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Updated Guideline on Bone-Modifying Agents for Metastatic Breast Cancer

In conjunction with Cancer Care Ontario, the American Society of Clinical Oncology has issued a focused guideline update on the role of bone-modifying agents (BMAs) in metastatic breast cancer. Evidence is not sufficient to support the choice of one BMA over another; options for zoledronic acid now include every-12-week dosing as an alternative to monthly treatment, and BMAs should not be used alone for management of bone pain, given their modest analgesic benefit.

IUD Use Associated With Lower Cervical Cancer Incidence

Prior studies have suggested that intrauterine devices (IUDs), one of the most reliable forms of long-acting reversible contraception, are associated with a reduction in cervical cancer. Now, a meta-analysis including 16 studies reported that the incidence of cervical cancer was reduced by about one-third in IUD users compared with nonusers. This protective effect is particularly important for women at higher risk of cervical cancer, such as those who have not received the human papillomavirus vaccine or who do not have access to cervical cancer screening. It is not known if the type of device influences the reduction in cervical cancer risk.

Vaginal Dehydroepiandrosterone for Genitourinary Symptoms in Postmenopausal Cancer Survivors

Treatment of genitourinary syndrome of menopause (GSM) in survivors of estrogen-sensitive malignancies is challenging because vaginal estrogen may be contraindicated. In a randomized trial comparing two doses of vaginal dehydroepiandrosterone (DHEA) with a nonhormonal vaginal moisturizer in postmenopausal cancer survivors (primarily breast cancer), all three groups reported similar improvement in dyspareunia and vaginal dryness symptoms at 12 weeks, but only the higher dose DHEA group reported significant improvement in sexual function over baseline on a validated sexual health measure. Vaginal DHEA holds promise as a GSM treatment for breast cancer survivors, but safety concerns remain because it increases serum estrogen levels.

Birth Rate After Radioiodine for the Treatment of Differentiated Thyroid Cancer

Radioiodine (RAI) is administered after thyroidectomy in selected patients with differentiated thyroid cancer. Transient amenorrhea may occur following therapy, but subsequent infertility is rare. In a cohort study of over 2000 women diagnosed with differentiated thyroid cancer between the ages of 15 and 39 years, treatment with RAI, compared with no RAI, was not associated with a reduced birth rate.

Nomogram to Estimate Survival In Advanced Pancreatic Cancer

Second-line therapy may improve survival in advanced pancreatic cancer (APC), although the best way to predict which patients will benefit is not established. An analysis of data from 462 consecutive patients with APC treated at a single institution identified nine factors (age, smoking status, liver metastases, performance status, pain, jaundice, ascites, duration of first-line chemotherapy, and second-line treatment regimen) that independently influenced survival and were used to develop a prognostic model which discriminated three groups. Benefit from second-line chemotherapy was higher in the better prognostic groups. The model is the basis for a nomogram to estimate individual survival probabilities following first-line chemotherapy for APC, which may assist in clinical decision making.

Osimertinib in EGFR Mutated Advanced Non-Small Cell Lung Cancer

First-generation tyrosine kinase inhibitors (TKIs) have been the standard front-line treatment for patients with advanced EGFR-mutant non-small cell lung cancer (NSCLC). In an interim analysis of the phase III FLAURA trial in these patients, osimertinib, a third-generation EGFR TKI, prolonged progression-free survival compared with either gefitinib or erlotinib. We now prefer osimertinib as the front-line option for advanced EGFR-mutant NSCLC, although earlier-generation EGFR TKIs are acceptable alternatives.

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