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American Society of Clinical Oncology Educational Book

Ji Youn Shin, Tammy I Kang, Robert B Noll, Sung Won Choi
This paper aims to review literature published on the support of cancer caregivers with health technology. Eighteen articles were reviewed to better understand cancer caregiving and categorized into four different themes: (1) design guidelines, (2) information facilitation, (3) social support, and (4) multicomponent interventions. Analysis of the current articles revealed that there are substantial gaps in knowledge regarding a range of health technologies that facilitate family caregiver support and its distribution to health institutions...
May 23, 2018: American Society of Clinical Oncology Educational Book
Deanna Teoh, Thomas J Smith, Mihae Song, Nick M Spirtos
As cancer therapies improve, patients are living longer. With these improvements in therapy comes a responsibility to optimize patients' quality of life during cancer therapy and beyond. This report reviews three timely and important topics. The first section reviews the mechanism underlying chemotherapy-induced peripheral neuropathy and evaluates the evidence for interventions to prevent and treat peripheral neuropathy. It also provides a framework for approaching the diagnosis and management of this common and bothersome side effect...
May 23, 2018: American Society of Clinical Oncology Educational Book
Lindsay M Morton, Sarah L Kerns, M Eileen Dolan
The growing population of cancer survivors often faces adverse effects of treatment, which have a substantial impact on morbidity and mortality. Although certain adverse effects are thought to have a significant heritable component, much work remains to be done to understand the role of germline genetic factors in the development of treatment-related toxicities. In this article, we review current understanding of genetic susceptibility to a range of adverse outcomes among cancer survivors (e.g., fibrosis, urinary and rectal toxicities, ototoxicity, chemotherapy-induced peripheral neuropathy, subsequent malignancies)...
May 23, 2018: American Society of Clinical Oncology Educational Book
Elizabeth A Mittendorf, John M S Bartlett, Daphne L Lichtensztajn, Sarat Chandarlapaty
Higher-quality imaging, refined surgical procedures, enhanced pathologic evaluation, and improved understanding of the impact of tumor biology on treatment and prognosis have necessitated revisions of the AJCC breast cancer staging system. The eighth edition includes clinical and pathologic prognostic stages that incorporate biologic variables-grade, estrogen and progesterone receptor status, HER2 status, and multigene panels-with the anatomic extent of disease defined by tumor, node, and metastasis categories...
May 23, 2018: American Society of Clinical Oncology Educational Book
Douglas B Evans
The majority of patients with localized pancreatic cancer who undergo surgery with or without adjuvant therapy will develop metastatic disease, suggesting that surgery alone is not sufficient for cure and micrometastases are present at the time of diagnosis even when not clinically apparent. As such, the field is rapidly moving to consensus on treatment sequencing, which emphasizes the early delivery of systemic therapy and the application of surgery to the population of patients most likely to receive clinical benefit from such large operations-namely, those with stable or responding disease following systemic therapy and often chemoradiation...
May 23, 2018: American Society of Clinical Oncology Educational Book
Anne H Blaes, Paaladinesh Thavendiranathan, Javid Moslehi
Cancer therapies can cause a variety of cardiac toxicities, including ischemia, cardiomyopathy, heart failure, myocarditis, arrhythmias, vascular disease, hypertension, and hyperlipidemia. Addressing cardiovascular risk at baseline, before initiating therapy, during cancer treatment, and in the survivorship period is imperative. It may be useful to risk stratify individuals with cardiovascular risk factors using biomarkers or imaging before they receive potentially cardiotoxic therapies. Additionally, new guidelines recommend cardiac imaging with echocardiography in the survivorship period 6 to 12 months after completing cancer therapy for these high-risk individuals...
May 23, 2018: American Society of Clinical Oncology Educational Book
Vaia Florou, Antonio G Nascimento, Ashish Gulia, Gilberto de Lima Lopes
Sarcomas, rare and heterogenous malignancies that comprise less than 1% of all cancers, have poor outcomes in the metastatic and refractory setting. Their management requires a multidisciplinary approach that consists of medical and surgical oncologists, radiation oncologists, and pathologists as well as ancillary support. In addition to systemic treatments, most patients will require surgical resection and radiation therapy, which mandates the use of the latest technologies and specialized expertise. Management guidelines have been developed in high-income countries, but their applicability in low-income countries, where resources may be limited, remains a challenge...
