The Journal of Community and Supportive Oncology

The monoclonal antibody ipilimumab was the first treatment in more than 30 years to improve long-term survival in metastatic melanoma patients. Offering expensive ipilimumab treatment presented significant business challenges and potential financial risks for our private oncology practice and for patients because of the high acquisition cost of this agent. There was initial uncertainty about the willingness of insurance companies to reimburse for this new drug based on previous experiences in our practice with other expensive new drugs. Here we describe how our multiphysician practice methodically introduced ipilimumab treatment into the practice.

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The monoclonal antibody ipilimumab was the first treatment in more than 30 years to improve long-term survival in metastatic melanoma patients. Offering expensive ipilimumab treatment presented significant business challenges and potential financial risks for our private oncology practice and for patients because of the high acquisition cost of this agent. There was initial uncertainty about the willingness of insurance companies to reimburse for this new drug based on previous experiences in our practice with other expensive new drugs. Here we describe how our multiphysician practice methodically introduced ipilimumab treatment into the practice.

Click on the PDF icon at the top of this introduction to read the full article.

The monoclonal antibody ipilimumab was the first treatment in more than 30 years to improve long-term survival in metastatic melanoma patients. Offering expensive ipilimumab treatment presented significant business challenges and potential financial risks for our private oncology practice and for patients because of the high acquisition cost of this agent. There was initial uncertainty about the willingness of insurance companies to reimburse for this new drug based on previous experiences in our practice with other expensive new drugs. Here we describe how our multiphysician practice methodically introduced ipilimumab treatment into the practice.

Click on the PDF icon at the top of this introduction to read the full article.

In December 2015, alectinib became the third ALK inhibitor approved by the United States Food and Drug Administration for the treatment of non-small-cell lung cancer (NSCLC) that displays rearrangements of the anaplastic lymphoma kinase (ALK) gene. Alectinib is a second-generation small molecule inhibitor of the ALK protein that joins ceritinib in providing a useful treatment option for patients who have progressed on crizotinib, as a result of its ability to target crizotinib-resistant mutant forms of the ALK protein. Alectinib also displays enhanced penetrance of the blood-brain barrier, which improves efficacy against central nervous system (CNS) metastases.

Click on the PDF icon at the top of this introduction to read the full article.

In December 2015, alectinib became the third ALK inhibitor approved by the United States Food and Drug Administration for the treatment of non-small-cell lung cancer (NSCLC) that displays rearrangements of the anaplastic lymphoma kinase (ALK) gene. Alectinib is a second-generation small molecule inhibitor of the ALK protein that joins ceritinib in providing a useful treatment option for patients who have progressed on crizotinib, as a result of its ability to target crizotinib-resistant mutant forms of the ALK protein. Alectinib also displays enhanced penetrance of the blood-brain barrier, which improves efficacy against central nervous system (CNS) metastases.

Click on the PDF icon at the top of this introduction to read the full article.

In December 2015, alectinib became the third ALK inhibitor approved by the United States Food and Drug Administration for the treatment of non-small-cell lung cancer (NSCLC) that displays rearrangements of the anaplastic lymphoma kinase (ALK) gene. Alectinib is a second-generation small molecule inhibitor of the ALK protein that joins ceritinib in providing a useful treatment option for patients who have progressed on crizotinib, as a result of its ability to target crizotinib-resistant mutant forms of the ALK protein. Alectinib also displays enhanced penetrance of the blood-brain barrier, which improves efficacy against central nervous system (CNS) metastases.

Click on the PDF icon at the top of this introduction to read the full article.

