Showing papers by "Seattle Cancer Care Alliance published in 2020"
Northwestern University1, Seattle Cancer Care Alliance2, Case Western Reserve University3, Washington University in St. Louis4, Ohio State University5, Stanford University6, University of California, San Diego7, Brigham and Women's Hospital8, Memorial Sloan Kettering Cancer Center9, University of Colorado Boulder10, University of Texas MD Anderson Cancer Center11, Mayo Clinic12, Fox Chase Cancer Center13, Harvard University14, Duke University15, University of Pennsylvania16, Vanderbilt University17, Yale University18, City of Hope National Medical Center19, University of Wisconsin-Madison20, University of Michigan21, University of California, San Francisco22, Johns Hopkins University23, University of South Florida24, University of Alabama at Birmingham25, University of Utah26, Roswell Park Cancer Institute27, National Comprehensive Cancer Network28
TL;DR: The NCCN Guidelines specific to the workup and treatment of patients with recurrent/stage IV breast cancer are discussed in this article.
Abstract: This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer focuses on the clinical presentation and workup of suspected bladder cancer, treatment of non-muscle-invasive urothelial bladder cancer, and treatment of metastatic urothelial bladder cancer because important updates have recently been made to these sections. Some important updates include recommendations for optimal treatment of non-muscle-invasive bladder cancer in the event of a bacillus Calmette-Guerin (BCG) shortage and details about biomarker testing for advanced or metastatic disease. The systemic therapy recommendations for second-line or subsequent therapies have also been revised. Treatment and management of muscle-invasive, nonmetastatic disease is covered in the complete version of the NCCN Guidelines for Bladder Cancer available at NCCN.org. Additional topics covered in the complete version include treatment of nonurothelial histologies and recommendations for nonbladder urinary tract cancers such as upper tract urothelial carcinoma, urothelial carcinoma of the prostate, and primary carcinoma of the urethra.
1,018 citations
TL;DR: This Special Feature highlights the unique circumstances and challenges of cancer treatment amidst this global pandemic, and the importance of organizational structure, preparation, agility, and a shared vision for continuing to provide cancer treatment to patients in the face of uncertainty and rapid change.
Abstract: The first confirmed case of coronavirus disease 2019 (COVID-19) in the United States was reported on January 20, 2020, in Snohomish County, Washington. At the epicenter of COVID-19 in the United States, the Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, and University of Washington are at the forefront of delivering care to patients with cancer during this public health crisis. This Special Feature highlights the unique circumstances and challenges of cancer treatment amidst this global pandemic, and the importance of organizational structure, preparation, agility, and a shared vision for continuing to provide cancer treatment to patients in the face of uncertainty and rapid change.
440 citations
Fox Chase Cancer Center1, Ohio State University2, Brigham and Women's Hospital3, University of Tennessee Health Science Center4, University of Utah5, Washington University in St. Louis6, University of Pennsylvania7, University of Alabama at Birmingham8, Johns Hopkins University9, Roswell Park Cancer Institute10, Northwestern University11, University of Colorado Boulder12, Stanford University13, University of South Florida14, University of Texas MD Anderson Cancer Center15, University of California, San Francisco16, Duke University17, University of Michigan18, Seattle Cancer Care Alliance19, Memorial Sloan Kettering Cancer Center20, Vanderbilt University21, Case Western Reserve University22, University of Nebraska Medical Center23, Harvard University24, City of Hope National Medical Center25, Mayo Clinic26, University of Wisconsin-Madison27, National Comprehensive Cancer Network28
TL;DR: These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding criteria for high-penetrance genes associated with breast and ovarian cancer beyond BRCA1/2, pancreas screening and genesassociated with pancreatic cancer, genetic testing for the purpose of systemic therapy decision-making, and testing for people with Ashkenazi Jewish ancestry.
Abstract: The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic provide recommendations for genetic testing and counseling for hereditary cancer syndromes, and risk management recommendations for patients who are diagnosed with syndromes associated with an increased risk of these cancers. The NCCN panel meets at least annually to review comments, examine relevant new data, and reevaluate and update recommendations. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding criteria for high-penetrance genes associated with breast and ovarian cancer beyond BRCA1/2, pancreas screening and genes associated with pancreatic cancer, genetic testing for the purpose of systemic therapy decision-making, and testing for people with Ashkenazi Jewish ancestry.
344 citations
Seattle Cancer Care Alliance1, University of Michigan2, Johns Hopkins University3, University of South Florida4, Brigham and Women's Hospital5, City of Hope National Medical Center6, Yale Cancer Center7, Roswell Park Cancer Institute8, Harvard University9, Ohio State University10, University of Pennsylvania11, University of Utah12, Northwestern University13, Fox Chase Cancer Center14, Vanderbilt University15, University of California, San Diego16, Case Western Reserve University17, Stanford University18, Mayo Clinic19, Memorial Sloan Kettering Cancer Center20, Duke University21, University of Texas MD Anderson Cancer Center22, University of Colorado Boulder23, National Comprehensive Cancer Network24
TL;DR: The NCCN Guidelines for Management of Immunotherapy-Related Toxicities provide interdisciplinary guidance on the management of immune-related adverse events (irAEs) resulting from cancer immunotherapy as discussed by the authors.
