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Adjuvant chemotherapy in small, node negative TNBC
Given that the prognosis of small, node-negative, triple-negative breast cancers (TNBCs) is generally favorable, the benefit of adjuvant chemotherapy is unclear. In a retrospective review of almost 4400 patients with node negative pathologic T1 TNBCs, adjuvant chemotherapy was administered in 53 percent of cases [1]. In multivariate analysis, adjuvant chemotherapy improved breast cancer-specific survival in the overall group, but not for patients with T1a tumors, although there were only 18 patients in this subset. We administer adjuvant chemotherapy for patients with node-negative tumors that are >=T1b, but typically not for node negative, T1a TNBCs, although some such patients may reasonably elect for chemotherapy, given limitations in available data.
Consolidation radiation therapy for de novo metastatic nasopharyngeal carcinoma
Retrospective studies have suggested improved long-term outcomes when intensity-modulated radiation therapy (IMRT) is incorporated into the treatment of metastatic nasopharyngeal carcinoma (NPC). In a multicenter open-label phase III trial, 126 patients with de novo metastatic NPC and an at least partial response (PR) after three cycles of chemotherapy were randomly assigned to an additional three cycles of chemotherapy with or without consolidation IMRT to the primary tumor and cervical lymph nodes [2]. The addition of IMRT prolonged median progression-free survival by approximately five months and improved overall survival. Grade 3 or worse IMRT-related mucositis was reported in 34 percent; other severe IMRT-related toxicities were uncommon. In patients with de novo metastatic NPC and a good performance status who have an at least PR to systemic chemotherapy, we now suggest consolidation with IMRT rather than observation.
Updated ASCO guidelines on chemotherapy-induced peripheral neuropathy
Updated guidelines from the American Society of Clinical Oncology (ASCO) for prevention and treatment of chemotherapy-induced peripheral neuropathy (CIPN) state that no agent can be recommended for the prevention of CIPN in patients receiving potentially neurotoxic drugs [3]. Clinicians may offer duloxetine for treatment of painful CIPN, although the magnitude of benefit is modest. Three approaches (scrambler therapy, acupuncture, and exercise) may diminish symptoms of CIPN and appear to be reasonably safe, but further research is needed before they can be specifically recommended.
No survival benefit from atezolizumab added to chemotherapy in advanced, squamous NSCLC
Although the addition of atezolizumab to chemotherapy has improved survival in advanced, nonsquamous non-small cell lung cancer (NSCLC), its role in squamous cell NSCLC has been unclear. Now, in the IMpower 131 trial, among almost 700 patients with advanced, squamous NSCLC, the addition of atezolizumab to carboplatin and nabpaclitaxel improved progression free survival (PFS) but not overall survival (OS) [4]. However, in the subset with high expression of programmed cell death-ligand 1 (PD-L1), the addition of atezolizumab improved both PFS and OS. Given these results, we do not incorporate atezolizumab with chemotherapy for squamous tumors that are PD-L1-unselected or low, opting instead for pembrolizumab-based combinations.
1. Steenbruggen TG, van Werkhoven E, van Ramshorst MS, et al. Adjuvant chemotherapy in small node-negative triple-negative breast cancer. Eur J Cancer 2020; 135:66.
2. You R, Liu YP, Huang PY, et al. Efficacy and Safety of Locoregional Radiotherapy With Chemotherapy vs Chemotherapy Alone in De Novo Metastatic Nasopharyngeal Carcinoma: A Multicenter Phase 3 Randomized Clinical Trial. JAMA Oncol 2020.
3. Loprinzi CL, Lacchetti C, Bleeker J, et al. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. J Clin Oncol 2020; :JCO2001399.
4. Jotte R, Cappuzzo F, Vynnychenko I, et al. Atezolizumab in Combination With Carboplatin and Nab-Paclitaxel in Advanced Squamous NSCLC (IMpower131): Results From a Randomized Phase III Trial. J Thorac Oncol 2020; 15:1351.
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