Bernardo Rapoport, MD and Ronwyn Van Eeden MBChB, FCP(SA) of The Medical Oncology Centre of Rosebank, Johannesburg, South Africa discuss a side effect profile associated with checkpoint inhibitors. Doctors need to be aware of immune-related side effects, which are different than chemotherapy side effects like chemotherapy-induced nausea and vomiting (CINV). Sometimes symptoms can be vague, like fatigue or lethargy, but they may have a severe impact on patients. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016 Annual Meeting on Supportive Care in Cancer held in Adelaide, Australia.
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Roslyn Weetra, an Aboriginal Elder and cancer survivor, discusses her experience with cancer being a member of the Australian aboriginal community. She was diagnosed with non-Hodgkins lymphoma and required hospital treatment. At the beginning of her treatment she mentions not understanding what some of the medical jargon meant, as well as difficulty in understanding how the cancer was going to impact her. Referring to her aboriginal culture, cancer treatment, including chemicals and non-traditional healing remedies, was an uncomfortable scenario for her. Ms. Weetra also mentions there being a lack of information that she could access at mainstream hospitals. Jasmine Micklem,…
Bernardo Rapoport, MD and Ronwyn Van Eeden MBChB, FCP(SA) of The Medical Oncology Centre of Rosebank, Johannesburg, South Africa give a summary of immunotherapy messages from MASCC 2016. Dr Rapoport points out that immunotherapy is here to stay, however, even though it looks like it is less toxic than chemotherapy, if side effects are not managed correctly it could be fatal. Dr Van Eeden mentions that clinicians need to be aware of immune-related adverse events and should know how to manage them when treating patients with immunotherapy. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International…
Gordon Howarth, PhD of The University of Adelaide, Adelaide, Australia discusses mucositis with a focus on probiotics screening system. Mucositis is caused by chemotherapy or radiotherapy, as the same mechanism targets tumor and the lining of the mouth and the intestine. Mucositis is generally temporary, but the nerve damage can be permanent. Dr Howarth mentions that many of the plant extracts have got agents in them which can counteract the inflammation of the intestine. Some probiotic bacteria secret factors which inhibit mucositis development. A screening system is required to find the correct probiotics for this condition, followed by clinical trials…
Bernardo Rapoport, MD and Ronwyn Van Eeden MBChB, FCP(SA) of The Medical Oncology Centre of Rosebank, Johannesburg, South Africa talk about a correlation between a side effect occurrence and patient outcomes. One of the examples mentioned is vitiligo, as patients who develop this condition seem to respond better to the checkpoint inhibitor treatment. Dr Rapoport mentions that patients with colitis are among the long-term survivors, which Dr Rapoport compares to a therapeutic index, where certain level of toxicity is expected in order to have activity of a drug. Dr Van Ronwyn points out that toxicities need to be graded accordingly,…
Susan M. O’Brien, MD of University of California Irvine, gives an overview of Abstract 233: Five-Year Experience with Single-Agent Ibrutinib in Patients with Previously Untreated and Relapsed/Refractory Chronic Lymphocytic Leukemia/Small Lymphocytic Leukemia at the 58th Annual ASH Meeting in San Diego, CA.
Susan M. O’Brien, MD of University of California Irvine, gives an overview of Five-Year Experience with Single-Agent Ibrutinib in Patients with Previously Untreated and Relapsed/Refractory Chronic Lymphocytic Leukemia/Small Lymphocytic Leukemia at the 58th ASH Annual Meeting in San Diego, CA.