Abstract: The NCCN Guidelines for Management of Immunotherapy-Related Toxicities provide interdisciplinary guidance on the management of immune-related adverse events (irAEs) resulting from cancer immunotherapy. These NCCN Guidelines Insights describe symptoms that may be caused by an irAE and should trigger further investigation, and summarize the NCCN Management of Immunotherapy-Related Toxicities Panel discussions for the 2020 update to the guidelines regarding immune checkpoint inhibitor-related diarrhea/colitis and cardiovascular irAEs.
272 citations
University of Alabama at Birmingham1, City of Hope National Medical Center2, Case Western Reserve University3, Yale Cancer Center4, Johns Hopkins University5, University of Pennsylvania6, University of California, San Francisco7, Washington University in St. Louis8, Vanderbilt University9, Roswell Park Cancer Institute10, University of South Florida11, University of California, San Diego12, Northwestern University13, University of Michigan14, Memorial Sloan Kettering Cancer Center15, Harvard University16, Mayo Clinic17, Stanford University18, Duke University19, Ohio State University20, University of Wisconsin-Madison21, Seattle Cancer Care Alliance22, University of Colorado Boulder23, University of Utah24, Fox Chase Cancer Center25, American Brain Tumor Association26, National Comprehensive Cancer Network27
TL;DR: NCCN Guidelines recommendations for WHO grade I, II, III, and IV gliomas are described and treatment of brain metastases, the most common intracranial tumors in adults, is described.
Abstract: The NCCN Guidelines for Central Nervous System (CNS) Cancers focus on management of adult CNS cancers ranging from noninvasive and surgically curable pilocytic astrocytomas to metastatic brain disease. The involvement of an interdisciplinary team, including neurosurgeons, radiation therapists, oncologists, neurologists, and neuroradiologists, is a key factor in the appropriate management of CNS cancers. Integrated histopathologic and molecular characterization of brain tumors such as gliomas should be standard practice. This article describes NCCN Guidelines recommendations for WHO grade I, II, III, and IV gliomas. Treatment of brain metastases, the most common intracranial tumors in adults, is also described.
244 citations
Monash University, Clayton campus1, University College Hospital2, Flinders Medical Centre3, University of Western Australia4, Sir Charles Gairdner Hospital5, St James's University Hospital6, Princess Alexandra Hospital7, University of Queensland8, Karolinska University Hospital9, Christchurch Hospital10, Royal North Shore Hospital11, Harvard University12, Nicolaus Copernicus University in Toruń13, University of Barcelona14, Charles University in Prague15, Seattle Cancer Care Alliance16, City of Hope National Medical Center17, Academy for Urban School Leadership18, First Faculty of Medicine, Charles University in Prague19, Utrecht University20, University of Paris21, University of Sydney22, Concord Repatriation General Hospital23, National and Kapodistrian University of Athens24
TL;DR: Zanubrutinib treatment was associated with a trend toward better response quality and less toxicity, particularly cardiovascular toxicity, which demonstrate that zanubRutinIB and ibrut inib are highly effective in the treatment of WM.
243 citations
Fox Chase Cancer Center1, Roswell Park Cancer Institute2, University of South Florida3, Harvard University4, Ohio State University5, University of California, Los Angeles6, Stanford University7, Brigham and Women's Hospital8, University of Alabama at Birmingham9, University of Texas Southwestern Medical Center10, Vanderbilt University11, Memorial Sloan Kettering Cancer Center12, Seattle Cancer Care Alliance13, University of Colorado Boulder14, Johns Hopkins University15, University of Tennessee Health Science Center16, University of Wisconsin-Madison17, City of Hope National Medical Center18, Mayo Clinic19, University of Utah20, Duke University21, Case Western Reserve University22, University of Michigan23, University of Pennsylvania24, University of California, San Diego25, Washington University in St. Louis26, University of California, San Francisco27, National Comprehensive Cancer Network28
TL;DR: The panel discussion behind recent important updates to the NCCN Guidelines Insights summary the development of a separate and distinct guideline for gastrointestinal stromal tumors (GISTs), reconception of the management of desmoid tumors, and revision of the principles of radiation therapy for soft tissue sarcomas are summarized.
Abstract: The NCCN Guidelines for Soft Tissue Sarcoma provide recommendations for the diagnosis, evaluation, treatment, and follow-up for patients with soft tissue sarcomas. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including the development of a separate and distinct guideline for gastrointestinal stromal tumors (GISTs); reconception of the management of desmoid tumors; inclusion of further recommendations for the diagnosis and management of extremity/body wall, head/neck sarcomas, and retroperitoneal sarcomas; modification and addition of systemic therapy regimens for sarcoma subtypes; and revision of the principles of radiation therapy for soft tissue sarcomas.
