Contemporary Oncology Research Articles

Ocena patomorfologiczna materiału tkankowego raka piersi po leczeniu systemowym

Oncological management of patients with breast cancer, with the use of pre-operative systemic therapy in the last decade presented significant increase of effectiveness. The greater the number of cases with complete or major pathomorphological response means that getting the right material for postoperative histopathological assessment is becoming more and more difficult. In addition, the demonstrated correlation between complete pathomorphological response (pCR) and long-term treatment effects (in HER2-positive and triple-negative subtypes of breast carcinoma) makes the standardisation of postoperative pathomorphological examination, both at the gross and microscopic level, a necessity. This article presents the recommended rules for the preparation of such material and the method of its reporting, corresponding to the needs of contemporary oncology.

Brain metastases the challenge of contemporary oncology

Abstract Brain metastases (BM) represent the most common tumours of the central nervous system with ranged between 2.8 and 14.3 per 100.000. Despite advances in the diagnosis and treatment of brain metastases, such as surgery, chemotherapy and radiotherapy only 2.4% of patients will survive 5 years. BM causes a wide spectrum of neurological symptoms, such as hemiparesis, impaired coordination or walking, aphasia, and seizures. Despite the effective treatment of the primary tumor, in many cases, it does not protect against brain metastases. The main source of BMs in adults is, in descending order, non-small cell lung cancer, followed by breast cancer and melanoma and then renal cancer. Some malignancies particularly tend to produce “late” or “delayed” cerebral metastasis years or even decades after the anti-cancer treatment has been accomplished. There is still a need to develop more effective treatments for cancer and metastases to the brain.

Tailoring early-phase clinical trial design to address multiple research objectives.

In contemporary oncology drug development, implementation of novel early-phase designs with the ability to address multiple research objectives is needed to better refine regimens. This paper describes an adaptive design strategy for identifying a range of optimal regimens based on two endpoints within multiple cohorts. The proposed design was developed to address objectives in an early-phase trial of cancer vaccines in combination with agonistic antibodies to CD40 and CD27. We describe a model-based design strategy that was developed for a trial evaluating the safety and immunogenicity of vaccination with (1) peptides plus CD40 antibody and TLR3 ligand, (2) systemic administration of an agonistic CD27 antibody, and (3) to assess immune response from (1) and (2) compared to optimal controls in participants with stage IIB-IV melanoma. The proposed design is a practical adaptive method for use with combined immunotherapy regimens with multiple objectives within multiple cohorts of interest. Further advances in the effectiveness of cancer immunotherapies will require new approaches that include redefining optimal strategies to take multiple regimens forward into later phases, incorporating additional endpoints in the dose selection process and testing drug combination therapies to improve efficacy and reduce toxicity. Our goal is to facilitate the acceptance and application of more novel designs in contemporary early development trials.

RNA sequencing analysis for profiling activation of cancer-associated molecular pathways.

e13032 Background: Intracellular molecular pathways (IMPs) control all major events in the living cell. They are considered hotspots in contemporary oncology because knowledge of IMPs activation is essential for understanding mechanisms of molecular pathogenesis in oncology. Profiling IMPs requires RNA-seq data for tumors and for a collection of reference normal tissues. However, there is a shortage now in such profiles for normal tissues from healthy human donors, uniformly profiled in a single series of experiments. Access to the largest dataset of normal profiles GTEx is only partly available through the dbGaP. In TCGA database, norms are adjacent to surgically removed tumors and may be affected by tumor-linked growth factors, inflammation and altered vascularization. ENCODE datasets were for the autopsies of normal tissues, but they can’t form statistically significant reference groups. Methods: Tissue samples representing 20 organs were taken from post-mortal human healthy donors killed in road accidents no later than 36 hours after death, blood samples were taken from healthy volunteers. Gene expression was profiled in RNA-seq experiments using the same reagents, equipment and protocols. Bioinformatic algorithms for IMP analysis were developed and validated using experimental and public gene expression datasets. Results: From original sequencing data we constructed the biggest fully open reference expression database of normal human tissues including 465 profiles termed Oncobox Atlas of Normal Tissue Expression (ANTE, original data: GSE120795). We next developed a method termed Oncobox for interrogating activation of IMPs in human cancers. It includes modules of expression data harmonization and comparison and an algorithm for automatic annotation of molecular pathways. The Oncobox system enables accurate scoring of thousands molecular pathways using RNA-seq data. Oncobox pathway analysis is also applicable for quantitative proteomics and microRNA data in oncology. Conclusions: The Oncobox system can be used for a plethora of applications in cancer research including finding differentially regulated genes and IMPs, and for discovery of new pathway-related diagnostic and prognostic biomarkers.

