EGFR-Mutant Lung Cancer 11 | Managing Cancer Pain at the End of Life
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| Metastatic Breast Cancer
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VOLUME 6, ISSUE 15
AUGUST 25, 2015
Editor-in-Chief, James O. Armitage, MD | ASCOPost.com
Immune Checkpoint Inhibitors: The Dawn of a New Era for Lung Cancer Therapy
Best of ASCO
Studies Explore New Avenues to Pursue in Metastatic Triple-Negative Breast Cancer By Alice Goodman
By Suresh S. Ramalingam, MD
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wo agents targeting novel pathways show promise in metastatic triple-negative breast cancer, according to separate studies presented at the 2015 ASCO Annual Meeting and reviewed at the Best of ASCO® meeting by Steven J. Isakoff, MD, PhD, of Massachusetts General Hospital, Boston. The first study suggested that an irinotecan cousin, etirinotecan pegol (NKTR-102), may provide clinically meaningful benefit to patients with late-stage triple-negative breast cancer, especially those with brain metastases, which represents an unmet need.1 The second study revealed that the androgen receptor—a major target in prostate cancer—is also a valid therapeutic target in androgen receptor–positive triple-negative breast cancer,2 which accounts for 10% to 50% of all triple-negative breast cancers. Enzalutamide (Xtandi) achieved clinical benefit in patients who expressed the androgen receptor and would otherwise have been slated for more toxic chemotherapy.
Etirinotecan Pegol The phase III BEACON study, authored by Edith A. Perez, MD, of the Mayo Clinic, Jacksonville, and colleagues, showed promising results for etirinotecan pegol in a cohort of patients with triple-negative breast cancer. Steven J. Isakoff, MD, PhD BEACON was designed to compare etirinotecan pegol vs physician’s choice (any of the following agents: eribulin, vinorelbine, gemcitabine, taxane, or ixabepilone) in 852 patients with disease progression following anthracycline, taxane, and capecitabine. About 25% of patients had triplenegative breast cancer. At baseline, about 8% of patients in both groups had stable brain metastases, and 53% had liver mecontinued on page 10
Issues in Oncology
‘Right to Try’ Laws: Helpful or Harmful? By Jo Cavallo
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he therapeutic paradigm for lung cancer has changed rapidly over the past few years toward individualized therapy. For certain subsets of patients, molecularly targeted agents have resulted in robust gains in overall survival and quality of life. However, for the majority of patients with nonsquamous non–small cell lung cancer (NSCLC), and for all patients with squamous NSCLC, chemotherapy remains the cornerstone of treatment. Chemotherapy provides modest therapeutic benefits in patients with advanced-stage disease. This longstanding paradigm is now going through a major shift with the advent of immunotherapy. continued on page 90
Dr. Ramalingam is Professor of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta. Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO.
MORE IN THIS ISSUE
ince 2014, “Right to Try” legislation has been sweeping the nation. Created to enable terminally ill patients to gain access to experimental drugs, biologics, and devices by sidestepping the approval process of the U.S. Food and Drug Administration (FDA), at press time, 22 states have enacted Right to Try laws, and 19 states have legislation pending. Although provisions in the law vary from state to state, they generally permit terminally ill patients access to an investigational treatment if a physician rec-
ommends use of the treatment; the patient gives informed consent; and the treatment has completed a phase I clinical trial. In some states, the laws exempt drug manufacturers and physicians from liability against claims arising from adverse side effects of the treatment. However, Right to Try legislation does not mandate that pharmaceutical companies provide their drugs or devices to patients, nor are health insurance companies required to pay for the treatment. Critics say these laws have created a false expectation that desperate patients will be able to gain quick Not only don’t these laws access to potentially lifeaccomplish anything as a legal saving treatments because they can bypass the FDA’s matter, as a policy matter, to the expanded-access applicaextent that they confuse patients or tion process and go directly manufacturers about the process, they to the manufacturer for the drug. However, accordcould actually be quite harmful. ing to Patricia J. Zettler, —Patricia J. Zettler, JD JD, Associate Professor at
Oncology Meetings Coverage Best of ASCO ���������������������������� 1, 3, 4, 10 MASCC/ISOO Symposium ������������ 14–16 FDA Update ����������������������� 12–13, 22–23 Regorafenib in Colorectal Cancer ����������24 Peter B. Bach, MD, MAPP, on Calculating the Value of Cancer Drugs ������30 Mark R. Gilbert, MD, on Classification of Gliomas ��������������������������� 44 Geriatrics for the Oncologist �������������������50 Compassionate Drug Use Requests ��������54 Direct From ASCO �������������������������� 60–63
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