ASCO Provisional Clinical Opinion
3|
NCCN Guidelines
26 |
Acute Promyelocytic Leukemia
VOLUME 3, ISSUE 6
56
APRIL 15, 2012
Editor-in-Chief, James O. Armitage, MD
ASCOPost.com
Our Patients, Our Teachers
Society of Surgical Oncology Annual Symposium
Neoadjuvant Aromatase Inhibitor Therapy Converts Many Patients to Candidates for Breast-conserving Surgery By Matthew Stenger
By Richard J. Boxer, MD, FACS
T
he American College of Surgeons Oncology Group (ACOSOG) Z1031 trial examined the effect of neoadjuvant aromatase inhibitor therapy on clinical response and breast-conservation rates in postmenopausal women with estrogen receptor John A. Olson, Jr, MD, PhD (ER)-rich stage II or III breast cancer. An update of the surgical outcomes of the trial, reported by John A. Olson, Jr, MD, PhD, from The University of Maryland School of Medicine, Baltimore, at a plenary session of the Society of Surgical Oncology annual meeting,1 showed that a substantial proportion of patients who were considered at baseline to be candidates for mastectomy only or to have inoperable disease were converted to
being candidates for breast-conserving surgery after aromatase inhibitor therapy.
Study Eligibility In this randomized phase II, open-label trial, 377 patients with ER-positive (Allred score 6–8) breast cancer were randomly assigned to 16 weeks of neoadjuvant treatment with one of three aromatase inhibitors (letrozole at 2.5 mg/d, anastrozole at 1 mg/d, or exemestane at 25 mg/d). Patients had to have T2 to T4c, any N, M0 disease, with a palpable primary tumor of greater than See Page 93 2 cm, and had to agree to undergo lumpectomy or mastectomy after neoadjuvant aromatase inhibitor therapy. Patients with inflammatory breast cancer were excluded, as were patients with diagnosis established by incisional biopsy. continued on page 7
Health-care Policy
ACCC Meeting Focuses on Affordable Care Act: Its Future, and What It Might Accomplish By Margot J. Fromer
T
he Association of Community Cancer Centers (ACCC) mid-March Annual Meeting devoted several sessions to the Patient Protection and Affordable Care Act: Will it still be here after the Supreme Court decides its fate? If so, how much of it will survive, and how will it affect oncology practice? In late March, the Supreme Court heard an almost unprecedented 6 hours of arguments over 3 days about the constitutionality of the law, based primarily
on Florida’s assertion that Congress cannot mandate that individuals purchase and maintain health insurance (25 other states agree). The justices may rule as soon as mid-June, or they may postpone their decision until 2014 when the law will take effect.
CMS and Innovation
The Centers for Medicare & Medicaid Services (CMS) are front and center of how the Affordable Care Act is implemented. Richard Gilfillan, MD, CMS is planning new engines to Director of the CMS Innovation Center, said, revitalize and sustain Medicare and “CMS is planning new play an even greater role in the lives of engines to revitalize and sustain Medicare and providers and patients. We have the play an even greater role will to change and we will do what the in the lives of providers country needs. and patients. We have the will to change and we — Richard Gilfillan, MD
T
here is no greater professional satisfaction than the knowledge that you have cared for a patient and the care brought an improvement in the patient’s health. Regardless of the level of appreciation, whether the patient is cured or not, and even if the patient’s sense of well-being may be psychological rather than physical, we as physicians gain from the interaction. All economics aside, this is the essence of being a doctor.
The Doctor–Patient Relationship Patients have taught me so much about courage, spirituality, and dignity. Enduring surgery, chemotherapy, and radiation therapy takes a singularity of thought and a leap of faith. The lessons learned from my patients gave me the understanding and fortitude I needed when I continued on page 14
Dr. Boxer is Professor of Clinical Urology at the University of Miami, and Clinical Professor at the University of Wisconsin, Madison, and the Medical College of Wisconsin.
MORE IN THIS ISSUE Oncology Meetings Coverage Society of Surgical Oncology ���������������� 1, 7 ACCC Annual Meeting ��������������� 1, 17–19 GI Cancers Symposium ������������������� 9, 10 GU Cancers Symposium ������� 20, 22, 24 Paul A. Bunn, Jr, MD, on Lung Cancer ������ 30 Direct from ASCO ��������������������������������������� 43 Barbara L. Smith, MD, PhD, on Breast Cancer ������������������������������������������� 52 Hematology for the Oncologist ����������������� 58
continued on page 17
Fertility Preservation, see pages 26, 28, and 91
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