Author: Editor

Charles Loprinzi, MD of Mayo Clinic, Rochester, MN gives an overview of neuropathy risk factors and discusses new data showing promise for neuropathy reduction. The risk factors include patients genetic makeup, chemotherapy drugs used, diabetes, or increased body mass index. Patient with diabetes get more trouble with neuropathy particularly when treated with paclitaxel, oxaliplatin showing mixed data. If a patient has significant neuropathy to start with, it has to be put into perspective. The treatment should be stopped and rethought, with an option to switch to another therapy. New data show that exercise may decrease neuropathy, but further research is…

Merran Findlay, AdvAPD of The University of Sydney, Sydney, Australia, explains that a diagnosis of head and neck cancer typically has a high risk of malnutrition, which may be experienced throughout treatment, even if not experienced in the earlier stages of the disease. This has a lot to do with the site of the disease and the types of treatment, such as surgery, chemotherapy, and radiation, which can have a big impact on a patients ability to eat and drink as they would normally. Feeding tubes, often temporary, may be required; however, being well nourished enables patients to get through…

Gregory Crawford, MBBS, MPHC, MD, FRACGP, FAChPM of The University of Adelaide, Adelaide, Australia discusses the importance of understanding patients needs. Curing disease is only one of the aspects of medicine. Healthcare professionals need to meet patients needs as well. The challenge for doctors is to have a good knowledge of medicine, but also good communication skills to understand patients issues. Patients facing end of life decisions may have different priorities regarding treatment and care than patients with a less advanced disease. The subject of death is difficult to talk about, for both patients and doctors. The default position is…

Merran Findlay, AdvAPD of The University of Sydney, Sydney, Australia, discusses patient care and access to specialist dietitians. Specialist dietitians work as part of a multidisciplinary team, working closely with the nurses, doctors and speech pathologists, forming a core part of patient care. There is high-quality evidence that patients require access to a specialist dietitian earlier on, both prior and during treatment, during radiation, and then fortnightly post-treatment, for as long as required until the nutrition status of the patient is maintained. There are a range of options available, ranging from oral nutrition support, to high protein/high energy strategies that…

Jervoise Andreyev, MA, PhD, FRCP of The Royal Marsden NHS Foundation Trust, London, United Kingdom discusses the need for a multidisciplinary team approach to cancer care. Specialists from various fields like neuropathy, pain management, or dietetics need to work together to give patients the best possible care. Dr Andreyev highlights the importance of building links with other experts, who could help with treatment decisions when necessary. Data show that between 5-40% of the multidisciplinary team (MTD) decisions are changed by having the right person in the group. Dr Andreyev recommends a similar approach to MTD decision making for side effects…

Merran Findlay, AdvAPD of The University of Sydney, Sydney, Australia, discusses clinical guidelines and available literature on patient care from stages of pre-treatment to follow-up oncological care. She provides an insight into the clinical practice guidelines published onto a platform, which provides a thorough overview into appropriate access to care, nutrition quality and care, evaluation and monitoring. This looks into what patients should have available to them, from pre-treatment and primary oncological treatment, to follow-up oncological care; whether it concerns palliative care or survivorship issues.Typically patients need early nutrition intervention, especially with head and neck cancer, so patients should be…

James Larkin, MD, PhD, of the Royal Marsden NHS Foundation Trust, London, UK, discusses the highlights in melanoma from the 2016 Annual Meeting of the American Society of Oncology (ASCO), held in Chicago, IL. First, Dr Larkin highlights that data for the treatment of uveal melanoma with immunotherapy and in particular the newer immune checkpoint inhibitors, is now available. The data has shown that the drugs do not work as well in cases of uveal melanoma as they do in skin melanoma and cases of mucosal melanoma. Results show that patients with uveal melanoma who are treated with these drug…

James Larkin, MD, PhD, of the Royal Marsden NHS Foundation Trust, London, UK, discusses aggressive melanoma, which he considers to be one of the key areas in the field. One of the problems that patients have come across with trials is that it usually takes 2-3 weeks to start the program since patients require up-to-date scans etc. However, Dr Larkin points out, such patients cannot wait this long to start treatments, but in order to collect sufficient data to advance the study, the reality is that it is unlikely for every patient to go onto a clinical trial. Recorded at…

Sharon Liberali, BDS (Adel), DClinDent (FICD, FPFA, FRACDS) of Adelaide Dental Hospital, Adelaide, Australia, discusses the role of dentist in treatment stages leading up to allogeneic stem cell transplantation. Dentists focus on identifying the risks of odontogenic-related infections that may potentially cause a febrile illness during the course of the chemotherapy. In the longer term, post-transplant dentists can identify issues around risk for patients, including risks around graft-versus-host disease (GVHD), dental decay and risks around new malignancies in the soft tissues of the mouth and the lips. It is very important patients receive a comprehensive clinical and radiographic dental examination…