In the June podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses the approval of alectinib as a new option for ALK-positive patients with NSCLC who have progressed on crizotinib, and a How We Do It article in which the authors the implementation of ipilimumab therapy in a private practice oncology group. The authors describe how they addressed start-up and reimbursement issues related to ipilimumab as a model for other expensive new cancer drugs as well. Also included are research articles on long-term community-based results of breast-conserving therapy in early-stage breast cancer, the use of the neurokinin 1 receptor antagonist in moderately emetogenic chemotherapy, risk assessment for hereditary breast and ovarian cancer in minority women, the impact of a nurse practitioner-led symptom clinic on emergency department use in cancer patients, and assessing outpatient oncology needs. Finally, Dr Henry examines evolving therapeutic strategies in melanoma.

Listen to the podcast below.

In the June podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses the approval of alectinib as a new option for ALK-positive patients with NSCLC who have progressed on crizotinib, and a How We Do It article in which the authors the implementation of ipilimumab therapy in a private practice oncology group. The authors describe how they addressed start-up and reimbursement issues related to ipilimumab as a model for other expensive new cancer drugs as well. Also included are research articles on long-term community-based results of breast-conserving therapy in early-stage breast cancer, the use of the neurokinin 1 receptor antagonist in moderately emetogenic chemotherapy, risk assessment for hereditary breast and ovarian cancer in minority women, the impact of a nurse practitioner-led symptom clinic on emergency department use in cancer patients, and assessing outpatient oncology needs. Finally, Dr Henry examines evolving therapeutic strategies in melanoma.

Listen to the podcast below.

In the June podcast for The Journal of Community and Supportive Oncology, Dr David Henry discusses the approval of alectinib as a new option for ALK-positive patients with NSCLC who have progressed on crizotinib, and a How We Do It article in which the authors the implementation of ipilimumab therapy in a private practice oncology group. The authors describe how they addressed start-up and reimbursement issues related to ipilimumab as a model for other expensive new cancer drugs as well. Also included are research articles on long-term community-based results of breast-conserving therapy in early-stage breast cancer, the use of the neurokinin 1 receptor antagonist in moderately emetogenic chemotherapy, risk assessment for hereditary breast and ovarian cancer in minority women, the impact of a nurse practitioner-led symptom clinic on emergency department use in cancer patients, and assessing outpatient oncology needs. Finally, Dr Henry examines evolving therapeutic strategies in melanoma.

Listen to the podcast below.

For the May podcast for The Journal of Community and Supportive Oncology, Dr David Henry highlights original reports on the prognostic significance of HPV status in postoperative squamous cell carcinoma of the head and neck, the contributions of caregivers in American Indian cancer patients, and the omission of dexamethasone from antiemetics treatment in breast cancer patients with hepatitis B infection or diabetes. He also describes how providers at a comprehensive cancer center devised a framework for implementing survivorship care planning, and, in keeping with the ‘how we do it’ theme, he discusses an article by 2 practicing on oncologists on managing and treating multiple myeloma. The line-up is rounded off with articles on the effects of exercise interventions during different treatments in patients with breast cancer, the approval of trabectedin for some forms of advanced soft tissue sarcoma, and a Case Report on a rare case of hypoglycemia induced by a classical gastro-intestinal stromal tumor.

Listen to the podcast below.

For the May podcast for The Journal of Community and Supportive Oncology, Dr David Henry highlights original reports on the prognostic significance of HPV status in postoperative squamous cell carcinoma of the head and neck, the contributions of caregivers in American Indian cancer patients, and the omission of dexamethasone from antiemetics treatment in breast cancer patients with hepatitis B infection or diabetes. He also describes how providers at a comprehensive cancer center devised a framework for implementing survivorship care planning, and, in keeping with the ‘how we do it’ theme, he discusses an article by 2 practicing on oncologists on managing and treating multiple myeloma. The line-up is rounded off with articles on the effects of exercise interventions during different treatments in patients with breast cancer, the approval of trabectedin for some forms of advanced soft tissue sarcoma, and a Case Report on a rare case of hypoglycemia induced by a classical gastro-intestinal stromal tumor.

Listen to the podcast below.

