Blog postings will resume week of August 8th

To all Grey Horizon readers, 

Please note that blog postings will resume the week of August 8, 2022. 

Thank you, take care, and stay well.  

Anticancer drugs in the adjuvant setting have considerable costs, raising questions of sustainability

A recently released cross-sectional analysis of approved anticancer drugs by the U.S. Food and Drug Administration (FDA) over a 4 year period (January 2018 - March 2022), determined that "the price of anticancer drugs is on an upward trajectory" worldwide, "with forecasts of global oncology therapeutic sales reaching $250 billion U.S. by 2024."   The authors of this cross-sectional analysis further emphasis the importance of estimating the cost per event averted in adjuvant therapies.  While only 11 approvals were analyzed, "the median cost per event averted of drugs in the adjuvant setting was $1 610 000 US, with...the median cost of a complete adjuvant treatment" totaled $158 000 US per patient. 

To read more about this analysis, click here.  

Source mentioned: Mousavi I, Olivier T, Prasad V. Cost per Event Averted in Cancer Trials in the Adjuvant Setting From 2018 to 2022. JAMA Netw Open 2022;5(6):e2216058.

Only a quarter of phase III studies demonstrated improved quality of life in advanced cancer setting

 A recently completed retrospective cohort study published by the Division of Cancer Care and Epidemiology at the Cancer Research Institute in Queen's University (Kingston, Ontario) indicated that nearly 50% of anticancer drug studies "demonstrated improved PFS [progression-free survival] (but) showed no improves in OS [overall survival] or QOL [quality of life]."  Led by Dr. Bishal Gyawali, the study authors further mentioned that studies with negative QOL results are either published after considerable delay or not at all, however "focusing on non-curative settings only is a strength rather than a limitation of the analysis because the risk-benefit thresholds are different in curative settings." 

To read more about this study, click here. 

Source mentioned: Samuel JN, Booth CM, Eisenhauer E, et al. Association of Quality-of-Life Outcomes in Cancer Drug Trials With Survival Outcomes and Drug Class. JAMA Oncol 2022;8(6):879-886.

Electronic symptom monitoring with PROs improves patient-reported physical function, symptom control and HRQOL

 Results from the PRO-TECT randomized controlled trial, conducted in 52 community oncology practices was recently published in JAMA.  The purpose of PRO-TECT was to "determine whether electronic monitoring of symptoms by patients undergoing treatment for metastatic cancer improves survival, quality of life outcomes and other outcomes compared with usual care."  Following enrollment of 1191 adult metastatic cancer patients, patients in the PRO group "had significantly greater odds of experiencing clinical meaningful benefits versus usual care for physical function", with an improvement of at least 5 points in 7.7% of patients studied. 

To read more about the PRO-TECT trial, click here. 

Source mentioned: Basch E, Schrag D, Henson S, et al. Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer A Randomized Clinical Trial. JAMA 2022;327(24):2413-2422.

Some patients with NSCLC (non-small cell lung cancer) may respond poorly to COVID-19 MRNA vaccines

 A recently completed study from the Emory University School of Medicine in Atlanta, Georgia, determined that 25% of patients with non-small cell lung cancer (NSCLC) experienced a negative antibody response after receiving COVID-19 mRNA vaccines.  Study lead Professor Rafi Ahmed further emphasized that his team "did not find a correlation with the type of cancer treatment and the magnitude of the antibody response."  In addition, further research is required as the Emory University study was small, comprised of 82 patients with NSCLC and 53 heathy volunteers.

To read more about this study click here.  