Sharon Liberali, BDS (Adel), DClinDent (FICD, FPFA, FRACDS) of Adelaide Dental Hospital, Adelaide, Australia, emphasizes the importance of the treatment planning process for the dentist, in order for them to analyze and project which teeth are at risk of osteonecrosis of the jaw (ONJ). Bisphosphonates have a strong affinity for the bone, even if patients have stopped taking the medication for quite some time. The bone remembers these drugs in the system, therefore the risk of ONJ is almost lifelong for these patients. Dr. Liberali mentions that dentists have a clinical responsibility for a soft tissue examination, as well as…

Gregory Crawford, MBBS, MPHC, MD, FRACGP, FAChPM of The University of Adelaide, Adelaide, Australia discusses a session organised by the Palliative Care Work Group, looking at end of life issues, e.g. what is a good death. A push for advanced care directives across the world helps people with end of life decisions. What doctors think their patients want can be quite different from what people themselves want. Being comfortable, having the right people around, and symptoms control are often mentioned by patients who are looking at the end of their life. Recorded at the Multinational Association of Supportive Care in…

James Larkin, MD, PhD, of the Royal Marsden NHS Foundation Trust, London, UK, discusses the session Clinical problems in oncology that he was involved in at the 2016 Annual Meeting of the American Society of Oncology (ASCO), held in Chicago, IL. He believes that this session provided a good opportunity to discuss some of the problems faced in the day-to-day practice. Clinical trials have not been able to provide excessive insights into how to deal with such problems that may arise with patients, such as dealing with patients with brain metastases, who are often excluded from clinical trials. This is…

Karen Mustian, PhD, MPH, ACSM of the University of Rochester Medical Center, Rochester, New York, NY gives a brief overview of cachexia, which is a condition where patients lose over 10% of their muscle mass and/or fat mass. It puts patients at high risk for treatment dose reductions and is associated with a poor prognosis and a functional decline. It is also very closely associated with severe fatigue. Dr. Mustian proceeds to describe that more recently, there have been studies suggesting the use of exercise to treat fatigue and cachexia. It is therefore essential for doctors to realize that it…

James Larkin, MD, PhD, of the Royal Marsden NHS Foundation Trust, London, UK, explains the treatment options available for patients with stage III melanoma, which means that the disease has been cured with surgery but there is a risk of it coming back. According to Dr Larkin, treatment options are limited and usually participation in clinical trials is the recommended option for such patients. Last year, there was a trial comparing nivolumab and ipilimumab (IPI), and now there is a trial involving the use of pembrolizumab (PEMBRO) as a treatment option. For patients with stage III melanoma that cannot be…

Thomas Powles, MD, PhD from Barts Cancer Institute, London, UK discusses the BISCAY clinical trial in bladder cancer (NCT02546661). The trial looks at a group of patients with bladder cancer and next-generation sequencing (NGS) was performed on their tumor samples looking for specific mutations. The treatment will then be based on the patients’ mutations; for example if patient have an FGFR3 mutations, they will receive an FGFR3 inhibitior plus immunotherapy (durvalumab). Prof. Powles anticipates that high response rates will be seen in patients with specific mutations, who are receiving targeted therapy. Recorded at the American Society of Oncology (ASCO) 2016…

Martin Reck, MD, PhD of the LungenClinic Grosshansdorf, Grosshansdorf, Germany, highlights the importance of the randomized Phase III JAVELIN Lung 100 trial in non-small-cell lung cancer (NSCLC) (NCT02576574). This trial is investigating the new immune checkpoint inhibitor, the programmed death-1 receptor ligand (PD-L1), avelumab, compared to platinum-based chemotherapy in patients with metastatic or recurrent PD-L1-positive NSCLC who have never been treated before. This is an on-going trial and results are expected in early 2017. Finally, he mentions that the primary endpoint is progression-free survival (PFS) and further, they will look at overall survival (OS), tumor response and tolerability, which is…

James Larkin, MD, PhD, of the Royal Marsden NHS Foundation Trust, London, UK, discusses the upcoming Melanoma Patient Conference in June 2016. He believes that it is a very positive event, and patients are already very involved in discussions about their own care, highlighting that he has noticed that within the last 5-10 years, patients have become increasingly aware of the clinical trials that are happening all around the UK and have even asked to be referred. He believes the enthusiasm and knowledge within the community exists even more now, and when it comes to discussing treatment options, it is…

