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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..

Curr. Oncol., Volume 27, Issue 6 (December 2020) – 23 articles

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Conference Report
Abstracts Submitted to the Cell Therapy Transplant Canada 2020 Annual Conference
Curr. Oncol. 2020, 27(6), 664-684; https://doi.org/10.3747/co.27.7151 - 01 Dec 2020
Cited by 1 | Viewed by 448
Abstract
Cell Therapy Transplant Canada thanks the following sponsors for providing educational grants to publish the cttc 2020 abstracts in Current Oncology: [...] Full article
Review
Expression of PD-L1 for Predicting Response to Immune Checkpoint Inhibitors in Metastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis
Curr. Oncol. 2020, 27(6), 656-663; https://doi.org/10.3747/co.27.6437 - 01 Dec 2020
Cited by 2 | Viewed by 535
Abstract
Background: We conducted this meta-analysis and systematic literature review to study the ability of PD-L1 to predict objective response in patients with urothelial cancer treated with PD-1/PD-L1 inhibitors. Methods: Relevant studies of PD-1 or PD-L1 inhibitors in urothelial cancer that reported objective [...] Read more.
Background: We conducted this meta-analysis and systematic literature review to study the ability of PD-L1 to predict objective response in patients with urothelial cancer treated with PD-1/PD-L1 inhibitors. Methods: Relevant studies of PD-1 or PD-L1 inhibitors in urothelial cancer that reported objective response rate (orr) based on PD-L1 expression status in PubMed, embase, and the Cochrane Library were retrieved. Efficacy of PD-L1 expression status in predicting orr and the efficacy, safety of PD-1 and PD-L1 drugs were analyzed. Results: Studies were divided into ≥1%, ≥5%, and ≥25% based on PD-L1 positivity threshold, and the patients were grouped into PD-L1 positive and negative. In all 3 expression thresholds, patients with positive PD-L1 expression were more likely to experience an objective response [≥1% threshold odds ratio (or): 1.74; 95% confidence interval (ci): 1.20 to 2.53; ≥5% threshold or: 2.74; 95% ci: 2.01 to 3.724; ≥25% threshold or: 7.13; 95% ci: 2.38 to 21.40] in comparison with patients with negative PD-L1 expression. Of the 3 thresholds, the ≥25% threshold was better in predicting orr (1.74 vs. 2.93 vs. 7.13; p < 0.0001). The ≥1% PD-L1 threshold had a relatively high sensitivity in predicting orr; the ≥5% PD-L1 threshold was better for specificity. Sensitivity was higher at the ≥25% threshold than at the other two thresholds, but specificity was lower. Further, we found that there is no statistically significant difference in efficacy between PD-1 and PD-L1 drugs. Conclusions: Urothelial cancer patients with PD-L1 positive expression responded better than PD-L1 negative patients did, and a threshold of ≥5% or greater for PD-L1 expression might predict positive clinical response. Full article
Review
Bruton Tyrosine Kinase Inhibitors for the Frontline Treatment of Chronic Lymphocytic Leukemia
Curr. Oncol. 2020, 27(6), 645-655; https://doi.org/10.3747/co.27.6795 - 01 Dec 2020
Cited by 1 | Viewed by 531
Abstract
Chronic lymphocytic leukemia (cll) is the most commonly diagnosed adult leukemia in Canada. Biologic heterogeneity of cll between patients results in variable disease trajectories and responses to therapy. Notably, compared with patients lacking high-risk features, those with such features—such as deletions [...] Read more.
Chronic lymphocytic leukemia (cll) is the most commonly diagnosed adult leukemia in Canada. Biologic heterogeneity of cll between patients results in variable disease trajectories and responses to therapy. Notably, compared with patients lacking high-risk features, those with such features—such as deletions in chromosome 17p, aberrations in the TP53 gene, or unmutated immunoglobulin heavy chain variable region genes—experience inferior outcomes and responses to standard chemoimmunotherapy. Novel agents that target the B cell receptor signalling pathway, such as Bruton tyrosine kinase (btk) inhibitors, have demonstrated clinical efficacy and safety in patients with treatment-naïve cll, particularly those with high-risk features. However, given the current lack of head-to-head trials comparing btk inhibitors, selection of the optimal btk inhibitor for patients with cll is unclear and requires consideration of multiple factors. In the present review, we focus on the efficacy, safety, and pharmacologic features of the btk inhibitors that are approved or under clinical development, and we discuss the practical considerations for the use of those agents in the Canadian treatment landscape. Full article
Article
First-Line Therapy, Autologous Stem-Cell Transplantation, and Post-Transplantation Maintenance in the Management of Newly Diagnosed Mantle Cell Lymphoma
Curr. Oncol. 2020, 27(6), 632-644; https://doi.org/10.3747/co.27.7053 - 01 Dec 2020
Viewed by 475
Abstract
Background: In Ontario, no clearly defined standard of care for the management of mantle cell lymphoma (mcl) has been developed, and substantial variability from centre to centre is evident. This guidance document was prompted by the need to harmonize practice in [...] Read more.