Source mentioned: Valanparambil RM, Carlisle J, Linderman SL, et al. Antibody Response to COVID-19 mRNA Vaccine in Patients With Lung Cancer After Primary Immunization and Booster: Reactivity to the SARS-CoV-2 WT Virus and Omicron Variant. JCO; Published online 27 June 2022. DOI: 10.1200/JCO.21.02986

Age and frailty should be considered independently when evaluating potential risk for side effects among older adults treated with ICIS

 Researchers at the Princess Margaret Cancer Centre in Toronto recently released the findings of a population-level retrospective cohort study aimed at evaluating "the impact of age and frailty among older adults on use of acute care and immune-related adverse events (irAE) associated hospitalizations."  According to Dr. Lawson Eng of the Division of Medical Oncology and Hematology at the Princess Margaret Cancer Centre, older age carried a lower risk of being hospitalized due to irAE, particularly those over the age of 80, which constituted 18% of the 2737 patients who participated in the study.  The study concluded that age and frailty are significant associated factors which "may need to be considered independently when evaluating their use [in] influencing risk of toxicity among older adults receiving ICIs." 

To read more about this study, click here. 

Source mentioned: Eng L, Sutradhar R, Kaliwal Y, et al. Impact of age and frailty on acute care use during immune checkpoint inhibitor (ICI) treatment: A population-based study. J Clin Oncol 2022; 40 (suppl 16; abstr 12002). DOI: 10.1200/JCO.2022.40.16_suppl.12002

New trial alert: Marathon of Hope Cancer Centres Network Study for Ontario (MOHCCN-O)

 The Marathon of Hope Cancer Centres Network (MOHCCN), is presently recruiting cancer patients for its new study focusing on "evolving technologies such as genomics and artificial intelligence to study cancer so that the right treatment can be given to the right patient, at the right time."  Sponsored by the University Health Network in Toronto, and involving a collaboration between the Princess Margaret Hospital, the Ontario Institute for Cancer Research, and the Terry Fox Research Institute, this observational study,  over a 5-year period, aims to develop standard practices "to create a unique shareable dataset of molecular imaging, clinical, and health outcome information on Canadian cancer cases." 

To learn more about this trial and the MOHCCN, click here. 

Study shows public perception of e-cigarettes vs. cigarettes harms changed sharply during EVALID epidemic and COVID-19

 A new study conducted by the American Cancer Society indicates that perceptions by adults of "electronic or e-cigarettes as being more harmful than cigarettes...more than doubled between 2019-2020."  This perception coincides with results from the EVALI study, which focused on lung injury associated with e-cigarettes or vaping.  According to principal scientist Dr. Priti Bandi, all tobacco products, including e-cigarettes are harmful to one's health,  and "there is a need for behavioral interventions to encourage individuals to be informed consumers of available scientific findings and appreciate that while no tobacco product is safe, there are inherent differences between relative and absolute harms between tobacco products that can influence behavior."  

To read more about this study, click here. 

Study finds COVID-19 pandemic reduced breast, cervical, colorectal cancer screenings by millions in 2020

New statistics recently released by the American Cancer Society indicate that screening for breast cancer as dropped 6% (2.13 million), while screening for cervical cancer is done by 11% (4.47 million) in the United States.  Believed to be the first study to evaluate the impact of the COVID-19 pandemic using population-based data, the findings further revealed a 17% drop among Hispanic women undergoing cervical cancer screening, while 27% fewer Asian/Pacific women attended breast cancer screening, "the largest drop for any race."   

To read more about this study, click here. 

Incidence of colorectal, breast, kidney, pancreatic, and uterine cancers is increasing in young adults

 Epidemiological data regarding the incidence of 12 types of cancer among young adults was recently published in the British Journal of Cancer, June 2022.  According to the authors, "the incidence of colorectal, breast, kidney, pancreatic, and uterine cancers is increasing...whilst the incidence of lung, laryngeal, and bladder cancers is decreasing."  Further, the authors concluded that young adults with cancer are more likely to experience diagnostic delays, cautioning that "even when referred, younger patients may be referred through a less urgent route...[which] may results in cancer progressing to a less curable stage." While young adults are susceptible to lifestyle risk factors, namely obesity and smoking, the authors further emphasize that these preventable risk factors must be addressed early on. 

To read more about this study, click here. 

Source mentioned: di Martino E, Smith L, Bradley SH, et al. Incidence trends for twelve cancers in younger adults—a rapid review. Br J Cancer 2022;126:1374–1386. DOI: https://doi.org/10.1038/s41416-022-01704-x

Blog postings will resume week of May 30, 2022

  To all Grey Horizon readers, 

Please note that blog postings will resume the week of May 30, 2022. 