Eleni Efstathiou, MD, PhD of the University of Texas MD Anderson Cancer Center, Houston, Texas, TX, provides an overview of the Phase II trial of leuprolide acetate (LHRHa) and abiraterone acetate with or without ENZA (neoadjuvant enzalutamide) in high-risk prostate cancer (NCT01946165). Dr Efstathiou explains that the trial should not be considered as an independent trial, but as one in a series of companion trials. She explains that novel agents that are available from the more advanced disease settings, to explore what may be happening at a tumor micro-environment level, and treating patients and sampling their cancers. This was done…

Anas Younes, MD of Memorial Sloan Kettering Cancer Center, New York, NY talks about how social media can give you an overview of the medical field as journals, doctors, nurses and researchers use it frequently. Prof. Younes goes into further detail and explains the benefits of participating in social media discussions. Recorded at the American Society of Clinical Oncology (ASCO) 2016 Annual Meeting, in Chicago, IL.

Anas Younes, MD of Memorial Sloan Kettering Cancer Center, New York, NY talks about the iwNHL 2016 meeting that will occur between 2325 September in San Diego, CA. This invitation-only meeting will bring together the top thought leaders in the field of lymphoma. This year the meeting will focus on different types of lymphoma (large cell, mantle cell and T-cell lymphomas), but also areas such as immunotherapy and the updated Response Evaluation Criteria in Solid Tumours (RECIST), that will harmonize lymphoma response criteria using unidimensional measurements.

Karen Mustian, PhD, MPH, ACSM of the University of Rochester Medical Center, Rochester, New York, NY, discusses various fatigue dimensions and treatments, highlighting the difference between treatment for mental and physical fatigue. For mental fatigue both aerobic and anaerobic activity could be prescribed for patients. It would be suggested to the patient to do 10 minutes a day, most days of the week (3-5 days a week) in order to see a change in the mental fatigue. However, Dr Mustian highlights that the prescription would be different for physical fatigue. The data and evidence suggest that patients need to do…

Sharon Liberali, BDS (Adel), DClinDent (FICD, FPFA, FRACDS) of Adelaide Dental Hospital, Adelaide, Australia, emphasises the importance of dentists during multiple myeloma (MM) patients preparation for autologous stem cell transplantation. Dr. Liberali explains that patients treated with bisphosphonates are at significant risk of osteonecrosis of the jaw, (ONJ), with the risk increasing particularly around dental extractions. She mentions the importance of examining patients before they start bisphosphonate treatment, in order to provide any necessary dental extractions. Dr. Liberali also notes that in many cases, patients may not have visited the dentist for a very long time and may have several…

Charles Loprinzi, MD from Mayo Clinic, Rochester, MN discusses neurotoxicities caused by a chemotherapy treatment. Numbness, tingling, shooting, and burning pain can come with the chemotherapy and last long after the treatment is completed. The exact cause is unknown, with chemotherapy drugs affecting the nerves in different ways, e.g. causing loss of nerves at the end of the fingertips and toes. The neurotoxicity is often reversible to some degree, with some patients experiencing debilitating problems for months, or years. The two most common drugs causing neurotoxicity are paclitaxel and oxaliplatin. The pain tends to get better after a paclitaxel therapy…

Karen Mustian, PhD, MPH, ACSM of the University of Rochester Medical Center, Rochester, New York, NY, discusses advantages of using yoga as part of an exercise routine. Dr Mustians clinical trial showed yogas efficacy in improving sleep quality, insomnia, fatigue, and quality of life. In addition, Dr Mustians studies showed an improvement in regulation of patients circadian rhythm. Disruption in circardian rhythm is associated with disruptions in immune responses and inflammation, as well as sleep. Yoga helps to regulate the cancer survivors circadian rhythm, leading to improvements in sleep quality, insomnia, and fatigue. Recorded at the Multinational Association of Supportive…

Karen Mustian, PhD, MPH, ACSM of the University of Rochester Medical Center, Rochester, New York, NY, discusses the importance of exercise in treating cancer-related fatigue. Dr Mustian presented a talk where she summarized the data from 113 randomized clinical trials that were conducted by investigators from around the world. Aerobic (i.e. walking, cycling and swimming) and anaerobic exercises (such as resistance bands and weight training), either on its own, or in combination, help with a patients fatigue. The data suggests that exercise interventions actually produce larger improvements in fatigue and a more significant improvement than what pharmaceuticals have to offer.…