Background: In Ontario, no clearly defined standard of care for the management of mantle cell lymphoma (mcl) has been developed, and substantial variability from centre to centre is evident. This guidance document was prompted by the need to harmonize practice in Ontario with respect to first-line, conditioning, and post-transplantation maintenance therapy for patients newly diagnosed with transplantation-eligible mcl. Methods: The medline and embase databases were systematically searched from January 2013 to January 2020 for evidence, and the best available evidence was used to draft recommendations relevant to first-line therapy, autologous stem-cell transplantation, and post-transplantation maintenance in the management of transplantation-eligible newly diagnosed mcl. Final approval of this guidance document was obtained from the Stem Cell Transplant Advisory Committee. Recommendations: These recommendations apply to all cases of transplantation-eligible newly diagnosed mcl: (1) Alternating cycles of r-chop (rituximab plus cyclophosphamide–doxorubicin–vincristine–prednisolone) and r-dhap [rituximab plus dexamethasone–high-dose cytarabine–cisplatin] is the recommended first-line treatment for symptomatic patients newly diagnosed with mcl before autologous stem-cell transplantation (asct). (2) Rituximab plus hyperfractionated cyclophosphamide–vincristine–doxorubicin–dexamethasone (r–hypercvad), alternating with methotrexate and cytarabine, is not recommended for the treatment of patients with newly diagnosed mcl. (3) beam (carmustine–etoposide–cytarabine–melphalan), beac (carmustine–etoposide–cytarabine–cyclophosphamide), and total-body irradiation–based regimens are reasonable conditioning options for patients with mcl who have responded to first-line therapy and who are undergoing asct. (4) Maintenance therapy with rituximab is recommended for patients with newly diagnosed mcl who have undergone asct. Full article
Article
Canadian Guidelines on the Management of Colorectal Peritoneal Metastases
Curr. Oncol. 2020, 27(6), 621-631; https://doi.org/10.3747/co.27.6919 - 01 Dec 2020
Cited by 1 | Viewed by 386
Abstract
Modern management of colorectal cancer (CRC) with peritoneal metastasis (PM) is based on a combination of cytoreductive surgery (CRS), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (HIPEC). Although the role of hipec has recently been questioned [...] Read more.
Modern management of colorectal cancer (CRC) with peritoneal metastasis (PM) is based on a combination of cytoreductive surgery (CRS), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (HIPEC). Although the role of hipec has recently been questioned with respect to results from the PRODIGE 7 trial, the role and benefit of a complete CRS were confirmed, as observed with a 41-month gain in median survival in that study, and 15% of patients remaining disease-free at 5 years. Still, CRC with PM is associated with a poor prognosis, and good patient selection is essential. Many questions about the optimal management approach for such patients remain, but all patients with PM from CRC should be referred to, or discussed with, a PM surgical oncologist, because cure is possible. The objective of the present guideline is to offer a practical approach to the management of PM from CRC and to reflect on the new practice standards set by recent publications on the topic. Full article
Article
Implementing Changes to a Residency Program Curriculum before Competency-Based Medical Education: A Survey of Canadian Medical Oncology Program Directors
Curr. Oncol. 2020, 27(6), 614-620; https://doi.org/10.3747/co.27.6659 - 01 Dec 2020
Viewed by 255
Abstract
Background: Postgraduate medical education is undergoing a paradigm shift in many universities worldwide, transitioning from a time-based model to competency-based medical education (CBME). Residency programs might have to alter clinical rotations, educational curricula, assessment methods, and faculty involvement in preparation for CBME, a [...] Read more.
Background: Postgraduate medical education is undergoing a paradigm shift in many universities worldwide, transitioning from a time-based model to competency-based medical education (CBME). Residency programs might have to alter clinical rotations, educational curricula, assessment methods, and faculty involvement in preparation for CBME, a process not yet characterized in the literature. Methods: We surveyed Canadian medical oncology program directors on planned or newly implemented residency program changes in preparation for CBME. Results: Prior to implementing CBME, all program directors changed at least 1 clinical rotation, most commonly making hematology/oncology (74%) entirely outpatient and eliminating radiation oncology (64%). Introductory rotations were altered to focus on common tumour sites, and later rotations were changed to increase learner autonomy. Most program directors planned to enhance resident learning with electronic teaching modules (79%), new training experiences (71%), and academic half-day changes (50%). Most program directors (64%) planned to change assessment methods to be entirely based on entrustable professional activities. All programs had developed a competence committee to review learner progress, and most (86%) had integrated academic coaches. Conclusions: Transitioning to CBME led to major structural and curricular changes within medical oncology training programs. Identifying these commonly implemented changes could help other programs transition to CBME. Full article
Article
Code Status Communication Training in Postgraduate Oncology Programs: A Needs Assessment
Curr. Oncol. 2020, 27(6), 607-613; https://doi.org/10.3747/co.27.6221 - 01 Dec 2020
Cited by 1 | Viewed by 206
Abstract
Background: Discussions with patients with cancer about cardiopulmonary resuscitation directives (code status) are often led by residents. This study was carried out in Canada to identify current educational practices and gaps in training for this communication skill. Methods: Canadian medical and radiation oncology [...] Read more.
Background: Discussions with patients with cancer about cardiopulmonary resuscitation directives (code status) are often led by residents. This study was carried out in Canada to identify current educational practices and gaps in training for this communication skill. Methods: Canadian medical and radiation oncology residents and program directors (pds) were surveyed about teaching practices, satisfaction with current education, and barriers to teaching code status discussion skills. Relative frequencies of categorical and ordinal responses were calculated. Results: Between November 2016 and February 2017, 95 (58.6%) of 162 residents and 17 (63%) of 27 pds completed surveys. Only 54.1% and 48.3% of medical and radiation oncology residents, respectively, had received any code status communication training before entering an oncology program. While 41% of residents expected to receive formal teaching on this topic during residency, 47.1% of pds endorsed inclusion of this topic in curricula. Only 20% of residents reported receiving formal evaluation of this skill while 41.2% of pds indicated that evaluations are provided. The importance of this communication skill in oncology was strongly supported. Among residents, 88% desired more training, and 82.3% of pds identified the need for new educational resources. Lack of time, resources, and evaluation tools were among the most commonly identified barriers to teaching. Conclusions: Oncology residency pds and trainees feel that code status communication is important, but teaching and evaluation of this skill are limited. Barriers to teaching and skill-building have been identified. Further work is underway to develop novel educational resources for code status communication training. Full article
Article
Pre-Transplant Marital Status and Hematopoietic Cell Transplantation Outcomes
Curr. Oncol. 2020, 27(6), 596-606; https://doi.org/10.3747/co.27.6327 - 01 Dec 2020
Cited by 1 | Viewed by 414
Abstract
Background: Evidence about the impact of marital status before hematopoietic cell transplantation (hct) on outcomes after hct is conflicting. Methods: We identified patients 40 years of age and older within the Center for International Blood and Marrow Transplant Research registry who underwent hct [...] Read more.