Use of ovarian suppression with endocrine therapy among premenopausal United States women with breast cancer, 2001-2016.

e12010 Background: Clinical trials indicate that adding ovarian suppression (OS) to endocrine therapy (ET) in premenopausal women with non-metastatic breast cancer improves disease-free and overall survival. However, injectable OS may add cost, potential side effect burden, and additional clinic visits to adjuvant therapy. It is not known to what extent OS is being used in contemporary community oncology settings. Methods: We identified women age 18-50 with incident breast cancer based on diagnosis codes from 2001-2016 in the commercial IBM MarketScan database. Eligible patients were continuously enrolled for a year prior to cancer diagnosis and filled at least 1 prescription for oral ET (i.e., tamoxifen, toremifene, anastrozole, letrozole, and/or exemestane) in the year after diagnosis. We classified use of OS as any prescription for a gonadotropin-releasing hormone agonist in outpatient pharmacy claims or procedure code for OS implant or injection 1) in the week prior to ET initiation or 2) following ET initiation and for up to 18 months after diagnosis. We estimated the proportion of women that were OS users in each diagnosis year using linear binomial regression, and examined associations between OS use, age at diagnosis, and geographic region. Results: A total of 26,114 women meeting all inclusion criteria were identified from the MarketScan database, of whom 1,452 (5.6%) were OS users. The most common OS drug was leuprolide or leuprorelin (55.2%), followed by goserelin (46.7%), and triptorelin (1.1%). Risk of OS use varied from 3.2% in 2001 to 9.3% in 2016, peaking at 11.4% in 2015. OS use varied by region (χ2 p = 0.0003), with the highest use observed in the Northeast (6.5%) and the lowest in the South (5.0%). Younger patients were significantly more likely to use OS than older patients, with each additional year of age at diagnosis associated with a 0.57 percentage point lower risk (95% confidence interval [CI]: -0.63, -0.51). After controlling for age group (≤40, 41-44, 45-46, 47-48, 49-50) and region, each additional calendar year was associated with 0.25 percentage point greater risk of OS use (95% CI: 0.19, 0.31). Conclusions: OS use with ET appears to be increasing in US breast oncology practice among women under 50.

Predicting VTE in Cancer Patients: Candidate Biomarkers and Risk Assessment Models.

Risk prediction of chemotherapy-associated venous thromboembolism (VTE) is a compelling challenge in contemporary oncology, as VTE may result in treatment delays, impaired quality of life, and increased mortality. Current guidelines do not recommend thromboprophylaxis for primary prevention, but assessment of the patient’s individual risk of VTE prior to chemotherapy is generally advocated. In recent years, efforts have been devoted to building accurate predictive tools for VTE risk assessment in cancer patients. This review focuses on candidate biomarkers and prediction models currently under investigation, considering their advantages and disadvantages, and discussing their diagnostic performance and potential pitfalls.

The Rate of Venous Thromboembolism in Cancer Patients Varies By Khorana Risk Category