Mark Schubert, DDS, MSD of Seattle Care Alliance, Seattle, WA provides an overview of his journey through plasmacytoma treatment. With symptoms beginning in 2007, he mentions experiencing fatigue, peripheral neuropathies and weight loss, before officially being diagnosed with plasmacytoma in his left ilium. He then provides a brief overview of the various forms of treatment received: 5 courses of radiation, a treatment with lenalidomide and dexamethasone for a number of years, a switch to bortezomib and dexamethasone and then preceded to an autologous transplant in March 2014. Following that process, he was maintained with bortezomib and is now taking ixazomib.…

Rachel Gibson, PhD of University of South Australia, Adelaide, Australia highlights the 25th anniversary of MASCC in Adelaide, Australia. MASCC organisation has dedicated 25 years working on many approaches to improve supportive care resulting in positive advances for cancer patients. Dr. Gibsons key message emphasizes supportive care as the absolute cornerstone of a patients journey. There is now a wealth of understanding behind the specific side effects of cancer treatment, therefore allowing supportive care to discover ways to support and treat patients experiencing treatment related side effects. Dr. Gibson highlights the importance of patients being aware that supportive care is…

Mark Schubert, DDS, MSD of Seattle Care Alliance Seattle, WA discusses what he as a dental clinician has learnt through his own experience of cancer care treatment, with the aim to translate this knowledge to other patients and hopefully improve their patient care. Dr. Schubert mentions the noticeable change in patients reaction after discovering that he shares the same experience of cancer care as a patient, a closer relationship is built alongside reducing anxiety, as patients feel he can relate to them. Dr. Schubert mentions having the ability to provide his patients with information on a more personal level, for…

Dr. Luke Peppone of University of Rochester Medical Center, Rochester, NY discusses results from a preliminary study measuring omega 3 versus omega 6 supplementation for fatigue among breast cancer survivors (NCT02352779). The study took patients with a fatigue level of 4 out of a 0-10 scale. Patients were randomized into one of three groups and were either given a high dose of omega 3 supplement (sourced from fish oil), a high dose of omega 6 supplement (sourced from soybean oil), or a combination of a low dose of both omega 3 and 6. Results show that those with a high…

Rachel Gibson, PhD of University of South Australia, Adelaide, Australia explores the links between chemotherapy induced toxicities that would normally be treated in isolation. With chemotherapy induced diarrhea, many patients are experiencing significant pain. Dr. Gibson mentions studies which have explored this further in the brain, in the case of chemotherapy induced neuropathy. Results from studies show that pathogenic bacteria responsible for producing LPS are also found in the spinal cord. Therefore, there is hope to show that in the spinal cord there are two linked toxicities. This would be the first time showing clear mechanistic links between toxicities and…

In this Ask the Expert segment, Dr. Gareth Morgan of UAMS Myeloma Institute answers a question from Patient Power viewer, Rick, about taking a break from treatment. Rick would like to temporarily stop treatment with Kyprolis (carfilzomib) and wants to know if this will reduce the effectiveness of the medication. Dr. Morgans response is directed toward patient quality of life. 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 presentation from the ESMO 18th World Congress on Gastrointestinal Cancer, Dr. Bertram Wiedenmann discusses the clinician’s contribution to the approach for gastric neuroendocrine tumors (NET).

In this presentation from the ESMO 18th World Congress on Gastrointestinal Cancer, Dr. Christophe Deroose discusses the contribution of isotopic scanning to the imaging of neuroendocrine tumors (NET).

In this presentation from the ESMO 18th World Congress on Gastrointestinal Cancer, Dr. Timm Denecke discusses the contribution of CT and MRI to the imaging of neuroendocrine tumors (NET).

In this presentation from the ESMO 18th World Congress on Gastrointestinal Cancer, Dr. Florian Lordick discusses new agents on the horizon in gastric cancer.

In this presentation from the ESMO 18th World Congress on Gastrointestinal Cancer, Dr. Andrés Cervantes discusses the impact of targeting HER2 and angiogenesis in gastric cancer.

In this presentation from the ESMO 18th World Congress on Gastrointestinal Cancer, Dr. William H. Allum provides the surgeon’s perspective on neo-adjuvant/adjuvant treatment in gastric cancer.

In this presentation from the ESMO 18th World Congress on Gastrointestinal Cancer, Dr. March Ychou provides the EU perspective on neo-adjuvant/adjuvant treatment in gastric cancer.

In this Keynote Lecture, Dr. Adam Bass examines the taxonomy in gastric cancer.

In this presentation from the ESMO 18th World Congress on Gastrointestinal Cancer, Dr. Fátima Carneiro discusses the pathologist’s perspective on gastric carcinogenesis of gastric cancer.

