is not a reliable means of selecting breast cancer patients for adjuvant paclitaxel chemotherapy, investigators from Houston’s M.D. Anderson Cancer Center stated, adding that while Tau expression does predict survival, it does so in an unexpected way.

Data presented by the ATAC Trialists’ Group extends the value of the Oncotype DX Recurrence Score in assessing risk of distant recurrence in breast cancer patients receiving an aromatase inhibitor.

The cure for cancer lies in the biology of circulating and disseminating tumor cells that, unfortunately, evade detection and treatment very easily, according to one of the world’s leaders in the field. In a plenary lecture, Klaus Pantel, MD, described the properties and clinical relevance of the cells that eventually cause metastatic relapse but remain elusive at primary diagnosis.

The concept of bisphosphonates as anticancer agents took a leap forward this week thanks to results from the AZURE trial. Investigators from the UK reported that patients receiving zoledronic acid along with neoadjuvant chemotherapy experienced a doubling in complete pathological response.

Emerging knowledge about breast cancer biology must be integrated into clinical trials in order to personalize treatment in patients with early breast cancer. Two speakers at an educational session on clinical trial design discussed our advancing understanding of basic science and the ways in which that can change and refine the design of clinical trials.

Estrogen-receptor–positive advanced breast cancer patients who have become resistant to endocrine therapies can derive clinical benefit from 6-mg daily doses of estradiol, according to a phase II study conducted at Washington University in St. Louis.

Aromatase inhibitors were associated with greater reductions in the risk of breast cancer recurrence in comparison with tamoxifen, according to a meta-analysis involving nearly 20,000 hormone receptor-positive early breast cancer patients.

STOCKHOLM-Final analysis of the phase III Avastin in Lung Study (AVAiL), which evaluated bevacizumab (Avastin) as first-line therapy for advanced nonsmall- cell lung cancer, showed that adding bevacizumab to gemcitabine/cisplatin significantly extends progression-free survival, Christian Manegold, MD, of Heidelberg University in Mannheim, Germany, reported at ESMO 2008 (abstract LBA1).

STOCKHOLM-Advances in surgical resection have removed the label of “death sentence” associated with colorectal metastases to the liver and lung. But that means oncologists must take on the task of refining strategies to increase resectability. At ESMO 2008, Alfredo Falcone, MD, of the University of Pisa and Instituto Toscano Tumori in Italy, discussed his approach for creating the ideal conditions for resectability.

It’s no secret that enrollment into cancer care clinical trials has reached a level that could be described as anemic. Conventional wisdom puts adult enrollment at 3% to 5%, even though two-thirds of cancer patients say they are receptive to participating.

STOCKHOLM-Clinical trials have not clearly determined if advanced colorectal cancer patients should receive their first line of chemotherapy in combination or in sequence. In a debate at ESMO 2008, Cornelis J.A. Punt, MD, PhD, from Radboud University Nijmegen Medical Centre in Nijmegen, the Netherlands, and Aimery de Gramont, MD, of Hospital Saint-Antoine in Paris, discussed the pearls and pitfalls of each approach.