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Current Treatment Options in Oncology

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https://www.readbyqxmd.com/read/28439798/the-changing-landscape-of-genetic-testing-for-inherited-breast-cancer-predisposition
#1
REVIEW
Anosheh Afghahi, Allison W Kurian
The advent of multiple-gene germline panel testing has led to significant advances in hereditary breast and ovarian cancer risk assessment. These include guideline-specific cancer risk management recommendations for patients and their families, such as screening with breast magnetic resonance imaging and risk-reducing surgeries, which have the potential to reduce substantially the morbidity and mortality associated with a hereditary cancer predisposition. However, controversy remains about the clinical validity and actionability of genetic testing in a broader patient population...
May 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28439797/desmoid-type-fibromatosis-who-when-and-how-to-treat
#2
REVIEW
Javier Martínez Trufero, Isabel Pajares Bernad, Irene Torres Ramón, Jorge Hernando Cubero, Roberto Pazo Cid
Desmoid-type fibromatosis is a sarcoma subtype that gathers some singular characteristics, making it a difficult challenge to face in clinical practice. Despite its excellent survival prognosis, these tumors may be unpredictable, ranging from an asymptomatic indolent course to persistent, local, and extended recurrences that significantly impair quality of life. Although surgery was initially considered the first elective treatment, collected published data during the past few years are now pointing to the "wait and see" approach as a reasonable initial strategy because many patients can live a long life with the disease without having symptoms...
May 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28439796/adjuvant-endocrine-therapy-in-breast-cancer-evolving-paradigms-in-premenopausal-women
#3
REVIEW
Lorenzo Rossi, Olivia Pagani
In the last few years, new adjuvant endocrine treatment options have become available in young women with early breast cancer, such as the addition of ovarian function suppression to tamoxifen or aromatase inhibitors. Treatment duration has been also adapted in the latest guidelines based on the individual risk of recurrence. The oncologist is therefore challenged to precisely assess the risk of recurrence according to currently available predictive and prognostic factors in order to offer the most appropriate therapeutic option to the individual patient, considering also potential side effects, quality of life, pregnancy planning and patients' preferences...
May 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28434181/management-options-for-biochemically-recurrent-prostate-cancer
#4
REVIEW
Farhad Fakhrejahani, Ravi A Madan, William L Dahut
Prostate cancer is the most common solid tumor malignancy in men worldwide. Treatment with surgery and radiation can be curative in organ-confined disease. Unfortunately, about one third of men develop biochemically recurrent disease based only on rising prostate-specific antigen (PSA) in the absence of visible disease on conventional imaging. For these patients with biochemical recurrent prostate cancer, there is no uniform guideline for subsequent management. Based on available data, it seems prudent that biochemical recurrent prostate cancer should initially be evaluated for salvage radiation or prostatectomy, with curative intent...
May 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28391424/optimal-radiation-therapy-for-small-cell-lung-cancer
#5
REVIEW
Michael F Gensheimer, Billy W Loo
Radiation therapy plays an important role in the management of both limited stage and extensive stage small cell lung cancer. For limited stage disease, there has been a trend toward reduced size of thoracic radiation fields, which has the potential to reduce toxicity. FDG-PET staging helps make this possible by more accurately identifying areas of nodal and metastatic involvement. Trials have demonstrated similar outcomes using a range of radiation fractionation schedules, allowing flexibility in individualizing treatment...
April 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28391423/image-guided-thermal-ablative-therapies-in-the-treatment-of-sarcoma
#6
REVIEW
Scott M Thompson, John J Schmitz, Grant D Schmit, Matthew R Callstrom, Anil Nicholas Kurup
Percutaneous thermal ablation, including microwave ablation (MWA), radiofrequency ablation (RFA), and cryoablation, is a well-established focal treatment option for primary and metastatic malignancies. While published literature specific to ablation of sarcomas is relatively lacking compared with non-sarcomatous malignancies, what is available is promising. In situations where a focal treatment option is desired, strong consideration should be given to percutaneous thermal ablation, in addition to surgery and radiation therapy...
April 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28391422/osteogenic-sarcoma-systemic-chemotherapy-options-for-localized-disease
#7
REVIEW
Douglas J Harrison, Cindy L Schwartz
Treatment for osteosarcoma, the most common malignant tumor of bone in children and adolescents, has not changed in decades. Treatment is multimodal, employing neoadjuvant chemotherapy followed by aggressive and complete surgical resection to achieve negative margins and a prolonged course of adjuvant chemotherapy. The primary tumor is usually successfully managed via surgery, but micrometastases are likely present in most patients at diagnosis. Death is the result of tumor recurrence in the lungs or more rarely in other bones despite aggressive treatment regimens and is likely attributable to innate resistance to chemotherapy...