163 citations
Mayo Clinic1, University of Wisconsin-Madison2, Northwestern University3, University of Texas Southwestern Medical Center4, University of Nebraska Medical Center5, University of Michigan6, Harvard University7, University of Tennessee Health Science Center8, University of California, San Diego9, Ohio State University10, Case Western Reserve University11, University of Pennsylvania12, University of Alabama at Birmingham13, Roswell Park Cancer Institute14, Seattle Cancer Care Alliance15, City of Hope National Medical Center16, Johns Hopkins University17, Duke University18, Memorial Sloan Kettering Cancer Center19, University of California, Los Angeles20, Stanford University21, University of California, San Francisco22, University of South Florida23, University of Utah24, Washington University in St. Louis25, University of Texas MD Anderson Cancer Center26, National Comprehensive Cancer Network27
TL;DR: This manuscript discusses the management of patients with solitary plasmacytoma, smoldering multiple Myeloma, and newly diagnosed multiple myeloma.
Abstract: Multiple myeloma is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. This manuscript discusses the management of patients with solitary plasmacytoma, smoldering multiple myeloma, and newly diagnosed multiple myeloma.
159 citations
Memorial Sloan Kettering Cancer Center1, University of Texas MD Anderson Cancer Center2, University of Nebraska Medical Center3, University of South Florida4, University of Utah5, University of Michigan6, Vanderbilt University7, Brigham and Women's Hospital8, Mayo Clinic9, University of California, San Diego10, University of California, San Francisco11, Roswell Park Cancer Institute12, Seattle Cancer Care Alliance13, University of Pennsylvania14, Stanford University15, University of Wisconsin-Madison16, University of Colorado Hospital17, City of Hope National Medical Center18, Yale University19, Harvard University20, Ohio State University21, University of Alabama at Birmingham22, Johns Hopkins University23, Fox Chase Cancer Center24, Case Western Reserve University25, Duke University26, University of California, Los Angeles27, Washington University in St. Louis28, Northwestern University29, National Comprehensive Cancer Network30
TL;DR: Recent updates to the NCCN guidelines, including changes to certain systemic therapy recommendations for patients with relapsed or stage IV RCC, and the addition of a new section to the guidelines that identifies and describes the most common hereditary RCC syndromes.
Abstract: The NCCN Guidelines for Kidney Cancer provide multidisciplinary recommendations for diagnostic workup, staging, and treatment of patients with renal cell carcinoma (RCC). These NCCN Guidelines Insights focus on recent updates to the guidelines, including changes to certain systemic therapy recommendations for patients with relapsed or stage IV RCC. They also discuss the addition of a new section to the guidelines that identifies and describes the most common hereditary RCC syndromes and provides recommendations for genetic testing, surveillance, and/or treatment options for patients who are suspected or confirmed to have one of these syndromes.
156 citations
TL;DR: Pembrolizumab demonstrated significant antitumor activity with durable responses and a favorable safety profile in patients with advanced MF/SS.
Abstract: PURPOSETo assess the efficacy of pembrolizumab in patients with advanced relapsed or refractory mycosis fungoides (MF) or Sezary syndrome (SS).PATIENTS AND METHODSCITN-10 is a single-arm, multicent...
123 citations
Roswell Park Cancer Institute1, Boston University2, Fred Hutchinson Cancer Research Center3, Ohio State University4, Columbia University5, Cleveland Clinic6, Baystate Medical Center7, Georgetown University8, Mayo Clinic9, University of Texas MD Anderson Cancer Center10, Seattle Cancer Care Alliance11, Loyola University Chicago12
TL;DR: In this paper, the authors report that despite reported widespread use of dietary supplements during cancer treatment, few empirical data with regard to their safety or efficacy exist, because of concerns that some supplements, p...
Abstract: PURPOSEDespite reported widespread use of dietary supplements during cancer treatment, few empirical data with regard to their safety or efficacy exist. Because of concerns that some supplements, p...
TL;DR: The incidence of invasive melanoma in the United States appeared to decrease in adolescents and young adults from 2006 to 2015, and this finding contrasted with increases in older populations, suggesting that public health efforts may be favorably influencing melanoma incidence.
Abstract: Importance Melanoma is epidemiologically linked to UV exposure, particularly childhood sunburn. Public health campaigns are increasing sun-protective behavior in the United States, but the effect on melanoma incidence is unknown. Objective To examine the incidence of melanoma in the United States and whether any age-specific differences are present. Design, Setting, and Participants Observational, population-based registry data were extracted on July 3, 2018, from the combined National Program of Cancer Registries–Surveillance Epidemiology and End Results United States Cancer Statistics database for 2001-2015. Deidentified data for 988 103 cases of invasive melanoma, withInternational Classification of Diseases for Oncologyhistologic categorization codes 8720 to 8790, were used for analysis. Data analysis was performed from July 1, 2018, to March 1, 2019. Main Outcomes and Measures The annual rates of melanoma in pediatric, adolescent, young adult, and adult age groups were determined. Analyses were stratified by sex, and incidence rates were age-adjusted to the 2000 US standard population. Annual percentage change (APC) in incidence rate was calculated over the most recent decade for which data were available (2006-2015) using the weighted least squares method. Results In 2015, 83 362 cases of invasive melanoma were reported in the United States, including 67 in children younger than 10 years, 251 in adolescents (10-19 years), and 1973 in young adults (20-29 years). Between 2006 and 2015, the overall incidence rate increased from 200.1 to 229.1 cases per million person-years. In adults aged 40 years or older, melanoma rates increased by an APC of 1.8% in both men (95% CI, 1.4%-2.1%) and women (95% CI, 1.4%-2.2%). In contrast, clinically and statistically significant decreases were seen in melanoma incidence for adolescents and young adults. Specifically, incidence rates decreased by an APC of −4.4% for male adolescents (95% CI, −1.7% to −7.0%), −5.4% for female adolescents (95% CI, −3.3% to −7.4%), −3.7% for male young adults (95% CI, −2.5% to −4.8%), and −3.6% for female young adults (95% CI, −2.8% to −4.5%). Data on skin pigmentation and sun protection history were unavailable; similar trends were observed with data limited to non-Hispanic whites. Young adult women appeared to have twice the risk of melanoma as young adult men. Conclusions and Relevance The incidence of invasive melanoma in the United States appeared to decrease in adolescents and young adults from 2006 to 2015, and this finding contrasted with increases in older populations. These incidence trends suggest that public health efforts may be favorably influencing melanoma incidence in the United States.