Background: Evidence about the impact of marital status before hematopoietic cell transplantation (hct) on outcomes after hct is conflicting. Methods: We identified patients 40 years of age and older within the Center for International Blood and Marrow Transplant Research registry who underwent hct between January 2008 and December 2015. Marital status before hct was declared as one of: married or living with a partner, single (never married), separated or divorced, and widowed. We performed a multivariable analysis to determine the association of marital status with outcomes after hct. Results: We identified 10,226 allogeneic and 5714 autologous hct cases with, respectively, a median follow-up of 37 months (range: 1–102 months) and 40 months (range: 1–106 months). No association between marital status and overall survival was observed in either the allogeneic (p = 0.58) or autologous (p = 0.17) setting. However, marital status was associated with grades 2–4 acute graft-versus-host disease (gvhd), p < 0.001, and chronic gvhd, p = 0.04. The risk of grades 2–4 acute gvhd was increased in separated compared with married patients [hazard ratio (hr): 1.13; 95% confidence interval (ci): 1.03 to 1.24], and single patients had a reduced risk of grades 2–4 acute gvhd (hr: 0.87; 95% ci: 0.77 to 0.98). The risk of chronic gvhd was lower in widowed compared with married patients (hr: 0.82; 95% ci: 0.67 to 0.99). Conclusions: Overall survival after hct is not influenced by marital status, but associations were evident between marital status and grades 2–4 acute and chronic gvhd. To better appreciate the effects of marital status and social support, future research should consider using validated scales to measure social support and patient and caregiver reports of caregiver commitment, and to assess health-related quality of life together with health care utilization. Full article
Article
Primary Care Use after Cancer Treatment: An Analysis of Linked Administrative Data
Curr. Oncol. 2020, 27(6), 590-595; https://doi.org/10.3747/co.27.5993 - 01 Dec 2020
Viewed by 383
Abstract
Background: Primary care–led follow-up is a safe and acceptable alternative to oncologist-led follow-up. We sought to investigate patterns of primary care use during cancer follow-up care. Methods: We identified all persons in Nova Scotia, diagnosed with an invasive breast, prostate, colorectal, or gynecologic [...] Read more.
Background: Primary care–led follow-up is a safe and acceptable alternative to oncologist-led follow-up. We sought to investigate patterns of primary care use during cancer follow-up care. Methods: We identified all persons in Nova Scotia, diagnosed with an invasive breast, prostate, colorectal, or gynecologic cancer between January 2006 and December 2013. We linked this dataset to cancer centre, hospital discharge abstracts, physicians’ billing, and census data. We identified a survivor cohort (n = 12,201), then descriptively examined primary care use during follow-up care. Multivariate Poisson and negative binomial regression, respectively, were used to examine primary care use for two outcomes: total number of primary care provider (pcp) visits (all reasons) and total number of cancer-specific pcp visits. Results: The mean numbers of pcp visits (all reasons) and cancer-specific pcp visits per year for survivors who did not receive cancer centre follow-up (cc-fup) were 8.12 and 0.43 visits, respectively, and for survivors who continued to receive cc-fup were 8.75 and 0.63 visits, respectively. Age, cancer type, stage at diagnosis, comorbidity scores, year of diagnosis, and receipt of cc-fup were associated with both outcomes. Compared with prostate cancer survivors, breast, colorectal, and gynecologic cancer survivors had, respectively, 56%, 69%, and 56% fewer expected cancer-specific PCP visits. Receipt of cc-fup increased the expected number of pcp visits (all reasons) by 12% and cancer-specific pcp visits by 50%. Conclusions: Primary care use was higher in survivors who continued to visit their oncology teams for follow-up. This suggests that survivors who remain with their oncology teams after treatment continue to have high needs not met by these teams alone. Full article
Article
Economic Evaluation of Adjuvant Trastuzumab Emtansine in Patients with HER2-Positive Early Breast Cancer and Residual Invasive Disease after Neoadjuvant Taxane and Trastuzumab–Based Treatment in Canada
Curr. Oncol. 2020, 27(6), 578-589; https://doi.org/10.3747/co.27.6517 - 01 Dec 2020
Viewed by 420
Abstract
Background: In the katherine trial, adjuvant trastuzumab emtansine [T-DM1, Kadcyla (Genentech, South San Francisco, CA, U.S.A.)], compared with trastuzumab, significantly reduced the risk of recurrence or death by 50% (unstratified hazard ratio: 0.50; 95% confidence interval: 0.39 to 0.64; p < 0.0001) in [...] Read more.
