High-Risk Smoldering Myeloma: Perspective on watchful monitoring
In a 2008 paper, Dispenzieri and colleagues at the Mayo Clinic proposed a risk stratification system for patients with smoldering multiple myeloma (SMM) based upon the presence of 3 risk factors – serum M-protein ≥3 g/dL, bone marrow plasma cell percentage ≥10%, and a FLC ratio (κ to λ) of either ≤0.125 or ≥8 [1]. The patient in this vignette has all 3 risk factors, classifying him as high-risk, with an associated median time to progression (TTP) of 1.9 years. This is significan tly worse than a patient with intermediate-risk (median TTP 5.1 years) or low-risk (10 years) disease. (Source: Seminars in Oncology)
Source: Seminars in Oncology - November 4, 2016 Category: Cancer & Oncology Authors: Siyang Leng, Herbert Irving Pavilion Source Type: research
Recommend Maintenance Therapy with Lenalidomide in Multiple Myeloma
Thalidomide was the first immunomodulatory drug used as maintenance after autologous stem cell transplant (ASCT) in MM. This showed improved progression-free survival (PFS) and in some cases, overall survival (OS) [1 –3]. Despite this, use of thalidomide was limited due to toxicity and high rates of therapy discontinuation. Lenalidomide, an analog of thalidomide, had a more favorable toxicity profile making its use in maintenance a potential approach. The use of lenalidomide as a maintenance therapy after ASCT in newly diagnosed MM patients has been investigated in four phase III randomized control studies [4–7]. (Sour...
Source: Seminars in Oncology - November 4, 2016 Category: Cancer & Oncology Authors: Elisabet E. Manasanch Source Type: research
Treatment of Newly Diagnosed Myeloma: Bortezomib-Based Triplet
In this paper we review the options for the treatment of newly diagnosed myeloma in a patient who is a candidate for autologous stem cell transplantation. Bortezomib, lenalidomide, dexamethasone (VRD) has been studied in two randomized trials as first line therapy. In one of these trials, VRD demonstrated improved overall survival compared with lenalidomide plus dexamethasone (Rd). By contrast, phase III data with overall survival differences are not available for other bortezomib containing regimens compared with modern lenalidomide containing regimens. (Source: Seminars in Oncology)
Source: Seminars in Oncology - November 4, 2016 Category: Cancer & Oncology Authors: Archana M. Rajan, S. Vincent Rajkumar Source Type: research
Mind the Gap: An analysis of foregone health gains from unfunded cancer medicines in New Zealand
To compare funded access to cancer medicines in New Zealand and Australia and examine the potential foregone population health gains due to differences between these two countries. (Source: Seminars in Oncology)
Source: Seminars in Oncology - November 2, 2016 Category: Cancer & Oncology Authors: Jackie Evans, George Laking, R. Matthew Strother, Tony Wang, R. Scott Metcalfe, Gary Blick, Reinhard Pauls, Steffan Crausaz Source Type: research
Controversies in multiple myeloma: Evidence-based update
The US Food and Drug Administration (FDA) approved 10 new drugs for the treatment of multiple myeloma (MM) over the last two decades. The influx of new anti-myeloma agents with high efficacy and acceptable tolerability add complexity to the clinical decision-making process. First, treatment of smoldering multiple myeloma (SMM) remains investigational to date, although a randomized trial showed a survival gain in high-risk patients receiving lenalidomide. Second, in newly diagnosed MM, the majority of contemporary induction regimens have been studied in single-arm trials or compared to an older regimen, which complicates ev...
Source: Seminars in Oncology - November 1, 2016 Category: Cancer & Oncology Authors: Inhye E. Ahn, Sham Mailankody Source Type: research
Controversies in Multiple Myeloma: Evidence Based Update
The U.S. Food and Drug Administration approved ten new drugs for the treatment of multiple myeloma over the last two decades. The influx of new anti-myeloma agents with high efficacy and acceptable tolerability add complexity to the clinical decision-making process. First, treatment of smoldering multiple myeloma remains investigational to date, although a randomized trial showed a survival gain in high-risk patients receiving lenalidomide. Second, in newly-diagnosed multiple myeloma, the majority of contemporary induction regimens have been studied in single-arm trials or compared to an older regimen, which complicates ev...