In this presentation from the ESMO 18th World Congress on Gastrointestinal Cancer, Dr. David H. Ilson examines which is the most optimum perioperative treatment in esophageal cancer.

Thomas Powles, MD, PhD from Barts Cancer Institute, London, UK discusses key points of a new Phase III clinical trial looking at moving immune single agent and immune combination therapy into the frontline setting in bladder cancer (NCT02516241). The trial has three arms: chemotherapy vs. single agent durvalumab vs. a combination of durvalumab and tremelimumab. The hope is that chemotherapy can be replaced. Recorded at the American Society of Oncology (ASCO) 2016 Annual Meeting held in Chicago, IL.

Sumanta Pal, MD of City of Hope, Duarte, CA, discusses the introduction of new data of the new single-agent cabozantinib for advanced renal cell carcinoma. The agent is a dual MET and VEGFR2 inhibitor, and has been assessed in metastatic renal cell carcinoma and other diseases. Dr Pal highlights his involvement in the Phase I trials of cabozantinibs development in renal cell carcinoma, where impressive responses were observed. He proceeds to highlight that most recently, cabozantinib was used in a Phase III METEOR trial comparing it to the agent everolimus (NCT01865747). This study identified an improvement in response rate, overall…

Press brief by Philip Mack, PhD of the UC Davis Comprehensive Cancer Center, Sacramento, CA, at the 2016 Annual Meeting of the American Society of Clinical Oncology (ASCO), held in Chicago, IL.

Paolo Ascierto, MD, of the National Tumor Institute Fondazione G. Pascale, Naples, Italy, discusses the safety of nivolumab for advanced melanoma in the context of the Phase II CheckMate 172 trial (NCT02156804). According to Prof. Ascierto, nivolumab has shown to be safe with few side effects. He further explains the impact of ipilimumab, the first checkpoint inhibitors and the toxicity associated with its use. However, he emphasizes that nivolumab is a more potent compound with less side effects with an incidence of immune-related grade 3/4 adverse events of around 5-6%. Recorded at the American Society of Oncology (ASCO) 2016 Annual…

James Larkin, MD, PhD, of the Royal Marsden NHS Foundation Trust, London, UK, discusses the next steps for the treatment of advanced melanoma. Dr Larkin first discusses that it really comes back down to the patients who are not benefiting from the use of checkpoint inhibitors such as nivolumab and pembrolizumab. He highlights that a lot of the interest in this situation lies with figuring out what is inside of the tumor which stops the drug from carrying out its full effect. He believes that in cases of clinical trials, when the drug alone is not working, a biopsy should…

Erika Hamilton of Sarah Cannon Research Institute, Nashville, TN talks about a Phase I trial of ONT-380 in combination with capecitabine and T-DM1 (trastuzumab emtansine), in patients with HER2+ metastatic breast cancer (NCT02025192). ONT-380 is a potent small molecule selective inhibitor of HER2. She explains that what is exciting about this compound is that it also crosses into the brain; as a result, what was unusual is that patients with both untreated and treated brain metastases were also allowed into the study, making the patients a very high risk population. The study showed that the response rate of ONT-380 in…

David Ross Camidge, MD, PhD of the University of Colorado, Denver, CO, provides an insight into emibetuzumab, a monoclonal antibody directed towards the mesenchymal-to-epithelial transition (MET) factor. MET can be a primary driver of some subtypes of lung cancer, particularly the mutated MET Exon 14, and highly amplified versions of MET. He further explains that it is also a mechanism of acquired resistance in those who have an EG5 mutation, who were initially treated with an Eg5 kinesin inhibitor, but then develop acquired resistance. He explains that we already understand T790M mutation, which occurs in about 60% of cases. He…

What is phlebotomy, and how will it help my polycythemia vera (PV)? Patient Power Founder and Host, Andrew Schorr,, discusses this cornerstone treatment with Dr. Mark Heaney of Columbia University Medical Center. Dr. Heaney explains phlebotomy, and the reason its the cornerstone of PV treatment. low-dose aspirin and cytoreductive therapies, hydroxyurea (Hydrea) and ruxolitinib (Jakafi), are also explained. 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

What is the role of transplant in treatment of multiple myeloma? From our town meeting in Little Rock, Arkansas, in partnership with UAMS Myeloma Institute, myeloma expert Dr. Gareth Morgan shares his perspective. Listen as Dr. Morgan discusses the vital and ongoing role of transplant as well as doublet, triplet and quadruplet combination therapies for myeloma. According to Dr. Morgan, the time has come to address a deeper understanding of cure and long-term control of this disease. 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+…