Five Interesting Articles Worth Reading

  • Clinical Cancer Advances in 2019. The American Society of Clinical Oncology (ASCO) released its annual report on progress in cancer treatment. This important article highlights some of the major breakthroughs in solid and hematologic malignancies in the past year, with special attention to advances in treating rare cancers. The authors also identify several areas for future advancement in cancer prevention and clinical care, including increasing diversity in clinical trials, better prediction of responses to immunotherapy, and reducing the impact of obesity on cancer incidence and outcomes. J Clin Oncol. 2019 Jan 31. [Epub ahead of print.]


  • Updates in Biomarker Testing for NSCLC. Because of the large number of targetable driver mutations found in patients with metastatic non-small cell lung cancer (NSCLC), appropriate biomarker testing at diagnosis and throughout treatment is essential to best outcomes. This report from the National Lung Cancer Roundtable highlights recommendations for biomarker testing for NSCLC from the most recent guidelines. Testing for alterations in EGFR, ALK, ROS1, and BRAF genes is currently required, along with immunohistochemistry for PD-L1 expression. Furthermore, the authors support additional biomarker testing including HER2, MET, RET, KRAS, NTRK, and microsatellite instabilities (MSI) with next-generation sequencing (NGS) panels that can identify these rare alterations and mutational tumor burden and increase enrollment in clinical trials. Important financial and logistic considerations related to biomarker testing in patients with advanced NSCLC are also evaluated. J Thorac Oncol. 2019 Jan 30. [Epub ahead of print.]


  • Management of Steroid Refractory Immune-Related Toxicity. While immunotherapy has become a mainstay of cancer treatment across tumor types, it is sometimes associated with development of challenging immune-related adverse events (irAEs). This article discusses strategies for the treatment of uncommon irAEs and management of irAEs that become refractory to steroid therapy, including novel immunosuppressive drugs. Additionally, the authors provide a useful algorithm for management of steroid-refractory irAEs meant to help guide clinicians in making treatment decisions. Lancet. 2019;20(1):PE-54-PE64.


  • Does Antibiotic Use Impact Immunotherapy Efficacy? In this letter to the editor, the authors examine the impact of antibiotic use on the efficacy of immune checkpoint inhibitors in patients with advanced NSCLC. Several retrospective studies have examined this question and results of some studies indicate that use of antibiotics may have detrimental effect on clinical activity of immunotherapy. The authors evaluate outcomes in 96 patients from two cancer centers with non-squamous NSCLC undergoing treatment with immune checkpoint inhibitors and found no impact of antibiotic exposure on survival for all patients, although the effect was opposite in two centers and authors wonder if imbalance in performance status led to confounding results. They indicate that this question should be prospectively evaluated in the future. Ann Oncol. 2019 Jan 24. [Epub ahead of print.]


  • Managing Ibrutinib-Associated Complications in CLL. The Brutons tyrosine kinase inhibitor ibrutinib is a standard of care for patients with advanced chronic lymphocytic leukemia (CLL) as initial treatment or salvage therapy. However, in the real-world setting, about 50% of patients discontinue treatment due to ibrutinib-related adverse events (AEs), including atrial fibrillation, bleeding, infections, and arthralgias. Treatment of these patients requires a careful and individualized approach in order to avoid the risk of long-term complications. In this interesting article, two experts in the field of CLL discuss three clinical cases of patients with specific ibrutinib-related AEs and strategies they use in clinical practice for managing AEs and proving alternative treatment options for patients who are unable to tolerate ibrutinib. Blood. 2019 Jan 15. [Epub ahead of print.]


Clinical Opinion Poll

What frontline therapy would you recommend for a 49 y/o woman diagnosed with low tumor burden metastatic ALK+ NSCLC (lung and liver metastases, normal brain MRI, PS0)?