Introduction: Venous thromboembolism (VTE) is common in cancer patients and associated with adverse consequences. Risk factors for cancer-associated VTE are multifactorial and a validated tool, the Khorana risk score (KRS), is recommended by guidelines to determine risk. This study evaluates contemporary rates of VTE in real world settings using this risk score.Methods: The Optum©'s Clinformatics® Data Mart database (01/01/2012 - 09/30/2017) was used to select adult patients with ≥1 hospitalizations or 2 outpatient medical claims with a cancer diagnosis (index date) who were initiated on cancer therapy (e.g., chemotherapy or radiation therapy) within 45 days of the index date. To be included in this study, patients were also required to meet the following criteria: (1) continuous eligibility for ≥6 months before the index date (baseline period), (2) no VTE event during the baseline period, (3) no use of anticoagulants prior to the index date or up until a VTE event during the follow-up, (4) no evidence of a major surgery after the index date, (5) ≥1 laboratory test result for hemoglobin, leukocyte, and platelet counts within 28 days before cancer treatment initiation. The KRS was calculated using the index cancer site, body mass index, and laboratory test results prior to treatment initiation (i.e., hemoglobin, leukocyte, and platelet counts). Based on the risk score, patients were classified into cohorts of 0, 1, 2 or ≥3 KRS. The main outcome was a VTE; defined as a primary VTE diagnosis during a hospitalization or a secondary VTE diagnosis during a hospitalization followed by either 1) another hospitalization or outpatient visits with a diagnosis (primary or secondary) of VTE or 2) an anticoagulant dispensing within 30 days after the discharge date of the first hospitalization. Kaplan-Meier (KM) analyses were used to evaluate time to first VTE event. Patients without an event were censored at the end of the observation period (i.e., the earliest date between the end of data availability, death, end of insurance coverage, or 12 months post-index). KM rates were reported at 12 months and cohorts were compared using adjusted Cox proportional hazards models controlling for the following baseline characteristics: age, sex, insurance type, year and month of index date, Charlson comorbidity index (CCI) score, Elixhauser comorbidities with a proportion ≥5%, index cancer type, and healthcare resource utilization and costs.Results: The study population comprised 6,194 patients (KRS=0: 2,488; KRS=1: 2,125; KRS=2: 1,074; KRS≥3: 507). Patients were, on average, 68 years old, 48% female, and mean CCI score ranged from 1.1 to 1.4 for 1 to ≥3 KRS. The mean observation period was 9.6, 8.7, 8.0, and 6.9 months for KRS cohorts of 0, 1, 2, and ≥ 3, respectively. The 12-month cumulative VTE rates were 2.8% (KRS=0), 4.6% (KRS=1), 7.9% (KRS=2), and 13.2% (KRS≥3); with an associated mean (median) time to VTE event of 3.0 (2.0), 3.6 (3.0), 3.6 (2.7), and 2.3 (1.6) months for KRS cohorts of 0, 1, 2, and ≥ 3, respectively (Figure 1). The adjusted hazard ratio (95% confidence interval) at 12 months using the KRS=0 cohort as a reference cohort was 1.60 (1.14, 2.25) for KRS=1 vs 0; 2.66 (1.85, 3.83) for KRS=2 vs 0; and 4.82 (3.22, 7.23) for KRS ≥3 vs 0 (all p-values<0.05).Conclusions: This real-world retrospective analysis found that the rate of VTE events among newly diagnosed cancer patients who were initiated on cancer therapy significantly increased with VTE risk level based on the KRS. Over 25% of patients in the observed cohort have KRS≥2 and are 3 times more likely to develop VTE from the time of cancer diagnosis. These findings further validate the KRS in contemporary oncology patients and support ongoing studies of thromboprophylaxis in patients with a score of 2 or higher. [Display omitted] DisclosuresKhorana:Sanofi: Consultancy; Bayer: Consultancy; Pfizer: Consultancy; Janssen: Consultancy. Kuderer:Celldex: Consultancy; Mylan: Consultancy, Other: Travel, Accommodations, Expenses; Coherus Biosciences: Consultancy, Other: Travel, Accommodations, Expenses; Halozyme: Consultancy; Myriad Genetics: Consultancy; Pfizer: Consultancy; Janssen Scientific Affairs, LLC: Consultancy, Other: Travel, Accommodations, Expenses. Milentijevic:Janssen Scientific Affairs, LLC: Employment, Equity Ownership. Germain:Janssen Scientific Affairs, LLC: Research Funding. Laliberté:Janssen Scientific Affairs, LLC: Research Funding. Le:Janssen Scientific Affairs, LLC: Research Funding. Lefebvre:Janssen Scientific Affairs, LLC: Research Funding. Lyman:Generex Biotechnology: Membership on an entity's Board of Directors or advisory committees; Halozyme; G1 Therapeutics; Coherus Biosciences: Consultancy; Amgen: Other: Research support.

