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  • Sep 1, 2022
    First-Line Immune Checkpoint Inhibitors and Metastatic Melanoma

    This is a retrospective, nationwide study of patients with newly diagnosed stage 4 cutaneous melanoma between 2010 and 2019, identified by national cancer database (NCDB). The goal of the study was to determine the rate of immune checkpoint inhibitor (ICI) usage in the wake of its FDA approval in addition to overall survival (OS). 16,831 patients with stage IV melanoma were identified; immunotherapy usage increased from 9% in 2010 to 39% in 2015, and 62% in 2019. OS increased from 7.7 months in 2010 to 17.5 months in 2018. In 2018, 38% of patients were still not receiving first-line ICI, use varied by patients’ socioeconomic factors.

    (Open Access)

    Reference (Pub-Med Link): Lamba, N., Ott, P. A., & Iorgulescu, J. B. (2022). Use of First-Line Immune Checkpoint Inhibitors and Association With Overall  Survival Among Patients With Metastatic Melanoma in the Anti-PD-1 Era. JAMA Network Open, 5(8), e2225459. https://doi.org/10.1001/jamanetworkopen.2022.25459

    Key Institution: Harvard, Dana-Farber Cancer Institute, Brigham and Women’s Hospital
    Keywords: Melanoma, Immunotherapy

  • Sep 1, 2022
    Risk Prediction Models for Heart toxicity After Treatment for Hodgkin Lymphoma

    A major concern in the treatment of Hodgkin lymphoma (HL), particularly when it comes to radiation, is the risk of late outcomes such as heart disease. Previous efforts to individually predict cancer treatment–related CVD have mostly focused on childhood cancer survivors and cannot be directly translated to survivors of adolescent and adult cancers because absolute and relative risks of treatment-related CVD differ by age. The aim of this study was to develop prediction models for coronary heart disease (CHD) and heart failure (HF) for survivors of adolescent/adult HL.

    For model development, they included 1,400 5-year HL survivors treated between 1965 and 2000 and age 18-50 years at HL diagnosis, with complete data on administered chemotherapy regimens, radiotherapy volumes and doses, and cardiovascular follow-up. Using cause-specific hazard models, covariate-adjusted cumulative incidences for CHD and HF were estimated in the presence of competing risks of death. Age at HL diagnosis, sex, smoking status, radiotherapy, and anthracycline treatment were included as predictors. External validation for the CHD model was performed using a Canadian cohort of 708 HL survivors treated between 1988 and 2004 and age 18-50 years at HL diagnosis.

    In this study, two separate prediction models were developed for CHD and HF, which were internally and externally validated with moderate to good discrimination and calibration. The models allow for an individual prediction of CHD or HF risk on the basis of treatment-related factors including sex, age at treatment, radiotherapy field or dose, anthracycline (dose), and smoking. Based on these models, 30-year risks ranged from 4% to 78% for CHD and 3% to 46% for HF, depending on risk factors.

    These validated models define risk of coronary artery disease and congestive HF after treatment for Hodgkin lymphoma. Moving forward, these data can be used to identify HL survivors who might benefit from targeted screening for CVD and early treatment for CVD risk factors.

    Reference (Pub-Med Link): de Vries, S., Haaksma, M. L., Jó┼║wiak, K., et al. (2022). Development and Validation of Risk Prediction Models for Coronary Heart Disease and Heart Failure After Treatment for Hodgkin Lymphoma. Journal of Clinical Oncology (online ahead of print). https://doi.org/10.1200/JCO.21.02613

    Key Institution: Multi-Center
    Keywords: Hodgkin Lymphoma

  • Aug 1, 2022
    Post-op SBRT for prostate cancer

    This article describes the data from a phase II trial in which prostate patients who have had prostatectomy with biochemical recurrence underwent SBRT for salvage treatment. Radiation dose was 30-34 Gy in 5 fractions delivered with either CT or MR guidance. A total of 100 patients were enrolled. Median follow-up was 29.5 months. Acute and late grade 2 GU toxicities were both 9%, while acute and late grade 2 GI toxicities were 5% and 0%. Three patients had grade 3 toxicity. Conclusion: post-prostatectomy SBRT was well tolerated at short-term follow-up.