Background: In the katherine trial, adjuvant trastuzumab emtansine [T-DM1, Kadcyla (Genentech, South San Francisco, CA, U.S.A.)], compared with trastuzumab, significantly reduced the risk of recurrence or death by 50% (unstratified hazard ratio: 0.50; 95% confidence interval: 0.39 to 0.64; p < 0.0001) in patients with HER2-positive early breast cancer (ebc) and residual invasive disease after neoadjuvant systemic treatment. A cost–utility evaluation, with probabilistic analyses, was conducted to examine the incremental cost per quality-adjusted life–year (qaly) gained associated with T-DM1 relative to trastuzumab, given the higher per-cycle cost of T-DM1. Methods: A Markov model comprising a number of health states was used to examine clinical and economic outcomes over a lifetime horizon from the Canadian public payer perspective. Patients entered the model in the invasive disease-free survival (idfs) state, where they received either T-DM1 or trastuzumab. Transition probabilities between the health states were derived from the katherine trial, Canadian life tables, and published literature from other relevant clinical trials (emilia, cleopatra, and M77001). Resource use, costs, and utilities were derived from katherine, other clinical trials, published literature, provincial fee schedules, and clinical expert opinion. Sensitivity analyses were conducted for key assumptions and model parameters. Results: Compared with trastuzumab, adjuvant T-DM1 was associated with a cost savings of $8,300 per patient and a 2.16 incremental qaly gain; thus T-DM1 dominated trastuzumab. Scenario analyses yielded similar results, with T-DM1 dominating trastuzumab or producing highly favourable incremental cost–utility ratios of less than $10,000 per qaly. Conclusions: Adjuvant T-DM1 monotherapy is a cost-effective strategy compared with trastuzumab alone in the treatment of patients with HER2-positive ebc and residual invasive disease after neoadjuvant systemic treatment. Full article
Article
Comprehensive Genomic Profiling for Non-Small-Cell Lung Cancer: Health and Budget Impact
Curr. Oncol. 2020, 27(6), 569-577; https://doi.org/10.3747/co.27.5995 - 01 Dec 2020
Cited by 4 | Viewed by 466
Abstract
Background: Single-gene tests and hotspot panels targeting specific subsets of biomarkers constitute the Canadian genomic testing landscape for non-small-cell lung cancer (nsclc). However, newer testing options such as comprehensive genomic profiling (cgp) offer improved detection rates and identification of multiple classes of [...] Read more.
Background: Single-gene tests and hotspot panels targeting specific subsets of biomarkers constitute the Canadian genomic testing landscape for non-small-cell lung cancer (nsclc). However, newer testing options such as comprehensive genomic profiling (cgp) offer improved detection rates and identification of multiple classes of genomic alterations in a single assay, minimizing tissue requirements and turnaround time. The objective of the present analysis was to assess the health and budget impacts of adopting cgp testing for nsclc in Canada. Methods: This study assessed the impact of funding the cgp tests FoundationOne CDx and FoundationOne Liquid (Foundation Medicine, Cambridge, MA, U.S.A.) over a 3-year time horizon using a Canadian societal perspective for Ontario. Conventional testing strategies were summarized into two reference scenarios: a series of single-gene tests only, and reflex single-gene testing followed by a hotspot panel for negative results. Four adoption scenarios for cgp testing were considered: replacing all single-gene and hotspot panel testing, replacing hotspot panel testing only, use after negative single-gene and hotspot testing, and use of FoundationOne Liquid in individuals with insufficient tissue for conventional testing. Results: When cgp testing was assumed to replace all conventional testing with 50% uptake, the budget impact per person per year ranged from $0.71 to $0.87, depending on the reference scenario, with a 3-year gain of 680.9 life–years and 3831 working days over the full cohort. Conclusions: Given the present testing landscape for patients with nsclc in Canada, listing cgp testing could optimize the selection of appropriately targeted treatments, and thus add life–years and productivity for this population, with a minimal budget impact. Full article
Article
Lysine Analogue Use during Cancer Surgery: A Survey from a Canadian Tertiary Care Centre
Curr. Oncol. 2020, 27(6), 560-568; https://doi.org/10.3747/co.27.6613 - 01 Dec 2020
Viewed by 236
Abstract
Background: When used during surgery, antifibrinolytic hemostatic agents such as lysine analogues are effective at reducing blood loss and the need for transfusions. Despite proven efficacy, use of hemostatic agents remains low during some surgeries. Our objective was to explore surgeon opinions [...] Read more.
Background: When used during surgery, antifibrinolytic hemostatic agents such as lysine analogues are effective at reducing blood loss and the need for transfusions. Despite proven efficacy, use of hemostatic agents remains low during some surgeries. Our objective was to explore surgeon opinions about, and use of lysine analogues in, oncologic surgeries at a large tertiary care academic institution. Methods: We administered a survey to surgeons who perform high-transfusion-risk oncologic surgeries at a large academic hospital in Ottawa, Ontario. Design and distribution of the survey followed a modified Dillman method. To ensure that the survey questionnaire was relevant, clear, and concise, we performed informant interviews, cognitive interviews, and pilot-testing. The final survey consisted of 19 questions divided into 3 sections: respondent demographics, use of hemostatic agents, and potential clinical trial opinions. Results: Of 28 surgeons, 24 (86%) participated. When asked to indicate the frequency of lysine analogue use, “never” accounted for 46% of the responses, and “rarely” (<10% of the time) accounted for 23% of the responses. Reasons for never using included “unfamiliar with benefits” and “prefer alternatives.” Fifteen surgeons (63%) felt that a trial was needed to demonstrate the efficacy and safety of lysine analogues in their cancer field. Conclusions: Our survey found that lysine analogues are infrequently used during oncologic surgeries at our institution. Many surgeons are unfamiliar with the benefits and side effects of lysine analogues and, alternatively, use topical hemostatic agents. Our results demonstrate that future trials exploring the efficacy and safety of lysine analogues in oncologic surgery are needed. Full article
Article
Longitudinal Health Utilities, Symptoms and Toxicities in Patients with ALK-Rearranged Lung Cancer Treated with Tyrosine Kinase Inhibitors: A Prospective Real-World Assessment
Curr. Oncol. 2020, 27(6), 552-559; https://doi.org/10.3747/co.27.6563 - 01 Dec 2020
Viewed by 453
Abstract
Background: Tyrosine kinase inhibitors (TKIs) have dramatically improved the survival of patients with ALK-rearranged (ALK+) non-small-cell lung cancer (NSCLC). Clinical trial data can generally compare drugs in a pair-wise fashion. Real-world collection of health utility data, symptoms, and toxicities [...] Read more.