Thank you, take care, and stay well.  

Cancer care in war zones: what have we learnt?

 A recent clinical practice perspective interview by the European Society of Medical Oncology (ESMO), with Professor Richard Sullivan, from the Conflict and Health Research Group at King's College in London, UK, emphasizes the impact of cancer care in war zones for the global oncology community.  Discussion topics include challenges caring for refugees with cancer, coordinating cancer care support amongst different agencies, and the impact of the current conflict in Ukraine on cancer care in the future. 

To read the complete interview, click here.  

Webinar: survivorship needs for people living with advanced and metastatic Cancers

 A recent webinar by Dr. Michelle Mollica, Senior Advisor at the National Cancer Institute's (NCI) Office of Cancer Survivorship, discusses efforts by the NCI on "understanding and addressing the survivorship needs for the growing population of survivors who are living with advanced and metastatic cancers." Dr. Mollica's presentation includes discussions on managing symptoms, psychosocial support, health care delivery and behaviours. 

Fore more information and to view the webinar, click here. 

Increased risk of cancer in early life among individuals with autism spectrum disorders

Results from a recently completed population-based cohort study at the Karolinska Institutet in Sweden determined that "individuals with autism spectrum disorders, when present with comorbid intellectual disability and/or birth defects, were at a higher risk of cancer in early life."  With a focus on autism spectrum patients diagnosed with cancer before age 30, the study concluded that "autism spectrum disorders alone...without comorbid intellectual disability or birth defects...was not associated with an increased risk of any cancer."   

To read more about this study, click here. 

Study mentioned: Liu Q, Yin W, Meijjsen JJ, et al. Cancer risk in individuals with autism spectrum disorder. Annals of Oncology; Published online 13 April 2022. DOI: https://doi.org/10.1016/j.annonc.2022.04.006

First study examining mental illness and self-harm events across 26 cancer types

 Recently published findings in Nature Medicine studied risk of unnatural death following self-harm amongst 459,542 cancer patients diagnosed with 26 different types of cancer.  Due to psychological distress and depression experienced by cancer patients, the study authors concluded that the self-harm "prevalence ratio is higher among younger individuals, as they are more likely to be referred for specialized psychosocial cancer care."  In particular, the study further revealed the patients with co-occurring were mostly likely to cause self-harm to themselves during the first 12 months of a cancer diagnosis. 

To read more about this study, click here.  

Source mentioned: Chang WH, Lai AG. Cumulative burden of psychiatric disorders and self-harm across 26 adult cancers. Nature Medicine; Published online 28 March 2022. DOI: https://doi.org/10.1038/s41591-022-01740-3

NGS is effective in identifying actionable genetic alterations for investigational targeted therapies in paediatric and young adult patients with refractory cancers

A recent study published by the Texas Children's Cancer and Hematology Center recently published findings regarding "the feasibility of a nationwide screening and centralized testing Protocol to select patients with tumours harbouring actionable alterations for enrolment in clinical studies of molecularly targeted therapies."   Following completed testing for 94.7% of tumours, actionable alternations were detected in 31.5% of the first 1,000 tumours screened, with "treatment arm assignment and enrolment occurring in 28.4% and 13.1% of patients." 

To read more about this study, click here. 

Source mentioned: Parsons DW, Janeway KA, Patton DR, et al. Actionable Tumor Alterations and Treatment Protocol Enrollment of Pediatric and Young Adult Patients With Refractory Cancers in the National Cancer Institute–Children's Oncology Group Pediatric MATCH Trial. JCO; Published online 30 March 2022. DOI: 10.1200/JCO.21.02838

Children of patients with cancer more likely to experience medical financial hardship and emotional and educational challenges following parental diagnosis

 A new study conducted by researchers at the American Cancer Society indicates that children "living in families with a history of parental cancer were more likely to face financial, emotional, and educational challenges."  According to Dr. Zhiyuan Zheng, lead author of the study, 3.4% of children between 5-17 are living in families with a parental history of cancer.  As a result, these children may miss school and may be less likely to receive medical care due to lack of family financial resources.  Further, the study states that these children "were particularly vulnerable and began to experience psychosocial and behavioral challenges that often went unaddressed." 