May 23, 2018: American Society of Clinical Oncology Educational Book
S Vincent Rajkumar
Major advances have occurred in the treatment of multiple myeloma, including several new drugs that typically cost more than $100,000 per year. Although the gains in myeloma therapy improve overall survival considerably, they are available to only a fraction of the population of patients with myeloma in the world because of regulatory barriers and cost. Myeloma is an example of what is happening in cancer on a much larger scale. Many of the problems discussed call for a wider discussion across all cancers, but they are amplified in myeloma because of the need for multidrug regimens that combine three or more expensive new drugs for prolonged periods of time...
May 23, 2018: American Society of Clinical Oncology Educational Book
Eduardo Cazap
In the next few decades, breast cancer will become a leading global public health problem as it increases disproportionately in low- and middle-income countries. Disparities are clear when comparisons are made with rates in Europe and the United States, but they also exist between the countries of the region or even within the same country in Latin America. Large cities or urban areas have better access and resource availability than small towns or remote zones. This article presents the status of the disease across 12 years with data obtained through three studies performed in 2006, 2010, and 2013 and based on surveys, reviews of literature, patient organizations, and public databases...
May 23, 2018: American Society of Clinical Oncology Educational Book
Jeffrey S Weber
The approvals of six checkpoint inhibitory antibodies since 2011 have established immunotherapy for cancer as a fifth treatment modality after chemotherapy, surgery, radiation, and targeted therapy. Long-lasting responses have been observed in melanoma, non-small cell lung cancer, renal cell cancer, and head and neck cancer, to name a few, and more approvals for these drugs undoubtedly are coming in the near future. The application of checkpoint inhibitors has expanded well beyond melanoma, and, with wider use, the management of the immune-related adverse events (irAEs) that accompany these drugs has received increased attention...
May 23, 2018: American Society of Clinical Oncology Educational Book
Brian Boulmay, Tatiana Prowell, Marcelo Blaya, Maria Catherine Pietanza
Several factors play a role in job selection after completion of a hematology/oncology training program, such as a fellows' overall career goals, expected income potential, and limitations imposed by visa status, among many others. Training programs play an integral role in mentoring trainees in career selection. For many, the first job is often not career-long. In addition to considerations for a fellow considering a first job out of fellowship, physicians will consider a change because of dissatisfaction at one's current position, desire for advancement opportunities, or a desire to work in a different sector...
May 23, 2018: American Society of Clinical Oncology Educational Book
Shilpa Grover, Osama E Rahma, Nikroo Hashemi, Ramona M Lim
Gastrointestinal toxicities are among the leading causes of immune-related adverse effects of checkpoint blockade. These adverse events can be severe enough to require interruption or withdrawal of immune checkpoint blockade therapy. Patients with immune-related adverse effects require early recognition with an evaluation to rule out alternative etiologies and effective management to minimize complications. This article reviews the gastrointestinal and hepatic toxicities of the antibodies that target immune checkpoints CTLA-4 and PD-1/PD-L1 and provides an approach to their diagnosis and management...
May 23, 2018: American Society of Clinical Oncology Educational Book
William Lydiatt, Brian O'Sullivan, Snehal Patel
Oncologists should be aware of three major modifications and additions to staging head and neck cancer that became effective in 2018. Oral cavity cancers have the addition of depth of invasion; oropharyngeal cancers (OPCs) are now distinguished by the immunohistochemical stain, p16, into those that are associated with high-risk human papillomavirus and those that are not; and all sites except nasopharyngeal carcinoma and high-risk human papillomavirus OPC will now include the important parameter of extranodal extension...
May 23, 2018: American Society of Clinical Oncology Educational Book
Gabriel N Hortobagyi, Stephen B Edge, Armando Giuliano
Expanded understanding of biologic factors that modulate the clinical course of malignant disease have led to the gradual integration of biomarkers into staging classifications. The American Joint Committee on Cancer (AJCC) TNM staging system is universally used and has largely displaced other staging classifications for most, although not all, cancers. Many of the chapters of the eighth edition of the AJCC TNM staging system integrated biomarkers with anatomic definitions. The Breast Chapter added estrogen receptor (ER) and progesterone receptor (PR) expression, HER2 expression, and/or amplification and histologic grade to the anatomic assessment of tumor size, regional lymph node involvement, and distant metastases (known as TNM)...
