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Sequential versus simultaneous integrated radiation boost with whole-breast radiation (June 2023)
Although a radiation boost is typically administered after whole-breast radiation in patients receiving breast-conserving therapy (BCT) for non-metastatic breast cancer, trials are evaluating a simultaneous integrated boost as a way to decrease treatment duration and reduce toxicity. In a randomized open-label trial among 2600 such patients, local recurrence rates were similar in patients receiving a boost either sequential to or simultaneously integrated with whole-breast radiation therapy.1 Dose escalation of the simultaneous integrated boost did not improve outcomes but did increase toxicity. We await long-term data prior to incorporating a simultaneous integrated radiation boost into routine practice for patients with non-metastatic breast cancer.
Long-term mortality in childhood cancer survivors (June 2023)
Cardiovascular (CV) disease is one of the leading causes of morbidity and mortality in childhood cancer survivors. In an observational study from the Childhood Cancer Survivor Study Cohort (CCSS) of over 34,000 childhood cancer survivors, the 40-year cumulative all-cause mortality was 23 percent, with heart disease and cerebrovascular disease among the most common causes.2 These data suggest the importance of long-term surveillance, recognition, and treatment of CV disease in childhood cancer survivors as they transition through adulthood.
Adjuvant therapies for hepatocellular carcinoma treated with resection or ablation (June 2023)
For patients with hepatocellular carcinoma (HCC) treated with curative intent using resection or ablation, studies are evaluating adjuvant therapies to reduce recurrence risk. In a phase III trial (IMbrave050) in over 300 patients with HCC at high-risk for recurrence after resection or ablation, adjuvant atezolizumab plus bevacizumab improved one-year recurrence-free survival (78 versus 65 percent) but increased grade >=3 toxicity (41 versus 13 percent) compared with surveillance.3 In a separate randomized trial in over 300 patients with resected HCC and microvascular invasion, at median follow-up of two years, adjuvant hepatic arterial infusion using fluorouracil plus leucovorin and oxaliplatin (FOLFOX) improved disease-free (median 20 versus 10 months) but not overall survival relative to surveillance.4 The use of these adjuvant therapies in HCC, while promising, remain investigational, and clinical trial enrollment is encouraged, where available.
Pembrolizumab plus chemotherapy in advanced cervical cancer (June 2023)
Preliminary results of a randomized trial had suggested a survival benefit for the addition of pembrolizumab to chemotherapy in advanced cervical cancer, but final results were pending. With a median follow-up of 39 months among 617 patients receiving first-line chemotherapy for persistent, recurrent, or metastatic cervical cancer, the addition of pembrolizumab to chemotherapy improved median overall survival in the overall group (26 versus 17 months), with comparable benefits among those with programmed cell death ligand 1 (PD-L1) combined positive score (CPS) >=1 and among those with CPS >=10.5 However, a benefit was not observed among patients with CPS <1. Based on these data, for patients with metastatic cervical cancer with PD-L1 CPS >=1, we recommend the addition of pembrolizumab to chemotherapy.
1. Coles C E, Haviland JS, Kirby AM, et al. Dose-escalated simultaneous integrated boost radiotherapy in early breast cancer (IMPORT HIGH): a multicentre, phase 3, non-inferiority, open-label, randomised controlled trial. Lancet. 2023;online June 8, 2023
2. Dixon SB, Liu Q, Chow EJ, et al. Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet. 2023;401(10386):1447. Epub 2023 Apr 5.
3. Kudo M, Chen M, Chow PKH, et al. Efficacy, safety and patient reported outcomes (PROs) from the phase III IMbrave050 trial of adjuvant atezolizumab (atezo) + bevacizumab (bev) vs active surveillance in patients with hepatocellular carcinoma (HCC) at high risk of disease recurrence following resection or ablation. J Clin Oncol. 2023;41;16S
4. Li SH, Mei J, Cheng Y, et al. Postoperative Adjuvant Hepatic Arterial Infusion Chemotherapy With FOLFOX in Hepatocellular Carcinoma With Microvascular Invasion: A Multicenter, Phase III, Randomized Study. J Clin Oncol. 2023;41(10):1898. Epub 2022 Dec 16.
5. Monk BJ, Colombo N, Tewari KS, et al. KEYNOTE-826: Final overall survival results from a randomized, double-blind, phase 3 study of pembrolizumab + chemotherapy vs placebo + chemotherapy for first-line treatment of persistent, recurrent, or metastatic cervical cancer. J Clin Oncol. 2023;41S:ASCO #5500.
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