April 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28391421/the-rising-incidence-of-younger-patients-with-colorectal-cancer-questions-about-screening-biology-and-treatment
#8
REVIEW
Louise C Connell, José Mauricio Mota, Maria Ignez Braghiroli, Paulo M Hoff
Colorectal cancer (CRC) is the third leading cancer diagnosed globally and an important cause of cancer-related mortality. Of interest, while we have witnessed a declining incidence trend over the past few decades in the older population, incidence rates for adolescents and young adults have been increasing steadily. Several factors may well explain this apparent epidemic in the young, namely a lack of routine screening and emerging lifestyle issues such as obesity, lack of exercise, and dietary factors. It is known that both environmental and genetic factors can increase the likelihood of developing CRC...
April 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28391420/a-neuro-oncologist-s-perspective-on-management-of-brain-metastases-in-patients-with-egfr-mutant-non-small-cell-lung-cancer
#9
REVIEW
Tresa McGranahan, Seema Nagpal
Management of non-small cell lung cancer (NSCLC) with brain metastasis (BrM) has been revolutionized by identification of molecular subsets that have targetable oncogenes. Historically, survival for NSCLC with symptomatic BrM was weeks to months. Now, many patients are surviving years with limited data to guide treatment decisions. Tumors with activating mutations in epidermal growth factor receptor (EGFRact+) have a higher incidence of BrM, but a longer overall survival. The high response rate of both systemic and BrM EGFRact+ NSCLC to tyrosine kinase inhibitors (TKIs) has led to the rapid incorporation of new therapies but is outpacing evidence-based decisions for BrM in NSCLC...
April 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28382538/treatment-of-philadelphia-chromosome-positive-acute-lymphocytic-leukemia
#10
REVIEW
Aaron Ronson, Ariella Tvito, Jacob M Rowe
Opinion statementOver the past 15 years, the landscape of Ph+ ALL has changed dramatically. No longer the most dreaded form of acute leukemia, the advent of tyrosine kinase inhibitors (TKIs) has ushered in a new era, as TKIs have become the backbone of any treatment regimen for Ph+ ALL. A greater number achieve a complete remission allowing for more patients to get the transplant, although probably less patients need a transplant. For the first time in decades, there is hope for older patients with Ph+ ALL...
March 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28332083/phase-iii-soft-tissue-sarcoma-trials-success-or-failure
#11
REVIEW
Alexander T J Lee, Seth M Pollack, Paul Huang, Robin L Jones
Two recently reported phase III randomised control trials (RCTs) have resulted in the registration of two new systemic therapies for advanced soft tissue sarcoma. Both of these trials' designs were informed by phase II data that guided the selection of sensitive STS diagnoses, enabling the demonstration of benefit in certain subtypes. A number of other phase III trials reported in the last 18 months have seemingly fit into a recurrent pattern of failure-promising efficacy signals in earlier phase studies being lost in the survival follow-up of large, highly heterogeneous cohorts...
March 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28286925/cabozantinib-for-renal-cell-carcinoma-current-and-future-paradigms
#12
REVIEW
Ahmed Abdelaziz, Ulka Vaishampayan
Cabozantinib was approved by the FDA in April 2016 for the treatment of advanced renal cancer, pretreated with at least one prior antiangiogenic therapy. This is the first agent in the therapy of kidney cancer to show a statistically significant improvement in all three endpoints of clinical efficacy, response rate, progression free survival, and overall survival (OS), in a phase III randomized trial. The reporting of METEOR coincided with that of the Checkmate 025 study which randomized similarly eligible patients to receive nivolumab or everolimus 10 mg daily...
March 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28286924/treatment-of-relapsed-refractory-acute-myeloid-leukemia
#13
REVIEW
Prithviraj Bose, Pankit Vachhani, Jorge E Cortes
Approximately 40-45% of younger and 10-20% of older adults with acute myeloid leukemia (AML) will be cured with current standard chemotherapy. The outlook is particularly gloomy for patients with relapsed and/or refractory disease (cure rates no higher than 10%). Allogeneic hematopoietic stem cell transplantation (HSCT), the only realistic hope of cure for these patients, is an option for only a minority. In recent years, much has been learned about the genomic and epigenomic landscapes of AML, and the clonal architecture of both de novo and secondary AML has begun to be unraveled...