May 23, 2018: American Society of Clinical Oncology Educational Book
Ramon Andrade De Mello, Luis Castelo-Branco, Pedro Castelo-Branco, Daniel Humberto Pozza, Louis Vermeulen, Sofia Palacio, Matthew Salzberg, A Craig Lockhart
Esophageal cancer and gastric cancer are aggressive diseases for which treatment approaches are facing a new era. Some molecular pathways, such as VEGF, EGFR, fibroblast growth factor receptor, PIK3CA, and PARP-1, have been studied, and novel targeted drugs are presumed to be developed in the near future. From The Cancer Genome Atlas report, 80% of Epstein-Barr virus tumors and 42% of tumors with microsatellite instability have PIK3CA mutations, suggesting that this pathway could be reevaluated as a possible target for new systemic treatment of gastric cancer...
May 23, 2018: American Society of Clinical Oncology Educational Book
Ravindran Kanesvaran, Raul Cordoba, Ronald Maggiore
Immunotherapy has expanded the therapeutic landscape for advanced cancers, including solid tumors and lymphomas. For many patients with cancer, these agents have been shown to have substantial efficacy and favorable toxicity compared with cytotoxic agents, particularly in the second-line setting. With the advent of anti-PD-1 and anti-PD-L1 checkpoint inhibitors, combination immunotherapy- and chemoimmunotherapy-based strategies have emerged as promising novel regimens to improve cancer-related outcomes. Older adults age 65 or older represent the growing majority of patients diagnosed with cancer...
May 23, 2018: American Society of Clinical Oncology Educational Book
Saro Armenian, Smita Bhatia
Anthracyclines (doxorubicin, daunorubicin, epirubicin, and idarubicin) are among the most potent chemotherapeutic agents and have truly revolutionized the management of childhood cancer. They form the backbone of chemotherapy regimens used to treat childhood acute lymphoblastic leukemia, acute myeloid leukemia, Hodgkin lymphoma, Ewing sarcoma, osteosarcoma, and neuroblastoma. More than 50% of children with cancer are treated with anthracyclines. The clinical utility of anthracyclines is compromised by dose-dependent cardiotoxicity, manifesting initially as asymptomatic cardiac dysfunction and evolving irreversibly to congestive heart failure...
May 23, 2018: American Society of Clinical Oncology Educational Book
Jane Lowe Meisel, Vyshak Alva Venur, Michael Gnant, Lisa Carey
As we consider best practices and approaches to targeted therapy in the clinic and in terms of trial design, breast cancer can serve as a useful model for other disease types, because estrogen receptor-positive and HER2-positive breast cancer have been known entities for several decades. In this review, we provide a history of the development of anti-estrogen therapy and anti-HER2-directed therapy and we discuss our growing understanding of resistance to targeted therapy as seen through this lens. We highlight some of the recent breakthroughs that have enhanced our understanding of resistance to endocrine and anti-HER2 therapy, and we discuss some of the ongoing research in the field...
May 23, 2018: American Society of Clinical Oncology Educational Book
Krithika Murali, Vicky Makker, James Lynch, Susana Banerjee
Physician burnout remains a highly complex and topical issue. The negative impact of burnout on physicians, patients, and institutions has become increasingly apparent. Globally, a multitude of professional bodies and organizational leaders are giving this important subject much-deserved attention. In this review, we provide a summary of the latest evidence, with a focus on solutions and future strategies, while incorporating our own perspectives as practicing oncologists.
May 23, 2018: American Society of Clinical Oncology Educational Book
Nitin Jain, Philip Thompson, Alessandra Ferrajoli, Chadi Nabhan, Anthony R Mato, Susan O'Brien
Three small molecule inhibitors have been approved for the treatment of chronic lymphocytic leukemia (CLL) in the last 4 years. Ibrutinib, idelalisib, and venetoclax are oral agents with excellent efficacy and different toxicity profiles. Issues discussed herein include the current role for chemoimmunotherapy in CLL, the use of oral inhibitors in older patients, and the sequencing of these molecules in daily practice.
May 23, 2018: American Society of Clinical Oncology Educational Book
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