After studying the genetic makeup of acute myeloid leukemia (AML), researchers determined that this malignancy exists in at least 11 different forms, each with its own distinguishing clinical features (Papaemmanuil E, et al. N Engl J Med. 2016;374:2209-2221).
Using data from 1540 patients participating in 3 different prospective multicenter clinical trials for AML (AML-HD98A, AML-HD98B, and AMLSG-07-04), scientists looked at patterns between gene mutations. Patients in the AML-HD98A trial were aged 18 to 65 years, and induction chemotherapy consisted of idarubicin, cytarabine, and etoposide (ICE). High-risk patients received allogeneic stem-cell transplantation, intermediate-risk patients received stem-cell allograft or intensive chemotherapy, and low-risk patients received intensive chemotherapy.
The patients in the AML-HD98B trial were aged 58 to 84 years, whereas the patients in the AMLSG-07-04 trial were 18 to 61 years of age. Both cohorts were randomly assigned to induction therapy with ICE or ICE plus all-trans retinoic acid, with patients in the AMLSG-07-04 trial receiving additional therapy as dictated by response.
Previous research had suggested that AML could be classified into 8 subgroups, but a large number of patients with AML in the current study did not fall into any of them. When the 3 new subgroups were added to the already identified 8 subgroups, 80% of patients overall were able to be classified.
The 3 newly identified subgroups included patients with AML with gene mutations that regulate RNA splicing, chromatin, or transcription (18%); AML with the TP53 mutation, complex karyotype alterations, cytogenetically visible copy-number alterations (aneuploidies), or a combination of both (13%); and AML with IDH2R172 mutations (1%).
The investigators hope that these findings will help develop more targeted, individualized treatments for patients with AML.
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Lung cancer screening based on individualized risk could prevent more lung cancer deaths over 5 years compared with the current US Preventive Services Task Force (USPSTF) recommendations, according to new recommendations (Katki HA, et al. JAMA. 2016;315:2300-2311).
The USPSTF currently recommends annual computed tomography (CT) lung cancer screening for current smokers (aged 55-80 years) and former smokers (aged 55-77 years) with at least 30 pack-years of smoking and no more than 15 years since quitting.
Researchers at the National Cancer Institute examined data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, a large randomized trial to determine the effects of screening on cancer-related mortality, and developed and validated empirical risk models for lung cancer incidence and death when no CT screening is performed.
Over 5 years, an estimated 46,488 deaths from lung cancer could be avoided by using the USPSTF recommendations for lung cancer screening, whereas an estimated 55,717 deaths could be prevented by using a risk-based model, which translates to a 20% increase in screening-avertable deaths.
In an accompanying editorial, Michael K. Gould, MD, MS, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, questioned who gets the final say in lung cancer screening (JAMA. 2016;315:2279-2281). “There is a difference between clinical and policy-level decision making,” he said. “On the policy side, there will always be a trade-off between screening efficiency and preventing as many lung cancer deaths as possible. In clinical practice, the decision to screen is very personal and should be individualized for each patient.”
The American Society of Clinical Oncology (ASCO) issued new guidelines for the management of patients with potentially curable, locally advanced, unresectable pancreatic cancer. A systematic review of the literature from January 2002 to June 2015 was undertaken by a panel that included oncology, gastroenterology, palliative care, and advocacy experts. The panel recommendations are in part based on evidence from 26 randomized controlled trials that met the inclusion criteria (Balaban EP, et al. J Clin Oncol. 2016 May 31. Epub ahead of print).
According to the new recommendations, clinicians should perform a multiphase computed tomography scan of the abdomen and pelvis using a pancreatic protocol or magnetic resonance imaging to evaluate the anatomic relationships of the primary tumor and to assess for the presence of intra-abdominal metastases.
Patients should be assessed for baseline performance status, symptom burden, and comorbidities. The goals of care and patient preferences should be discussed before establishing a multidisciplinary treatment plan. Patients should also be informed of any relevant clinical trials that may be available.
Preoperative therapy should be offered as an alternative treatment strategy for patients who have radiographic findings that are suspicious for extrapancreatic disease but who have not been diagnosed; radiographic interference between the primary tumor and mesenteric vasculature; and cancer antigen 19-9 level suggestive of disseminated disease. Patients with a performance status or comorbidity that is not conducive for major abdominal surgery should also be considered for preoperative therapy. The guidelines recommend 6 months of adjuvant therapy for patients who receive preoperative therapy.
The guidelines also recommend that after preoperative therapy, patients should undergo a complete restaging before surgical planning.
For patients with resected pancreatic cancer who did not undergo preoperative therapy, 6 months of adjuvant chemotherapy with either gemcitabine or fluorouracil plus folinic acid should be offered and should be initiated 8 weeks after surgery.
Patients with microscopically positive margins and/or node-positive disease after the completion of 4 to 6 months of systemic adjuvant chemotherapy should be offered adjuvant chemoradiation.
Finally, the guidelines recommend that patients who have completed treatment should be followed every 3 to 4 months during the first 2 years, with the interval increasing to every 6 months thereafter once stability is achieved.
