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Reirradiation for local recurrence of breast cancer after breast conserving therapy
For women with localized breast cancer who undergo breast conserving therapy (BCT, lumpectomy followed by whole breast radiation) and experience a recurrence, mastectomy, rather than repeat BCT, is typically performed in order to avoid toxicities associated with reirradiation. Now, in a phase 2 study of 58 women with local recurrence after BCT, partial breast radiation after second lumpectomy was associated with a five-year in-breast recurrence rate of 5 percent, with severe late adverse events in 7 percent [1]. Although this study suggests acceptable local recurrence rates and tolerability, we continue to avoid reirradiation in most women with local recurrences after BCT for breast cancer, pending further data.
Updated guidelines for managing patients at risk for hereditary pancreatic cancer
The International Cancer of the Pancreas Screening (CAPS) Consortium has published updated guidelines on identification and management of patients at risk for hereditary pancreatic cancer (PC) [2]. The guidelines continue to recommend that screening for PC be performed only in high-risk individuals and in a research setting by multidisciplinary teams in centers with appropriate expertise. The updated guidelines suggest that individuals with mutations in the ataxia-telangiectasia mutated (ATM) gene and one first-degree relative with PC also be considered candidates for PC screening and that screening be performed with endoscopic ultrasound and/or magnetic resonance imaging/magnetic retrograde cholangiopancreatography.
Perineal powder use in adult women not associated with ovarian cancer risk
A previous meta-analysis suggested an association between use of perineal talc and ovarian cancer, but results were driven largely by case-control studies, which are subject to recall-bias. A new study pooling data from four prospective cohort studies (n>250,000 women) found no association between use of perineal powder (eg, applied to the underwear or diaphragm contraceptive) and ovarian cancer risk by age 70, although data regarding the type of powder used was not presented [3]. This study supports the conclusion that there is no association between perineal powder use and ovarian cancer. However, it may have been underpowered to detect true but small increases in cancer risk.
Long-term survival outcomes for nivolumab plus ipilimumab in metastatic renal cell carcinoma
Combination immunotherapy with nivolumab plus ipilimumab is a standard treatment option for patients with metastatic renal cell carcinoma (RCC), but durable survival outcomes have not been previously established. In long-term follow-up of a randomized phase III trial (CheckMate 214) conducted in over 1000 patients with treatment-naive metastatic clear cell RCC, nivolumab plus ipilimumab improved 30-month overall survival over sunitinib in the entire study population and in those with intermediate- or poor-risk disease [4]. This study confirms a survival benefit for nivolumab plus ipilimumab over sunitinib in those with metastatic RCC. Nivolumab plus ipilimumab remains one of our preferred treatment options in this population.
1. Arthur DW, Winter KA, Kuerer HM, et al. Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast: The NRG Oncology/RTOG 1014 Phase 2 Clinical Trial. JAMA Oncol 2019.
2. Goggins M, Overbeek KA, Brand R, et al. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut 2020; 69:7.
3. O'Brien KM, Tworoger SS, Harris HR, et al. Association of Powder Use in the Genital Area With Risk of Ovarian Cancer. JAMA 2020; 323:49.
4. Motzer RJ, Rini BI, McDermott DF, et al. Nivolumab plus ipilimumab versus sunitinib in first-line treatment for advanced renal cell carcinoma: extended follow-up of efficacy and safety results from a randomised, controlled, phase 3 trial. Lancet Oncol 2019; 20:1370.
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