Interesting Articles Worth Reading

  • New Multiple Myeloma Treatment Guidelines. In recent years, several novel agents from across multiple lines of therapy have emerged for management of multiple myeloma. To aid physicians in evaluating new data and selecting the best treatment from a variety of options, the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario released updated treatment guidelines. In these guidelines, an expert panel provides evidence-based recommendations regarding the treatment of patients with multiple myeloma across the course of disease, including assessing for transplant eligibility, selecting appropriate induction and consolidation therapies, treating transplant ineligible patients, and using patient characteristics to guide selection of treatment for relapsed disease. Throughout the guidelines there is a special emphasis placed on defining appropriate treatment goals for each line of therapy. J Clin Oncol. 2019 April 1. [Epub ahead of print.]
  • Selecting First-Line Immunotherapy for NSCLC. Immunotherapies, either as monotherapy or in combination with other treatment, have become standard treatment options for newly diagnosed patients with advanced non-small cell lung cancer (NSCLC) without driver mutations. However, as the number of first-line therapy options for NSCLC grow, identifying the appropriate, patient-personalized therapy is becoming extremely challenging. In this interesting review, the expert authors summarize data supporting first-line immunotherapies alone and in combination with other agents and discuss important considerations when selecting treatments, such as patient characteristics, tumor histology, and biomarkers including PD-L1 expression and tumor mutation burden (TMB). Ann Oncol. 2019 March 26. [Epub ahead of print.]
  • Adjusting Treatment Doses in Patients With Renal or Hepatic Impairment. Many patients with cancer develop liver and/or kidney damage as a result of their disease, side effects from anticancer treatments, or because of comorbidities and increased age. Because most anticancer drugs are dosed near their maximum tolerated dose, damage to the liver or kidneys may impact pharmacokinetic profile of these agents and dose adjustments are required to avoid unnecessary toxicity. In this important review, the authors provide practical guidance for clinicians in selecting appropriate dose adjustment for 160 anticancer drugs in patients with various degrees of kidney or liver damage based on evidence from published literature, information from drug labels, and extrapolations based on pharmacokinetic characteristics of the drug. Lancet Oncol. 2019;20(4):PE200-E207.
  • Considerations for Direct Oral Anticoagulants in the Management of Cancer-Related Venous Thromboembolism. Venous thromboembolism (VTE) including deep venous thrombosis and pulmonary embolism is a common complication of cancer, particularly in patients with advanced-stage disease. Treatment of VTE can be challenging. Currently, low molecular weight heparin (LMWH) is recommended as the preferred first-line treatment for both short- and long-term treatment of cancer-associated VTE. Recently, direct oral anticoagulants (DOAC) have emerged as potential alternatives to standard anticoagulant therapy, based on results from clinical trials suggesting these agents have similar efficacy and safety as standard anticoagulant therapy and may be more convenient for patients. In this review, the authors evaluate the evidence to date supporting the use of DOAC for management of VTE in patients with cancer and provide recommendations for the use of these agents. Authors highlighted that in gastrointestinal cancers, DOAC should be used with caution due to higher risk of bleeding. Ann Oncol. 2019 March 27. [Epub ahead of print.]

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