Compared to earlier generation TKIs, osimertinib is associated with improved survival as well as increased CNS activity A major benefit of this strategy is that it allows for response assessment before considering LAT. Patients with tumors refractory to systemic therapy or harboring aggressive subclinical micrometastases who were destined for progression despite systemic therapy are no longer eligible for LCT.
De Ruysscher et al. Reflecting the era, stereotactic radiotherapy was only utilized for intracranial metastases, while extracranial sites were treated with surgery or radical dose of conventional radiotherapy e. In this cohort, 1, 2, and 5-year OS were Although no extracranial SABR was used, only 7. Iyengar et al. The trial was planned to accrue 36 patients, but stopped early as an interim analysis showed a significant PFS benefit favoring the LAT arm 9.
Immunological and serological analyses from this trial indicated that LCT was associated with less circulating tumor DNA ctDNA , a lower number of detected mutations, and fewer tumor clonal expansions In one of the larger retrospective series, Hu et al. Xu et al. The study was planned to recruit 34 patients but stopped at 18 due to slow accrual. There has been growing laboratory and clinical evidence of radiotherapy enhancing anticancer immune activation by tumor neoantigen release and presentation 24 , 53 - In fact, there may be a synergistic effect of SABR and immunotherapy combinations, through induction of anticancer T lymphocytes-mediated activities 54 , 57 , Other nuances when combining immunotherapy and SABR are noteworthy.
Upfront SABR may result in challenges in response assessment using traditional measures like RECIST after immunotherapy, owing to fibrotic effects within tumor targets, most notably within the lung In addition, patients treated with immunotherapy may experience delayed tumor response due to pseudoprogression, which refers to tumor flare due to immune cell tumor infiltration prior to tumor shrinkage Or worse, another phenomenon known as hyperprogression may occur, wherein accelerated tumor progression is observed in small proportion of NSCLC patients after immunotherapy 60 - Nonetheless, the optimal sequencing of LAT has yet to be clearly elucidated and may depend on the mechanism of action of specific immunomodulatory agents As advanced practitioners caring for women receiving bevacizumab, we see the myriad of side effects that our patients can experience with this VEGF inhibitor: hypertension, arthralgia, proteinuria, delayed wound healing, and the rare patient who develops posterior reversible encephalopathy syndrome or bowel perforation.
As our goal of therapy is efficacy with the least amount of adverse events, we can now recommend bevacizumab for a shorter duration more confidently. O'Malley said.
Patients with platinum-agnostic ovarian cancer were defined as having either platinum-resistant disease recurrence within 6 months of last platinum dose or platinum-sensitive disease response to platinum and no disease progression within 6 months.
The primary endpoint of the trial was investigator- assessed response. Median progression-free survival was The adverse events observed with the doublet were manageable and consistent with the side-effect profiles of each agent, according to Dr.
O'Malley concluded about the trial. It is always exciting to have a new treatment option on the horizon, especially for our platinum-resistant ovarian cancer patients. We have cared for several patients in clinic who have received mirvetuximab soravtansine on protocol. Anecdotally, I can say that this has been a tolerable therapy, and these results seem to support that.
The study aimed to analyze the main concerns in long-term survival to improve follow-up care. From to , 1, long-term diagnosis more than 5 years ago survivors with ovarian cancer were recruited. Median survival time at recruitment was 11 years. More than half of participants had been diagnosed with advanced stage ovarian cancer Almost half have developed recurrent disease Almost half The main concerns reported were fatigue Patients with a history of recurrence and those under current treatment had a worse health status and more health concerns.
Fatigue, polyneuropathy, nausea and concentration problems improved with the time of survival. However, fatigue is still present in There was no significant difference in pain between 5 to 10 In this cohort, Woopen commented.
The results of the Carolin meets HANNA study give us some much-needed insight as to the frequency and types of side effects long-term survivors of ovarian cancer experience. These side effects include fatigue, pain, polyneuropathy, gastrointestinal symptoms, and memory problems.
To address these in a meaningful way, we need additional information: the extent to which the side effects are interfering with the patients' quality of life; which, if any, providers have been active in helping manage these symptoms; interventions they have tried; and barriers they have encountered. A woman undergoing active treatment and followed by her oncology team should be queried at every treatment or maintenance clearance visit about her symptoms related to cancer and side effects related to treatment.
A plan for addressing the concerns that are affecting her quality of life should be developed by the provider and patient at every visit. In our practice, each patient has an end-of-treatment survivorship visit, at which time we perform detailed survivorship ROS and identify residual side effects that are affecting the patient's quality of life.
Treatment plans to address the identified concerns are developed by the provider and patient, and we refer to appropriate resources as needed to help with management. We find this method to be effective in following and managing side effects. Of course, it is important to continue to check in with patients at their surveillance visits regarding any reported side effects following treatment.
Patients and methods: Two hundred forty-four patients were randomly assigned after conservative breast surgery to receive 12 weeks of cyclophosphamide, doxorubicin, methotrexate, fluorouracil, and prednisone CAMFP before RT CT-first or after RT RT-first. Median follow-up for surviving patients was months. Results: There were no significant differences between the CT-first and RT-first arms in time to any event, distant metastasis, or death.
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