Three Articles Worth Reading

  • ASCO Guidelines on HPV Testing in Head and Neck Cancer. The American Society for Clinical Oncology (ASCO) released a guideline endorsement for the College of American Pathologists guidelines surrounding human papillomavirus (HPV) testing in patients with head and neck cancers. The new guidelines call for HPV testing for all newly diagnosed squamous cell oropharyngeal cancers by using surrogate marker p16 immunohistochemistry (IHC), either on the primary tumor or on regional lymph node metastases if clinical investigations indicate an oropharyngeal primary. p16 expression is reliably detected if there is at least 70% nuclear and cytoplasmatic staining with moderate to strong intensity. Additional HPV testing may be performed at the discretion of the pathologist or physician. Of note, p16 as a marker of HPV positivity is not reliable for nonoropharyngeal tumors or other histology types. J Clin Oncol. 2018 Sept 6. [Epub ahead of print].


  • Diagnosis and Treatment of Lynch Syndrome–Associated Colorectal Cancer. Lynch syndrome is the most common cause of inherited colorectal cancer (CRC) and is responsible for approximately 3% of new cases each year. In this interesting article, the author utilizes a clinical vignette of a patient with Lynch syndrome–associated CRC to outline current best practices in diagnosis (detection of germline mutation in a mismatch-repair gene or in epithelial-cell adhesion molecule) and treatment of Lynch syndrome–associated CRC, including treatment guideline recommendations and the most recent data supporting immune checkpoint inhibitors in patients with Lynch syndrome and metastatic CRC. N Engl J Med. 2018;379(8):764-773.


  • Hyperprogressive NSCLC on PD-1/PD-L1 Inhibitors. Hyperprogression is a unique pattern of progression that sometimes occurs in cancer patients treated with PD-(L)1 inhibitors. A retrospective analysis evaluated rates of tumor growth in 406 patients with previously treated patients with non-small cell lung cancer (NSCLC) who were undergoing treatment with PD-(L)1 inhibitors. Hyperprogression occurred in 13.8% of patients and was associated with significant reductions in overall survival (OS) compared to patients who did not experience hyperprogression (3.4 months vs 6.2 months; HR 2.18, P=.003). In comparison, hyperprogression occurred in 5.1% of patients treated with single agent chemotherapy. JAMA Oncol. 2018 Sept 6. [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)?