New data being presented today at the American Society of Clinical Oncology (ASCO) 2015 Annual Meeting will provide long-sought, conclusive answers to three clinical questions, as well as an answer to an urgent question about immunotherapy in melanoma.
"Despite tremendous advances, physicians still don't always know when the benefits of aggressive therapy outweigh the possible side effects," commented ASCO spokesperson Jyoti D. Patel, MD, associate professor of medicine-hematology/oncology at Northwestern University Feinberg School of Medicine, in Chicago.
"With today's studies, we finally have conclusive answers for patients considering surgery for oral cancer or radiation when cancer spreads to the brain. At the same time, it's clear that less aggressive therapy is paying major dividends for childhood cancer survivors," she said.
Presentations at the plenary session this afternoon will cover the following:
Optimal timing of surgery for oral cancer (abstract LBA3). When performing surgery for oral cancer, removing surrounding lymph nodes as a preventive measure (elective node dissection) gives better outcomes than performing the dissection once the patient has relapsed (therapeutic node dissection). There has been a long-standing debate over the timing of this node dissection. "Our study is the first to conclusively prove that more lives can be saved with elective neck dissection," said lead study author Anil D’Cruz, MBBS, FRCS, professor and chief, Department of Head and Neck Surgery, at Tata Memorial Centre, in Mumbai, India.
Use of whole-brain radiation for patients with brain metastases (abstract LBA4). Patients with one to three small brain metastases who received radiosurgery followed by whole-brain radiotherapy (WBRT) were more likely to experience cognitive decline than those who received radiosurgery alone, and the WBRT did not significantly extend patient survival, though it did help control growth of brain metastases. "We now know that the toxicities of this therapy are worse for the patient than cancer growth or recurrences in the brain," said senior study author Jan C. Buckner, MD, a professor of oncology at Mayo Clinic, in Rochester, Minnesota. "We expect that practice will shift to reserve the use of whole-brain radiation therapy for salvage treatment and end-stage palliative care."
Impact of less aggressive therapy on childhood cancer survival (abstract LBA2). Although childhood cancer cure rates started to improve 50 years ago, the aggressive treatments had severe consequences that could result in premature death from cardiac and lung disease or subsequent cancers. But modifications to treatment regimens have reduced the risk for these consequences, and a new analysis of data from the Childhood Cancer Survivor Study shows that all-cause mortality at 15 years after diagnosis has dropped during the last 3 decades from 12.4% to 6%. "We've not only helped more children survive their primary cancer, but we've also extended their overall lifespan by reducing the overall toxicity of treatment in more modern eras," said lead author Gregory T. Armstrong, MD, MSCE, a pediatric oncologist at St. Jude Children's Research Hospital, in Memphis, Tennessee.
Comparison of immune checkpoint inhibitors in melanoma (Checkmate 067 study, abstract LBA1). Initial treatment of melanoma with nivolumab (Opdivo, Bristol-Meyers Squibb Company) was superior to treatment with ipilimumab (Yervoy, Bristol-Meyers Squibb Company) with improved progression-free survival and response rates. Even better results were seen with the combination of nivolumab plus ipilimumab compared with ipilimumab alone, but this combination also had increased side effects. This might offset its benefit for some patients, commented ASCO expert Steven O'Day, MD, adding: "Physicians and patients will need to weigh these considerations carefully." Dr Day is clinical associate professor of medicine at the University of Southern California Keck School of Medicine, in Los Angeles.
"Even with recent advances in the treatment of melanoma with immunotherapy, which has transformed our approach to this disease, today's findings underscore our need for ongoing study. Today's take-away reinforces that some patients will do just fine with one treatment, avoiding the additional side effects of a two-drug combination," commented Dr Patel
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Cite this: Sunday at ASCO: News That Will Affect Clinical Practice - Medscape - May 31, 2015.