As part of our 2016 American Society of Hematology (ASH) annual meeting coverage, MPN experts Dr. Catriona Jamieson, Dr. John Mascarenhas, Dr. Stephen Oh and our own Andrew Schorr, gathered to discuss the latest updates on treatment and research for myeloproliferative neoplasms (MPNs). In this fruitful discussion, the experts shared their perspectives and optimism for the future, reviewed treatments in development and results from recent trials, the role of genetic testing, and advice for patients related to seeking the best care and therapy. Get email alerts | http://www.patientpower.info/alerts Subscribe on YouTube | http://www.youtube.com/patientpower Like on Facebook | http://www.fb.com/patientpower.info Follow on…
Doctors and Healthcare Professionals answer questions at the Press Briefing Q&A: Improved Outcomes in Leukemia, Trauma Settings with Personalized Medicine Approaches at the 58th ASH Annual Meeting in San Diego, CA.
Francois-Xavier Mahon, MD, PhD of University of Bordeaux, presents a press briefing on Cessation of Tyrosine Kinase Inhibitors Treatment in Chronic Myeloid Leukemia Patients with Deep Molecular Response: Results of the Euro-Ski Trial at the 58th ASH Annual Meeting in San Diego, CA.
Evi X. Stavrou, MD of Case Western Reserve University, presents a press briefing on Miniaturized Microfluidic Dielectric Sensor for Point-of-Care Assessment of Blood Coagulation at the 58th ASH Annual Meeting in San Diego, CA.
Mhairi Copland, BSc (Hons) MB ChB PhD FRCP FRCPath of the University of Glasgow, presents a press briefing of Chronic Myeloid Leukaemia Patients with Stable Molecular Responses (at least MR3) May Safely Decrease the Dose of Their Tyrosine Kinase Inhibitor: Data from the British Destiny Study at the 58th ASH Annual Meeting in San Diego, CA.
Harry P. Erba, MD, PhD of the University of Alabama at Birmingham School of Medicine, presents a press brief on A Phase 1b Study of Vadastuximab Talirine in Combination with 7+3 Induction Therapy for Patients with Newly Diagnosed Acute Myeloid Leukemia (AML) at the 58th ASH Annual Meeting in San Diego, CA.
Julie Jaffray, MD of Children’s Hospital Los Angeles, presents a press brief on Determining the Incidence and Risk Factors for Central Venous Catheter Related Thrombosis in Children at the 58th ASH Annual Meeting in San Diego, CA.
Mikkael Sekeres, MD, MS of Cleveland Clinic, introduces the press briefing to Improved Outcomes in Leukemia, Trauma Settings with Personalized Medicine Approaches at the 58th ASH Annual Meeting in San Diego, CA. This press briefing features studies showing new means of treating hematologic illnesses by tailoring medicines to patients specific disease characteristics.
Doctors and Healthcare Professionals answer questions at the Press Briefing Q&A: Developing Novel Therapies and Unique Delivery Methods to Improve Treatment for Bleeding Crises at the 58th ASH Annual Meeting in San Diego, CA.
Terry J. Fry, MD of National Cancer Institute, presents a press brief on Minimal Residual Disease Negative Complete Remissions Following Anti-CD22 Chimeric Antigen Receptor (CAR) in Children and Young Adults with Relapsed/Refractory Acute Lymphoblastic Leukemia (ALL) at the 58th ASH Annual Meeting in San Diego, CA.
Katherine A. High, MD of Spark Therapeutics, presents a press briefing on Spk-9001: Adeno-Associated Virus Mediated Gene Transfer for Hemophilia B Achieves Sustained Mean Factor IX Activity Levels of >30% without Immunosuppression at the 58th ASH Annual Meeting in San Diego, CA.
Allan Doctor, MD of Washington University School of Medicine in St. Louis, presents Erythromer (EM), a Nanoscale Bio-Synthetic Artificial Red Cell: Proof of Concept and In Vivo Efficacy Results at the 58th ASH Annual Meeting in San Diego, CA.
Caroline E. Hansen, BS of Georgia Institute of Technology presents Leveraging the Contractile Force of Platelets for Targeted Factor VIII Delivery in Hemophilia with Inhibitors at the 58th ASH Annual Meeting in San Diego, CA.