To read more about this study, click here. 

Source mentioned: Zheng Z, Zhao J, Nogueira L, Han X, Fan Q, Yabroff KR. Associations of Parental Cancer With School Absenteeism, Medical Care Unaffordability, Health Care Use, and Mental Health Among Children. JAMA Pediatr. Published online April 11, 2022. doi:10.1001/jamapediatrics.2022.0494

 

Benefit of adjuvant capecitabine after curative resection of biliary tract cancer maintained with a long-term analysis

Results from BILAP, a 5-year study on survival data conducted at the UCL Cancer Institute in London, U.L. confirmed "the benefit of capecitabine as adjuvant therapy after surgical resection of biliary tract cancer...and should be considered as the standard of care."   Conducted between March 15 2006 - December 4, 2014 on 447 patients (of whom 223 were assigned to the capecitabine group for curative intent), indicated a period of 24.3 months for median recurrence-free survival for patients prescribed capecitabine compared to 17.4 months for those in the observation group.  

To read more about the BILAP study, click here. 

Source mentioned: Bridgewater J, Fletcher P, Palmer DH, et al. Long-Term Outcomes and Exploratory Analyses of the Randomized Phase III BILCAP Study. Journal of Clinical Oncology; Published online 22 March 2022. DOI: 10.1200/JCO.21.02568

Tumour budding demonstrates independent prognostic value for disease-free and overall survival in patients with stage III colon cancer

 Joint research conducted in Paris at the Department of Pathology, Sorbonne University, and the Department of Oncology, Georges Pompidou Hospital, indicates that the use of tumour budding as a prognostic biomarker in colon cancer could influence disease-free and overall survival for patients diagnosed at stage III.  Defined as "a single cancer cell of up to four cancer cells at the tumour invasive margin", tumour budding was applied to 1,048 stage III colon cancer patients in the joint Paris post-hoc study.  While the study authors acknowledge that further research is required, their findings do support the notion that "tumour budding seems to provide additional and clinically relevant prognostic information beside risk groups and Immunoscore." 

To learn more about this study, click here. 

Source mentioned: Basile D, Broudin C, Emile JF, et al. Tumor budding is an independent prognostic factor in stage III colon cancer patients: A post-hoc analysis of the IDEA-France phase III trial (PRODIGE-GERCOR). Annals of Oncology; Published online 16 March 2022. DOI: https://doi.org/10.1016/j.annonc.2022.03.002

COVID-19 & cancer: future of the pandemic [YouTube video presentation]

Dr. Otis Brawley, a renowned cancer control expert from Johns Hopkins University recently held a question and answer session discussing "the current state of the COVID-19 pandemic and what cancer survivors need to know going forward to best protect themselves."  Dr. Brawley's research is focused on cancer screening strategies and lifestyle reduction programs, including "striving to close racial, economic, and social disparities in the prevention, detection, and treatment of cancer in the United States and worldwide." 

To view the complete session, click here. 

Survivors of childhood, adolescent, and young adult cancer not at increased risk of testing positive for COVID-19, nor for serious sequelae when contracting infection

A recent study conducted in Ontario explored population-based registries to identify all 5-year survivors of childhood cancer between 0-17 years of age, as well as 6 common cancers afflicting young adults between 15-21 years old.  Findings indicated that "survivors were not at increased risk of receiving a positive COVID-19 test...and were more likely to be fully vaccinated."  Further, there was no increased risk to survivors in the emergency department or who needed to be admitted, and "no survivor experienced intensive care unit admission or died after COVID-19 infection. 

To read more about this study, click here. 