Johns Hopkins University1, University of Tennessee Health Science Center2, Seattle Cancer Care Alliance3, University of Nebraska Medical Center4, Ohio State University5, Case Western Reserve University6, University of Wisconsin-Madison7, Roswell Park Cancer Institute8, Vanderbilt University9, Stanford University10, Duke University11, University of Utah12, University of Texas MD Anderson Cancer Center13, University of South Florida14, Harvard University15, Mayo Clinic16, Children's Memorial Hospital17, Washington University in St. Louis18, Brigham and Women's Hospital19, City of Hope National Medical Center20, University of Pennsylvania21, University of California, San Diego22, University of Michigan23, National Comprehensive Cancer Network24
TL;DR: The NCCN Clinical Practice Guidelines for pediatric ALL provide recommendations on the workup, diagnostic evaluation, and treatment of the disease, including guidance on supportive care, hematopoietic stem cell transplantation, and pharmacogenomics.
Abstract: Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Advancements in technology that enhance our understanding of the biology of the disease, risk-adapted therapy, and enhanced supportive care have contributed to improved survival rates. However, additional clinical management is needed to improve outcomes for patients classified as high risk at presentation (eg, T-ALL, infant ALL) and who experience relapse. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for pediatric ALL provide recommendations on the workup, diagnostic evaluation, and treatment of the disease, including guidance on supportive care, hematopoietic stem cell transplantation, and pharmacogenomics. This portion of the NCCN Guidelines focuses on the frontline and relapsed/refractory management of pediatric ALL.
Stanford University1, University of California, San Francisco2, Johns Hopkins University3, Brigham and Women's Hospital4, University of South Florida5, Case Western Reserve University6, University of Texas MD Anderson Cancer Center7, Northwestern University8, Roswell Park Cancer Institute9, City of Hope National Medical Center10, Harvard University11, Washington University in St. Louis12, Mayo Clinic13, University of Michigan14, University of Wisconsin-Madison15, Fox Chase Cancer Center16, Seattle Cancer Care Alliance17, Ohio State University18, Duke University19, University of Tennessee Health Science Center20, Vanderbilt University21, University of California, San Diego22, University of Colorado Boulder23, University of Pennsylvania24, Yale Cancer Center25, University of Utah26, Memorial Sloan Kettering Cancer Center27, National Comprehensive Cancer Network28
TL;DR: The introduction of less toxic and more effective regimens has significantly advanced HL cure rates and this portion of the NCCN Guidelines focuses on the management of classic HL.
Abstract: The NCCN Clinical Practice Guidelines in Oncology for Hodgkin Lymphoma (HL) provide recommendations for the management of adult patients with HL. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. Current management of classic HL involves initial treatment with chemotherapy alone or combined modality therapy followed by restaging with PET/CT to assess treatment response. Overall, the introduction of less toxic and more effective regimens has significantly advanced HL cure rates. This portion of the NCCN Guidelines focuses on the management of classic HL.
University of Colorado Boulder1, University of South Florida2, Huntsman Cancer Institute3, Mayo Clinic4, Stanford University5, Vanderbilt University6, University of Wisconsin-Madison7, Harvard University8, University of California, San Francisco9, Fox Chase Cancer Center10, Roswell Park Cancer Institute11, University of Pennsylvania12, Memorial Sloan Kettering Cancer Center13, Johns Hopkins University14, Case Western Reserve University15, Duke University16, University of Michigan17, University of California, San Diego18, University of Nebraska Medical Center19, Washington University in St. Louis20, University of Alabama at Birmingham21, City of Hope National Medical Center22, University of Tennessee Health Science Center23, Ohio State University24, Brigham and Women's Hospital25, University of Texas MD Anderson Cancer Center26, Seattle Cancer Care Alliance27, National Comprehensive Cancer Network28
Seattle Cancer Care Alliance1, Roswell Park Cancer Institute2, University of Alabama at Birmingham3, University of Michigan4, University of Texas MD Anderson Cancer Center5, University of California, San Diego6, Northwestern University7, Johns Hopkins University8, University of Wisconsin-Madison9, University of Nebraska Medical Center10, Yale Cancer Center11, Fox Chase Cancer Center12, Ohio State University13, University of Pennsylvania14, Vanderbilt University15, Case Western Reserve University16, University of Utah17, University of South Florida18, University of Colorado Boulder19, Memorial Sloan Kettering Cancer Center20, Harvard University21, Mayo Clinic22, University of California, San Francisco23, City of Hope National Medical Center24, Duke University25, Washington University in St. Louis26, National Comprehensive Cancer Network27
TL;DR: The NCCN Guidelines for Hematopoietic Growth Factors provide suggestions for appropriate evaluation, risk determination, prophylaxis, and management of febrile neutropenia (FN).