Jeffrey E. Lancet, MD of Moffitt Cancer Center presents Survival Following Allogeneic Hematopoietic Cell Transplantation in Older High-Risk Acute Myeloid Leukemia Patients Initially Treated with CPX-351 Liposome Injection Versus Standard Cytarabine and Daunorubicin: Subgroup Analysis of a Large Phase III Trial at the 58th ASH Annual Meeting in San Diego, CA.
Dr. Armand Keating, MD, FRCP(C), Director, Cell Therapy Program and Philip S. Orsino Facility for Cell Therapy, Princess Margaret Hospital/Ontario Cancer Institute, introduces the 58th ASH Annual Meeting Press Briefing in San Diego, CA. Research to be presented introduces new therapies and methods, concluding that gene therapy and emerging drug delivery methods hold promise for patients with various forms of blood diseases.
Stephen Sonis, DMD, DMSc of Brigham and Women’s Hospital, Boston, MA discusses cancer supportive care and its importance for cancer prognosis in the future. Incidence of cancer is going to increase significantly in the next 25 years, but prof Sonis points out that survivability is going to increase too, although that depends largely on patients location. In developed countries the gap between survivability and mortality is getting better, which means that supportive care deals not only with acute toxicities, but also with toxicities which continue through survivorship. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International…
Phyllis Butow, BA (Hons), Dip Ed, MClinPsych, MPH, PhD of The University of Sydney, Sydney, Australia talks about a family involvement in patient-doctor communication. Family members are very important parts of consultations. However, family members bring their own agendas and issues. Some may have conflicting views leading to challenges for doctors in terms of managing a large family group and reaching a mutual agreement on a way forward. E-communications can be helpful in terms of training the doctors to deliver that sort of care effectively. Modelling is used frequently to demonstrate difficult situations and some different ways of approaching a…
Michael Brown, MBBS, FRACP, FRCPA of Royal Adelaide Hospital, Adelaide, Australia discusses side effects associated with immune checkpoint inhibitors. For anti-CLTA-4 therapies the side effects are more severe and include colitis, which can be resolved with immunosuppression. The anti-PD-1 antibodies are milder in their toxicity range, but serious side effects can occur, including pneumonitis. A combination of checkpoint inhibitors may have greater efficacy, but this comes at a price of a higher toxicity. Prof Brown points out that there is no data indicating that management of side effects with immunosuppression impairs treatment efficacy. Supportive care plays an important role in…
Mette Marcussen, DDS, PhD of Aalborg University Hospital, Aalborg, Denmark discusses studies focused on identification of mucositis biomarkers. Biopsies from patients treated with melphalan, one of the most toxic chemotherapy drugs, were analyzed at three different time points: before, after, and during melphalan treatment. A gene expression analysis confirmed results from the animal studies, highlighting the role of immunoregulatory and DNA damage genes. Only two genes were differently expressed in patients with mild and severe mucositis. Interestingly, two variants of a gene expressed on the surface of dendritic cells in the mucosa showed different expression patterns, which could be a…
Matthew Ciorba, MD of Washington University School of Medicine in St. Louis, St. Louis, MO discusses mucositis prevention using probiotics. A phase 1 clinical trial focused on safety of probiotics in cancer patients uses Lactobacillus bacterial strain, which was shown to be effective in mucositis prevention in animal models. Dr Ciorba describes freeze-dried pills containing bacteria, which is a preferred option of probiotic delivery to the gut, as the purity and potency is more certain compared to a yogurt based product. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016…
Jean Klastersky, MD, PhD of Institut Jules Bordet, Brussels, Belgium talks about the severity of side effects associated with immune checkpoint inhibitors. The side effects are relatively common, but they are rarely severe. However, Prof Klastersky points out that in some cases they may be life threatening, which requires fast detection and treatment. This is a difficult task for clinicians, as there are no biomarkers, which can predict the severity of complications. Corticosteroids are used to counteract the side effects, followed by more potent immunosuppressants. Depending on the situation the checkpoint inhibitor treatment may be discontinued. Combining two different classes…