MiRNA-130a Significantly Improves Accuracy of SGA Nutritional Assessment Tool in Prediction of Malnutrition and Cachexia in Radiotherapy-Treated Head and Neck Cancer Patients.

Background: Investigation of novel cachexia-related markers is one of the major challenges in contemporary oncology. Among studied markers, the miRNA seems to be promising due to its possibility to regulate genes responsible for induction of inflammatory response, muscle atrophy and fat tissue wasting. The aim of the study was to investigate the role of blood-circulating miRNA-130a in prediction of cancer cachexia in 70 head and neck cancer patients (HNC) subjected to radiotherapy. Moreover, diagnostic accuracy of SGA (Subjective Global Assessment) scoring and miRNA-130a level was evaluated in various cachexia models. Results: miRNA-130a level negatively correlated with plasma TNF-α concentration (r = −0.560; p < 0.001). Patients with low miRNA expression had over 3-fold higher risk of body mass index (BMI) decrease below 18.5 after the termination of therapy; over 6-fold higher risk of losing over 5% of body weight and higher risk of >10% weight reduction odds ratio (OR) = 14.18 compared to other cases. ROC analysis performed for miRNA-130a allowed to distinguish cachectic patients (body weight loss >5%) from moderately or mildly malnourished ones with optimal sensitivity of 79.4% and specificity of 80.8% area under the curve (AUC) = 0.865). miRNA significantly improved nutritional assessment conducted using SGA, achieving the following values: sensitivity 88.6%, specificity 94.3%, positive predictive value (PPV) 93.9%, negative predictive value (NPV).89.2%. Conclusion: miRNA-130a demonstrates potential clinical utility in prediction of cachexia prior to the therapy in HNC patients. Simultaneous use of both tools—SGA and miRNA—significantly improved the accuracy in the diagnosis of cachexia.

The benefits of targeted endoscopic biopsy performed using the autofluorescence based diagnostic technique in 67 cases of diagnostically difficult gastrointestinal tumors.

The search for new diagnostic and therapeutic procedures is an essential task in contemporary oncology. The purpose of our study was the evaluation of the practical usefulness of autofluorescence endoscopy (AFE) using the Onco-LIFE system, compared with the use of white light endoscopy (WLE), and the estimation of the correlation between the histopathological evaluation with the degree of lesions' Numerical Color Value (NCV index) and the method's sensitivity and specificity valuation. 67 patients were analyzed at the Center for Laser Diagnostics and Therapy. All patients previously had a gastrointestinal tract tumor, which appeared malignant, but without histopathological confirmation. We measured NCV, estimated the correlation of the clinical diagnosis based on histopathological evaluation with the degree of NCV index from gastrointestinal lesions, and calculated the sensitivity and specificity of this method. In the group of 67 patients, we found 44 cases of primary or secondary cancers and 7 cases of non-epithelial malignancies. In this group (51 patients) we identified 13 colorectal cancers and 38 upper gastrointestinal cancers. Based on the NCV index at NCV > 1.0, we revealed, that the sensitivity for malignant neoplastic lesions was 100% and the specificity was 73%, while for NCV > 1.5, the sensitivity for malignant neoplastic lesions was 86% and the specificity 100%. AFE using the Onco-LIFE system is a helpful tool to perform targeted biopsies at the outset. A significant correlation was found between lesions' NCV index and the grade of dysplasia or tumor malignancy. AFE sensitivity and specificity is higher than WLE. Further studies are needed, especially performed by expert endoscopists.

Controversy over the Use of Proton Therapy for the Treatment of Tumors of Central Nervous System

