CT Screening for Lung Cancer
7, 36
| Ibrutinib in Leukemia, Lymphoma 24, 26 | Future of Pediatric Oncology
VOLUME 4, ISSUE 13
70
AUGUST 15, 2013
Editor-in-Chief, James O. Armitage, MD
ASCO Annual Meeting
Maintenance Treatment Delays Progression in Metastatic Colorectal Cancer
ASCOPost.com
Molecular Tests and Precision Medicine: Not So Fast Now!
By Caroline Helwick
By William T. McGivney, PhD
F
or patients with unresectable metastatic colorectal cancer, maintenance treatment with capecitabine (Xeloda) and bevacizumab (Avastin) significantly delayed disease progression and improved overall survival in the phase III CAIRO3 study by the Dutch Colorectal Cancer Group. Miriam Koopman, MD, PhD, of University Medical Center Utrecht in The Netherlands, presented the findings at the 2013 ASCO Annual Meeting.1
Study Rationale “The optimal duration of chemotherapy and bevacizumab in metastatic colorectal cancer is not well established, and the value of chemotherapy-free intervals tested in several studies is still a matter of debate. What we do know is that drug holidays are preferred by many patients,” Dr. Koopman said.
“Given this, the CAIRO3 study was designed to investigate the efficacy of observation vs maintenance treatment with capecitabine plus bevacizumab after induction treatment with six cycles of capecitabine/oxaliplatin plus bevacizumab Miriam Koopman, MD, PhD (CAPOX-B) in patients not progressing during induction,” she said. The study included patients with previously untreated, unresectable metastatic colorectal cancer who had stable disease or better after six cycles of standard CAPOX-B. Patients were randomly assigned between observation or maintenance with capecitabine at 625 mg/m2 twice daily and bevacicontinued on page 16
Issues in Oncology
continued on page 132
Oncologists Speak Out Against the High Cost of Cancer Drugs
Dr. McGivney is Principal, McGivney Global Advisors.
By Jo Cavallo
MORE IN THIS ISSUE
T
hat the United States spends twice as much on health care than other industrialized countries—about $2.8 trillion in 2012—without reaping appreciably better outcomes1 is not news. The topic has been dissected on the front pages of leading newspapers for years and was the subject of the entire feature section of an issue of Time2 magazine in March. What is different about the debate making news now is the number of oncologists speaking out
Peter B. Bach, MD
T
he era of the application of genomic, proteomic, and a host of other “omic” analyses to guide decision-making in the therapeutic selection of drugs and biologics is now a key part of cancer care. Medical practice is working to keep up with the scientific advances, evaluate them, and add a variety of biomarker tests to the guidelines and pathways that drive decisions about patient management. While medical practice is challenged, the regulatory and coverage/reimbursement worlds are struggling to determine how this emerging, critically important area of oncology should be managed. The depth of the struggle and potential negative implications for integrating molecular testing into everyday practice are well illustrated by a declaration in February 2013 issued by the Medicare contractor Palmetto.
Leonard B. Saltz, MD
Send your comments to editor@ASCOPost.com
against the high cost of cancer drugs and its impact on patient care. Last October, three physicians from Memorial Sloan-Kettering Cancer Center in New York—Peter B. Bach, MD, Director of the Center for Health Policy and Outcomes; Leonard B. Saltz, MD, Chief, Gastrointestinal Oncology Service and Chairman of the Pharmacy and Therapeutics Committee; and Robert E. Wittes, MD, former Physician-in-Chief—led the way with an Op-Ed piece in The New York Times.3 They wrote the editorial to explain their decision not to give ziv-afilbercept (Zaltrap), a new “phenomenally expensive” cancer drug, to their patients with advanced colorectal cancer. They noted that the new agent provided no advantage over bevacizumab Robert E. Wittes, MD
ASCO Annual Meeting Breast Cancer ������������������������������������������ 3 Ovarian Cancer ��������������������������������� 4, 6 Lung Cancer����������������������������������������� 15 Lymphoma ������������������������������������������� 18 Issues in Oncology������������������������������� 44 ALK Inhibition in NSCLC ������������� 14, 30 Women in Oncology: Diane E. Meier, MD �������������������������������� 40 Afatinib in Lung Cancer����������������� 50, 56 New Genomic Resource for Cancer Research�������������������������������� 62 Direct from ASCO �������������������������� 75–78
continued on page 130
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