Ian Hewson, BDSc, FICD, FADI, FPFA of Alfred Hospital, Melbourne, Australia talks about his treatment journey after being diagnosed with low grade follicular lymphoma (FL). Side effects from 6 cycles of CHOP treatment included peripheral neuropathy and overall feeling of being unwell. Dr Hewson mentions that sometimes it is better not to treat until disease progression, as treatments are associated with side effects like losing hair. A discussion with a clinician about wait and watch is recommended to address any doubts. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016…
Gordon Howarth, PhD of The University of Adelaide, Adelaide, Australia talks about probiotics and the way they are perceived. Unlike antibiotics which are widely used and recognised by the medical community, probiotics do not have the same recognition. Generally probiotics are harmless, with their mechanism of action changing from organism to organism. Dr Howarth highlights Streptococcus thermophilus TH-4, which secrets folic acid and could be used to ameliorate damage done by methotrexate, a chemotherapy drug. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016 Annual Meeting on Supportive Care in…
David Currow, BMed, PhD, MPH, FRACP, FAChPM, FAHMS, GAICD of Flinders University, Adelaide, Australia, discusses delirium in cancer patients. Patients, who are acutely unwell are at a much higher risk of being acutely confused. This is observed more frequently late in life, however, all patients being treated for cancer or living with the disease are at a greater risk than the population at large. A high index of suspicion is needed when peoples cognition changes. The majority of patients experience a hyperactive delirium, but hypoactive delirium can also occur. Vivid recollections of delirium, including hallucinations are common. Dr Currow highlights…
Bernardo Rapoport, MD and Ronwyn Van Eeden MBChB, FCP(SA) of The Medical Oncology Centre of Rosebank, Johannesburg, South Africa discuss how to manage immune-related toxicities associated with checkpoint inhibitors. Skin toxicity is a common side effect, which can be quite debilitating and affecting patients quality of life. Colitis symptoms can be very severe and should be treated promptly with corticosteroids or infliximab to avoid morbidity and mortality. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016 Annual Meeting on Supportive Care in Cancer held in Adelaide, Australia.
Rachel Gibson, PhD of University of South Australia, Adelaide, Australia, discusses the role of gut microbiome in causing diarrhea in chemotherapy-treated patients. Dr. Gibson mentions recruiting a number of patients who had been hospitalized due to their chemotherapy-induced diarrhea, taking a stool sample for the investigation. Analyzing these results, Dr. Gibson mentions that results showed a clear differentiation between the commensal and pathogenic bacteria, as patients displayed huge numbers of pathogenic bacteria. This suggests chemotherapy was altering the gut microbiome. She then highlights how this will allow for targeting of specific treatments and investigations to look into the gut microbiome.…
Phyllis Butow, BA (Hons), Dip Ed, MClinPsych, MPH, PhD of The University of Sydney, Sydney, Australia discusses teaching communication skills online. She mentions one of the issues being how communication skills is taught, this is because the best way of teaching communication skills is face-to-face, getting feedback in a safe environment where different strategies can be attempted. However, this is not very cost effective and it is difficult to get people together. Dr. Butow mentions the need to replicate online what can be done in person. Strategies that have already been applied include: showing people videos of communication and getting…
Matthew Ciorba, MD of Washington University School of Medicine in St. Louis, St. Louis, MO discusses how microbes can modify response to cancer therapy. Many patients receive both radiation and chemotherapy, or at radiosensitizing chemotherapy in case of gastrointestinal cancer. Mucositis is one of the significant side effects which can result in symptoms like diarrhea, nausea, vomiting, and anemia. New therapies are needed to help prevent mucositis. Historical data suggest that the intestinal microbiome can modify the guts response to radiation injury. Dr Ciorba mentions studies focused on the use of probiotics and points out that not all probiotics are…