Source mentioned: Gupta S, Sutradhar R, Alexander S, et al. Risk of COVID-19 Infections and of Severe Complications Among Survivors of Childhood, Adolescent, and Young Adult Cancer: A Population-Based Study in Ontario, Canada. JCO; Published online 28 February 2022. DOI: 10.1200/JCO.21.02592

Humoral response to the third dose of the MRNA-based COVID-19 vaccine in a large cohort of patients with cancer

 A recently published letter to the editor in Annals of Oncology, authored by Dr. Vincenzo Di Noia from the Regina Elena National Cancer Institute in Rome, Italy, "described the serological response to the third dose of the BNT162b2 mENA COVID-19 vaccine in a large cohort of patients with cancer."  407 patients received a third dose of BN1162b3 between September - November 2021.  366 (89.9%) of patients were on active anticancer treatment 28 days before BNT162b2 was administered.  Median age of patients was 67, with breast (28.5%) and lung (19.9%) identified as the most common cancer types.  402 (98.8%) of patients studied "had a positive serological status after the third vaccine dose." 

To read more about this study, click here. 

Study mentioned: Di Noia V, Pimpinelli F, Renna D, et al. Potentiation of humoral response to BNT162b2 vaccine after the third dose in patients with solid cancer. Annals of Oncology; Published online 21 February 2022. doi: https://doi.org/10.1016/j.annonc.2022.02.006

Higher risk of major adverse cardiovascular events and cancers with tofacitinib

 

During the recently held Pharmacovigilance Risk Assessment Conference (PRAC), the European Medicines Agency (EMA) revealed results from a study indicating that patients "taking tofacitinib for rheumatoid arthritis and who were at risk of heart disease were more likely to experience a major cardiovascular problem...and had a higher risk of developing cancer."  In 3 nearly equivalent patient groups (1455 patients received 5mg of tofacitinib twice daily; 1456 received 10mg of tofacitinib twice daily; 1451 received a TNF inhibitor), incidences of cancer were higher (2.4% for 5mg; 4.2% for 10mg) for those administered tofacitinib vs. 2.5% who received a TNF inhibitor. 

To learn more about this study, click here.  

Source mentioned: Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med 2022;386:316-326.

Blog postings will resume week of March 2, 2022

 To all Grey Horizon readers, 

Please note that blog postings will resume the week of March 2, 2022. 

Thank you, take care, and stay well.  

Greater severity of adverse events in women across multiple anticancer treatment modalities

 Results of 202 phase II and III clinical trials conducted between 1989 and 2019 on 23, 296 cancer patients has revealed "greater severity of both symptomatic adverse events and haematology adverse events in women across multiple treatment modalities."  Researchers at the SWOG Cancer Research Network determined that of the 23, 296 patients studies (8,838/37.9% women and 14,458/62.1% men) female patients "had a 34% increased risk of adverse events [across various cancer therapies administered] compared to men."  

To learn more about this study, click here. 

Source mentioned: Unger JM, Vaidya R, Albain KS, et al. Sex Differences in Risk of Severe Adverse Events in Patients Receiving Immunotherapy, Targeted Therapy, or Chemotherapy in Cancer Clinical Trials. JCO; Published online 4 February 2022. DOI: 10.1200/JCO.21.02377

Trial alert from the PACIFIC study: Robust and sustained survival benefit with consolidation durvalumab after concurrent chemoradiotherapy for unresectable, stage III non-small-cell lung cancer

 Recently released results on survival analyses from the PACIFIC study focusing on the benefits of durvalumab in patients with unresectable, stage iii non-small-cell lung cancer (NSCLC) and no cancer progression following concurrent chemoradiotherapy treatment indicated that "42.9% of patients randomly assigned to durvalumab remain alive at 5 years and 33.1^ of patients remain alive and free of disease progression. 

Click here to read more about this study, the first to "demonstrate a survival advantage with immune checkpoint inhibitor in a curative-intent setting."

Source mentioned: Spigel DR, Faivre-Finn C, Gray JE, et al. Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non–Small-Cell Lung Cancer. JCO; Published online 2 February 2022. DOI: 10.1200/JCO.21.01308

Personalized immunotherapy for metastatic breast cancer

 Results from an ongoing clinical trial conducted at the National Cancer Institute's (NCI) Center for Cancer Research, has found that "many people with metastatic breast cancer can mount an immune reaction against their tumors."  The clinical trial conducted on 42 women with metastatic breast cancer showed that 67% (28 of the 42 trial participants) had an immune response towards their cancer affliction.  As such, the immune reaction approach was applied to treat 6 of the 28 women, "half of whom experienced measurable tumor shrinkage."  

