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.
Peritumoral lidocaine injection before incision for breast cancer surgery (September 2023)
In a multicenter, randomized trial of over 1000 patients with early breast cancer undergoing mastectomy or breast-conserving surgery, peritumoral injection of 0.5% lidocaine prior to incision improved five-year disease-free survival (87 versus 83 percent) and five-year overall survival (90 versus 86 percent).1 The mechanism is unknown but thought to involve blocking voltage-gated sodium channels and thereby preventing activation of prometastatic pathways. The trial protocol for surgical management of breast cancer deviated from what may be considered standard treatment in many clinical practices, so further validation is necessary; however, peritumoral injection of lidocaine may be a reasonable intervention given its simplicity and minimal cost.
Atezolizumab in alveolar soft parts sarcoma (September 2023)
The prognosis of metastatic alveolar soft parts sarcoma (ASPS) is poor, and trials are investigating immune checkpoint inhibitors as a treatment strategy. In longer follow-up of a previously reported single arm trial in 52 adult and pediatric patients, atezolizumab was associated with a response rate of 37 percent and median progression-free survival of 25 months.2 There were no grade 4 or 5 events. Atezolizumab is approved by the US Food and Drug Administration for the treatment of adult and pediatric patients with unresectable or metastatic ASPS,3 and we consider it to be an acceptable option for such patients with limited, but progressive, extracranial disease.
Cemiplimab in advanced non-small cell lung cancer (September 2023)
Trials are reporting long-term outcomes of immune checkpoint inhibitors in advanced non-small cell lung cancer (NSCLC). In a randomized trial among 565 patients with advanced NSCLC with programmed death-ligand 1 (PD-L1) of >=50 percent, cemiplimab improved overall survival relative to platinum-doublet chemotherapy at 35 months' follow-up (26 versus 13 months), with fewer grade 3-4 treatment-emergent adverse events (18 versus 40 percent).4 Based on results from this trial, cemiplimab has regulatory approval in the United States for use in patients with advanced NSCLC with PD-L1 of >=50 percent without an EGFR, ROS1, or ALK genetic aberration,5 and we consider it to be an appropriate option in this setting.
Olanzapine for cancer-associated anorexia and cachexia (August 2023)
Studies are evaluating approaches to management of anorexia and cachexia in patients with advanced cancer. In a randomized trial, 124 patients starting chemotherapy for lung, pancreaticobiliary, or stomach cancer were assigned to olanzapine 2.5 mg daily or placebo.6 More patients in the olanzapine group experienced at least 5 percent weight gain (60 versus 9 percent) and appetite improvement (43 versus 30 percent). Olanzapine was well tolerated. These and earlier data led the American Society of Clinical Oncology to support low-dose olanzapine once daily to improve weight gain and appetite in patients with advanced cancer,7 while recognizing that the majority of data come from patients with lung or gastrointestinal cancer.
1. Badwe RA, Parmar V, Nair N, et al. Effect of Peritumoral Infiltration of Local Anesthetic Before Surgery on Survival in Early Breast Cancer. J Clin Oncol. 2023;41(18):3318. Epub 2023 Apr 6.
2. Chen AP, Sharon E, O'Sullivan-Coyne G, et al. Atezolizumab for Advanced Alveolar Soft Part Sarcoma. N Engl J Med. 2023;389(10):911.
3. Atezolizumab: United States Food and Drug Administration Prescribing Label https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/761034s047lbl.pdf (Accessed on December 14, 2022).
4. Ozguroglu M, Kilickap S, Sezer A, et al. First-line cemiplimab monotherapy and continued cemiplimab beyond progression plus chemotherapy for advanced non-small-cell lung cancer with PD-L1 50% or more (EMPOWER-Lung 1): 35-month follow-up from a mutlicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2023;24(9):989. Epub 2023 Aug 14.
5. Cemiplimab-rwlc injection. United States Prescribing Information. US National Library of Medicine. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/761097s000lbl.pdf (Accessed on February 26, 2021).
6. Sandhya L, Devi Sreenivasan N, Goenka L, et al. Randomized Double-Blind Placebo-Controlled Study of Olanzapine for Chemotherapy-Related Anorexia in Patients With Locally Advanced or Metastatic Gastric, Hepatopancreaticobiliary, and Lung Cancer. J Clin Oncol. 2023;41(14):2617. Epub 2023 Mar 28.
7. Roeland EJ, Bohlke K, Baracos VE, et al. Cancer Cachexia: ASCO Guideline Rapid Recommendation Update. J Clin Oncol. 2023;41(25):4178. Epub 2023 Jul 12.
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.