Source: Seminars in Oncology - November 1, 2016 Category: Cancer & Oncology Authors: Inhye E. Ahn, Sham Mailankody Source Type: research
Talimogene laherparepvec (T-Vec) for the treatment of melanoma and other cancers
Talimogene laherparepvec (T-Vec) is the first live virus to be approved by the FDA for the treatment of cancer. This engineered version of herpes simplex virus type 1 (HSV-1) is the product of decades of preclinical work aimed at identifying and modifying aspects of the viral genome involved in virulence and immunogenicity. T-Vec preferentially infects and lyses tumor cells and, in some cases, induces a systemic immune response against the tumor. These properties have translated into significant and durable clinical responses, particularly in advanced melanoma. (Source: Seminars in Oncology)
Source: Seminars in Oncology - October 26, 2016 Category: Cancer & Oncology Authors: Claud Grigg, Zo ë Blake, Robyn Gartrell, Adrian Sacher, Bret Taback, Yvonne Saenger Source Type: research
Genetic Predisposition to Leukemia and other Hematologic Malignancies
In this review, we provide an overview of familial myelodysplastic syndromes (MDS)/acute leukemia (AL) and bone marrow failure syndromes, as well as insights into familial myeloproliferative neoplasms (MPNs), familial multiple myeloma (MM), familial Waldenstrom macroglobulinemia (WM), familial lymphoma, and cancer predisposition syndromes with increased risk of MDS/AL. This field will continue to accelerate as next-generation sequencing (NGS) techniques identify novel predisposition alleles in families with a genetic predisposition to hematologic malignancies. (Source: Seminars in Oncology)
Source: Seminars in Oncology - October 24, 2016 Category: Cancer & Oncology Authors: Simone Feurstein, Michael W. Drazer, Lucy A. Godley Source Type: research
The future of clinical cancer genomics
Whether or not it was first said by atom-splitter Niels Bohr or splitter-ball catcher Yogi Berra, we all agree “it’s tough to make predictions- especially about the future.” In the concluding section of this monograph on the current status of predictive cancer genomics, it is appropriate to ponder the future of this translational field of medical science. As will also be addressed here, it is particula rly instructive for the providers and consumers of the rapid advances in genomics and medicine to make their own predictions of the impact of “personalized genomics” on preventive oncology. (Source: Seminars in Oncology)
Source: Seminars in Oncology - October 17, 2016 Category: Cancer & Oncology Authors: Kenneth Offit Source Type: research
Updates on Breast Cancer Genetics: Clinical Implications of Detecting Syndromes of Inherited Increased Susceptibility to Breast Cancer
Since the initial discovery that pathogenic germline alterations in BRCA 1/2 increase susceptibility to breast and ovarian cancer, many additional genes have now been discovered which also increase breast cancer risk. Given that several more genes have now been implicated in hereditary breast cancer syndromes, there is increased clinical use of multigene panel testing to evaluate patients with a suspected genetic predisposition to breast cancer. While this is most certainly a cost-effective approach, broader testing strategies have resulted in a higher likelihood of identifying moderate-penetrance genes, for which manageme...
Source: Seminars in Oncology - October 6, 2016 Category: Cancer & Oncology Authors: Erin F. Cobain, Kara Milliron, Sofia D. Merajver Source Type: research
outside front cover
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Source: Seminars in Oncology - September 30, 2016 Category: Cancer & Oncology Source Type: research
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Source: Seminars in Oncology - September 30, 2016 Category: Cancer & Oncology Source Type: research
Editorial Board
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Source: Seminars in Oncology - September 30, 2016 Category: Cancer & Oncology Source Type: research
Table of Contents
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Source: Seminars in Oncology - September 30, 2016 Category: Cancer & Oncology Source Type: research
Advances in inherited cancers: Introduction
For decades, clinicians and researchers have recognized families with an apparent “excess of cancers” and struggled with how to best treat their cancers and prevent additional tumors in at-risk relatives. Painstaking work using candidate gene studies, linkage analysis, and positional cloning involving hundreds of families has led to the identification of literally dozens of g enes implicated in inherited cancer susceptibility. While some of these genes have been implicated in the pathogenesis of relatively rare, highly penetrant cancer syndromes (eg, Li-Fraumeni syndrome, hereditary breast ovarian cancer syndrome, Lync...
Source: Seminars in Oncology - September 21, 2016 Category: Cancer & Oncology Authors: Elena M. Stoffel, Kathleen A. Cooney Source Type: research