Abstract: Management of febrile neutropenia (FN) is an integral part of supportive care for patients undergoing cancer treatment. The NCCN Guidelines for Hematopoietic Growth Factors provide suggestions for appropriate evaluation, risk determination, prophylaxis, and management of FN. These NCCN Guidelines are intended to guide clinicians in the appropriate use of growth factors for select patients undergoing treatment of nonmyeloid malignancies. These NCCN Guidelines Insights highlight important updates to the NCCN Guidelines regarding the incorporation of newly FDA-approved granulocyte-colony stimulating factor biosimilars for the prevention and treatment of FN.
TL;DR: The discovery of the DNA methylation-based biomarkers for biological tissue age and the construction of various epigenetic age-estimators for human clinical outcomes and health/life span are discussed.
Abstract: The incidence of cancer, adjusted for secular trends, is directly related to age, and advanced chronologic age is one of the most significant risk factors for cancer. Organismal aging is associated with changes at the molecular, cellular, and tissue levels and is affected by both genetic and environmental factors. The specific mechanisms through which these age-associated molecular changes contribute to the increased risk of aging-related disease, such as cancer, are incompletely understood. DNA methylation, a prominent epigenetic mark, also changes over a lifetime as part of an "epigenetic aging" process. Here, we give an update and review of epigenetic aging, in particular, the phenomena of epigenetic drift and epigenetic clock, with regard to its implication in cancer etiology. We discuss the discovery of the DNA methylation-based biomarkers for biological tissue age and the construction of various epigenetic age estimators for human clinical outcomes and health/life span. Recent studies in various types of cancer point to the significance of epigenetic aging in tumorigenesis and its potential use for cancer risk prediction. Future studies are needed to assess the potential clinical impact of strategies focused on lowering cancer risk by preventing premature aging or promoting healthy aging.
Huntsman Cancer Institute1, University of Utah2, Memorial Sloan Kettering Cancer Center3, Fred Hutchinson Cancer Research Center4, Harvard University5, Oregon Health & Science University6, National Institutes of Health7, University of Texas MD Anderson Cancer Center8, University of New Mexico9, University of Pennsylvania10, University of Arizona11, University of California, San Francisco12, University of Pittsburgh13, Ohio State University14, Partners HealthCare15, Tufts University16, Emory University17, Royal North Shore Hospital18, University of Sydney19, Rutgers University20, New York University21, Royal Prince Alfred Hospital22, University of South Florida23, University of Queensland24, University of Washington25, Seattle Cancer Care Alliance26, Virginia Commonwealth University27, United States Department of Veterans Affairs28, Stanford University29
TL;DR: More evidence is needed to support using GEP testing to inform recommendations regarding SLNB, intensity of follow-up or imaging surveillance, and postoperative adjuvant therapy and the MPWG recommends further research to assess the validity and clinical applicability of existing and emerging GEP tests.
Abstract: Importance Use of prognostic gene expression profile (GEP) testing in cutaneous melanoma (CM) is rising despite a lack of endorsement as standard of care. Objective To develop guidelines within the national Melanoma Prevention Working Group (MPWG) on integration of GEP testing into the management of patients with CM, including (1) review of published data using GEP tests, (2) definition of acceptable performance criteria, (3) current recommendations for use of GEP testing in clinical practice, and (4) considerations for future studies. Evidence Review The MPWG members and other international melanoma specialists participated in 2 online surveys and then convened a summit meeting. Published data and meeting abstracts from 2015 to 2019 were reviewed. Findings The MPWG members are optimistic about the future use of prognostic GEP testing to improve risk stratification and enhance clinical decision-making but acknowledge that current utility is limited by test performance in patients with stage I disease. Published studies of GEP testing have not evaluated results in the context of all relevant clinicopathologic factors or as predictors of regional nodal metastasis to replace sentinel lymph node biopsy (SLNB). The performance of GEP tests has generally been reported for small groups of patients representing particular tumor stages or in aggregate form, such that stage-specific performance cannot be ascertained, and without survival outcomes compared with data from the American Joint Committee on Cancer 8th edition melanoma staging system international database. There are significant challenges to performing clinical trials incorporating GEP testing with SLNB and adjuvant therapy. The MPWG members favor conducting retrospective studies that evaluate multiple GEP testing platforms on fully annotated archived samples before embarking on costly prospective studies and recommend avoiding routine use of GEP testing to direct patient management until prospective studies support their clinical utility. Conclusions and Relevance More evidence is needed to support using GEP testing to inform recommendations regarding SLNB, intensity of follow-up or imaging surveillance, and postoperative adjuvant therapy. The MPWG recommends further research to assess the validity and clinical applicability of existing and emerging GEP tests. Decisions on performing GEP testing and patient management based on these results should only be made in the context of discussion of testing limitations with the patient or within a multidisciplinary group.