Background: Tyrosine kinase inhibitors (TKIs) have dramatically improved the survival of patients with ALK-rearranged (ALK+) non-small-cell lung cancer (NSCLC). Clinical trial data can generally compare drugs in a pair-wise fashion. Real-world collection of health utility data, symptoms, and toxicities allows for the direct comparison between multiple TKI therapies in the population with ALK+ NSCLC. Methods: In a prospective cohort study, outpatients with ALK+ recruited between 2014 and 2018, treated with a variety of TKIs, were assessed every 3 months for clinico-demographic, patient-reported symptom and toxicity data and EQ-5D-derived health utility scores (HUS). Results: In 499 longitudinal encounters of 76 patients with ALK+ NSCLC, each TKI had stable longitudinal HUS when disease was controlled, even after months to years: the mean overall HUS for each TKI ranged from 0.805 to 0.858, and longitudinally from 0.774 to 0.912, with higher values associated with second- or third-generation TKIs of alectinib, brigatinib, and lorlatinib. Disease progression was associated with a mean HUS decrease of 0.065 (95% confidence interval: 0.02 to 0.11). Health utility scores were inversely correlated to multiple symptoms or toxicities: rho values ranged from −0.094 to −0.557. Fewer symptoms and toxicities were associated with the second- and third-generation TKIs compared with crizotinib. In multivariable analysis, only stable disease state and baseline Eastern Cooperative Oncology Group performance status were associated with improved HUS. Conclusions: There was no significant decrease in HUS when patients with ALK+ disease were treated longitudinally with each TKI, as long as patients were clinically stable. Alectinib, brigatinib, and lorlatinib had the best toxicity profiles and exhibited high mean HUS longitudinally in the real-world setting. Full article
Article
Presenting Stage and Risk Group in Men Dying of Prostate Cancer
Curr. Oncol. 2020, 27(6), 547-551; https://doi.org/10.3747/co.27.6385 - 01 Dec 2020
Cited by 2 | Viewed by 233
Abstract
Introduction: Prostate cancer remains the 3rd leading cause of cancer-related mortality in Canadian men, and yet screening for prostate cancer continues to be controversial because the majority of men diagnosed with prostate cancer do not die of the disease. It also remains [...] Read more.
Introduction: Prostate cancer remains the 3rd leading cause of cancer-related mortality in Canadian men, and yet screening for prostate cancer continues to be controversial because the majority of men diagnosed with prostate cancer do not die of the disease. It also remains uncertain whether treatment of cases that can be treated with curative intent alters the mortality rate. There are very few studies describing the presenting stage, risk groups, and survival after diagnosis for men dying of prostate cancer in the literature. In this study, we explored these characteristics for all men who died of prostate cancer in British Columbia between 2013 and 2015. Methods: The population-based BC Cancer databases were used to identify all patients diagnosed between January 2013 and December 2015 who died of prostate cancer. Patient, tumour, and treatment characteristics were collected, and the risk grouping for each tumour was determined. The proportion of cases in each risk group at the time of diagnosis was determined. Survival time from diagnosis to death was calculated for all patients and for each risk group using the Kaplan–Meier method. Results: A total of 1256 patients died of prostate cancer. Of patients who presented with metastatic disease, 57.2% presented with a Gleason score of 8 or more, compared with only 35.7% of patients who presented with nonmetastatic disease (p < 0.0001). The presenting stage and risk group of those dying of prostate cancer were as follows: 32% metastatic disease, 3% regional (defined as node-positive), 39% localized high risk, 9% localized intermediate risk, 4% localized low risk, 6% localized not otherwise specified, and 7% unknown. Therefore, 80.3% of those with a known risk group presented with either localized high-risk, regional, or metastatic disease at diagnosis. The median survival times from diagnosis to death were 12 years for localized low-risk, 10 years for localized intermediate-risk, 6.5 years for localized high-risk, 4 years for regional, and 1.7 years for metastatic disease at diagnosis. Conclusions: This population-based analysis demonstrates that patients with localized high-risk, regional, or metastatic disease at diagnosis constitute the overwhelming majority of patients who die of prostate cancer in British Columbia. Unless these disease states can reliably be identified at an earlier low- or intermediate-risk localized state in the future, it is unlikely that treatment of localized low- and intermediate-risk cancer will have an impact on survival. Furthermore, patients with de novo metastatic disease had identifiable risk factors of a higher prostate-specific antigen and Gleason score. Further studies are required to confirm these results. Full article
Article
Comparison of Transarterial Bland and Chemoembolization for Neuroendocrine Tumours: A Systematic Review and Meta-Analysis
Curr. Oncol. 2020, 27(6), 537-546; https://doi.org/10.3747/co.27.6205 - 01 Dec 2020
Viewed by 231
Abstract
Background: Treatment of hepatic metastases from neuroendocrine tumours improves survival and symptom relief. Hepatic arterial embolotherapy techniques include transarterial chemoembolization (TACE) and bland embolization (TAE). The relative efficacy of the techniques is controversial. The purpose of the present study was to use [...] Read more.