Proton beam therapy (PBT) is one of the most discussed topics in contemporary oncology. PBT is characterized by certain physical properties that make it theoretically better as a treatment than standard photon therapy. On the other hand, there are some uncertainties regarding the localization of the dose peak (Bragg peak) in real clinical situations and the value of radiobiological effectiveness at the end of proton beam. Unfortunately, the high expectations of PBT have not been fulfilled in published clinical studies. In the present article, the results of PBT are compared with those of standard photon therapy for the treatment of low-and high-grade gliomas, pituitary adenomas, vestibular schwannomas, chordomas and chondrosarcomas, and pediatric central nervous system tumors. PBT was not better in tumor control or in reducing toxicity than photon therapy. The higher risk of post-radiation brain tissue necrosis after PBT is alarming. PBT is mostly considered for pediatric tumors, because the radiobiological models predict lower damage to neurocognitive functions and a reduction in secondary malignancies. However, this hypothesis has its opponents and sufficient clinical data to justify the models are still lacking. The cost of PBT is several times higher than that of photon therapy. PBT is a revolutionary technology in modern radiotherapy, but so far, clinical data have not proved it to be superior to that of standard photon therapy. PBT should be considered on an individual basis in cases where modern photon therapy cannot meet the dose limits of healthy tissues.Key words: proton therapy - neoplasms - central nervous systemSubmitted: 24. 10. 2017Accepted: 23. 11. 2017 The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Contemporary oncology research: a special issue on the mechanobiology and biophysics of cancer development and progression

Contemporary oncology research: a special issue on the mechanobiology and biophysics of cancer development and progression

Nanotechnology Strategies To Advance Outcomes in Clinical Cancer Care.

Ongoing research into the application of nanotechnology for cancer treatment and diagnosis has demonstrated its advantages within contemporary oncology as well as its intrinsic limitations. The National Cancer Institute publishes the Cancer Nanotechnology Plan every 5 years since 2005. The most recent iteration helped codify the ongoing basic and translational efforts of the field and displayed its breadth with several evolving areas. From merely a technological perspective, this field has seen tremendous growth and success. However, an incomplete understanding of human cancer biology persists relative to the application of nanoscale materials within contemporary oncology. As such, this review presents several evolving areas in cancer nanotechnology in order to identify key clinical and biological challenges that need to be addressed to improve patient outcomes. From this clinical perspective, a sampling of the nano-enabled solutions attempting to overcome barriers faced by traditional therapeutics and diagnostics in the clinical setting are discussed. Finally, a strategic outlook of the future is discussed to highlight the need for next-generation cancer nanotechnology tools designed to address critical gaps in clinical cancer care.

Texas pharmacy legend James D. McKinley dies at 93.

James Daniel McKinley, Jr., founder and longtime chief of the pharmacy department at the University of Texas MD Anderson Cancer Center in Houston, died September 29 at the age of 93. “Jim McKinley was a pioneering leader who laid the foundation for contemporary oncology pharmacy practice, and he was a mentor and friend to so many,” said ASHP Chief Executive Officer Paul W. Abramowitz. “His status as a pharmacy legend was established decades ago, and he will forever be recognized as an innovator and leader whose work set the course for the clinical and patient-focused profession we have today.” Under McKinley’s leadership, the pharmacy department established an i.v. admixture service—a rarity at the time—and a drug information service that supported clinicians at the start of the modern era of cancer chemotherapy. “He built the department from nothing,” said Roger W. Anderson, who succeeded McKinley as pharmacy director and considered him a friend and mentor. “He was such a committed person in general—committed to pharmacy, and he had such a heavy commitment to the early years of MD Anderson…. I really consider it a great honor to have been the one to follow him as director.”

A Review of the Therapeutic Antitumor Potential of Cannabinoids.

The aim of this review is to discuss cannabinoids from a preclinical and clinical oncological perspective and provide the audience with a concise, retrospective overview of the most significant findings concerning the potential use of cannabinoids in cancer treatment. A literature survey of medical and scientific databases was conducted with a focus on the biological and medical potential of cannabinoids in cancer treatment. Cannabis sativa is a plant rich in more than 100 types of cannabinoids. Besides exogenous plant cannabinoids, mammalian endocannabinoids and synthetic cannabinoid analogues have been identified. Cannabinoid receptors type 1 (CB1) and type 2 (CB2) have been isolated and characterized from mammalian cells. Through cannabinoid receptor and non-receptor signaling pathways, cannabinoids show specific cytotoxicity against tumor cells, while protecting healthy tissue from apoptosis. The dual antiproliferative and proapoptotic effects of cannabinoids and associated signaling pathways have been investigated on a large panel of cancer cell lines. Cannabinoids also display potent anticancer activity against tumor xenografts, including tumors that express high resistance to standard chemotherapeutics. Few studies have investigated the possible synergistic effects of cannabinoids with standard oncology therapies, and are based on the preclinically confirmed concept of "cannabinoid sensitizers." Also, clinical trials aimed to confirm the antineoplastic activity of cannabinoids have only been evaluated on a small number of subjects, with no consensus conclusions regarding their effectiveness. A large number of cannabinoid compounds have been discovered, developed, and used to study the effects of cannabinoids on cancers in model systems. However, few clinical trials have been conducted on the use of cannabinoids in the treatment of cancers in humans. Further studies require extensive monitoring of the effects of cannabinoids alone or in combination with standard anticancer strategies. With such knowledge, cannabinoids could become a therapy of choice in contemporary oncology.