     

    (Open Access)

    Reference (Pub-Med Link): Ma, T. M., Ballas, L. K., Wilhalme, H., et al. (2022). Quality-of-Life Outcomes and Toxicity Profile Among Patients With Localized Prostate Cancer After Radical Prostatectomy Treated With Stereotactic Body Radiation: The SCIMITAR Multicenter Phase 2 Trial. International Journal of Radiation Oncology, Biology, Physics. https://doi.org/10.1016/j.ijrobp.2022.08.041

    Key Institution: UCLA

    Keywords: Prostate

  • Aug 1, 2022
    SBRT for sarcoma lung metastases

    This report is a prospective phase II trial assessing the role of SBRT for patients with lung metastases from sarcoma. Sarcoma is a generally considered a radioresistant histology and patients with lung metastases are standardly managed with metastasectomy. This trial assessed the feasibility of treating up to 4 lung metastases ≤5cm in size using different fractionation schemes. Overall, there were 41 patients with 71 lung metastases and most patients were treated with 48 Gy/4 fx (86%). At 12 months, local control was 98.5% and local recurrence free survival was 58.8%.

    Reference (Pub-Med Link): Navarria, P., Baldaccini, D., Clerici, E., et al. (2022). Stereotactic Body Radiation Therapy for Lung Metastases From Sarcoma in Oligometastatic Patients: A Phase 2 Study. International Journal of Radiation Oncology, Biology, Physics, 114(4), 762–770. https://doi.org/10.1016/j.ijrobp.2022.08.028

    Key Institution: Humanitas Research Hospital, Milan, Italy

    Keywords: Sarcoma, oligometastases

  • Aug 1, 2022
    Chemoradiotherapy in Muscle-invasive Bladder Cancer: Phase 3 Trial

    Muscle-invasive bladder cancer is the 6th most common cancer in men and 17th most common cancer in women worldwide. The current standard of care includes either radical cystectomy or trans urethral resection of bladder tumor followed by radiotherapy with or without radiosensitizing chemotherapy, also known as organ conserving therapy. No well-powered randomized trials compare these two approaches. BC2001 is the largest organ conservation trial in muscle-invasive bladder cancer, and compares chemoradiotherapy using 5-fluorouracil and mitomycin C vs RT alone. The primary analysis, published in 2012, reported significant improvement in locoregional control with chemoradiotherapy vs radiotherapy alone (HR 0.68 (0.48-0.96); p=0.03) with a median follow-up of five years. Now with 10-year median follow-up, improvement in locoregional control with chemoradiotherapy persists (HR 0.61 (0.43-0.86); p=0.004). As in the primary analysis, disease-related outcomes (disease-free survival, bladder cancer-specific survival, and overall survival) trended toward but did not reach statistical significance.

    Given the absence of randomized data comparing radical cystectomy to organ conserving therapy, this further follow-up maintains the centrality of multimodal treatment to practitioners of bladder-conserving therapy but is unlikely to change practices in those who assert that radical cystectomy is the gold-standard for locally invasive bladder cancer despite patients’ continued reluctance to accept randomization to bladder-sparing or radical cystectomy-based approaches, likely making any randomized comparison out of reach. 

    (Open Access)

    Reference (Pub-Med Link): Hall, E., Hussain, S. A., Porta, N., et al. (2022). Chemoradiotherapy in Muscle-invasive Bladder Cancer: 10-yr Follow-up of the Phase 3 Randomised Controlled BC2001 Trial. European Urology, 82(3), 273–279. https://doi.org/10.1016/j.eururo.2022.04.017

    Key Institution: The Institute of Cancer Research, London, UK
    Keywords: Bladder

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