September 2012, Vol 3, No 6

In this era of upwardly spiraling healthcare costs, the management of low-risk prostate cancer is changing. Although approximately two thirds of men with a diagnosis of prostate cancer have a low prostate-specific antigen (PSA) value or low-risk disease, approximately 90% of these men receive early intervention, with surgery or with radiation. Findings from a new study from the Minneapolis Veterans Affairs Health Care System suggest that localized prostate cancer, especially low-risk cancer, can be safely managed by observation alone.

Multiple myeloma (MM), a clonal malignancy of plasma cells, is responsible for 10% to 15% of all hematologic malignancies and for 20% of deaths resulting from hematologic cancers.^1,2 In most patients, MM evolves from monoclonal gammopathy of undetermined significance (MGUS), an asymptomatic plasma-cell disorder.

New York, NY—Diarrhea is a common side effect of standard chemo­therapy, but the risk is less well characterized with molecularly targeted agents, which may add to the risk of diarrhea when combined with standard chemo­therapy, according to Lowell Anthony, MD, Professor of Medicine, University of Kentucky, and Chief of Medical Oncology, UK HealthCare, Lexington, who discussed this topic at the 2012 Multinational Association of Supportive Care in Cancer Inter­national Symposium.

On July 6, 2012, the Centers for Medicare & Medicaid Services (CMS) issued the Physician Fee Schedule (PFS) and Hospital Out­patient Prospective Pay­ment System (HOPPS) proposed rules for fiscal year 2013. These rules include a number of proposed changes aimed at improving quality and promoting value in cancer care in the Medicare program. Although many of these changes are positive, a number of proposed cuts to payment rates, particularly to services performed by radiation oncologists, could have a devastating impact on oncology providers and patients.

New York, NY—Two major advances over the past decades have improved the management of febrile neutropenia (FN)—the MASCC (Multinational Association of Supportive Care in Cancer) scoring system for predicting the risk of FN, and the use of granulocyte colony-stimulating factors (G-CSFs) for the prevention of FN. However, the need for improvement still exists, said Jean Klastersky, MD, Professor, Institut Jules Bordet, Brussels, Belgium, at the 2012 MASCC International Symposium. Among the remaining challenges is refining the optimal use of these agents.

Many studies have shown that cyclic androgen deprivation is associated with a reduction in toxic effects in patients with prostate cancer. Results of a new international study show that the use of intermittent androgen treatment after radiotherapy in patients with elevated prostate-specific antigen (PSA) levels is noninferior to continuous androgen treatment and leads to improvements in some QOL measures (Crook JM, et al. N Engl J Med. 2012;367:895-903).

The FDA approval of new drugs for advanced solid tumors is relying heavily on demonstration of increased survival duration in phase 3 clinical trials. Most trials, however, are not designed to detect differences in quality of life (QOL) or in toxicity levels. A new meta-analysis reviewed pivotal clinical trials that have led to FDA approval of new anticancer drugs focusing on QOL outcomes in 3 areas—treatment-related differences in grade 3 or 4 adverse events (AEs), treatment discontinuation, and toxic deaths (Niraula S, et al. J Clin Oncol. 2012;30:3012-3019).