For the May podcast for The Journal of Community and Supportive Oncology, Dr David Henry highlights original reports on the prognostic significance of HPV status in postoperative squamous cell carcinoma of the head and neck, the contributions of caregivers in American Indian cancer patients, and the omission of dexamethasone from antiemetics treatment in breast cancer patients with hepatitis B infection or diabetes. He also describes how providers at a comprehensive cancer center devised a framework for implementing survivorship care planning, and, in keeping with the ‘how we do it’ theme, he discusses an article by 2 practicing on oncologists on managing and treating multiple myeloma. The line-up is rounded off with articles on the effects of exercise interventions during different treatments in patients with breast cancer, the approval of trabectedin for some forms of advanced soft tissue sarcoma, and a Case Report on a rare case of hypoglycemia induced by a classical gastro-intestinal stromal tumor.

Listen to the podcast below.

Multiple myeloma (MM) is a bone marrow- based malignancy of plasma cells that is diagnosed in over 30,000 patients annually in the United States. Despite the many recent advances in the treatment of MM, it remains an incurable disease. Thus, the need for the development of new effective therapies remains critical for these patients.

Smoldering MM
In general, it has not been shown that patients with smoldering MM (SMM) benefit from early treatment, but recent studies have identified a subset of patients who are at high-risk and may require therapy more quickly. Recent guidelines from the International Myeloma Working Group recommend immediate treatment of this subgroup of SMM.¹ However, although findings in a Spanish study suggested that early treatment of high-risk SMM patients with the immunomodulatory agent (IMiD) lenalidomide and dexamethasone improves overall survival (OS),² the design of that study limits its clinical applicability, and no other randomized trials have been completed to show the advantage of early therapy for these patients.

Specific drugs
The development of novel agents such as proteasome inhibitors (PIs), IMiDs, histone deacetylase inhibitors (HDACIs), and monoclonal antibodies (mAbs) in recent years has vastly changed the approach to the treatment of MM patients.

PIs that are cytotoxic to MM cells, such as bortezomib, have become a foundation for MM treatment over the past decade. However, patients develop drug resistance to bortezomib by acquiring gene mutations and through other mechanisms. In recent years, newer forms of PIs such as carfilzomib and the oral formulations ixazomib and oprozomib have been and are currently being developed.³ Preclinical studies have shown that resistance to one PI can be overcome with treatment with another PI.⁴

Click on the PDF icon at the top of this introduction to read the full article.

Multiple myeloma (MM) is a bone marrow- based malignancy of plasma cells that is diagnosed in over 30,000 patients annually in the United States. Despite the many recent advances in the treatment of MM, it remains an incurable disease. Thus, the need for the development of new effective therapies remains critical for these patients.

Smoldering MM
In general, it has not been shown that patients with smoldering MM (SMM) benefit from early treatment, but recent studies have identified a subset of patients who are at high-risk and may require therapy more quickly. Recent guidelines from the International Myeloma Working Group recommend immediate treatment of this subgroup of SMM.¹ However, although findings in a Spanish study suggested that early treatment of high-risk SMM patients with the immunomodulatory agent (IMiD) lenalidomide and dexamethasone improves overall survival (OS),² the design of that study limits its clinical applicability, and no other randomized trials have been completed to show the advantage of early therapy for these patients.

Specific drugs
The development of novel agents such as proteasome inhibitors (PIs), IMiDs, histone deacetylase inhibitors (HDACIs), and monoclonal antibodies (mAbs) in recent years has vastly changed the approach to the treatment of MM patients.

PIs that are cytotoxic to MM cells, such as bortezomib, have become a foundation for MM treatment over the past decade. However, patients develop drug resistance to bortezomib by acquiring gene mutations and through other mechanisms. In recent years, newer forms of PIs such as carfilzomib and the oral formulations ixazomib and oprozomib have been and are currently being developed.³ Preclinical studies have shown that resistance to one PI can be overcome with treatment with another PI.⁴

Click on the PDF icon at the top of this introduction to read the full article.

