Onc Daily: DPD Testing Advised, Free Parking at Cancer Centers

Nick Mulcahy

May 05, 2020

Here are the most important stories that Medscape Oncology's editors picked for you to read today:

DPD Testing Advised Prior to Fluorouracil Treatment

Before patients with cancer begin treatment with intravenous fluorouracil and related drugs, they should be tested for lack of the enzyme dihydropyrimidine dehydrogenase (DPD), says the Committee for Medicinal Products for Human Use, an advisory panel to the European Medicines Agency.

Patients who lack this enzyme may end up with increased blood levels of the drug, leading to toxicity and even death.

The recommendation also applies to capecitabine (Xeloda, Genentech) and tegafur, which are converted to fluorouracil in the body. As a group, these chemotherapeutic agents are widely used to treat a variety of malignancies, including colorectal, breast, and head and neck cancers.

A Call for Free Parking at Cancer Centers

Parking fees at cancer centers in the United States can be a financial burden on patients and should be abolished, argue a trio of oncologists from three different centers.

Unlike other issues, such as the high cost of cancer drugs, this is a small step that is eminently feasible, they say in a recent essay. The approach is already in place at some centers offering parking vouchers.

Parking costs can add up. Consider a hypothetical breast cancer patient undergoing 15 sessions of hyprofractionated radiotherapy after lumpectomy. Estimated cost (at a rate of $13/day): about $200 out of pocket.

The story is already striking a chord with our readers: "Let's not nickel and dime to death the most ill who cannot afford additional financial burdens we needlessly impose for a bottom-line profit," a nurse writes in the comments section.

Modest Results Seen in Difficult-to-Treat Cancers

In a phase 2 trial, there was a response rate of 34% among patients with extensive-stage small cell lung cancer (ES-SCLC) undergoing second-line treatment with the investigational immune checkpoint inhibitor camrelizumab (Incyte Biosciences and Jiangsu Hengrui Medicine Co) and the tyrosine kinase inhibitor (TKI) apatinib (Jiangsu), which is approved only in China.

That's an improvement over standard second-line therapy with topotecan and its reported response rates of 9% to 23%, observed investigator Jie Wang, MD, from the National Cancer Center/Cancer Hospital in Beijing, China during the American Association for Cancer Research (AACR) virtual annual meeting.

Also at the meeting, a novel combination of an immunotherapy and targeted therapy yielded an improvement in median progression-free survival vs immunotherapy alone in biliary tract cancers that are relapsed or refractory. But these rare and difficult-to-treat cancers had only a couple of partial responses in each group.

Get to Know Tucatinib, New Drug for Breast Cancer

Here's an easy-to-read yet detailed look at the new drug tucatinib (Tukysa, Seattle Genetics), including interactions, administration, and a patient handout. The US Food and Drug Administration recently approved it for pretreated patients with HER2-positive metastatic breast cancer. In a clinical trial in which 50% of patients had brain metastases, tucatinib (in combination with other agents) improved survival by more than 4 months compared with placebo and those other agents.

DNR Orders Take on New Meaning for Cancer Patients

When Robin Hodges, a Boston-area woman with advanced lung cancer, signed a do-not-resuscitate order in 2016, sitting in a neurosurgeon's office and looking at an image of her brain metastases, she didn't think it was a document that she would return to. Then came COVID-19. As reported by STAT News, her story and others reveal some of the psychological effects of the pandemic among patients with cancer.

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