To read more about the results of this trial, click here. 

Source mentioned: Zacharakis N, Lutfi LM, Seitter SJ, et al. Breast Cancers Are Immungenic: Immunologic Analyses and a Phase II Pilot Clinical Trial Using Mutation-Reactive Autologous Lymphocytes. February 1, 2022. JCO. DOI: 10.1200/JCO.21.02170.

Artificial intelligence for diagnosis and Gleason grading of prostate cancer

 The Prostate Cancer Grade Assessment (PANDA) Challenge, a global artificial intelligence competition, recently published findings of their "blueprint for evaluating AI [artificial intelligence] algorithms in digital pathology" for prostate cancer patients.  In the PANDA report, prostate tumours were categorized into 5 grade groups, based on the Gleason growth patterns of tumour tissue.  Following the application of AI to grade 10,616 digitized prostate biopsies, "the algorithms achieved agreements of 0.862...[compared with] 0.868 with expert uropathologists." 

To read more about the PANDA Challenge, click here. 

Source mentioned: Bulten W, Kartasalo K, Chen P-HC, et al. Artificial intelligence for diagnosis and Gleason grading of prostate cancer: the PANDA challenge. Nature Medicine; Published online 13 January 2022. DOI: https://doi.org/10.1038/s41591-021-01620-2

Breakthrough SARS-CoV-2 infection following COVID-19 vaccination in patients with cancer

 Research conducted by the COVID-19 and Cancer Consortium, the results of which were recently published in the Annals of Oncology maintains that cancer patients who contract COVID-19 despite being vaccinated "remain susceptible to severe outcomes."  Dr. Toni K. Choueri of the Department of Medical Oncology at the Dana-Farber Cancer Institute in Boston, emphasizes that "vaccination of close contacts, masking, boosters, and social distancing are needed to protect patients with cancer", particularly if cancer patients come into contact with members of the public that are unvaccinated. 

Click here to read more about this study, believed to be the first to evaluate clinical characteristics and outcomes of cancer patients being infected by COVID-19 after vaccination.    

Source mentioned: Schmidt AL, Labaki C, Hsu C-Y, et al. COVID-19 vaccination and breakthrough infections in patients with cancer. Annals of Oncology; Published online 24 December 2021. DOI: https://doi.org/10.1016/j.annonc.2021.12.006

Dual inhibition of LAG-3 and PD-1 in patients with previously untreated metastatic or unresectable melanoma

 Findings from a recent phase II/III trial, RELATIVITY-047, evaluating "dual inhibition of LAG-3 and PD-1 using a new combination of LAG-3-blocking antibody relatlimab and PD-1 blocking antibody nivolumab..." were published by the Texas MD Anderson Cancer Center in The New England Journal of Medicine.  A cell surface molecule expressed on immune cells, LAG-3 "negatively regulates T-cell proliferation and effector T-cell function."  The RELATIVITY-047 study evaluated relatlimib and nivolumab together as a fixed dose regimen compared to patients receiving only nivolumab alone over a 4 week period in patents with untreated metastatic or unresectable melanoma.  Progression free survival was 10.1 months in patients receiving the relatlimab-nivolumab combination vs 4.6 months for those only being administered nivolumab. 

To read more about this trial, click here. 

Sources mentioned

• Tawbi HA, Schadendorf D, Lipson EJ, et al. Relatlimab and Nivolumab versus Nivolumab in Untreated Advanced Melanoma. N Engl J Med 2022;386:24-34. DOI: 10.1056/NEJMoa2109970
• Frampton AE, Sivakumar S. A New Combination Immunotherapy in Advanced Melanoma. N Engl J Med 2022;386:91-92. DOI: 10.1056/NEJMe2116892