Ohio State University1, University of Washington2, Medical College of Wisconsin3, Center for International Blood and Marrow Transplant Research4, Royal Melbourne Hospital5, Carolinas Healthcare System6, University of Wisconsin-Madison7, Case Western Reserve University8, Mayo Clinic9, Karolinska Institutet10, Uppsala University11, Boston Children's Hospital12, Seattle Cancer Care Alliance13, University of Maryland, Baltimore14, University of Pennsylvania15
TL;DR: This study provides epidemiologic data on TA‐TMA and its impact on transplant outcomes and increased awareness of the risk factors will enable providers to be vigilant of this uncommon but serious transplant complication.
Abstract: Transplant-associated thrombotic microangiopathy (TA-TMA) is a complication of allogeneic transplantation (allo-HCT). The incidence and risk factors associated with TA-TMA are not well known. A retrospective analysis from the Center for International Blood and Marrow Transplant Research (CIBMTR) was conducted including patients receiving allo-HCT between 2008 and 2016, with the primary objective of evaluating the incidence of TA-TMA. Secondary objectives included identification of risk factors associated with TA-TMA, and the impact of TA-TMA on overall survival and the need for renal replacement therapy (RRT). Among 23,665 allo-HCT recipients, the 3-year cumulative incidence of TA-TMA was 3%. Variables independently-associated with increased incidence of TA-TMA included female sex, prior autologous transplant, primary disease (acute lymphoblastic leukaemia and severe aplastic anaemia), donor type (mismatched or unrelated donor), conditioning intensity (myeloablative), GVHD prophylaxis (sirolimus + calcineurin inhibitor), pre-transplant kidney dysfunction and acute GVHD (time-varying effect). TA-TMA was associated with higher mortality (HR = 3·1, 95% Confidence Interval [CI] = 2·8-16·3) and RRT requirement (HR = 7·1, 95% CI = 5·7-311·6). This study provides epidemiologic data on TA-TMA and its impact on transplant outcomes. Increased awareness of the risk factors will enable providers to be vigilant of this uncommon but serious transplant complication. The results will also provide benchmarking for future study designs and comparisons.
Washington University in St. Louis1, Memorial Sloan Kettering Cancer Center2, Mayo Clinic3, University of California, San Francisco4, Harvard University5, University of Pennsylvania6, University of Texas MD Anderson Cancer Center7, University of Tennessee Health Science Center8, University of California, San Diego9, Northwestern University10, University of Utah11, University of Colorado Boulder12, Stanford University13, Brigham and Women's Hospital14, Case Western Reserve University15, University of Nebraska Medical Center16, Duke University17, University of Wisconsin-Madison18, Johns Hopkins University19, Vanderbilt University20, Seattle Cancer Care Alliance21, University of South Florida22, Roswell Park Cancer Institute23, University of Michigan24, Ohio State University25, City of Hope National Medical Center26, National Comprehensive Cancer Network27
TL;DR: The diagnosis and management of MF and SS are discussed (with a focus on systemic therapy), and novel agents such as romidepsin, brentuximab vedotin, and mogamulizumab are approved.
Abstract: Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma (CTCL), and Sezary syndrome (SS) is a rare erythrodermic and leukemic subtype of CTCL characterized by significant blood involvement. Although early-stage disease can be effectively treated predominantly with skin-directed therapies, systemic therapy is often necessary for the treatment of advanced-stage disease. Systemic therapy options have evolved in recent years with the approval of novel agents such as romidepsin, brentuximab vedotin, and mogamulizumab. These NCCN Guidelines Insights discuss the diagnosis and management of MF and SS (with a focus on systemic therapy).
Ohio State University1, Case Western Reserve University2, University of Michigan3, University of Nebraska Medical Center4, University of South Florida5, Roswell Park Cancer Institute6, Huntsman Cancer Institute7, University of Alabama at Birmingham8, Harvard University9, Memorial Sloan Kettering Cancer Center10, University of Colorado Boulder11, Brigham and Women's Hospital12, Duke University13, Stanford University14, University of Wisconsin-Madison15, Mayo Clinic16, University of Pennsylvania17, Johns Hopkins University18, Seattle Cancer Care Alliance19, Northwestern University20, City of Hope National Medical Center21, University of Texas MD Anderson Cancer Center22, Vanderbilt University23, Washington University in St. Louis24, Fox Chase Cancer Center25, University of California, San Diego26, National Comprehensive Cancer Network27
TL;DR: The NCCN Guidelines for Hematopoietic Cell Transplantation focus on recommendations for pretransplant recipient evaluation and the management of GVHD in adult patients with malignant disease.
