Given the abundance of new research, it can be challenging to stay current on the latest advancements and findings. Oncology Times is here to help with summaries of the newest studies to ensure you are up-to-date on the latest innovations in oncology practice.
COLORECTAL CANCER
Improving cancer preventive behaviors: a randomized trial of tailored lifestyle feedback in colorectal cancer screening
Recent findings show that a program that provided individually tailored lifestyle recommendations for patients undergoing screening for colorectal cancer helped encourage healthy behavior (Cancer Epidemiol Biomarkers Prev 2018;27(12):1442-1449). Researchers invited 3,642 men and women aged 50-74, from two different areas in southeastern Norway, to receive a sigmoidoscopy. A total of 1,054 patients enrolled in the study. Participants completed two lifestyle questionnaires, one before screening and one a year after screening. Patients were asked questions regarding smoking status, weight, physical activity, alcohol consumption, and intake of fruits, vegetables, and red or processed meat. Investigators were randomized to receive either standardized, individually tailored, written feedback on their health habits; a standard leaflet about healthy behaviors; or nothing, as part of the control group. Overall, the researchers found that, over the course of the year, those who received the individually tailored feedback increased their number of cancer preventive behaviors by 0.11 compared with the control group. The study showed that some changes were more significant among participants who had not previously adhered to healthy lifestyles. Among this population, those who received the individually tailored recommendations had a significantly larger weight loss of -0.84 kg compared to the control group. "Tailored written feedback at sigmoidoscopy screening led to small improvements in cancer-preventive behaviors," study authors concluded. "Colorectal cancer screening is a suitable setting for increasing awareness of cancer-preventive behavior."
HEAD & NECK CANCER
Pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma (KEYNOTE-040): a randomised, open-label, phase 3 study
A randomized phase III study involving 97 medical centers in 20 countries found that treating patients who have chemotherapy-resistant head and neck cancer with pembrolizumab is more effective and less toxic than standard chemotherapy (Lancet 2018; doi:10.1016/S0140-6736(18)31999-8). Data from this trial called KEYNOTE-040 compared the immunotherapy drug head-to-head to three go-to chemotherapy drugs currently used as standard treatment: methotrexate, docetaxel, and cetuximab. The study also pointed to potential biomarkers that can guide oncologists to determine which patients are most likely to respond to anti-PD-1 drugs. Over a 17-month period, researchers randomized 247 to receive pembrolizumab and 248 patients were randomly selected by their physicians to receive one of the three standard therapies. The median overall survival for patients receiving immunotherapy was 8.4 months compared to 6.9 months for patients treated with standard care. The median duration of response was 18.4 months in the pembrolizumab group versus 5 months in the standard therapy group. Twelve months after initiating the trial, 37 percent of patients receiving pembrolizumab were alive compared to 26.5 percent of patients on standard therapy, according to study findings. "The clinically meaningful prolongation of overall survival and favorable safety profile of pembrolizumab in patients with recurrent or metastatic head and neck squamous cell carcinoma support the further evaluation of pembrolizumab as a monotherapy and as part of combination therapy in earlier stages of disease," study authors wrote.
BREAST CANCER
Image analysis with deep learning to predict breast cancer grade, ER status, histologic subtype, and intrinsic subtype
In a recent study, researchers reported they used a form of artificial intelligence called machine learning, or deep learning, to train a computer to identify certain features of breast cancer tumors from images (NPJ Breast Cancer 2018; doi:10.1038/s41523-018-0079-1). The computer also identified the tumor type based on complex molecular and genomic features. For the study, researchers utilized a set of 571 images of breast cancer tumors from the Carolina Breast Cancer Study to train the computer to classify tumors for grade, estrogen receptor status, PAM50 intrinsic subtype, histologic subtype, and risk of recurrence score. The investigators created software that learned how to predict labels from images using a training set, so that new images could be processed in the same way. Then a different set of 288 images was used to test the computer's ability to distinguish features of the tumor on its own, comparing the computer's responses to findings of a pathologist for each tumor's grade and subtype, and to separate tests for gene expression subtypes. Researchers found that the computer was able to distinguish low-intermediate versus high-grade tumors 82 percent of the time. Additionally, the study authors reported that the computer identified estrogen receptor status, distinguished between ductal and lobular tumors, and determined whether each case had a high or low risk of recurrence high levels of accuracy. It also identified one of the molecular subtypes of breast cancers-the basal-like subtype-with 77 percent accuracy. According to the research team, "Image-based methods could be promising for identifying patients with a greater need for further genomic testing, or in place of classically scored variables typically accomplished using human-based scoring."
BRAIN TUMOR
The molecular landscape of glioma in patients with Neurofibromatosis 1
A new study suggests that a slow-growing brain tumor arising in patients affected by neurofibromatosis type 1 (NF1) may be vulnerable to immunotherapy (Nat Med 2018; doi:10.1038/s41591-018-0263-8). Researchers from 25 institutions around the world performed an in-depth analysis of tumor samples from 56 patients to create the first comprehensive inventory of the genetic, epigenetic, and immune alterations in NF1 gliomas. The findings showed that many slow-growing NF1 gliomas contain few macrophages and produce neoantigens that can trigger an immune system attack. "Low-grade tumors exhibited fewer mutations that were over-represented in genes of the MAP kinase pathway," study authors reported. "Approximately 50 percent of low-grade NF1-gliomas displayed an immune signature, T lymphocyte infiltrates, and increased neo-antigen load." The researchers also found a subgroup of brain tumors in patients without NF1 share the same molecular profile as the slow-growing NF1 gliomas. Although aggressive NF1 tumors were packed with macrophages and are likely to resist immunotherapy, the investigators reported that many had a genetic defect that may leave them more sensitive to DNA-damaging therapies.
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