Rituximab Retreatment vs Maintenance
90
| The Mentor/Mentee Relationship
126, 127
| Years of Progress
146
VOLUME 5, ISSUE 16
OCTOBER 15, 2014
Editor-in-Chief, James O. Armitage, MD | ASCOPost.com
ASTRO Annual Meeting
Chest Radiation Improves Survival and Intrathoracic Recurrence Rates in Extended-Stage Small Cell Lung Cancer
Relevance of the Hippocratic Oath in the 21st Century By Hagop Kantarjian, MD, and David P. Steensma, MD
By Alice Goodman
T
horacic radiotherapy extended progression-free survival, reduced intrathoracic recurrences, and improved overall survival at 2 years when added to prophylactic cranial irradiation in patients with extended-stage small cell lung cancer in an international randomized controlled trial.1 “Thoracic radiation should be added to prophylactic cranial irradiation and be offered to all extendedstage small cell lung cancer patients with a response to initial chemotherapy to improve outcomes,” stated lead author Ben Slotman, MD, Professor and Chairman of Radiation Oncology at VU University Medical Center, Amsterdam. Dr. Slotman presented these results at the 56th Annual Meeting of the American Society for Radiation Oncology (ASTRO) in San Francisco. The work was simultaneously published in The Lancet. 2
CREST Trial The multinational CREST trial enrolled 498 patients with extendedstage small cell lung cancer who had a complete, partial, or good response to initial platinum/etoposide chemotherapy. Patients Ben Slotman, MD were randomly assigned 1:1 to receive prophylactic cranial irradiation with or without thoracic radiotherapy within 2 to 7 weeks of chemotherapy. Thoracic radiotherapy was delivered in 10 fractions of 3 Gy. “We know prophylactic cranial irradiation improves symptomatic brain metastases and overall survival at 1 year. We also know that persistent intrathoraccontinued on page 4
Best of ASCO
Health-Care Reform Is Changing the Oncology Landscape alue-based health-care reform is happening. We have to get on board,” Rena Conti, PhD, a health economist at the University of Chicago, advised attendees of the Best of ASCO Seattle meeting. She discussed highlights from Annual Meeting sessions that addressed the impact of the Affordable Care Act on the field of oncology and on disparities in care.1,2
n the face of it, the idea that a code of professional conduct dating to the ancient Iron Age could possibly retain any relevance in the current era of “Big Data,” religious and cultural pluralism, trillion-dollar government budgets, and nanotechnology seems preposterous. Yet the well-publicized challenges of contemporary health care mean that the ideals of the Hippocratic Oath (see sidebar on page 104)1— continued on page 101
Dr. Kantarjian is Chairman of the Leukemia Department at The University of Texas MD Anderson Cancer Center and a Baker Institute Scholar for Health Policies at Rice University, Houston. Dr. Steensma is a physician in the Dana-Farber Cancer Institute Adult Leukemia Program and Associate Professor of Medicine at Harvard Medical School, Boston. Disclaimer: This commentary represents the views of the authors and may not necessarily reflect the views of ASCO.
MORE IN THIS ISSUE
By Susan London
“V
O
Imperative for Reform
High and persistently rising national spending on cancer care underscores the urgent need for reform, according to Dr. Conti. “Spending on cancer care outpaces [gross domestic product] growth in the United States, but also spending growth in health care more generally,” she noted. Contributors to this phenomenon include agWe can keep the current system ing of the population and as it is, but we need to make breakthroughs in therapy in the past few decades. reimbursement more closely match While survival for the acquisition costs of these drugs, many cancers has improved in recent decades, essentially wringing out the profit overuse and underuse of that chemotherapy provides in the effective cancer treatments also coexist in our system. outpatient setting. There are also stark racial —Rena Conti, PhD
Oncology Meetings Coverage ASTRO Annual Meeting ....... 3–6, 15–21 Best of ASCO .................................... 21–28 Debates and Didactics in Hematology/Oncology .......................30, 34 Breast Cancer Symposium ............... 38–53 Eileen M. O’Reilly, MD, on Pancreatic Cancer .......................................54 D. Ross Camidge, MD, PhD, on REVEL Trial in NSCLC .......................56 David Fishman, MD, on Preventing Ovarian Cancer ........................69 Direct From ASCO ........................ 97–100 George D. Demetri, MD, on Sarcoma 2014 .......................................117
continued on page 27
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