Abstract: Hematopoietic cell transplantation (HCT) involves the infusion of hematopoietic progenitor cells into patients with hematologic disorders with the goal of re-establishing normal hematopoietic and immune function. HCT is classified as autologous or allogeneic based on the origin of hematopoietic cells. Autologous HCT uses the patient's own cells while allogeneic HCT uses hematopoietic cells from a human leukocyte antigen-compatible donor. Allogeneic HCT is a potentially curative treatment option for patients with certain types of hematologic malignancies, and autologous HCT is primarily used to support patients undergoing high-dose chemotherapy. Advances in HCT methods and supportive care in recent decades have led to improved survival after HCT; however, disease relapse and posttransplant complications still commonly occur in both autologous and allogeneic HCT recipients. Allogeneic HCT recipients may also develop acute and/or chronic graft-versus-host disease (GVHD), which results in immune-mediated cellular injury of several organs. The NCCN Guidelines for Hematopoietic Cell Transplantation focus on recommendations for pretransplant recipient evaluation and the management of GVHD in adult patients with malignant disease.
TL;DR: Sipuleucel-T is an autologous cellular immunotherapy that induces an immune response targeted against prostatic acid phosphatase to treat asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer and may be an ideal combination partner with immunotherapies including immune checkpoint inhibitors or with radiation therapy.
Abstract: Sipuleucel-T is an autologous cellular immunotherapy that induces an immune response targeted against prostatic acid phosphatase (PAP) to treat asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer. In the phase III IMPACT study, sipuleucel-T was associated with a statistically significantly increased overall survival (OS) (median = 4.1 months) vs placebo. Patients with baseline prostate-specific antigen levels in the lowest quartile (≤22.1 ng/mL) exhibited a 13-month improvement in OS with sipuleucel-T. Together, this led sipuleucel-T to be approved and recommended as first-line therapy in various guidelines for treatment of metastatic castration-resistant prostate cancer. This review discusses the varied findings about the mechanisms of action of sipuleucel-T, bringing them together to form a more coherent picture. These pieces include inducing a statistically significant increase in antigen-presenting cell activation; inducing a peripheral immune response specific to the target (PAP) and/or immunizing (PA2024) antigens; stimulating systemic cytotoxic T-lymphocyte activity; and mediating antigen spread (ie, increased antibody responses to secondary proteins in addition to PAP and PA2024). Each of these pieces individually correlates with OS. Sipuleucel-T also traffics T cells to the prostate and is associated with long-term immune memory such that a second course of treatment induces an anamnestic immune response. Prostate cancer does not have a strongly inflamed microenvironment, thus its response to immune checkpoint inhibitors is limited. Because sipuleucel-T is able to traffic T cells to the tumor, it may be an ideal combination partner with immunotherapies including immune checkpoint inhibitors or with radiation therapy.
University of Kansas1, University of California, Davis2, Fred Hutchinson Cancer Research Center3, Seattle Cancer Care Alliance4, University of Pittsburgh5, Duke University6, Fox Chase Cancer Center7, University of New Mexico8, Kaiser Permanente9, University of Washington Medical Center10, Yale University11, University of Michigan12, University of Texas MD Anderson Cancer Center13
TL;DR: PARP inhibitors are effective in BRCA-mutation-associated metastatic breast cancer(MBC) but there are no studies evaluating PARPi + platin chemotherapy in BrcA wild-type breast cancer (wt...
Abstract: 1001Background: PARP inhibitors(i) are effective in BRCA-mutation-associated metastatic breast cancer(MBC). However, there are no studies evaluating PARPi + platin chemotherapy in BRCA wild-type(wt...
Harvard University1, Vanderbilt University2, University of Pittsburgh3, University of Rochester Medical Center4, Duke University5, Memorial Sloan Kettering Cancer Center6, University of North Carolina at Chapel Hill7, Baylor College of Medicine8, Seattle Cancer Care Alliance9, Indiana University10, Johns Hopkins University11, Beth Israel Deaconess Medical Center12, Myriad Genetics13
TL;DR: In this prospective preoperative trial in TNBC, HRD was not predictive of pathologic response and Tumors were similarly responsive to preoperative paclitaxel or cisplatin chemotherapy.
TL;DR: Primary MCC location is associated with a pattern of distant spread, which may assist in optimizing surveillance and reflect outcomes before PD1‐pathway inhibitor availability, which May positively impact survival.
Abstract: Approximately one-third of Merkel cell carcinoma (MCC) patients eventually develop distant metastatic disease. Little is known about whether the location of the primary lesion is predictive of initial distant metastatic site, or if survival likelihood differs depending on the metastatic site. Such data could inform imaging/surveillance practices and improve prognostic accuracy. Multivariate and competing-risk analyses were performed on a cohort of 215 MCC patients with distant metastases, 31% of whom had two or more initial sites of distant metastasis. At time of initial distant metastasis in the 215 patients, metastatic sites (n = 305) included non-regional lymph nodes (present in 41% of patients), skin/body wall (25%), liver (23%), bone (21%), pancreas (8%), lung (7%), and brain (5%). Among the 194 patients who presented with MCC limited to local or regional sites (stage I-III) but who ultimately developed distant metastases, distant progression occurred in 49% by 1 year and in 80% by 2 years following initial diagnosis. Primary MCC locations differed in how likely they were to metastasize to specific organs/sites (P < .001). For example, liver metastases were far more likely from a head/neck primary (43% of 58 patients) versus a lower limb primary (5% of 39 patients; P < .0001). Skin-only distant metastasis was associated with lower MCC-specific mortality as compared to metastases in multiple organs/sites (HR 2.7; P = .003), in the liver (HR 2.1; P = .05), or in distant lymph nodes (HR 2.0; P = .045). These data reflect outcomes before PD1-pathway inhibitor availability, which may positively impact survival. In conclusion, primary MCC location is associated with a pattern of distant spread, which may assist in optimizing surveillance. Because it is linked to survival, the site of initial distant metastasis should be considered when assessing prognosis.