Background: Treatment of hepatic metastases from neuroendocrine tumours improves survival and symptom relief. Hepatic arterial embolotherapy techniques include transarterial chemoembolization (TACE) and bland embolization (TAE). The relative efficacy of the techniques is controversial. The purpose of the present study was to use a meta-analysis and systematic review to compare tace with TAE in the treatment of hepatic metastases. Methods: A literature search identified studies comparing TACE and TAE for treatment of hepatic metastases. Outcomes of interest included overall survival (OS), progression-free survival (PFS), radiographic response, complications, and symptom control. The hazard ratios (HRs) and odds ratios (ORs) were estimated and pooled. Results: Eight studies and 504 patients were included. No statistically significant differences between TACE and TAE were observed for OS at 1, 2, and 5 years or for HRs [1-year OR: 0.72; 95% confidence interval (CI): 0.27 to 1.94; p < 0.52; 2-year OR: 0.69; 95% CI: 0.43 to 1.11; p < 0.12; 5-year OR: 0.91; 95% CI: 0.37 to 2.24; p < 0.85; HR: 0.96; 95% CI: 0.73 to 1.24; p < 0.74]. No statistically significant differences between TACE and TAE were observed for PFS at 1, 2, and 5 years or for HRs (1-year OR: 0.71; 95% CI: 0.38 to 1.55; p < 0.30; 2-year OR: 0.83; 95% CI: 0.33 to 2.06; p < 0.69; 5-year OR: 0. 91; 95% CI: 0.37 to 2.24; p < 0.85; HR: 0.99–1.74; 95% CI: 0.74 to 1.73; p < 0.97). Both techniques are safe and effective for symptom control. Conclusions: No statistically significant differences between TACE and TAE were observed for OS and PFS. Full article
Article
Clinicopathologic Characteristics, Survival, and Treatments for Gastric Adenosquamous Carcinoma: A Population-Based Study
Curr. Oncol. 2020, 27(6), 527-536; https://doi.org/10.3747/co.27.6337 - 01 Dec 2020
Viewed by 292
Abstract
Background: Gastric adenosquamous carcinoma (GASC) is a rare entity with distinctive characteristics that are not fully understood. In the present study, we evaluated the characteristics of this rare disease. Methods: The U.S. Surveillance, Epidemiology, and End Results program database was searched [...] Read more.
Background: Gastric adenosquamous carcinoma (GASC) is a rare entity with distinctive characteristics that are not fully understood. In the present study, we evaluated the characteristics of this rare disease. Methods: The U.S. Surveillance, Epidemiology, and End Results program database was searched to determine the clinicopathologic features, prognostic factors, and treatments for 246 patients with GASC and 42,735 patients with gastric adenocarcinoma (GAC). Results: Relative to GAC, GASC is associated with higher proportions of cardia involvement, high-grade tumours, deep tumour invasion, metastatic lymph nodes, and chemotherapy treatment. In patients who underwent potentially curative surgery (PCS), GASC was associated with a higher proportion of radiotherapy use and poorer overall survival (p < 0.001), although no significant difference (p = 0.802) was observed after propensity score matching (PSM). Multivariate analysis after PSM revealed that the independent prognostic factors for GASC were TNM stage [hazard ratio (HR): 1.512; p = 0.021] and regional nodes examined (HR: 0.588; p = 0.02). In patients with advanced disease, no significant difference in survival between GASC and GAC was observed (p = 0.212), although survival was significantly poorer for GASC after PSM (p = 0.019). Multivariate analysis after PSM revealed that the independent prognostic factors for GASC were invasion depth (HR: 1.303; p = 0.036) and chemotherapy (HR: 0.444; p < 0.001). Conclusions: Relative to GAC, GASC was associated with more aggressive features, although survival outcomes were similar after PCS. Chemotherapy remains a mainstay of treatment for patients with advanced GASC, but its role remains unclear for patients who are undergoing PCS. Full article
Article
Cancer-Related Lymphedema: Clinical Pearls for Providers
Curr. Oncol. 2020, 27(6), 336-340; https://doi.org/10.3747/co.27.7225 - 01 Dec 2020
Cited by 3 | Viewed by 486
Abstract
Lymphedema is a chronic inflammatory condition that results from damage to the lymphatic system. Lymphedema is classified as either primary or secondary, the former being caused by a malformation of lymph vessels or nodes, and the latter resulting from trauma, chronic lymphatic system [...] Read more.
Lymphedema is a chronic inflammatory condition that results from damage to the lymphatic system. Lymphedema is classified as either primary or secondary, the former being caused by a malformation of lymph vessels or nodes, and the latter resulting from trauma, chronic lymphatic system overload, or the sequelae of cancer treatments. In the present article, we focus on secondary cancer-related lymphedema (CRL), a potential survivorship treatment-related effect. Treatments for breast, gynecologic, prostate, and head-and-neck cancers, and melanoma and other skin cancers are most frequently associated with CRL. The incidence of CRL varies widely based on cancer location and treatment modalities, with estimates ranging from 5% to 83% in various cancers. Given the lack of a universal definition and diagnostic criteria, the prevalence of CRL is difficult to ascertain; current estimates suggest that more than 300,000 Canadians are affected by CRL. Here, we present an overview of CRL, divided into 5 subtopics: lymphedema risk factors; early identification and intervention; diagnosis and staging; management, with emphasis on the volume reduction and maintenance phases, plus patient support and education; and clinical pearls to help providers integrate knowledge about CRL into their practice. Full article
Case Report
The Abscopal Effect in Head-and-Neck Squamous Cell Carcinoma Treated with Radiotherapy and Nivolumab: A Case Report and Literature Review
Curr. Oncol. 2020, 27(6), 330-335; https://doi.org/10.3747/co.27.6687 - 01 Dec 2020
Cited by 5 | Viewed by 508
Abstract
Introduction: The abscopal effect is a rarely observed outcome of radiotherapy wherein there is a reduction in metastatic disease burden outside of the targeted treatment area. Likely due to an in situ vaccine effect of radiotherapy, the abscopal effect may be augmented [...] Read more.
