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.

Underrecognition of radiation dermatitis in patients with breast cancer undergoing radiotherapy (May 2022)

Radiation dermatitis is the most common adverse effect of radiation therapy (RT) but may be underrecognized in some patients. In a cohort study that included nearly 10,000 patients from the United States with breast cancer who received RT and completed a patient-reported outcome questionnaire, 99 percent were matched to physician Common Terminology Criteria for Adverse Events (CTCAE) assessments [1]. Among over 5500 individuals reporting at least one RT symptom of breast pain, pruritus, edema, and fatigue, underrecognition by the physician occurred in 53 percent. Factors independently associated with underrecognition included age <50 years, being of Black or other than White ethnicity, receiving conventional fractionation, and male physician sex. Assessing subjective symptoms in patients undergoing RT may help reduce potential disparities in the diagnosis and management of radiation-related adverse effects, including dermatitis.

Immunotherapy for locally advanced rectal cancer with deficient mismatch repair (June 2022)

Approximately 5 percent of rectal adenocarcinomas are deficient in DNA mismatch repair (dMMR), indicating potential responsiveness to immune checkpoint inhibitor immunotherapy. In a prospective study of 12 patients with stage II or III dMMR rectal cancer treated with dostarlimab monotherapy for 6 months, all 12 had a complete clinical response (radiographic and endoscopic), did not undergo chemoradiotherapy or surgery, and were free of residual or recurrent tumor with short-term follow-up (range 6 to 25 months) [2]. While this approach cannot yet be considered standard, individuals with dMMR tumors who place a high value on avoiding the long-term morbidity associated with surgery and pelvic radiation might choose this nonstandard approach if they are willing to accept the uncertainty of long-term outcomes, the small risk of fatal side effects from checkpoint inhibitors, and the need for very close follow-up.

Pyelocalyceal mitomycin (Jelmyto) for low-grade upper tract urothelial carcinomas (May 2022)

Pyelocalyceal mitomycin is used for patients with low-grade upper tract urothelial carcinoma (UTUC), but long-term efficacy data are lacking. In the final analysis of an open-label, single arm trial (OLYMPUS) of over 70 patients with treatment-naive or recurrent low-grade UTUC, at median follow-up of one year, pyelocalyceal mitomycin demonstrated a complete response (CR) rate of 58 percent at three months [3,4]. Among the 41 patients with a CR, 23 (56 percent) had continued CRs at one year. Based on these data, for patients with treatment-naive or recurrent low-grade UTUC, we continue to offer pyelocalyceal mitomycin as an alternative to nephroureterectomy.

Avoidance of rucaparib for BRCA carriers with multiply-relapsed ovarian cancer (April 2022, Modified June 2022)

Rucaparib previously had regulatory approval in the United States for advanced ovarian cancer in patients who had received >=2 chemotherapies and had a deleterious germline or somatic BRCA mutation, based on previously reported progression-free survival benefits over chemotherapy [5]. However, the manufacturer has withdrawn the agent from use in this setting based on longer-term data demonstrating worsened overall survival results with rucaparib (20 versus 27 months, with chemotherapy) [6]. We no longer use rucaparib as treatment for multiply-relapsed, BRCA-associated, advanced ovarian cancer, but it remains an appropriate option as maintenance therapy in patients with recurrent ovarian cancer who are in complete or partial response to platinum-based chemotherapy.

1. Jagsi R, Griffith KA, Vicini F, et al. Identifying Patients Whose Symptoms Are Underrecognized During Treatment With Breast Radiotherapy. JAMA Oncol. 2022;8(6):887.

2. Cercek A, Lumish M, Sinopoli J, et al. PD-1 Blockade in Mismatch Repair-Deficient, Locally Advanced Rectal Cancer. N Engl J Med. 2022;386(25):2363. Epub 2022 Jun 5.

3. Kleinmann N, Matin SF, Pierorazio PM, et al. Primary chemoablation of low-grade upper tract urothelial carcinoma using UGN-101, a mitomycin-containing reverse thermal gel (OLYMPUS): an open-label, single-arm, phase 3 trial. Lancet Oncol. 2020;21(6):776. Epub 2020 Apr 29.

4. Matin SF, Pierorazio PM, Kleinmann N, et al. Durability of Response to Primary Chemoablation of Low-Grade Upper Tract Urothelial Carcinoma Using UGN-101, a Mitomycin-Containing Reverse Thermal Gel: OLYMPUS Trial Final Report. J Urol. 2022;207(4):779. Epub 2021 Dec 17.

5. Kristeleit R, Lisyanskaya A, Fedenko A, et al. Rucaparib versus standard-of-care chemotherapy in patients with relapsed ovarian cancer and a deleterious BRCA1 or BRCA2 mutation (ARIEL4): an international, open-label, randomised, phase 3 trial. Lancet Oncol. 2022;23(4):465. Epub 2022 Mar 14.

6. https://www.ema.europa.eu/en/documents/dhpc/direct-healthcare-professional-commu (Accessed on June 17, 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.