UpToDate(R) and Oncology Times are collaborating to present select content synopses on "What's New in Oncology." UpToDate is an evidence-based, clinical support resource used worldwide by healthcare practitioners to make decisions at the point of care. For complete, current "What's New" content, or to become a subscriber for full content access, go to http://www.uptodate.com. "What's New" abstract information is free for all medical professionals.
Carboplatin in neoadjuvant therapy for triple negative breast cancer (February 2022)
The effect of incorporation of carboplatin in neoadjuvant regimens for triple negative breast cancer (TNBC) is being evaluated. In a randomized trial, among patients with stage II to III TNBC receiving anthracycline-based chemotherapy, the addition of carboplatin increased the breast pathologic complete response rate from 46 to 60 percent but did not improve five-year event-free survival or overall survival [1]. However, the study was not powered to assess survival outcomes. In a separate trial, the addition of pembrolizumab to a carboplatin-containing chemotherapy regimen improved event-free survival (overall survival results were immature). Based on these data, our preferred regimen for patients with stage II or III TNBC includes both pembrolizumab and carboplatin.
Bupropion for low sexual desire in female cancer survivors (February 2022)
Sexual dysfunction, including low sexual desire, is common among female cancer survivors, but clinical trials evaluating pharmacologic agents are limited. In a randomized trial in over 200 female survivors of breast and gynecologic cancer with low baseline sexual desire, treatment with bupropion at either 150 mg or 300 mg over a 10-week period did not improve sexual desire scores compared with placebo [2]. Our approach for female cancer survivors with low desire is to initially treat underlying physical etiologies and refer patients with persistent symptoms to a mental health and/or sexual therapist.
Role of HPV on cervical cancer prognosis (February 2022)
In almost all cases, cervical cancer is the result of human papillomavirus (HPV) infection; however, it is unclear if HPV-positive cancer confers a better prognosis than HPV-negative cancer. In a prospective study including over 2800 patients with invasive cervical cancer, HPV-positive compared with HPV-negative cancer was associated with 43 percent relative decrease in mortality [3]. These findings are consistent with patients with head and neck cancer, in whom HPV-related disease is also associated with improved prognosis. Thus, HPV-positive disease may be used along with other factors (eg, disease stage, lymph node status) to counsel patients with cervical cancer about disease prognosis.
Postoperative radiation therapy in resected stage III N2 NSCLC (January 2022)
Among patients with stage III N2 non-small cell lung cancer (NSCLC) who have undergone complete surgical resection, the use of postoperative radiation therapy (PORT) is controversial. In the Lung ART trial, among over 500 patients with completely resected NSCLC with pathologically proven N2 disease, those assigned to PORT versus no PORT experienced similar disease-free and overall survival [4]. However, more adverse effects were observed in the PORT group, particularly cardiopulmonary toxicity. Based on these and previous data, for patients with completely resected N2 disease, some UpToDate experts do not offer PORT, while others offer it to very select high-risk patients.
Third mRNA COVID-19 vaccine dose and Omicron immunogenicity among cancer patients (January 2022)
The Omicron variant of SARS-CoV-2 partially evades vaccine-induced immunity, but for mRNA COVID-19 vaccine recipients in the general population, a third vaccine dose increases neutralizing activity against Omicron; comparable data in cancer patients are lacking. In a prospective cohort study, a third vaccine dose of the mRNA vaccine BNT162b2 was associated with a higher likelihood of detectable neutralizing activity against Omicron in patients with cancer, although the benefit was less in patients with blood cancer compared with those with solid tumors [5]. These data support administering a third dose of mRNA vaccine for patients with active cancer; such patients are also eligible for a booster dose five months later.
1. Shepherd JH, Ballman K, Polley MC, et al. CALGB 40603 (Alliance): Long-Term Outcomes and Genomic Correlates of Response and Survival After Neoadjuvant Chemotherapy With or Without Carboplatin and Bevacizumab in Triple-Negative Breast Cancer. J Clin Oncol. 2022; PMID: 35044810.
2. Barton DL, Pugh SL, Ganz PA, et al. Randomized Controlled Phase II Evaluation of Two Dose Levels of Bupropion Versus Placebo for Sexual Desire in Female Cancer Survivors: NRG-CC004. J Clin Oncol. 2022;40(4):324. Epub 2021 Dec 9.
3. Lei J, Arroyo-Muhr LS, Lagheden C, et al. Human Papillomavirus Infection Determines Prognosis in Cervical Cancer. J Clin Oncol. 2022; PMID: 35077203.
4. Le Pechoux C, Pourel N, Barlesi F, et al. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial. Lancet Oncol. 2022;23(1):104. Epub 2021 Dec 15.
5. Fendler A, Shepherd S, Au L, Wu M, et al. Omicron neutralising antibodies after third COVID-19 vaccine dose in patients with cancer. Lancet. 2022.
Disclaimer: This content is provided for reference purposes only and represents a portion of the UpToDate topic. You may not rely on the content or any information cited here as being applicable to specific patient circumstances. All topics are updated as new evidence becomes available and our peer review process is complete. Subscribe to http://www.uptodate.com for current content and recommendations.