Multiple myeloma (MM) is a bone marrow- based malignancy of plasma cells that is diagnosed in over 30,000 patients annually in the United States. Despite the many recent advances in the treatment of MM, it remains an incurable disease. Thus, the need for the development of new effective therapies remains critical for these patients.

Smoldering MM
In general, it has not been shown that patients with smoldering MM (SMM) benefit from early treatment, but recent studies have identified a subset of patients who are at high-risk and may require therapy more quickly. Recent guidelines from the International Myeloma Working Group recommend immediate treatment of this subgroup of SMM.¹ However, although findings in a Spanish study suggested that early treatment of high-risk SMM patients with the immunomodulatory agent (IMiD) lenalidomide and dexamethasone improves overall survival (OS),² the design of that study limits its clinical applicability, and no other randomized trials have been completed to show the advantage of early therapy for these patients.

Specific drugs
The development of novel agents such as proteasome inhibitors (PIs), IMiDs, histone deacetylase inhibitors (HDACIs), and monoclonal antibodies (mAbs) in recent years has vastly changed the approach to the treatment of MM patients.

PIs that are cytotoxic to MM cells, such as bortezomib, have become a foundation for MM treatment over the past decade. However, patients develop drug resistance to bortezomib by acquiring gene mutations and through other mechanisms. In recent years, newer forms of PIs such as carfilzomib and the oral formulations ixazomib and oprozomib have been and are currently being developed.³ Preclinical studies have shown that resistance to one PI can be overcome with treatment with another PI.⁴

Click on the PDF icon at the top of this introduction to read the full article.

Background There are limited data on the prognostic significance of human papillomavirus (HPV) status in relation to traditional risk factors for head and neck squamous-cell carcinoma (HNSCC) in the postoperative setting.

Objective To clarify the impact of HPV status on the risk for HNSCC in the postoperative setting.

Methods We retrospectively evaluated an institutional cohort of 128 patients with HNSCC patients who had been treated with definitive surgery with or without adjuvant radiotherapy or chemoradiotherapy. Patient, disease, and treatment factors were analyzed as potential prognostic indicators.

Results Lymph node extracapsular extension (ECE), perineural invasion (PNI), and lymphovascular space invasion (LVSI) positivity predicted poorer locoregional control (LRC), disease-free survival (DFS), and overall survival (OS). Positive margins related to poorer DFS and OS. HPV status alone did not predict LRC, DFS, or OS. Compared with patients who were HPV-positive and ECE-negative, both HPV-positive and HPV-negative patients with ECE experienced significantly poorer OS (78.6%, 60%, and 43.7%, respectively; P = .010 and P = .018, respectively).

Limitations Retrospective, single-institution study; small patient cohort; short follow-up time

Conclusion The influence of HPV in postoperative HNSCC seems limited compared with traditional risk factors such as ECE, LVSI, and PNI. De-escalation of postoperative treatment based on HPV status alone should be approached with caution.


Click on the PDF icon at the top of this introduction to read the full article.

Background There are limited data on the prognostic significance of human papillomavirus (HPV) status in relation to traditional risk factors for head and neck squamous-cell carcinoma (HNSCC) in the postoperative setting.

Objective To clarify the impact of HPV status on the risk for HNSCC in the postoperative setting.

Methods We retrospectively evaluated an institutional cohort of 128 patients with HNSCC patients who had been treated with definitive surgery with or without adjuvant radiotherapy or chemoradiotherapy. Patient, disease, and treatment factors were analyzed as potential prognostic indicators.

Results Lymph node extracapsular extension (ECE), perineural invasion (PNI), and lymphovascular space invasion (LVSI) positivity predicted poorer locoregional control (LRC), disease-free survival (DFS), and overall survival (OS). Positive margins related to poorer DFS and OS. HPV status alone did not predict LRC, DFS, or OS. Compared with patients who were HPV-positive and ECE-negative, both HPV-positive and HPV-negative patients with ECE experienced significantly poorer OS (78.6%, 60%, and 43.7%, respectively; P = .010 and P = .018, respectively).

