American Society of Clinical Oncology educational book
-
Am Soc Clin Oncol Educ Book · May 2018
ReviewBeyond Chemotherapy: Checkpoint Inhibition and Cell-Based Therapy in Non-Hodgkin Lymphoma.
Immune-based treatment strategies, such as checkpoint inhibition and chimeric antigen receptor (CAR) T cells, have started a new frontier for treatment in non-Hodgkin lymphoma (NHL). Checkpoint inhibition has been most successful in Hodgkin lymphoma, where higher expression of PD-L1 is correlated with better overall response rate. Combinations of checkpoint inhibition with various chemotherapy or biologics are in clinical trials, with initially promising results and manageable safety profiles. ⋯ Despite the recent successes with CAR T-cell clinical trials, major concerns associated with this therapy include cytokine release syndrome, potential neurotoxicities, B-cell aplasia, loss of tumor antigen leading to relapse, and cost and accessibility of the treatment. Although first-generation CAR T-cell therapies have failed in solid malignancies, newer second- and third-generation CAR T cells that target antigens other than CD19 (such as mesothelin or B-cell maturation antigen) are being studied in clinical trials for treatment of lung cancer or multiple myeloma. Overall, immune-based treatment strategies have given oncologists and patients hope when there used to be none, as well as a new basket of tools yet to come with further research and development.
-
Am Soc Clin Oncol Educ Book · May 2018
ReviewThe American Society of Hematology and ASCO Curricular Milestones for Assessment of Fellows in Hematology/Oncology: Development, Reflection, and Next Steps.
The American Society of Hematology (ASH)/ASCO Curricular Milestones is a tool for assessment and teaching for fellows in hematology/oncology. The expectations of the Next Accreditation System of the Accreditation Council of Graduate Medical Education (ACGME) was developed over years from the creation of the six core competencies in 1999 to the current data-driven outcomes-based system. The current internal medicine subspecialty milestones (ACGME reporting milestones) follow the general rubric of the general internal medicine milestones. ⋯ The ACGME has acknowledged that these milestones may be different for each of the specialties. The program committees of ASH and ASCO agree that revision of the ACGME reporting milestones would decrease the overlap of domains, lack of clarity, and negative language that is present in version 1.0. ASH and ASCO are working with the ACGME and American Board of Internal Medicine (ABIM) to develop Curricular Milestones, version 2.0.
-
Am Soc Clin Oncol Educ Book · May 2018
ReviewWhere We Stand With Immunotherapy in Colorectal Cancer: Deficient Mismatch Repair, Proficient Mismatch Repair, and Toxicity Management.
With the recent U. S. ⋯ Extensive ongoing efforts are exploring additional combinations of therapy in both deficient and proficient mismatch repair colorectal cancer. This review will outline the current status of such efforts and discuss the critical aspects of recognition and management of immune-related toxicities from checkpoint inhibitors.
-
Am Soc Clin Oncol Educ Book · May 2018
ReviewImmunotherapy in Older Adults With Advanced Cancers: Implications for Clinical Decision-Making and Future Research.
Immunotherapy has expanded the therapeutic landscape for advanced cancers, including solid tumors and lymphomas. For many patients with cancer, these agents have been shown to have substantial efficacy and favorable toxicity compared with cytotoxic agents, particularly in the second-line setting. With the advent of anti-PD-1 and anti-PD-L1 checkpoint inhibitors, combination immunotherapy- and chemoimmunotherapy-based strategies have emerged as promising novel regimens to improve cancer-related outcomes. ⋯ Thus, the results of these studies are difficult to generalize to a broader patient population with these competing risks. Furthermore, robust evaluation of toxicities, effect on quality of life and functional status, and aging-related (i.e., immunosenescence) and immunotherapy-related changes affecting the immune system remain underexplored research areas for older adults. This review examines the role of immunotherapy and its unique issues, specifically in older adults with lung cancer, bladder cancer, and lymphomas.
-
Am Soc Clin Oncol Educ Book · May 2018
ReviewPractice-Changing Developments in Stage III Melanoma: Surgery, Adjuvant Targeted Therapy, and Immunotherapy.
In this article, we will focus on the practice-changing developments for stage III melanoma, from the use of the sentinel node (SN) biopsy to complete lymph node dissection (CLND) and upcoming adjuvant therapies. MSLT-1 (Multicenter Selective Lymphadenectomy Trial-1) was the first and only prospective randomized controlled trial to examine whether the SN biopsy has any notable melanoma-specific survival benefit (primary endpoint). MSLT-1 randomly assigned 2,001 patients to undergo either wide local excision (WLE) and an SN biopsy or WLE and nodal observation. ⋯ The CheckMate 238 study demonstrated a notable benefit for adjuvant nivolumab in terms of 18-month relapse-free survival (RFS) rates compared with high-dose adjuvant ipilimumab. Single-agent adjuvant BRAF inhibition has been examined and failed to improve RFS. However, the COMBI-AD study did demonstrate a substantial benefit for combination BRAF and MEK inhibition for patients with BRAF-mutated resected stage IIIA to IIIC melanoma.