Independent News for the Oncologist and Hematologist/Oncologist CLINICALONCOLOGY.COM • October 2014 • Vol. 9, No. 10
INSIDE CURRENT PRACTICE New pathway paving way for first U.S. biosimilar ......... 5 HEMATOLOGIC DISEASE Jane Winter, MD: How I manage advanced Hodgkin lymphoma, Part 1 .................. 10 SOLID TUMORS Report from ESMO: Afatinib tops erlotinib for PFS as second-line therapy for squamous cell lung cancer.......................... 15
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n the past three years, six drugs have been approved for melanoma, including immunotherapies, BRAF inhibitors and a mitogen-activated extracellular signal-regulated kinase (MEK) inhibitor (Table 1, page 13). Programmed death receptor-1 (PD-1) inhibitors are the newest agents to jump into the mix, with the recent FDA approval of pembrolizumab, which was granted an indication for patients who do not respond to ipilimumab or a BRAF inhibitor. Approval of another PD-1 inhibitor, nivolumab, is thought to be just around the corner. see MELANOMA, page 13
by the
IMAGES in ONCOLOGY
PD-1 Blocker Class Will Shake Up Melanoma Treatment
Breast cancer cells. For strategies to streamline breast cancer care, see story on page 19.
numbers
Trial participation rates low for late-stage lung and CRC patients See story on page 7.
More Donor Grafts Means Transplants Can Play Larger Role
EDITORIAL BOARD COMMENTARY
For Optimal Cancer Care, Consider the Nontraditional
Experts encourage early HLA matching to maximize success 74.3%
25.7%
7.6% Did not discuss clinical trial Discussed clinical trial Participated in clinical trial
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ematopoietic cell transplantation (HCT) should be considered for essentially every patient with a hematologic malignancy, according to a large and growing body of data collected by the National Marrow Donor Program (NMDP). According to those leading the NMDP, work-up for a possible HCT should begin at the earliest point in care. “The time to think of transplant and to conduct HLA typing is at the time of diagnosis,” according to Dennis Confer, MD, the chief medical officer of the NMDP, in Minneapolis. Routine workup in blood cancers is recommended see DONOR GRAFTS, S page 8
Psychosocial support and other such factors increasingly found to affect cancer outcomes
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n the early days of the modern oncologic era, essentially the sole focus of clinical investigation was on favorably impacting overall survival by the effective surgical removal of the cancer, killing the malignancy with radiation, and/or destroying what could not be eliminated locally or regionally by delivering cytotoxic antineoplastic therapy (or, in certain cases, hormone-based treatments). Over the years, the concept of multimodality treatments has evolved and they have become the Maurie standard of care in many settings, both improving survival and reducing Markman, MD the unwanted side effects of specific treatments (eg, limb-sparing surgery with external beam radiation for extremity sarcomas). Additionally, cancer researchers have an ever-increasing awareness of the negative effect on quality of life of both the short-term (eg, emesis, mucositis, diarrhea, etc) see NONTRADITIONAL, page 4
Implementation of Immunotherapy in the Management of Melanoma The Society for Immunotherapy of Cancer Consensus Statement See insert after page 20.