TL;DR: The current and future role of SGRT alongside and in concert with other imaging techniques is explored, as well as future horizons and innovative ideas that may shape and impact the direction of S GRT going forward.
TL;DR: Patients with solid tumors and their primary caregiver dyads were willing to participate in a financial navigation program that addresses various financial issues, particularly cost of living expenses in lower income participants.
Abstract: Background Few studies have engaged patients and caregivers in interventions to alleviate financial hardship. We collaborated with Consumer Education and Training Services (CENTS), Patient Advocate Foundation (PAF), and Family Reach (FR) to assess the feasibility of enrolling patient-caregiver dyads in a program that provides financial counseling, insurance navigation, and assistance with medical and cost of living expenses. Methods Patients with solid tumors aged ≥18 years and their primary caregiver received a financial education video, monthly contact with a CENTS counselor and PAF case manager for 6 months, and referral to FR for help with unpaid cost of living bills (eg, transportation or housing). Patient financial hardship and caregiver burden were measured using the Comprehensive Score for Financial Toxicity-Patient-Reported Outcomes (COST-PRO) and Caregiver Strain Index (CSI) measures, respectively, at baseline and follow-up. Results Thirty patients (median age, 59.5 years; 40% commercially insured) and 18 caregivers (67% spouses) consented (78% dyad participation rate). Many participants faced cancer-related financial hardships prior to enrollment, such as work change or loss (45% of patients; 39% of caregivers) and debt (64% of patients); 39% of caregivers reported high levels of financial burden at enrollment. Subjects received $11,000 in assistance (mean, $772 per household); 66% of subjects with income ≤$50,000 received cost-of-living assistance. COST-PRO and CSI scores did not change significantly. Conclusions Patient-caregiver dyads were willing to participate in a financial navigation program that addresses various financial issues, particularly cost of living expenses in lower income participants. Future work should address financial concerns at diagnosis and determine whether doing so improves patient and caregiver outcomes.
TL;DR: P/LP germline variants are prevalent in men with prostate cancer and AAC, Hispanic, and API men with cancer are under-represented in studies of germline testing, potentially contributing to higher rates of VUS relative to Caucasian and Ashkenazi Jewish men.
Abstract: Background Prostate cancer is among the most heritable cancers, and clinical testing for germline genetic variants based on ethnicity, disease features, and family history has recently become standard of care for men with advanced disease. It is not established whether prevalence of germline variants varies based on ethnicity or race. Methods We retrospectively examined germline genetic and clinical data of men reporting a diagnosis of prostate cancer referred to Color Genomics by a healthcare provider for testing of 30 genes associated with hereditary cancer risk. Variants were classified as pathogenic (P), likely pathogenic (LP), variant of uncertain significance (VUS), likely benign, or benign. P/LP and VUS prevalence was compared among subgroups classified by age at diagnosis, self-reported ethnicity, family history, and history of other cancer. Results We identified 1,351 men reporting a diagnosis of prostate cancer of any stage who underwent germline testing. Overall, 78% of men were Caucasian, 11% Ashkenazi Jewish, 3% African-American/Canadian (AAC), 2% Hispanic, 2% Asian/Pacific Islander (API), and 4% Other (multiple, unknown, Native-American). One-hundred eighty-seven men (13.8%) carried a P/LP variant, and the most prevalent P/LP variants were in BRCA2 (3.4%), CHEK2 (2.8%), MUTYH (1.8%), and ATM (1.7%). Age at diagnosis, ethnicity, type of family member with prostate cancer, and type of second cancer were not associated with risk of carrying any P/LP variant. Ashkenazi Jewish men (6.7%) were more likely to carry P/LP BRCA2 variants than Caucasian men (2.8%) (P Conclusions P/LP germline variants are prevalent in men with prostate cancer. AAC, Hispanic, and API men with prostate cancer are under-represented in studies of germline testing, potentially contributing to higher rates of VUS relative to Caucasian and Ashkenazi Jewish men. Further studies in these groups will facilitate reclassification of VUS, increasing opportunities for early detection, cancer risk modification, and targeted therapeutics.
Northwestern University1, Seattle Cancer Care Alliance2, Thomas Jefferson University3, Johns Hopkins University4, Oregon Health & Science University5, Memorial Sloan Kettering Cancer Center6, University of California, San Francisco7, Duke University8, University of Minnesota9, Wayne State University10, University of Washington11, University of Wisconsin-Madison12, Cornell University13, University of Chicago14, Yale Cancer Center15, University of Michigan16, University of California, Los Angeles17, Harvard University18, University of North Carolina at Chapel Hill19, University of California, San Diego20
TL;DR: This review addresses current guidelines, considerations, and challenges for PCa genetic testing and offers a practical guide for genetic counseling and testing delivery, with solutions to help address potential barriers andChallenges for both providers and patients.