Jean Klastersky, MD, PhD of Institut Jules Bordet, Brussels, Belgium gives an overview of a session focused on geriatric assessment. Supportive care or palliative care consultation is focused primarily on symptom management and coping strategies. Geriatric assessment has a broader spectrum, looking at the cancer within other health problems, nutritional and functional needs. Sometimes cancer is not the main problem for the patient and the symptoms experienced may be due to another condition. Doctors should look beyond cancer and do a correct geriatric screening in order to individualise the plan of care. Recorded at the Multinational Association of Supportive Care…
Jean Klastersky, MD, PhD of Institut Jules Bordet, Brussels, Belgium discusses adverse effects associated with immune checkpoint inhibitors. Prof Klastersky points out that adverse effects in this field are different than the adverse effects observed in classical chemotherapy, which means new challenges for cancer supportive care. Fatigue and nausea are the most common adverse effects observed. In addition, there are other complications, like colitis, pneumonitis, eye and dermatological conditions. No link between likelihood of response and the appearance of side effects has to be established so far. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International…
Ian Hewson, BDSc, FICD, FADI, FPFA of Alfred Hospital, Melbourne, Australia discusses his experiences after being diagnosed with low grade follicular lymphoma (FL). FL can be controlled by chemotherapy, but it is probably not curable at this stage. One of the treatments is to not treat and dr Hewson and his doctor decided to wait and watch. The FL started progressing after 3 years. Having knowledge of the disease progression was useful to help manage expectations. Dr Hewson assessed his working commitments and retired from one of the hospitals, which made his working life more manageable. Recorded at the Multinational…
Gordon Howarth, PhD of The University of Adelaide, Adelaide, Australia discusses complementary therapies for patients with mucositis. The role of researchers is to move towards a more robust characterisation of complementary medicines. A whole range of plant extracts, animal extracts, and Chinese traditional medicines have been tried clinically. A starting material and results of these studies have been variable, so another approach is required. Dr Howarth suggests looking at clinical efficacy in animal models and in vitro systems first, followed by human studies for selected medicines, which meet rigorous criteria. Recorded at the Multinational Association of Supportive Care in Cancer…
Giovanni Rosti, MD of Ospedale Generale, Treviso, Italy highlights key discussion points from MASCC 2016. New drugs help to reduce vomiting, but patients still experience nausea. Two things are needed to address this problem. First, a way to measure nausea in a dynamic way. Second, new drugs to treat nausea. Dr Rosti mentions that medical oncologists should have a broader view and aim to help patients experiencing side effects like pain. There is a need to abolish the barriers, e.g. a lack of opioid treatment in some countries, and increase the understanding of supportive care treatments, which to patients are…
David Currow, BMed, PhD, MPH, FRACP, FAChPM, FAHMS, GAICD of Flinders University, Adelaide, Australia, discusses chronic breathlessness in cancer patients. Breathlessness is a major problem for people affected by cancer, which can be a result of the disease, comorbidities, or getting weak from cachexia. Dr Currow mentions the importance of stepwise progression: treating the treatable, then moving to the non-pharmacological support and finally to low-dose regular extended-release morphine. Breathlessness is incredibly debilitating and leads to further deconditioning. Dr Currow highlights the symposium data showing the importance of reversing the reversible causes. Recorded at the Multinational Association of Supportive Care in…
Bernardo Rapoport, MD and Ronwyn Van Eeden MBChB, FCP(SA) of The Medical Oncology Centre of Rosebank, Johannesburg, South Africa discuss immune-related side effects associated with checkpoint inhibitors. Dr Rapoport says that checkpoint inhibitors have been a major breakthrough in the management of malignant melanoma and non-small cell lung cancer. New checkpoint inhibitors are used to treat triple-negative breast cancer, blood cancer, ovarian and gastric cancer. Dr Van Eededn mentions that it is a new therapy with a different mechanism of action and side effect profile than chemotherapy or targeted therapies. Dr Rapoport and dr Van Eeden talk about anti-CLTA-4 and…
