Cancer therapy advisor

Author: f | 2025-04-25

Cancer Therapy Advisor Contributing Writer

Cancer Management - Cancer Therapy Advisor

2019;380(7):617-628. doi:10.1056/NEJMoa181401717. FDA approves ado-trastuzumab emtansine for early breast cancer. News release. US Food and Drug Administration. May 6, 2019. Accessed November 29, 2023. FDA approves combination of pertuzumab, trastuzumab, and hyaluronidase-zzxf for HER2-positive breast cancer. News release. US Food and Drug Administration. June 29, 2020. Accessed November 29, 2023. FDA grants regular approval to fam-trastuzumab deruxtecan-nxki for breast cancer. News release. US Food and Drug Administration. May 11, 2022. Accessed December 13, 2023. Jackisch C, Cortazar P, Geyer CE Jr, et al. Risk-based decision-making in the treatment of HER2-positive early breast cancer: recommendations based on the current state of knowledge. Cancer Treat Rev. 2021;99:102229. doi:10.1016/j.ctrv.2021.10222921. Lynce F, Barac A, Geng X, et al. Prospective evaluation of the cardiac safety of HER2-targeted therapies in patients with HER2-positive breast cancer and compromised heart function: the SAFE-HEaRt study. Breast Cancer Res Treat. 2019;175(3):595-603. doi:10.1007/s10549-019-05191-2Posted by Haymarket’s Clinical Content Hub. The editorial staff of Cancer Therapy Advisor played no role in this content’s production. Reviewed January 2024

Ovarian Cancer - Cancer Therapy Advisor

In the placebo group, but the study notes that this benefit was limited to node-positive HER+ breast cancer.15For patients who received neoadjuvant therapy, recommendations for systemic therapy after surgery (post-neoadjuvant therapy) are based on whether a patient achieved pCR with neoadjuvant treatment.11 In the KATHERINE trial (ClinicalTrials.gov identifier: NCT01772472), which investigated the effect of trastuzumab emtansine (T-DM1) on HER2+ early breast cancer in patients with residual invasive disease in the breast or axilla at surgery after receiving neoadjuvant therapy containing a taxane, the risk for recurrence of invasive breast cancer or death was 50% lower when patients were treated with adjuvant T-DM1 than with trastuzumab alone.16For patients with HER2+/HR+ early breast cancer, endocrine therapy is recommended in combination with trastuzumab and pertuzumab in both the adjuvant and post-neoadjuvant settings. Recommendations regarding the most appropriate type of endocrine therapy in the adjuvant setting depend on menopausal status; treatment may be recommended for up to 10 years. Patients with HER2+/HR+ early breast cancer with high recurrence risk may also consider extended adjuvant therapy with neratinib after completing adjuvant therapy containing trastuzumab.11 HER2-targeted combination therapies approved by the US Food and Drug Administration (FDA) for use in HER2+ breast cancer are listed in Table 1.17-19Managing Side Effects of Systemic TherapyBreast cancer systemic treatments may cause toxicities that can lead to both short-term and long-term side effects. Some of these side effects can be at least partly managed, and monitoring for chronic toxicities is recommended for patients at risk. For example, chemotherapy-related nausea can now be managed in many patients using antinausea drug regimens, and medications such as venlafaxine and gabapentin may help treat hot flashes associated with endocrine therapy.3Cardiotoxicity is a concern for patients treated with systemic therapies for HER2+ early breast cancer, as both chemotherapy and HER2-targeted therapies may cause cardiotoxicity and cardiac dysfunction.20 For this reason, treatment guidelines recommend post-treatment monitoring for cardiotoxicity for patients who receive left-sided radiation therapy, anthracyclines, and HER2-targeted therapy.11 However, in a prospective study investigating the safety of HER2-targeted therapies for patients with reduced cardiac function, 90% of patients completed their planned oncologic therapy without developing a cardiac event or displaying reduced left ventricular ejection fraction, supporting the concept that through cardiology and oncology collaboration, patients with HER2+ breast cancer can still receive optimal therapy while minimizing the risk for poor outcomes.21References1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates

