Interesting new from ASCO?

[Palex80]

Have any of you heard of any interesting news in this year's ASCO concerning radiation oncology?

It seems that locally advanced prostate cancer may be treated with up-front adjuvant chemo after RT in the future, although current evidence is not enough to support it.

It also looks like the med. oncs are going to give pretty much every patient some king of immunotherapy. What started in melanoma seems to be spreading to all different kinds of tumors...
I was quite shocked, when I read about the future standard of care involving ipilimumab and nivolumab for metastatic melanoma. We are talking about something like 250k per year in treatment costs...

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[xrthopeful]

Ipi is an awful drug with awful, awful toxicities.

 

[OTN]

What I've seen (took some of these from the NEJM issue email I just received):
- Chemo for high-risk prostate cancer does seem to have a benefit.
- Whole brain XRT has worse toxicity than previously thought/documented (note: it wasn't hippocampal-sparing WBRT as per RTOG 0933), should hold off for as long as possible, though I think most of us were already doing this
- Palbociclib has a benefit in hormone-receptor positive breast ca
- Benefit to elective (vs therapeutic) neck dissection in LN-negative oral cavity ca
- Nivolumab + Ipilimumab combination benefit in metastatic melanoma (the company hasn't released combined pricing info yet, btw)
- RCT of cavity-shaving for lumpectomy demonstrated decrease in re-excision (no-brainer there)
- Anastrazole may be better than Tamoxifen for DCIS
- "Precision medicine" tests for cancer treatments aren't nearly precise enough
- Everyone complains about cost of new drugs
- Rindopepimut (immunotherapy as well) may be better than Avastin for recurrent GBM

As always, breathless media PR reports from the drug companies, but in actuality they demonstrated slow, incremental advances in results, naturally priced as if massive breakthroughs.

Also, in a non-ASTRO report but still very cool, lymphatic vessels were recently discovered in the brain for the FIRST time ever. Pretty cool that new anatomic discoveries are still being made (
http://neurosciencenews.com/lymphatic-system-brain-neurobiology-2080/)

 

[medgator]

Taxotere seemed to have a huge OS benefit not just in high-risk locally-advanced prostate patients, but also in upfront metastatic hormone naive patients, something like a 13 month OS improvement vs those patients who went on taxotere after becoming castrate-resistant.

 

[ramsesthenice]

future standard of care involving ipilimumab and nivolumab for metastatic melanoma.

Things may be going that way. Could end up being relevant to us as RTs. Dual checkpoint blockade (PD-1 and CTLA-4) may be useful for incorporating RT as part of a systemic therapy for metastatic melanoma. The combination appears to be very good, preclinically, at stimulating an abscopal effect. Markedly better than either agent alone. Toxicity is completely unknown and lord knows how it will go combining TWO immune modulating drugs with hypofractionated radiation. But if it worked out, could be exciting.

See Twyman-Saint Victor et al. Nature 520 (16): 373 for reference.

 

[Phantom1]

Ipi is an awful drug with awful, awful toxicities.

Wrong. Ipi is an amazing drug, with moderate to severe acute side effects and rare chronic side effects. One of the things you will notice is that some patients who discontinue the drug due to whatever reason can still derive a long lasting benefit off the drug. These drugs are lifesavers for some patients.. truly amazing. Pricing will come down eventually there is a lot of competition which is good.