Dana-Farber / Brigham and Women's Cancer Center

NCCN Conference Presentations Inform National Cancer Care Guidelines

Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) oncology experts presented new guidelines for survivorship care and the latest advances in treatment for prostate, thyroid, and kidney cancers and multiple myeloma at the March 2013 National Comprehensive Cancer Network® (NCCN®) Annual Conference. The NCCN is a not-for-profit alliance of 23 of the world’s leading cancer centers.

“Treatment guidelines adopted by the NCCN aim to improve the quality and effectiveness of care provided to patients with cancer and are very important in setting standards of practice,” said Philip W. Kantoff, MD, Co-Chair the NCCN panel on prostate cancer, one of 47 panels that make recommendations for oncology practice, and Director of the DF/BWCC Center for Genitourinary Oncology. “As a founding member of the NCCN, we provide valuable insights when the organization sets or updates its guidelines.”

Establishing Survivorship Care

For the first time, NCCN released guidelines on how an array of health care providers can meet the needs of the growing survivorship population. Jennifer Ligibel, MD, a medical oncologist in the DF/BWCC Center for Breast Oncology, served as a panel member for the new NCCN Guidelines for Survivorship. Dr. Ligibel has worked extensively in evaluating the role of exercise, weight management, and diet in cancer survivorship.

“These guidelines focus on the vast and persistent impact of cancer diagnosis and treatment on adult survivors, particularly after they have completed their initial cancer treatment,” said Dr. Ligibel. “The new guidelines include a number of topics that were not addressed in prior NCCN guidelines, such as exercise and sexual functioning, as well as survivorship-focused updates on existing topics, like fatigue and pain management. These guidelines are designed to be a tool kit for the diverse array of providers who care for cancer survivors.”

Ligibel J. Lifestyle factors in cancer survivorship. J Clin Oncol 2012; 30: 3697-3704.
Ligibel JA. Role of adjuvant and post-treatment exercise programs in breast health. J Natl Compr Canc Netw 2011; 9: 251-256.

Sequencing Treatments for Advanced Prostate Cancer

Dr. Kantoff provided sequencing recommendations for new drugs approved for advanced, castration-resistant prostate cancer, including those that target androgen signaling – an area that remains important in castration-resistant disease. “Many of these drugs have been explored by our researchers, and the results of our studies have changed treatment and improved the survival for patients with advanced prostate cancer,” he said.

Kantoff PW, Higano CS, Shore ND, Berger ER, Small EJ, Penson DF, Redfern CH, Ferrari AC, Dreicer R, Sims RB, Xu Y, Frohlich MW, Schellhammer PF; IMPACT Study Investigators. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med. 2010 Jul 29;363(5):411-22.

Ryan CJ, Smith MR, de Bono JS, Molina A, Logothetis CJ, de Souza P, Fizazi K, Mainwaring P, Piulats JM, Ng S, Carles J, Mulders PF, Basch E, Small EJ, Saad F, Schrijvers D, Van Poppel H, Mukherjee SD, Suttmann H, Gerritsen WR, Flaig TW, George DJ, Yu EY, Efstathiou E, Pantuck A, Winquist E, Higano CS, Taplin ME, Park Y, Kheoh T, Griffin T, Scher HI, Rathkopf DE; COU-AA-302 Investigators. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med. 2013 Jan 10;368(2):138-48. Epub 2012 Dec 10. Erratum in: N Engl J Med. 2013 Feb 7;368(6):584.

New Options for Thyroid Cancer

Robert I. Haddad, MD, Director of the Center for Head and Neck Oncology, presented new treatments for patients with thyroid cancer who become resistant to the standard treatment with radioactive iodine. He outlined results seen with two recently-approved kinase inhibitors – cabozantanib and vandetanib – that have greatly extended progression-free survival in patients with advanced medullary cancer and noted that more are expected in the next few years. He also reported promising results with selumetinib, lenvatinib,
sorafenib, everolimus, and pazopanib in differentiated thyroid cancers that are resistant to radioactive iodine. “The field of thyroid cancer is rapidly changing. Until recently, there were no real treatment options for these patients. We are now seeing durable responses with biologic agents,” said Dr. Haddad.

Robinson B, Paz-Ares L, Krebs A, Vasselli J, Haddad R: Vandetanib (100 MG) in Patients with Locally Advanced or Metastatic Hereditary Medullary Thyroid Cancer. J Clin Endocrinol Metab. 2010 Jun;95(6):2664-71.

Lorch J, Busaidy N, Ruan D, Janne P, Limaye S, Wirth L, Barletta J, Rabinowits G, Garraway L, Van Allen E, Wagle N, Hanna G, Misiukiewicz K, Suda M, Haddad T, Devine C, Williams A, Warsi G, Posner M, Haddad R: Phase II study of everolimus in patients with aggressive RAI refractory (RAIR) thyroid cancer (TC). ASCO annual meeting 2013.

Kidney Cancer

Toni K. Choueiri, MD, Director of the Kidney Cancer Program in the DF/BWCC Center for Genitourinary Oncology, presented on progression-free survival in advanced renal cell carcinoma. He discussed the seven targeted drugs that have been approved for advanced kidney cancer over the past eight years. “Many of these drugs target the VEGF receptor in these angiogenically-rich tumors,” said Dr. Choueiri. “While sunitinib is the most commonly used drug for first-line therapy, our studies suggest that pazopanib may be better tolerated.” He also noted that cytoreductive nephrectomy continues to be important even in the era of targeted therapies.

Choueiri TK, Xie W, Kollmannsberger C, North S, Knox JJ, Lampard JG, McDermott DF, Rini BI, Heng DY. The impact of cytoreductive nephrectomy on survival of patients with metastatic renal cell carcinoma receiving vascular endothelial growth factor targeted therapy. J Urol. 2011; 185:60-6.

Motzer RJ, Hutson TE, Reeves J, et al. Randomized open-label phase III trial of pazopanib versus sunitinib in first-line treatment of patients with metastatic renal cell carcinoma (MRCC): Results of the COMPARZ trial. 2012 ESMO Congress. Abstract LBA8. Presented October 1, 2012.

Multiple Myeloma

Kenneth Anderson, MD, Director of the DF/BWCC Multiple Myeloma Program, discussed novel agents and future directions in treating patients with relapsed or refractory multiple myeloma. He discussed pomalidomide and carfilzomib, recently approved for the treatment of multiple myeloma, and outlined the development of immune therapies and novel agents targeting the myeloma cell in the bone marrow microenvironment, as well as rationally-based combination therapies.

“With these advances, myeloma will be a chronic illness, with sustained complete response in a significant percentage of patients,” said Dr. Anderson.

Richardson PG, Siegel D, Baz R, Munshi N, Laubach J, Sullivan D, Alsina M, Schlossman R, Ghobrial IM, Doss D, Loughery N, McBride L, Bilotti E, Anand P, Nardelli L, Wear S, Larkins G, Chen M, Zaki M, Jacques C, Anderson KC: A phase I dose-escalation study to determine the maximum tolerated dose of pomalidomide and its safety and efficacy in patients with relapsed and refractory multiple myeloma who have received prior treatment with lenalidomide and bortezomib. Blood 2013; 121: 1961-7.

Lawasut P, Chauhan D, Laubach J, Hayes C, Fabre C, Maglio M, Mitsiades C, HideshimaT, Anderson KC, Richardson PG. New proteasome inhibitors in myeloma. Curr Hematol Malig Rep. 2012; 7:258-66.

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Breast Cancer — New Horizons, Current Controversies
July 11 – 13, 2013
Boston Marriott Long Wharf
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