Alex Molassiotis, RN, MSc, PhD of The Hong Kong Polytechnic University, Hong Kong, discusses personalized treatments for nausea and vomiting. Nausea and vomiting is a multifactorial problem and it is not always clear which factors are involved, therefore patients need to be evaluated in order to identify the risk. A following prescription of antiemetics based on that risk is then required, beyond just the antiemetics that are directly linked to managing chemotherapy related problems. Dr. Molassiotis provides a hypothetical example of a personalized treatment for nausea. He mentions that if the patient is young, very anxious and with a past…
Patient Power Founder Andrew Schorr and MPN world expert Dr. Srdan Verstovsek of the University of Texas MD Anderson Cancer Center discuss team efforts between specialists and community doctors around the world. Dr. Verstovsek explains the important role that community doctors play in cancer care and how he works with patients and their local doctors to provide guidance, help with management, and keep them informed. Get email alerts | http://www.patientpower.info/alerts Subscribe on YouTube | http://www.youtube.com/patientpower Like on Facebook | http://www.fb.com/patientpower.info Follow on Twitter | http://www.twitter.com/patientpower Follow on Google+ | http://www.google.com/+patientpowerinfo
In this Ask the Expert segment, Dr. Ruben Mesa from Mayo Clinic responds to a Patient Power community member’s question about the connection between hypertension and essential thrombocythemia (ET). Dr. Mesa provides advice on how closely blood pressure should be monitored for someone with ET. Get email alerts | http://www.patientpower.info/alerts Subscribe on YouTube | http://www.youtube.com/patientpower Like on Facebook | http://www.fb.com/patientpower.info Follow on Twitter | http://www.twitter.com/patientpower Follow on Google+ | http://www.google.com/+patientpowerinfo
Afaf Girgis, PhD, of the University of New South Wales, Sydney, Australia, discusses the importance of psycho-oncology at the 2016 National Cancer Research Institute (NCRI) Conference in Liverpool, UK. Prof. Girgis explains that psycho-oncology is such a growing field at the moment and it is now well accepted that the psycho-social impact of cancer is just as important to assess as the physical impact of cancer. She goes on to say that if we are able to assess and understand that and actually address it, patients can be helped to complete their cancer treatment and cope with their cancer journey…
Robert Coleman, MBBS, MD, FRCP, FRCPE of Sheffield Cancer Research, University of Sheffield, UK gives an overview of a debate discussing new drug development vs repurposing existing drugs. Dr Coleman points out that the drug development process is no longer fit for purpose, with new drugs being too expensive to afford. The way to proceed could be to repurpose existing drugs, based on the available evidence and new clinical trials. The opposite view focuses on progress, innovation, and optimism, as without drug discovery there would be no drugs to repurpose. Dr Coleman finishes by saying that a mixture of both…
Lieping Chen, MD, PhD of Yale School of Medicine, New Haven, CT discusses two approaches to cancer immunotherapy. Immune system activation approach aims to push the immune system to the limit, but this may result in toxicities before treatment efficacy is reached. The alternative approach, as shown in the PD-1/PD-L1 study, is to regulate the immune system response to the normal level, which offers lower toxicity levels compared to other treatments like chemotherapy. Recorded at the 2016 National Cancer Research Institute (NCRI) Conference in Liverpool, UK.
Corinne Faivre-Finn, FRCR, MD, PhD of University of Manchester and the Christie NHS Foundation Trust, UK discusses key messages from the small-cell lung cancer (SCLC) session. Experts, who participated in the session talked about a lack of progress with systemic therapy, targeted agents, and chemotherapy. However, as Dr Faivre-Finn points out, a lot of progress has been made in SCLC with radiotherapy treatments due to better integration of radiotherapy and systemic therapy. Results of the CONVERT trial show better survival and less toxicity. Moreover, there is evidence that prophylactic cranial irradiation improves survival, with recent data from a European trial…