Chemotherapy with radiotherapy influences time-to-development of radiation-induced sarcomas: a multicenter study

Background:An increasing number and proportion of cancer patients with apparently localised disease are treated with chemotherapy and radiation therapy in contemporary oncology practice. In a pilot study of radiation-induced sarcoma (RIS) patients, we demonstrated that chemotherapy was associated with a reduced time to development of RIS. We now present a multi-centre collaborative study to validate this association.Methods:This was a retrospective cohort study of RIS cases across five large international sarcoma centres between 1 January 2000 to 31 December 2014. The primary endpoint was time to development of RIS.Results:We identified 419 patients with RIS. Chemotherapy for the first malignancy was associated with a shorter time to RIS development (HR 1.37; 95% CI: 1.08–1.72; P=0.009). In the multi-variable model, older age (HR 2.11; 95% CI 1.83–2.43; P<0.001) and chemotherapy for the first malignancy (HR 1.61; 95% CI 1.26–2.05; P<0·001) were independently associated with a shorter time to RIS. Anthracyclines and alkylating agents significantly contribute to the effect.Conclusions:This study confirms an association between chemotherapy given for the first malignancy and a shorter time to development of RIS.

The morbidity and mortality conference (MMC) concept applied to contemporary oncology practice: Retrospective findings on management of 233 patients (pts) who died of ovarian cancer (OC), colorectal cancer (CRC) and wild-type (no identified targetable mutation) nonsquamous non-small cell lung cancer (WTLC).

e18195 Background: MMC have traditionally evaluated pt management and potential areas for quality improvement. We hypothesized that this approach could be adapted and extrapolated to gain increased insight into how pts with common solid tumors are being treated in general oncology practice and how the approaches used align with evidence-based guidelines. Methods: 102 randomly recruited US-based general medical oncologists from a proprietary database of 4,019 agreed to consult their medical records and provide information on biomarkers assessed, systemic therapies administered and other treatment-related factors for the last pt in their practice to die from OC, CRC and/or WTLC. An IRB exemption was obtained and a modest honorarium was provided. Results: Pts with OC, CRC and WTLC received a median of 3, 3 and 2 lines of therapy, respectively, the majority of which were supported by guidelines, but in more than half of cases, the regimen administered required dose adjustment/discontinuation due to toxicity. Less than half of pts were offered trial participation and only 15 (6%) entered a trial. 19 pts with OC (25%), 25 pts with CRC (32%) and 58 pts with WTLC (73%) did not undergo BRCA, MSI and multiplex genomic testing, respectively, despite the recommendation of available guidelines. Conclusions: The MMC model may be an effective means to document variability as well as consistency in current oncologic care. Data generated via this assessment juxtaposed with current clinical evidence and available guideline recommendations could potentially serve as a powerful educational intervention. These findings require additional validation but provide initial support for future iterations of this exercise. [Table: see text]

Influence of chemotherapy combined with radiotherapy on the time-to-development of radiation-induced sarcomas: A multicenter, retrospective analysis.

