Boom in Bilateral Mastectomies 103 | Sexual Concerns in Cancer Survivors
126
| BRAF/MEK Inhibition in Melanoma
148
VOLUME 5, ISSUE 18
NOVEMBER 15, 2014
Editor-in-Chief, James O. Armitage, MD | ASCOPost.com
The Next-to-Last Frontier in Managing Acute Promyelocytic Leukemia
ESMO Congress
IMPRESS Trial: Lung Cancer Progression on First-Line Tyrosine Kinase Inhibitor Indicates the Drug Should Be Stopped
By Martin S. Tallman, MD
By Alice Goodman
T
he IMPRESS trial found no benefit for continuing treatment with the epidermal growth factor receptor (EFGR) tyrosine kinase inhibitor gefitinib (Iressa, discontinued in the United States) plus chemotherapy vs chemotherapy alone in patients with EGFR-mutated non–small cell lung cancer (NSCLC) who had disease progression on treatment with gefitinib. Progression was defined according to RECIST criteria in the IMPRESS trial, and not by clinical symptoms or metastatic spread.
Hotly Debated Issue “This study resolves a hotly debated issue, and the results demonstrated that EGFR tyrosine kinase inhibitors should not be continued beyond progression. The standard treatment at progression remains platinum-based chemotherapy,” stated lead author Tony S.K. Mok, MD, Professor of Clinical Oncology
at the Chinese University of Hong Kong, and the European Society for Medical Oncology (ESMO) 2014 Congress in Madrid.1 EGFR tyrosine kinase inhibitors are the standard first-line treatment for patients with EGFR-positive Tony S.K. Mok, MD NSCLC. Gefitinib is the EGFR tyrosine kinase inhibitor of choice in Asia and Europe, whereas erlotinib is used in the United States. Most patients who initially respond to first-line therapy with an EGFR tyrosine kinase inhibitor experience disease progression with “acquired resistance.” At that time, there are two options: to discontinue the EGFR tyrosine kinase inhibitor or to continue it and
Striving for Quality, Not Quantity, of Life
continued on page 71
Perspective
T
he treatment of acute promyelocytic leukemia (APL) represents one of the major triumphs in the field of hematologic malignancies. With either the vitamin A derivative all-trans retinoic acid (ATRA) combined with anthracycline-based chemotherapy or ATRA plus arsenic trioxide (Trisenox), approximately 85% to 90% of all patients can be cured of their disease if they survive induction therapy. Relapse after complete remission is achieved has become very uncommon even among high-risk patients (those with a presenting white blood cell count > 10,000/μL). Such success is due to the convergence of continued on page 86
Dr. Tallman is Chief of the Leukemia Service at Memorial Sloan Kettering Cancer Center and Professor of Medicine at Weill Cornell Medical College in New York. Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO.
A Conversation With Ezekiel J. Emanuel, MD, PhD By Jo Cavallo
A
MORE IN THIS ISSUE
dvances in science and medicine have led to humans living longer than at any other time in history. According to a new report1 on mortality from the Centers for Disease Control and Prevention’s National Center for Health Statistics, life expectancy in the United States is at an all-time high of 78.8 years, up 0.1 year since 2011. “Good news, America: We’re living longer!” read the opening line in a story in USA Today2 announcing the report’s findings. But those extra years do not necessarily add up
to quality ones. Advances in health care have not so much slowed the aging process as they have the dying process, contends Ezekiel J. Emanuel, MD, PhD, Chair, Medical Ethics & Health Policy at the University of Pennsylvania in Philadelphia, in an essay he penned in the October issue of The Atlantic.3 Titled “Why I Hope to Die at 75,” the article has set off a firestorm of controversy, including accusations by critics that Dr. Emanuel is advocating health-care rationing, death panels, and even legalized euthanasia for people living beyond 75, none of which is true. My main goal for writing the article Instead, Dr. Emanuel writes about his personal was to start a conversation about preference to refrain from the importance of quality rather taking life-sustaining medical steps once he reaches 75. than quantity of life, but I’m very While it is doubtless comfortable with lots of people not that death is a loss, living too long is also a loss, agreeing with my view. wrote Dr. Emanuel. “It —Ezekiel J. Emanuel, MD, PhD
Oncology Meetings Coverage ESMO ��� 1, 42-47, 51-55, 64-67, 71-76 Quality Care Symposium ������������� 3-5, 8-9 Best of ASCO ���������������������� 14-15, 24-26 Breast Cancer Symposium ����������������30, 34 Jeremy S. Abramson, MD, on Indolent Lymphoma �����������������������������������27 Direct From ASCO ��������������������������� 78-81 Andreas du Bois, MD, PhD, on Pazopanib in Ovarian Cancer ����������������� 106 Margaret Tempero, MD, on Pancreatic Cancer in 2014 ����������������������� 120 Hansjochen Wilke, MD, on Ramucirumab in Gastric Cancer ������������ 155
continued on page 175
November is Pancreatic Cancer and Lung Cancer Awareness Month
A Harborside Press® Publication