Introduction: The abscopal effect is a rarely observed outcome of radiotherapy wherein there is a reduction in metastatic disease burden outside of the targeted treatment area. Likely due to an in situ vaccine effect of radiotherapy, the abscopal effect may be augmented by immunotherapy. This report is the first case of the abscopal effect observed in metastatic head-and-neck squamous cell carcinoma (HNSCC) treated with concurrent radiotherapy and single-agent nivolumab. Case Description: An otherwise healthy 57-year-old man underwent craniofacial resection and adjuvant chemoradiotherapy for advanced sinonasal squamous cell carcinoma. Distant metastatic disease developed shortly after primary treatment, and immunotherapy in the form of nivolumab was initiated. Subsequent oligometastatic progression despite immunotherapy prompted palliative radiotherapy to a single metastasis due to pending symptomatology. Post-radiotherapy, the abscopal effect was observed with all distant sites of metastatic disease shrinking. Five months following treatment, a sustained reduction in disease burden has been demonstrated. Summary: We present the first case of the abscopal effect in a patient with metastatic hnscc treated with palliative radiotherapy concurrent with single-agent nivolumab immunotherapy, and only the third case of the abscopal effect in metastatic head-and-neck cancer. Dual treatment with immunotherapy and radiotherapy may be an important treatment option in the future, mediated through the abscopal effect. Full article
Article
Consensus Recommendations for Optimizing Biomarker Testing to Identify and Treat Advanced EGFR-Mutated Non-Small-Cell Lung Cancer
Curr. Oncol. 2020, 27(6), 321-329; https://doi.org/10.3747/co.27.7297 - 01 Dec 2020
Cited by 5 | Viewed by 568
Abstract
The advent of personalized therapy for non-small-cell lung carcinoma (nsclc) has improved patient outcomes. Selection of appropriate targeted therapy for patients with nsclc now involves testing for multiple biomarkers, including EGFR. EGFR mutation status is required to optimally treat patients with nsclc, and [...] Read more.
The advent of personalized therapy for non-small-cell lung carcinoma (nsclc) has improved patient outcomes. Selection of appropriate targeted therapy for patients with nsclc now involves testing for multiple biomarkers, including EGFR. EGFR mutation status is required to optimally treat patients with nsclc, and thus timely and accurate biomarker testing is necessary. However, in Canada, there are currently no standardized processes or methods in place to ensure consistent testing implementation. That lack creates challenges in ensuring that all appropriate biomarkers are tested for each patient and that the medical oncologist receives the results for making informed treatment decisions in a timely way.An expert multidisciplinary working group was convened to create consensus recommendations about biomarker testing in advanced NSCLC in Canada, with a primary focus on EGFR testing. Recognizing that there are biomarkers beyond EGFR that require timely identification, the expert multidisciplinary working group considered EGFR testing in the broader context of integration into complex lung biomarker testing. Primarily, the panel of experts recommends that all patients with nonsquamous NSCLC, regardless of stage, should undergo comprehensive reflex biomarker testing at diagnosis with targeted next-generation sequencing. The panel also considered the EGFR testing algorithm and the challenges associated with the pre-analytic, analytic, and post-analytic elements of testing. Strategies for funding testing by reducing silos of single biomarker testing for EGFR and for optimally implementing the recommendations presented here and educating oncology professionals about them are also discussed. Full article
Article
Perspectives of Hematology Oncology Clinicians about Integrating Palliative Care in Oncology
Curr. Oncol. 2020, 27(6), 313-320; https://doi.org/10.3747/co.27.6305 - 01 Dec 2020
Cited by 2 | Viewed by 244
Abstract
Patients with hematologic malignancies receive palliative care (PC) less frequently and later than patients with solid tumours. We compared survey responses of hematology oncology clinicians with other oncology clinicians to better understand their challenges with providing primary PC or using secondary PC. Patients’ [...] Read more.
Patients with hematologic malignancies receive palliative care (PC) less frequently and later than patients with solid tumours. We compared survey responses of hematology oncology clinicians with other oncology clinicians to better understand their challenges with providing primary PC or using secondary PC. Patients’ negative perceptions of PC and limited time or competing priorities were challenges for all clinicians. Compared with other oncology clinicians, more hematology oncology clinicians perceived PC referral criteria as too restrictive (40% vs. 22%, p = 0.021) and anticipated that integrating pc supports into their practice would require substantial change (53% vs. 28%, p = 0.014). This study highlights barriers that may need targeted interventions to better integrate pc into the care of patients with hematologic malignancies. Full article
Article
The Cost of Failed First-Line Cancer Treatment Related to Continued Smoking in Canada
Curr. Oncol. 2020, 27(6), 307-312; https://doi.org/10.3747/co.27.5951 - 01 Dec 2020
Cited by 1 | Viewed by 308
Abstract
Background: Smoking by cancer patients and survivors causes adverse cancer treatment outcomes, but little information is available about how smoking can affect cancer treatment costs. Methods: We developed a model to estimate attributable cancer treatment failure because of continued smoking after [...] Read more.
