Oncology News - December 2015

VBCC - December 2015, Vol 6, No 11 - Oncology News

In This Article

ASH's 5 New Choosing Wisely Recommendations for Hematologists

The American Society of Hematology (ASH) released the top 5 hematology-related tests and procedures based on recommendations from other medical societies that are often adopted into each organization's Choosing Wisely program. These 5 new recommendations are in addition to the 10 recommendations issued by ASH in the past 2 years. The goal of this initiative is to prompt conversations between patients and clinicians about the necessity of certain tests and procedures. These items were also presented during the recent 57th ASH annual meeting in Orlando, FL.

The 5 new ASH recommendations (available at www.hematology.org/ChoosingWisely), which represent a compilation of recommendations from different medical societies and organizations, include:

  • Don't order imaging for suspected pulmonary embolism without moderate or high pretest probability of this condition (American College of Radiology)
  • Don't routinely order thrombophilia testing for patients undergoing a routine infertility evaluation (American Society for Reproductive Medicine)
  • Don't perform repetitive complete blood count and chemistry testing for a person with stable clinical status and laboratory results (Society of Hospital Medicine/Adult Hospital Medicine)
  • Don't transfuse red blood cells for iron deficiency without hemodynamic instability (American Association of Blood Banks)
  • Avoid using positron emission tomography (PET) or PET-computed tomography scanning as part of routine follow-up care to monitor cancer recurrence in asymptomatic patients who have finished their initial treatment to eliminate the cancer, unless high-level evidence shows that imaging will change outcomes (American Society of Clinical Oncology).

The ASH Task Force reviewed 400 recommendations before selecting these 5 priorities directly relevant to hematologists. Avoiding harm and improving quality of care are ASH's top guiding principles in choosing the recommendations. "The Choosing Wisely initiative is a high visibility campaign that has increased awareness of overutilization in medicine, and at ASH we believe there is a potential for even greater impact when societies share information and work together to accomplish the same goals," said ASH's Choosing Wisely Task Force Chair Lisa Hicks, MD, from St Michael's Hospital and the University of Toronto.

Source: American Society of Hematology press release; December 2, 2015

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Advances in Multiple Myeloma Generate Excitement at ASH 2015

At the 57th American Society of Hematology (ASH) annual meeting in Orlando, FL, the recent FDA approval of 3 new drugs for multiple myeloma was met with much enthusiasm and excitement and had a prominent place among the many oral presentations and thousands of posters and abstracts. Paul Richardson, MD, Clinical Program Leader and Director of Clinical Research at Dana-Farber Jerome Institute Multiple Myeloma Center, Boston, delivered one of the key oral presentations, highlighting results of recent clinical trials showing that new drug combinations can significantly extend progression-free survival among patients with relapsed or treatment-resistant multiple myeloma.

Dr Richardson discussed the results of 3 clinical trials that included a combination of lenalidomide (Revlimid) and dexamethasone with 1 of the 3 new drugs approved in November 2015—daratumumab (Darzalex), the first monoclonal antibody approved by the FDA for multiple myeloma; ixazomib (Ninlaro), the first oral proteasome inhibitor approved for this disease; and elotuzumab (Empliciti), the second monoclonal antibody approved for this condition.

"With the recent approvals of daratumumab, ixazomib, and now elotuzumab, we have seen an unprecedented pace of progress in myeloma therapy this year. The results from these studies reflect the real benefits our patients can anticipate from these very important advances in currently available treatment," said Dr Richardson.

In several presentations at the meeting, other myeloma experts have advised listeners that combination therapy for patients with multiple myeloma is the new standard of care, except perhaps in frail elderly patients, because of the potential for increased toxicity.

Source: Paul Richardson, MD; ASH Annual Meeting, December 7, 2015; Orlando, FL

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First Precision Medicine Trial in Cancer Prevention Identifies Patients for Chemoprevention

More than 300,000 people are diagnosed with oral cancer, the most common type of head and neck cancer, worldwide annually.

"One of the greatest challenges in developing chemopreventive agents is to identify the population at highest cancer risk," said William N. William, Jr, MD, Associate Professor at M.D. Anderson Cancer Center, which led the enrollment and design of the study. "Not all patients with an oral premalignant lesion will develop oral cancer. By using a molecular test that can identify those at highest risk, we can focus preventive efforts on these specific individuals."

The Erlotinib Prevention of Oral Cancer (EPOC) trial included 379 patients with premalignant oral lesions. Patients were evaluated for loss of heterozygosity (LOH), a chromosomal abnormality involving the loss of tumor suppressor genes. Patients with LOH were considered to be at increased risk for oral cancer. Patients were randomized to erlotinib (Tarceva) or to placebo for 1 year. The rate of cancer-free survival was 87% among patients without LOH compared with 74% for patients with LOH. Erlotinib, however, did not reduce the rate of cancer-free survival after 3 years.

"To the best of our knowledge, EPOC represents the first study of oral premalignant lesions to use cancer as the primary endpoint, and the first molecularly-based precision medicine trial design in cancer prevention," said Scott Lippman, MD, Director of Moores Cancer Center, UC San Diego Health. The study was published in JAMA on November 5, 2015.

Source: US San Diego Health Sciences News; November 5, 2015

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Last modified: December 29, 2015
  • Rheumatology Practice Management
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology