Article Content

With a plethora of new oncology research at your disposal, it can be difficult to keep track of the latest innovations and findings. Oncology Times is offering our readers summaries of the newest studies to keep you abreast of advancements across the spectrum of oncology care.



Completion dissection or observation for sentinel-node metastasis in melanoma

Patients who receive the standard surgical treatment for melanoma that has spread to one or more key lymph nodes do not live longer, according to new data (NEJM 2017;376:2211-2222). While sentinel lymph node biopsy is linked to increased melanoma-specific survival, the value of completion lymph-node dissection for patients with sentinel-node metastases remains unclear. Researchers sought to determine the value of extensive surgery for patients who have melanoma in a limited number of lymph nodes. More than 1,900 patients with sentinel-node metastases were randomly assigned to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). Melanoma-specific survival was the primary endpoint. Secondary endpoints, included disease-free survival and the cumulative rate of nonsentinel-node metastasis. Dissection was not associated with increased melanoma-specific survival among 1,934 patients with data evaluated in an intention-to-treat analysis or among 1,755 patients in the per-protocol analysis. "Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases," authors concluded.



Exosomes facilitate therapeutic targeting of oncogenic KRAS in pancreatic cancer

A recently published study suggests genetic manipulation of exosomes may offer a new therapeutic approach to treating pancreatic cancer (Nature 2017; doi:10.1038/nature22341). Researchers modified exosomes as "iExosomes," capable of delivering small RNA to specifically target mutant KRAS. "Exosomes derived from normal fibroblast-like mesenchymal cells were engineered to carry short interfering RNA or short hairpin RNA specific to oncogenic KrasG12D," according to researchers. Study results showed treatment with iExosomes resulted in disease suppression and increased overall survival in mouse models. The team also found that micropinocytosis contributes to exosomes uptake in cancer cells with mutant KRAS. "Our results demonstrate an approach for direct and specific targeting of oncogenic KRAS in tumors using iExosomes," researchers wrote.



Radical cystectomy compared to combined modality treatment for muscle-invasive bladder cancer: a systematic review and meta-analysis

A meta-analysis showed no difference in 5-year and 10-year survival rates between patients who underwent radical cystectomy and a bladder-preserving combined modality treatment (CMT) plan (Int J Radiat Oncol Biol Phys 2017;97(5):1002-1020). Researchers reviewed 19 studies that included 12,380 patients. Eligible studies compared survival outcomes between the two treatment approaches. Results revealed no difference in overall survival at 5 years post-treatment (HR, 0.96, favoring CMT; p = 0.778; four studies, 452 patients) or 10 years (HR, 1.02, favoring RC; p = 0.905; five studies, 9,295 patients). Additionally, there was no difference in disease-specific survival at 5 years (HR, 0.83, favoring CMT; p = 0.390; two studies, 326 patients) or 10 years (HR, 1.17, favoring RC; p = 0.264; four studies, 9,171 patients). There were no studies that examined progression-free survival (PFS) at 5 years post-treatment. However, at 10 years, there was no difference in PFS (HR, 0.85, favoring CMT; p = 0.639; two studies, 293 patients). Investigators noted that further randomized trials are needed to determine the best treatment for individual patients.



Rising prices of targeted oral anticancer medications and associated financial burden on Medicare beneficiaries

The rising costs of targeted oral anticancer medications may negatively impact the financial relief offered by the closure of the coverage gap in Medicare Part D, according to new data (J Clin Oncl 2017; doi:10.1200/JCO.2017.72.3742). Investigators utilized SEER to identify 42,111 patients enrolled in Medicare Part D who received targeted oral anticancer medications between 2007 and 2012. Total drug costs and out-of-pocket payments per patient per month were calculated and compared the coverage gap with rising treatment costs. Researchers reported that mean prices for targeted oral anticancer medications increased 12 percent per year to $7,719 per patient each month in 2012, compared with 3 percent for the general prescription drug consumer price index. "Rising targeted oral anticancer medication prices threaten the financial relief patients have begun to experience under closure of the coverage gap in Medicare Part D," authors concluded. "Policymakers should explore methods of harnessing the surge of novel targeted oral anticancer medications to increase price competition for Medicare beneficiaries."



Trastuzumab emtansine versus treatment of physician's choice in patients with previously treated HER2-positive metastatic breast cancer (TH3RESA): final overall survival results from a randomised open-label phase 3 trial

Results from an international, phase III trial found that women with HER2-positive breast cancer that worsened after previous treatment, survived significantly longer with trastuzumab emtansine than other treatments (Lancet Oncol 2017; doi:10.1016/S1470-2045(17)30313-3). The trial included 602 patients who were randomly assigned to be treated with either trastuzumab emtansine (n=404) or a treatment of their physician's choice (n=198), which consisted of HER2-targeted therapy with either single-drug chemotherapy or hormonal therapy, or any of these drugs alone. All patients enrolled in the study had advanced, HER2 breast cancer and were progressing even after treatment with chemotherapy and the HER2-targeting drugs trastuzumab and lapatinib. Investigators reported that patients in the trastuzumab emtansine arm lived a median of 22.7 months compared to 15.8 months for those in the physician's choice group-a 44 percent improvement. The survival benefit of trastuzumab emtansine was consistent across patient subgroups, regardless of age, degree of metastasis, number of prior treatments, and type of treatment of physician's choice. Incidence of severe side effects was lower in the trastuzumab emtansine group (40%) compared to those in the physician's choice group (47%). Researchers concluded, "These data further solidify the role of trastuzumab emtansine in the management of patients with previously treated HER2-positive advanced breast cancer, and validate HER2 as a therapeutic target even after multiple lines of previous therapy."


Share New Research!

Is there a study you think your fellow oncologists should know about? Send new and innovative research to