Cancer of the breast, colon, lungs ... Putting research in perspective
March 2, 2014 | by Tami Dennis
No matter how impressive a research study’s conclusion may be – or how seemingly unsurprising – experts are needed to put the findings into context. Perhaps a study’s methodology wasn’t as strong as it could have been. Perhaps the conclusions confirmed that other researchers are on the right track. Perhaps the study missed the mark completely.
City of Hope’s physicians recently weighed in on an array of recent published studies, offering their expertise, insight and perspective via a special commentary feature in Clinical Oncology News.
From Journal of the National Cancer Institute came this recent study: "More Exercise Is Better During Breast Cancer Chemotherapy."
Commented Joanne Mortimer, M.D., director of the Women’s Cancers Program and professor and vice chair of the Department of Medical Oncology & Therapeutics Research at City of Hope:
The researchers “demonstrated that as little as 25 to 30 minutes of vigorous aerobic exercise three times a week can improve self-reported physical functioning in women undergoing adjuvant chemotherapy. Twice that amount of aerobic exercise resulted in a significant reduction in bodily pain and fatigue. ... The relationship between physical activity, obesity and breast cancer continues to intrigue us and provide important biological insights.”
From The Lancet: "Ramucirumab Monotherapy Shows Survival Benefit in Advanced Gastric Cancer"
Commented Joseph Chao, M.D., clinical assistant professor in the Department of Medical Oncology & Therapeutics Research:
"The REGARD study is remarkable in demonstrating that a monoclonal antibody alone, ramucirumab, added to best supportive care can yield a survival benefit in a treatment-refractory gastric cancer patient population. … The REGARD trial also generates some thought-provoking inquiries in meeting its primary end point where AVAGAST did not."
From Lung Cancer: "Radiotherapy Survival Benefit Seen in Elderly Patients With Lung Cancer"
Commented Karen L. Reckamp, M.D., M.S., co-director of the Lung Cancer and Thoracic Oncology Program:
The study "only begins to address the level of toxicity that patients experience from RT (radiation therapy) and does not address potential quality-of-life issues associated with treatments and AEs (adverse events). Many patients experience side effects from RT, and most receive outpatient treatment for these sequelae. In an aging population, goals of care and quality-of-life discussions are essential to determining appropriate therapy; especially when survival is limited."
From New England Journal of Medicine: "Mutational Analysis Critical in First-Line Treatment of Metastatic Colorectal Cancer"
Commented Marwan Fakih, M.D., co-director of the Gastrointestinal Cancer Program:
"Based on the data presented here, we have now incorporated an expanded RAS mutation assay for all of our mCRC (metastatic colorectal cancer ) patients before consideration of anti-EGFR (anti-epidermal growth factor receptor) therapy."
From Urology: "Bladder Cancer Outcomes Better in Induction Chemotherapy Responders"
Commented Przemyslaw W. Twardowski, M.D., clinical professor in the Department of Medical Oncology & Therapeutics Research:
"This study taken in isolation could be criticized for its retrospective nature, very long duration, lack of randomization and evolving surgical standards. However, evaluated in the context of other literature, it serves as a confirmatory piece of evidence supporting the concept that patients with advanced, metastatic bladder cancer can be cured, especially if the metastases are limited to pelvic or abdominal lymph nodes."
From Journal of Clinical Oncology: "Stringent Complete Response Preferred Multiple Myeloma Goal"
Commented Amrita Y. Krishnan, M.D., director of the Multiple Myeloma Program:
"The study suffers from the fact that a variety of induction regimens were chosen and that there is no complete assessment of maintenance therapy. The authors noted, 'Maintenance therapy was generally not used after ASCT.' However, we do know from the CALGB 100104 trial that maintenance with lenalidomide post-ASCT (autologous stem cell transplantation ) improved OS (overall survival), so we cannot discount the effect of maintenance on a subgroup of patients."
From Journal of Clinical Oncology: "The TIVO-1 Trial: Cause for a Paradigm Shift in Renal Cell Carcinoma?"
Commented Sumanta Kumar Pal, M.D., co-director of the Kidney Cancer Program:
"With four VEGF-TKIs (vascular endothelial growth factor - tyrosine kinase inhibitors) currently available, one might question the need for additional agents with a similar mechanism of action. Despite this, a consistent paradigm in drug development for mRCC (metastatic renal cell carcinoma) has been to refine the specificity and affinity of VEGF-TKIs for VEGF receptors (VEGFRs). Results from the recent TIVO-1 (Tivozanib versus Sorafenib in 1st line Advanced RCC) trial, may bring an end to this paradigm, however."
Discussion, debate, disagreement and suggestions – they're all crucial in moving medicine forward.
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