Zosia Chustecka

May 30, 2014

CHICAGO — News coming out today at the 2014 Annual Meeting of the American Society of Clinical Oncology® (ASCO) will focus on quality-of-life issues in cancer patients. A quick summary is provided here, but please check back on Medscape Oncology for detailed news reports with reactions to the findings.

"Today's research reveals new ways of making patients' lives better," commented ASCO expert Patricia Ganz, MD, director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, speaking at today's press briefing.

"Oncology isn't just about helping people to live longer — we need to ensure that patients have the best quality of life possible at every stage of their cancer journey, from active treatment through survivorship," she added.

Scaling Back on Therapy

Several of the studies highlighted at the ASCO press briefing today are about scaling back treatment.

Less frequent use of the bone drug zoledronic acid (Zometa) achieved similar effects to the standard dose in providing protection against fractures and other skeletal changes in women with breast cancer and bone metastases.

Usually, the drug is given by intravenous injection once a month. But results from the OPTIMIZE-2 study (abstract LBA9500) show that, after a year of monthly injections, treatment can be reduced to a schedule of 1 injection given every 3 months.

"We found that less frequent treatment may reduce the risk of serious side effects, with added benefits in reduced patient inconvenience and costs," commented lead author Gabriel Hortobagyi, MD, professor of medicine at the University of Texas M.D. Anderson Cancer Center in Houston. He will present the data on Monday, June 2.

Lowering the dose of radiation appears to be possible for patients with oropharyngeal cancer who have tested positive for human papillomavirus (HPV).

It's been known for some time that among patients with head and neck cancers, those who test HPV-positive have a better prognosis than those who are HPV-negative, and there has been speculation that they could be managed with less aggressive treatment. In this first-of-its-kind study, HPV-positive patients who responded well to induction chemoradiation then received a reduced dose of intensity-modulated radiotherapy instead of the standard dose. The results suggest that lowering the dose did not affect outcomes, but reduced the risk for radiation adverse effects.

However, these are early results from a 90-patient trial and longer follow-up, as well as a confirmatory phase 3 trial, is needed before "we can recommend applying this strategy in practice," commented lead author Anthony Cmelak, MD, professor of radiation oncology at the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee. He will present the study (abstract LBA6006) on Monday, June 2.

Preserving Fertility in Young Women

A devastating effect of cancer treatment can be loss of fertility, but a way of minimizing this risk has been found for young women with breast cancer. The results from the POEMS trial (abstract LBA505), which will be presented on Saturday, May 31, show that the hormone-suppressing drug goserelin can reduce the adverse effects of cyclophosphamide-containing chemotherapy on fertility, which can include ovarian failure.

"Goserelin appears to be not only highly safe but also effective, as it increased the odds of becoming pregnant and delivering a healthy baby following chemotherapy," said lead author Halle Moore, MD, a staff physician at the Cleveland Clinic.

At the End of Life

"Many doctors argue that, near the end of life, it is not necessary to continue medications for chronic illness that are not life-threatening. But we have no guidance on what medicines to stop and when to do so," commented Amy Abernethy MD, PhD, medical oncologist and palliative care specialist at Duke University Medical Center in Durham, North Carolina.

She will present a study (abstract LBA9514) on Tuesday, June 3 that shows that stopping statins for cholesterol-lowering is safe in patients with advanced cancer with a life-expectancy of less than a year. Stopping the statins did not shorten survival, and it improved quality of life.

A new palliative care support program, aimed at both patients with advanced cancer and their caregivers, involves monthly telephone sessions with advanced practice palliative care nurses. The earlier the support was introduced, the better for the caregivers, as immediate rather than delayed introduction of the program decreased depression and improved quality of life.

"This innovative study demonstrates the need for supporting family caregivers during their loved one's illness, and the specific benefit of initiating this support sooner rather than later," Dr. Ganz commented at the press briefing.

The findings come from the ENABLE III study and these results for caregivers (abstract LBA9513) will be presented on Tuesday, June 3, as will results for the cancer patients (abstract 9512).


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