PFAS and Cancer - Cancer Therapy Advisor

A consequence of these toxicities, immune checkpoint inhibitors are generally avoided in patients with pre-existing autoimmune disease or requiring chronic high-dose steroids.For patients with treatment-related hypothyroidism or adrenal insufficiency, replacement with levothyroxine and hydrocortisone plus fludrocortisone, respectively, is given and the immunotherapy is generally continued.4. First-line triple agent combination chemotherapy for patients with metastatic or unresectable bladder cancerFirst-line combination chemotherapy with three different chemotherapeutic agents is not superior to standard front line cisplatin plus gemcitabine for patients with metastatic or unresectable bladder cancer. The safety and efficacy of first-line triple agent combination systemic therapy with novel chemotherapeutic or targeted agents needs to be evaluated in well-designed prospective randomized clinical trials.5. Systemic chemotherapy for patients with metastatic or unresectable bladder cancer not eligible for cisplatin-based combination chemotherapyPatients with advanced bladder cancer with the following characteristics are not considered eligible for cisplatin-based combination chemotherapy:GFR less than 60 ml/min.Grade 2 or higher hearing loss.New York Heart Association heart failure class III or higher.Pre-existing moderate to severe or severe peripheral neuropathy.At the present time, there is no standard first-line chemotherapy regimen for patients with metastatic or unresectable bladder cancer and concomitant renal insufficiency (GFR A commonly prescribed front-line combination chemotherapy for patients with advanced bladder cancer and GFR of 30 to 60 ml/min includes:Carboplatin AUC 5 on day one plus gemcitabine 1000 mg/m2 on days one and eight every 21 days.A commonly prescribed front-line combination chemotherapy for patients with advanced bladder cancer and GFR less than mL/min includes:Paclitaxel 175 mg/m2 IV on day one plus gemcitabine 1000 mg/m2 on days one and eight every 21 days.6. Maintenance systemic chemotherapy for patients with advanced bladder cancerThe role of maintenance systemic therapy (chemotherapy or targeted therapy) after completion of first-line cisplatin-based combination chemotherapy is unknown. The safety and efficacy of maintenance systemic therapy for patients with. Cancer Therapy Advisor Contributing Writer Prostate Cancer Treatment (PDQ )–Health Professional Version. National Cancer Institute. Updated Febru. Cancer Therapy Advisor. Clinical Advisor. Clinical Pain Advisor

Vulvar Cancer - Cancer Therapy Advisor

Adverse effects, including cytopenias, gastrointestinal effects, and tumor lysis and cytokine release syndromes, are common in patients receiving most types of cancer therapy. Patients may also have adverse effects resulting from their cancer (eg, depression, pain). Successfully managing these adverse effects is important because it improves quality of life (see also Overview of Cancer Therapy).CytopeniasDecreased blood concentrations of red blood cells (RBCs), white blood cells (WBC), especially granulocytes, and platelets result from diverse systemic cancer therapies, especially conventional chemotherapy agents, and radiation therapy. Decreased levels of RBCs are common in patients with cancer. Decreases in RBCs result from a direct effect of the cancer (especially in blood and bone marrow cancers such as leukemias, lymphomas, and multiple myeloma) and from effects of cancer therapy, especially conventional cancer (chemotherapy) agents. Often anemia requires no therapy. Some patients, especially those with comorbidities such as arteriosclerotic cardiovascular disease, may benefit from RBC transfusions. Others may benefit from receiving recombinant erythropoietin, which can substitute for RBC transfusions. Some data suggest erythropoietin use can have adverse effects on cancer prognosis and is prothrombotic (1). Guidelines on RBC transfusion and erythropoietin use are available (2).A decrease in the platelet count is common in patients with cancer. Decreases in platelets result from a direct effect of the cancer (especially blood and bone marrow cancers such as leukemias, lymphomas, and multiple myeloma) and from effects of cancer therapy, especially conventional chemotherapy agents. The risk of bleeding is inversely proportional to the platelet count (see table Platelet Count and Bleeding Risk). Platelet concentrations 10,000/microL (10 × 109/L) are dangerous and require platelet transfusions. Molecularly cloned hormones, such as eltrombopag and avatrombopag, which stimulate megakaryocytes to produce platelets, have been used.Leukocyte depletion of transfused blood products may prevent alloimmunization to platelets and should be used in patients expected to need