March 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28286923/maintenance-therapies-in-indolent-lymphomas-should-recent-data-change-the-standard-of-care
#14
REVIEW
Michael T Tees, Ian W Flinn
The overall benefit of maintenance therapy for patients with an indolent lymphoma continues to go unanswered. A myriad of variables contribute to the lack of clear clinical guidance. First, the disease course is slow and treatment may not be required for years, requiring a long follow-up to prospectively study. Second, due to the long lag time from study initiation to conclusion, many of the induction therapies used at the onset of the study may not be favored at present, providing a conclusion that cannot be reconciled with current clinical practice...
March 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28286922/should-response-adapted-therapy-now-be-the-standard-of-care-for-advanced-hodgkin-s-lymphoma
#15
REVIEW
Peter Johnson, Jemma Longley
The choice of treatment for advanced Hodgkin's lymphoma has traditionally been made using an assessment of the baseline risk factors and a judgement of the balance between efficacy and toxicity for the group in question. The use of functional imaging with 2-(18F)-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) early in the course of therapy offers a way to make treatment better adjusted to the most important feature of Hodgkin's lymphoma: the response to therapy. Recent studies have shown that excellent results can be achieved by using early FDG-PET to modulate therapy, with escalation for those with an unsatisfactory response and treatment reduction for those with the most chemosensitive disease...
March 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28286921/treatment-strategies-for-metastatic-neuroendocrine-tumors-of-the-gastrointestinal-tract
#16
REVIEW
Mauro Cives, Jonathan Strosberg
The therapeutic landscape of gastroenteropancreatic-neuroendocrine tumors (GEP-NETs) has evolved significantly in recent years. Current and emerging treatment options include somatostatin analogs, radiolabeled somatostatin analogs, the mTOR inhibitor everolimus, and the tyrosine kinase inhibitor sunitinib. Although high-quality data from phase III trials are lacking, cytotoxic agents are commonly used for the treatment of poorly differentiated neuroendocrine carcinomas and well-differentiated NETs originating in the pancreas...
March 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28281215/neoadjuvant-treatment-for-locally-advanced-rectal-cancer-new-concepts-in-clinical-trial-design
#17
REVIEW
Nitesh Rana, A Bapsi Chakravarthy, Lisa A Kachnic
Treatment for locally advanced rectal cancer has evolved from surgery alone to surgery plus adjuvant therapy. Preoperative 5-fluorouracil- or capecitabine-based chemoradiation with standard fractionated radiation, surgery utilizing total mesorectal excision, and further chemotherapy has become the standard of care in the USA. Preoperative adjuvant chemoradiation treatment sequencing has allowed for decreased toxicity, more sphincter-sparing surgery, and improved local control rates as compared to delivering the chemoradiation postoperatively...
February 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28243993/what-is-optimal-front-line-therapy-for-chronic-lymphocytic-leukemia-in-2017
#18
REVIEW
Benjamin N Voorhies, Deborah M Stephens
The front-line management of patients with chronic lymphocytic leukemia (CLL) has evolved significantly in recent years due to introduction of novel, targeted agents. Upon CLL diagnosis, physicians should determine whether treatment or careful observation is indicated. Once treatment is required, choice of therapy should be based on the age and fitness of the patient and the distinct molecular profile of their disease. As multiple novel agents are in various stages of development, all patients regardless of their age, fitness, and disease risk should be evaluated for clinical trial participation before initiating any front-line therapy...
February 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28229364/molecular-subtyping-in-diffuse-large-b-cell-lymphoma-closer-to-an-approach-of-precision-therapy
#19
REVIEW
Reem Karmali, Leo I Gordon
It has become clear that there is immense biological heterogeneity in diffuse large B cell lymphoma (DLBCL). Developing technology has allowed better characterization of patient subsets at a molecular level, allowing for a link of phenotype and clinical outcomes to oncogenic mechanisms and biologic signatures. Cell of origin and double hit status are able to identify aggressive subsets, with molecular profiling allowing for a clearer understanding of biologic pathways that contribute to cellular resistance to conventional treatment in these subsets...
February 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28214977/braf-mutated-colorectal-cancer-what-is-the-optimal-strategy-for-treatment
#20
REVIEW
Romain Cohen, Pascale Cervera, Magali Svrcek, Anna Pellat, Chantal Dreyer, Aimery de Gramont, Thierry André
The BRAF activating mutation, harbored by approximately 10% of colorectal cancers (CRC), confers dramatic prognosis to advanced diseases. In early-stage setting, the identification of the BRAF mutation does not impact the therapeutic decision. Yet, the BRAF mutation could be considered as a stratification factor in adjuvant trials, because of its prognostic impact after relapse. Moreover, both BRAF mutation and mismatch repair (MMR) statuses should be determined in all CRC to help identify sporadic tumors versus Lynch syndrome-related tumors...
February 2017: Current Treatment Options in Oncology
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