Cancer Roundup: Updates and commentary on the latest in cancer
By Dr. Ajaz Bulbul
New Treatment for small cell lung cancer
March 18, saw the first FDA approval in decades for a type of lung cancer common in smokers called mall cell lung cancer. U.S. Food and Drug Administration (FDA) approved atezolizumab (Tecentriq) in combination with carboplatin and etoposide for treating patients with widespread metastatic small cell lung cancer. Which until now has had relatively dismal options to treat.
In a randomized, multicenter, trial in 403 patients with extensive-stage small cell lung cancer who received no prior chemotherapy treatment using a combination of this novel immunotherapy drug combined with chemotherapy improved survival by about 30%.
The Median overall survival was 12.3 months, with some patients living beyond close to 16 months while receiving immunotherapy with chemotherapy as compared to the 10.3 months of chemotherapy alone. Some of these patients have the potential to have longer-term control of disease as we follow these patients further. These are major improvements in a space in cancer that has had no significant improvement in a long time. A welcome change.
Small cell lung cancer is only seen in smokers and although the incidence in dropping as smoking rates decrease we see quite a bit of this cancer around here in southeast New Mexico due to higher smoking rates.
Mutational Burden in Colon Cancer
In an analysis of the clinical phase III trial called the CALGB/SWOG 80405 trial reported in the prestigious Journal of Clinical Oncology, Authors found that tumor mutational burden (or in other words how many mutations or abnormalities are present in a tumor) and microsatellite instability (how likely the tumor is to develop additional mutations) status affected how long patients lived after receiving chemotherapy.
The study involved analysis of tumor DNA from over 800 patients in the trial. A high tumor mutational burden (> 8 mutations/Mb) seemed to be the cutoff above which tumors responded better to treatment (30% greater survival). Patients with microsatellite instability-high tumors benefited more from biological drug bevacizumab than from cetuximab, both of which are commonly combined with chemotherapy in colon cancer. This study shed light on the importance of molecular and genetic testing of the tumor tissue. More studies are needed to confirm these findings.
Robotic Surgery for Endometrial Cancer
A robotic approach to cancer surgery is getting more common. With the concept of a better approach to tumors, higher fidelity in removing tumors and less cutting around and quicker recovery times. In a Danish study reported in JAMA Surgery, authors found that minimally invasive robotic surgery for early-stage endometrial cancer led to the reduction in serious complications of surgery and had no untoward effect on the survival of these patients.
This study involved 5,654 women who underwent minimally invasive robotic surgery, minimally invasive laparoscopic surgery or the commonly performed total abdominal hysterectomy over 10 years. The risk of complications was about 3.87 times higher with open surgery than with robotic surgery.
Triplet treatment in poor prognosis colon cancer
A three-drug combination of biological treatments (encorafenib, binimetinib, and cetuximab) have shown promise for an aggressive type of colon cancer with so-called BRAF V600E mutation. So far we know this subset of colon cancer patients has much poorer outcomes despite the currently available chemotherapy options. This regimen seemed to have a manageable safety profile and evidence of activity in the safety lead-in to the phase III BEACON Colorectal Cancer trial.
Looking at 30 patients with BRAF V600E–mutant metastatic colorectal cancer who had experienced treatment failure with 1 or 2 prior regimens participated in this safety study. The efficacy of this treatment seems promising compared with available therapies for BRAF mutant colon cancers.
Early morning radiation therapy reduces toxicities
Interesting research presented at the recent American Association for Cancer Research (AACR) Annual Meeting 2019 found that administering radiation treatments in patients with cancer in the morning as opposed to later in the day may significantly reduce the severity of mucositis and its related impacts like difficulty swallowing, eating or drinking
Oral mucositis (painful inflammation and ulceration of the mucous lining the digestive tract) is one of the most common adverse side effects caused by radiation therapy, Especially in patients with head and neck cancers. In a study of oral mucositis in 190 patients with head and neck cancer, they found a significant association between radiation treatment timing and oral mucositis severity.
Something as simple as identifying an optimal time of a day for radiation therapy may substantially prevent severe oral mucositis. The lowest toxicity also called “Mucositis soreness quality score” (MSQS) was seen in patients treated in the early morning (8:30 AM to before 9:30 AM).
Toxicity increased in patients treated at later times, peaking between 12:00 noon to 1:30 PM and 1:30 PM to 3:00 PM, and then decreased for patients treated in the late afternoon. It is interesting data. GThe mechanism behind why this would happen is not clear. But surely food for thought.
Q: I have bladder cancer. I am over 74 and frail with medical issues. I was told i cant get surgery. What options do I have?
A: Sorry to hear about your diagnosis. If your bladder cancer has been properly staged with a PET/CT scan and there is no evidence of cancer outside of the bladder and its surrounding lymph nodes a combination of chemotherapy and radiation can be considered.
There can be an Improvement in the two-year local disease-free survival with the combined use of chemotherapy and radiation (67 versus 54 percent in the radition therapy alone group). Therefore adding chemotherapy leads to a 32% improvement in outcomes. In one study (BC2001) there was a trend toward increased five-year OS in the chemoradiation group (48 versus 35 percent)
Talk to your oncologist about this option. I hope that helps.
Feel free to send your questions to firstname.lastname@example.org or cancer round up @ 101 S. Canal St., Carlsbad, NM, 88220
Dr. Ajaz Bulbul serves as a medical director at Kymera Independent Physicians and is currently practicing in Carlsbad and Hobbs. He is a Clinical Assistant Professor at Texas Tech University in the Division of Hematology and Oncology and a Clinical Assistant Professor at University of New Mexico with the Division of Hematology and Oncology