11046 Background: An increasing number and proportion of cancer patients with apparently localised disease are treated with chemotherapy and radiation therapy in contemporary oncology practice. In a pilot study of radiation-induced sarcoma (RIS) patients, we demonstrated that chemotherapy was associated with a reduced time to development of RIS. We now present an international multi-centre collaborative study to validate this association. Methods: This was a retrospective cohort study of RIS cases across five large international sarcoma centres between the 1st January, 2000 to 31st December, 2014. The primary endpoint was time to development of RIS, defined as the date of diagnosis of the first malignancy to date of the RIS diagnosis. We also assessed the relationship between chemotherapy, patient and cancer characteristics, and time to RIS. Results: We identified 419 patients with RIS, who were predominantly diagnosed with their first malignancy at adulthood. The median interval from the index cancer to development of RIS for the entire cohort was 11 years (range 1-64). Chemotherapy for the first malignancy was associated with a shorter time to RIS development (HR 1·37; 95% CI: 1·08-1·72; P = 0·009). In the multi-variable model, older age (HR 2·11; CI 1·83-2·43; P &lt; 0·001) and chemotherapy for the first malignancy (HR 1·61; CI 1·26-2·05; P &lt; 0·001) were independently associated with a shorter time to RIS. Anthracyclines and alkylating agents significantly contribute to the effect. Conclusions: This study confirms an association between chemotherapy given for the first malignancy and a shorter time to development of a RIS. Our data highlights the importance of vigilance in surveillance for RIS after chemotherapy and radiation therapy, particularly in younger patients who also have a longer potential time to develop a second malignancy.

Cardiovascular complications of chemotherapy

Many of the highly effective agents in contemporary oncology, including the anthracyclines and trastuzumab, are known to increase the risk of cardiac events in both the short and long term. As these agents are often used to obtain a cure, the means of maximising their benefits while reducing the risk to the heart has become a priority when managing the patient with a malignancy. In addition, the novel biologic therapies, designed to fulfil unmet needs in oncology, require the development of strategies for risk detection and management that aim to reduce the risk of cardiac toxicity.

The morbidity and mortality conference (MMC) concept applied to contemporary oncology practice: Retrospective findings on management of 233 patients (pts) who died of ovarian cancer (OC), colorectal cancer (CRC), and wild-type (no identified targetable mutation) nonsquamous non-small cell lung cancer (WTLC).

241 Background: MMC have traditionally evaluated pt management and potential areas for quality improvement. We hypothesized that this approach could be adapted and extrapolated to gain increased insight into how pts with common solid tumors are being treated in general oncology practice and how the approaches used align with evidence-based guidelines. Methods: 102 randomly recruited US-based general medical oncologists from a proprietary database of 4,019 agreed to consult their medical records and provide information on biomarkers assessed, systemic therapies administered and other treatment-related factors for the last pt in their practice to die from OC, CRC and/or WTLC. An IRB exemption was obtained and a modest honorarium was provided. Results: Pts with OC, CRC and WTLC received a median of 3, 3 and 2 lines of therapy, respectively, the majority of which were supported by guidelines, but in more than half of cases, the regimen administered required dose adjustment/discontinuation due to toxicity. Less than half of pts were offered trial participation and only 15 (6%) entered a trial. 19 pts with OC (25%), 25 pts with CRC (32%) and 58 pts with WTLC (73%) did not undergo BRCA, MSI and multiplex genomic testing, respectively, despite the recommendation of available guidelines. Conclusions: The MMC model may be an effective means to document variability as well as consistency in current oncologic care. Data generated via this assessment juxtaposed with current clinical evidence and available guideline recommendations could potentially serve as a powerful educational intervention. These findings require additional validation but provide initial support for future iterations of this exercise. [Table: see text]

РЕНТГЕНОЭНДОВАСКУЛЯРНАЯ ХИМИОЭМБОЛИЗАЦИЯ ПЕЧЕНОЧНОЙ АРТЕРИИ - СОВРЕМЕННЫЙ МЕТОД РЕГИОНАЛЬНОЙ ХИМИОТЕРАПИИ ЗЛОКАЧЕСТВЕННЫХ ПОРАЖЕНИЙ ПЕЧЕНИ

The paper deals with the review of literature devoted to one of the most important issues of contemporary oncology: treatment of malignant liver tumors. Much attention is paid to the analysis of modern endovascular treatment methods research, namely – transcatheter chemoembolization of the hepatic artery. The morphological and functional bases of chemoembolization are described in detail. The comparison between chemoembolization drugs are noted in the article, too. The results of research are shown. The conclusions about the efficiency that allows achieving positive dynamics and stabilization of the process are drawn.