Limitations Retrospective, single-institution study; small patient cohort; short follow-up time

Conclusion The influence of HPV in postoperative HNSCC seems limited compared with traditional risk factors such as ECE, LVSI, and PNI. De-escalation of postoperative treatment based on HPV status alone should be approached with caution.


Click on the PDF icon at the top of this introduction to read the full article.

Background There are limited data on the prognostic significance of human papillomavirus (HPV) status in relation to traditional risk factors for head and neck squamous-cell carcinoma (HNSCC) in the postoperative setting.

Objective To clarify the impact of HPV status on the risk for HNSCC in the postoperative setting.

Methods We retrospectively evaluated an institutional cohort of 128 patients with HNSCC patients who had been treated with definitive surgery with or without adjuvant radiotherapy or chemoradiotherapy. Patient, disease, and treatment factors were analyzed as potential prognostic indicators.

Results Lymph node extracapsular extension (ECE), perineural invasion (PNI), and lymphovascular space invasion (LVSI) positivity predicted poorer locoregional control (LRC), disease-free survival (DFS), and overall survival (OS). Positive margins related to poorer DFS and OS. HPV status alone did not predict LRC, DFS, or OS. Compared with patients who were HPV-positive and ECE-negative, both HPV-positive and HPV-negative patients with ECE experienced significantly poorer OS (78.6%, 60%, and 43.7%, respectively; P = .010 and P = .018, respectively).

Limitations Retrospective, single-institution study; small patient cohort; short follow-up time

Conclusion The influence of HPV in postoperative HNSCC seems limited compared with traditional risk factors such as ECE, LVSI, and PNI. De-escalation of postoperative treatment based on HPV status alone should be approached with caution.


Click on the PDF icon at the top of this introduction to read the full article.

Previous findings suggest that exercise is a safe and efficacious means of improving physiological and psychosocial outcomes in female breast cancer survivors. To date, most research has focused on post-treatment interventions. However, given that the type and severity of treatment-related adverse effects may be dependent on the type of treatment, and that the effects are substantially more pronounced during treatment, an assessment of the safety and efficacy of exercise during treatment is warranted. In this review, we present and evaluate the results of randomized controlled trials (RCTs) conducted during breast cancer treatment. We conducted literature searches to identify studies examining exercise interventions in breast cancer patients who were undergoing chemotherapy or radiation. Data were extracted on physiological and psychosocial outcomes.

Click on the PDF icon at the top of this introduction to read the full article.

Previous findings suggest that exercise is a safe and efficacious means of improving physiological and psychosocial outcomes in female breast cancer survivors. To date, most research has focused on post-treatment interventions. However, given that the type and severity of treatment-related adverse effects may be dependent on the type of treatment, and that the effects are substantially more pronounced during treatment, an assessment of the safety and efficacy of exercise during treatment is warranted. In this review, we present and evaluate the results of randomized controlled trials (RCTs) conducted during breast cancer treatment. We conducted literature searches to identify studies examining exercise interventions in breast cancer patients who were undergoing chemotherapy or radiation. Data were extracted on physiological and psychosocial outcomes.

Click on the PDF icon at the top of this introduction to read the full article.

Previous findings suggest that exercise is a safe and efficacious means of improving physiological and psychosocial outcomes in female breast cancer survivors. To date, most research has focused on post-treatment interventions. However, given that the type and severity of treatment-related adverse effects may be dependent on the type of treatment, and that the effects are substantially more pronounced during treatment, an assessment of the safety and efficacy of exercise during treatment is warranted. In this review, we present and evaluate the results of randomized controlled trials (RCTs) conducted during breast cancer treatment. We conducted literature searches to identify studies examining exercise interventions in breast cancer patients who were undergoing chemotherapy or radiation. Data were extracted on physiological and psychosocial outcomes.

Click on the PDF icon at the top of this introduction to read the full article.