Background: Smoking by cancer patients and survivors causes adverse cancer treatment outcomes, but little information is available about how smoking can affect cancer treatment costs. Methods: We developed a model to estimate attributable cancer treatment failure because of continued smoking after a cancer diagnosis (AFs). Canadian health system data were used to determine the additional treatment cost for AFs for the most common cancers in Canada. Results: Of 206,000 patients diagnosed with cancer annually, an estimated 4789 experienced afs. The annual incremental cost associated with treating patients experiencing afs was estimated at between $198 million and $295 million (2017 Canadian dollars), reflecting an added incremental cost of $4,810–$7,162 per patient who continued to smoke. Analyses according to disease site demonstrated higher incremental costs where the smoking prevalence and the cost of individual second-line cancer treatment were highest. Of breast, prostate, colorectal, and lung cancers, lung cancer was associated with the highest incremental cost for treatment after AFs. Conclusions: The costs associated with afs in Canada after a cancer diagnosis are considerable. Populations in which the smoking prevalence and treatment costs are high are expected to benefit the most from efforts aimed at increasing smoking cessation capacity for patients newly diagnosed with cancer. Full article
Article
A Systematic Review and Network Meta-Analysis of Second-Line Therapy in Hepatocellular Carcinoma
Curr. Oncol. 2020, 27(6), 300-306; https://doi.org/10.3747/co.27.6583 - 01 Dec 2020
Cited by 3 | Viewed by 611
Abstract
Background: In patients with advanced hepatocellular carcinoma (HCC) following sorafenib failure, it is unclear which treatment is most efficacious, as treatments in the second-line setting have not been directly compared and no standard therapy exists. This systematic review and network meta-analysis (NMA) [...] Read more.
Background: In patients with advanced hepatocellular carcinoma (HCC) following sorafenib failure, it is unclear which treatment is most efficacious, as treatments in the second-line setting have not been directly compared and no standard therapy exists. This systematic review and network meta-analysis (NMA) aimed to compare the clinical benefits and toxicities of these treatments. Methods: A systematic review of randomized controlled trials (RCTs) was conducted to identify phase iii RCTs in advanced HCC following sorafenib failure. Baseline characteristics and outcomes of placebo were examined for heterogeneity. Primary outcomes of interest were extracted for results, including overall survival (OS), progression-free survival (PFS), objective response rate (ORR), grade 3/4 toxicities, and subgroups. An nma was conducted to compare both drugs through the intermediate placebo. Comparisons were expressed as hazard ratios (HRs) for os and PFS, and as risk difference (RD) for ORR and toxicities. Subgroup analyses for OS and PFS were also performed. Results: Two RCTs were identified (1280 patients) and compared through an indirect network; CELESTIAL (cabozantinib vs. placebo) and RESORCE (regorafenib vs. placebo). Baseline characteristics of patients in both trials were similar. Both trials also had similar placebo outcomes. Cabozantinib, compared with regorafenib, showed similar os [hazard ratio (HR): 1.21; 95% confidence interval (CI): 0.90 to 1.62], pfs (HR: 1.02; 95% ci: 0.78 to 1.34) and ORR (−3.0%; 95% ci: −7.6% to 1.7%). Both treatments showed similar toxicities, but there were marginally higher risks of grade 3/4 hand–foot syndrome (5%; 95% ci: 0.1% to 9.8%), diarrhea (4.8%; 95% ci: 1.1% to 8.5%), and anorexia (4.4%; 95% ci: 0.8% to 8.0%) for cabozantinib. Subgroup results for os and pfs were consistent with overall results. Conclusions: Overall, this nma determined that cabozantinib and regorafenib have similar clinical benefits and toxicities for second-line HCC. Full article
Article
A Population-Based Study of Pulmonary Monitoring and Toxicity for Patients with Testicular Cancer Treated with Bleomycin
Curr. Oncol. 2020, 27(6), 291-298; https://doi.org/10.3747/co.27.6389 - 01 Dec 2020
Cited by 2 | Viewed by 230
Abstract
Background:Bleomycin is commonly used to treat advanced testicular cancer and can be associated with severe pulmonary toxicity. The primary objective of the present study was to describe the use of pulmonary function tests (PFTs) and chest imaging before, during, and after treatment [...] Read more.
Background:Bleomycin is commonly used to treat advanced testicular cancer and can be associated with severe pulmonary toxicity. The primary objective of the present study was to describe the use of pulmonary function tests (PFTs) and chest imaging before, during, and after treatment with bleomycin. Methods: To identify all incident cases of testicular cancer treated with bleomycin-based chemotherapy in the Canadian province of Ontario during 2005–2010, the Ontario Cancer Registry was linked with chemotherapy treatment records. Health administrative databases were used to describe use of PFTs, chest imaging, and physician visits for respiratory complaints. Results: Of 394 patients treated with orchiectomy and chemotherapy who received at least 1 dose of bleomycin, 93% had complete chemotherapy records available. In the 4 weeks before, during, and within 2 years after finishing bleomycin-based chemotherapy, pfts were performed in 17%, 17%, and 29% of patients respectively. Chest imaging was performed in 68%, 62%, and 98% of patients in the same time periods. In the 2 years after bleomycin-based chemotherapy, 23% of treated patients had a physician visit for respiratory symptoms. That rate was substantially higher for men with greater exposure to bleomycin: 40% (24 of 60) for 10–12 doses bleomycin compared with 21% (53 of 250) for 7–9 doses and with 14% (8 of 58) for 1–6 doses (p = 0.002). Conclusions: Quality improvement initiatives are needed to increase baseline rates of chest imaging within 4 weeks of starting chemotherapy for testicular cancer; to understand why such a high proportion of men have chest imaging during bleomycin-based chemotherapy; and to mitigate the excess pulmonary toxicity seen with increasing exposure to bleomycin. Full article
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