Experts said the striking survival improvements were a first for this precision medicine approach in these patients. And with less impressive results for other similar drugs in different trials, as Forbes discussed , it raises the question of which combinations will prove best for patients. And for more on the Nobel Prize-winning science behind ribociclib, read this blog post: Understanding how cells divide — the story of a Nobel prize. Immunotherapy, chemotherapy or both? New, unpublished trial results painted a mixed picture for some advanced stomach cancer patients.
On one side, the immunotherapy drug pembrolizumab Keytruda could prove just as effective as chemotherapy in prolonging the lives of patients with advanced cancers of the stomach or food pipe. And for some, the immune-boosting treatment offered improved survival in the trial compared to standard treatment.
When combined with chemotherapy, it added no extra survival benefits to patients. Our news report has the details: Immunotherapy comparable to chemo for some advanced stomach cancers. As a result, a few made headlines. By targeting genetic weaknesses inside cancer cells, a precision drug held some advanced pancreatic cancers at bay for a short time after chemo, according to new clinical trial results.
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The drug, called olaparib Lynparza , delayed the progression of the disease by 7. And while longer term survival analysis is still needed to gauge the potential impact, some pancreatic cancer experts were cautiously optimistic about the trial results. The Mail Online and Telegraph were among those who covered the early results. A new drug was added to the list of possible up-front treatment options for people diagnosed with prostate cancer that has spread.
Prostate Cancer: New Horizons in Research and Treatment | Michael L. Cher | Springer
With similar results seen in previous trials for a chemotherapy drug — called docetaxel — and another hormone treatment called abiraterone Zytiga , this points to the possibility of doctors and patients having 3 options for treatment in the future. But there was one thing for certain, according to Dr Tanya B. Intensity-modulated external-beam radiotherapy and VMAT employ dynamic multileaf collimators, which automatically and continuously adapt to the contours of the target volume seen by each beam.
Both techniques allow for a more complex distribution of the dose to be delivered within the treatment field and provide concave isodose curves, which are particularly useful as a means of sparing the rectum. Treatment plans must conform to pre-specified dose constraints to critical organs at risk of normal tissue damage, and a formal quality assurance process should be routine. With dose escalation using IMRT, organ movement becomes a critical issue, in terms of both tumour control and treatment toxicity. Evolving techniques will therefore combine IMRT with some form of image-guided radiotherapy IGRT , in which organ movement can be visualised and corrected for in real time, although the optimum means of achieving this is still unclear [ ].
Tomotherapy is another technique for the delivery of IMRT, using a linear accelerator mounted on a ring gantry that rotates as the patient is delivered through the centre of the ring, analogous to spiral CT scanning. Several RCTs have shown that dose escalation range Gy has a significant impact on five-year biochemical relapse [ ].
The best evidence of an OS benefit for patients with intermediate- or high-risk PCa, but not with low-risk PCa, comes from a non-randomised but well conducted propensity matched retrospective analysis of the U.
New prostate cancer treatment significantly improves survival
National Cancer Database covering a total of 42, patients [ ]. MD Anderson study [ ]. PROG [ ]. MRC RT01 [ ]. Dutch randomised phase III trial [ ]. GETUG 06 [ ]. RTOG [ ].
Fractionated RT utilises differences in the DNA repair capacity of normal and tumour tissue, and slowly proliferating cells are very sensitive to an increased dose per fraction [ ]. Hypofractionation HFX has the added advantage of being more convenient for the patient and cheaper for the health care system. Several studies report on HFX applied in various techniques and, in part, also including HT [ ].
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Lee, et al. Dearnaley, et al. CHHiP [ ] and [ ]. BCDF Aluwini, et al.
Catton, et al. Short-term biochemical control is comparable to conventional fractionation. However, there are concerns about high-grade GU and rectal toxicity, and long-term side-effects may not all be known yet [ , , ]. Therefore it seems prudent to restrict extreme HFX to prospective clinical trials and to inform patients on the uncertainties of the long-term outcome. Freeman, et al. Katz, et al. The main message is that for intermediate risk a short duration of around 6 months is optimal, while a longer one, around three years, is needed for high-risk patients.
No significant difference between neoadjuvant plus concomitant vs. Goserelin plus flutamide 2 mo. LHRH agonist given for 2 yr. EORTC [ ]. Better result with 3 yr. T poorly differentiated and M0, or T N M0. Significant benefit at 10 yr. TROG [ ]. Goserelin plus flutamide 3 or 6 mo. LHRH as a standard. LHRH agonist for 3 mo.
Mottet N, et al. Significant reduction of clinical progression; 5-yr. OS Zelefsky et al.
New Approach For Treating Recurrent Prostate Cancer On The Horizon
The prostate dose ranged from The duration of ADT was three months for low-risk patients and six months for intermediate-risk and high-risk patients, starting at three months before RT. The ten-year biochemical disease-free rate was significantly improved by dose escalation: above It was also improved by adding six months of ADT in intermediate- and high-risk patients.
There is also a very sharp fall-off for proton beams beyond their deposition depth, meaning that critical normal tissues beyond this depth could be effectively spared. In contrast, photon beams continue to deposit energy until they leave the body, including an exit dose.
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One RCT on dose escalation This trial shows improved outcome with the higher dose, but it cannot be used as evidence for the superiority of proton therapy per se [ ]. Thus, unequivocal information that shows an advantage of protons over IMRT photon therapy is still not available.
Studies from the SEER database and from Harvard describing toxicity and patient-reported outcomes do not point to an inherent superiority for protons [ , ]. Meanwhile, proton therapy must be regarded as a promising, but experimental, alternative to photon-beam therapy. Low-dose rate brachytherapy uses radioactive seeds permanently implanted into the prostate. The only available RCT comparing RP and brachytherapy as monotherapy was closed due to poor accrual [ ].
Outcome data are available from a number of large population cohorts with mature follow-up [ ]. A significant correlation has been shown between the implanted dose and biochemical control [ ]. The technical differences are outlined in Table 6. The use of published guidelines is strongly recommended [ ]. High-dose rate brachytherapy can be delivered in single or multiple fractions and is often combined with EBRT of at least 45 Gy [ ].
EBRT However, a very high, uncommon, rate of early recurrences was observed in the EBRT arm alone, even after two years, possibly due to a dose lower than the current standard used [ ].