AHCC and Cancer - Cancer Therapy Advisor

Tumor stage only considered the tumor size, nodal status, and metastasis, which was evaluated clinically or pathologically; however, with the most recent update, the staging system now includes anatomic staging with prognostic staging, using tumor grade, HRs and oncogene expression, and multigene testing.12 Although the NCCN guidelines provide treatment recommendations based on factors related to recurrence risk, they also stress the importance of shared decision making between patients and physicians after discussing the potential risks and benefits of different treatment options.11Treatment for HER2+ Early Breast CancerInitial TherapyIt is recommended that women with early HER2+ breast cancer receive neoadjuvant subtype-specific systemic therapy, followed by surgery.3 Paclitaxel plus trastuzumab, docetaxel/carboplatin/trastuzumab, or docetaxel/carboplatin/trastuzumab/pertuzumab are the preferred preoperative regimens listed in the NCCN guidelines for patients with HER2+ breast cancer. In some circumstances, different chemotherapy regimens may be useful or recommended, such as regimens including cyclophosphamide or doxorubicin. Treatment response during neoadjuvant therapy should be regularly evaluated by clinical examination and imaging studies.11Whether or not a patient achieves a pathological complete response (pCR) — defined as no cancer cells in a surgical specimen after treatment — to neoadjuvant systemic therapy can provide valuable prognostic information and can help direct therapy decisions after surgery.3 A recent literature analysis of recurrence in HER2+ early breast cancer found that achieving pCR was associated with a decreased risk for recurrence in all treatment settings.7 In the NeoSphere trial (ClinicalTrials.gov identifier: NCT00545688), patients with HER2+ breast cancer achieved pCR at a significantly higher rate when receiving a triplicate combination of docetaxel/trastuzumab/pertuzumab (45.8%) than they did with docetaxel/trastuzumab (29.0%), pertuzumab/trastuzumab (16.8%), or pertuzumab/docetaxel (15.8%), with a similar number of serious adverse events in each group.13Combination therapy with best pCR results in the NeoSphere trial FlipThe triplicate combination of docetaxel/trastuzumab/pertuzumab achieved significantly higher pCR in patients than did any other tested combination.Adjuvant and Post-Neoadjuvant TherapyPatients with HER2+ breast cancer with high recurrence risk should consider adjuvant systemic therapy, but the recommendations for which adjuvant therapy they should receive differ based on several factors,including HR-positive (HR+) status, node positivity, tumor size, risk for recurrence, and prior receipt of neoadjuvant therapy.11 In the APHINITY trial (ClinicalTrials.gov identifier: NCT01358877), patients with HER2+ early breast cancer who received adjuvant combination therapy with chemotherapy/trastuzumab/pertuzumab had significantly improved 3-year invasive-disease-free survival (iDFS) than those who received chemotherapy/trastuzumab/placebo.14 A follow-up study showed that patients who received pertuzumab also showed fewer iDFS events 6 years after randomization than those

Bladder Cancer - Cancer Therapy Advisor

K, Lyman GH, et al: Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 33(28):3199–3212, 2015. doi: 10.1200/JCO.2015.62.3488Gastrointestinal EffectsGastrointestinal adverse effects are common in patients with cancer. These effects may be caused by the cancer itself, cancer therapy, or both. Anorexia is common in patients with cancer and may be caused by the cancer directly or as a consequence of cancer therapy(ies). Loss of more than 10% of ideal body weight predicts an adverse prognosis. Efforts should be made to maintain reasonable nutrition. Sometimes parenteral nutrition (PN) is needed. Patients with surgical interruption of the gastrointestinal tract may need a feeding gastrostomy. Medications that may increase appetite include corticosteroids, megestrol acetate, androgenic steroids, and dronabinol. Whether these medications convincingly reduce anorexia, reverse weight loss, improve quality of life, or prolong survival is unclear. Anabolic steroids, such astestosterone, are contraindicated in patients with prostate or liver cancer.Constipation is common in patients with cancer and is often exacerbated by opioids used to treat pain. A stimulant laxative such as senna 2 tablets orally at bedtime (maximum 8 tablets/day) or bisacodyl 5 to 15 mg orally at bedtime should be initiated when repeated opioid use is anticipated. Established constipation can be treated with various medications (eg, bisacodyl 5 to 15 mg orally every 24 hours, milk of magnesia 15 to 30 mL orally at bedtime, lactulose 15 to 30 mL [10 to 20 g] every 12 to 24 hours, magnesium citrate 195 to 300 mL once every 24 hours). Enemas and suppositories should be avoided in patients with neutropenia or thrombocytopenia.Diarrhea is common after chemotherapy, targeted therapy, and radiation therapy, especially if the abdomen and/or pelvis is included in the radiation field. It is usually treated with loperamide 2 to 4 mg. Cancer Therapy Advisor Contributing Writer