Radiation Fails to Improve Lung Cancer Outcomes
Whether to use post-operative radiation in patients with non-small-cell lung cancer who have undergone complete resection of the cancer but still have mediastinal nodal (N2) involvement has remained unclear. To determine disease-free survival at 3 years for those in this population who received radiation, researchers enrolled patients who had been diagnosed with non-small-cell lung cancer that had been completely resected but who were also found to have N2 involvement proven by histo-cytology. Disease-free survival was achieved by 47.1% of patients who underwent radiation, compared with 43.8% of those who did not. Median disease-free survival lengths were 22.8 months in those who did not undergo radiation and 30.5 months in those who did. No statistically significant differences in overall survival were observed. Patients in the radiation group also experienced more toxicities, particularly cardiopulmonary toxicity (11% vs 5%) when compared with the control group. The first event in the disease-free survival analysis was most often recurrence of disease in the mediastinum. Of events that occurred in the control arm, 46.1% were mediastinal recurrence, compared with 25% in the radiation arm. Brain metastases occurred more often in the radiotherapy arm (23.6% vs 17.6%) than in the control arm. ESMO2020 V I R
COVID-19 Associated With Rising Burnout Numbers Among Oncologists
Evidence suggests that the impact of the COVID-19 pandemic on the wellbeing of oncologists has the potential for serious negative consequences on work, home life, and patient care. To investigate this impact, the ESMO Resilience Task Force collaboration conducted two online surveys of oncology professions (survey 1: April/May, survey 2: July/August 2020). Statistical analyses were used to examine differences between the survey respondents, associations, and predictors of wellbeing/distress, burnout, and COVID-19 job performance. With 1,520 participants from 101 countries, survey 1 found that 25% were at risk for distress, with 38% reporting feeling burnout and 66% not able to perform their job to pre-COVID-19 levels. Differences in wellbeing and job performance between countries were related to COVID-19 mortality rates. Main predictors of wellbeing, burnout, and job performance were resilience and changes to work hours. Still undergoing analysis, survey 2 results suggest that overall wellbeing and burnout rates have worsened over time, whereas job performance has improved. Among those completing both surveys, burnout rates rose from 22% to 31%.
Preoperative Immunotherapy Safe & Feasible in Early Stage NSCLC
Evidence indicates that neoadjuvant immunotherapy has several advantages over adjuvant immunotherapy, including higher antigen load, neoantigen release from untreated tumors that could better prime the immune system, and the opportunity to evaluate tumor response to immunotherapy. Two studies sought to better understand these potential benefits in patients with earlystage non-small cell lung cancer (NSCLC). For one, patients were treated with three courses of a PD-L1 inhibitor on days 1, 15, and 29, with surgery scheduled 2-14 days after the last infusion. Complete surgical resection was completed in 89.1% of patients, with 8.7% showing a partial radiological response, 78.3% showing stable disease, and 18.6% experiencing a major pathological response. At 1 year, 89.1% of patients were still alive and 78.2% had not relapsed. In the other study, patients with early-stage NSCLC received one injection of a different PD-L1 inhibitor 4 weeks prior to surgery. Among participants, 97% had a complete surgical resection, with 7% showing a partial radiological response, 93% achieving stable disease, 14% experiencing a major pathological response, and 41% having a pathological response. There was no correlation between radiological and pathological response. However, there was a correlation between pathological response and PD-L1 expression at baseline.
Dual AR/AKT Blockade Effective in mCRPC With PTEN Loss
Research suggests that approximately 40% to 50% of metastatic castration-resistant prostate cancer (mCRPC) tumors show loss of the AKT phosphate PTEN, which leads to hyperactivation of the oncogenic PI3K/AKT signaling pathway. Other studies show that, due to reciprocal cross talk, blockade of the androgen receptor (AR)- activated pathway activates the PI3K/AKT signaling pathway, enabling prostate cancer cell survival. Therefore, PTEN loss in mCRPC is associated with worse prognosis and reduced benefit of AR blockade. To evaluate the efficacy and safety of an AKT inhibitor with a combination AR inhibitor (dual AR/AKT blockade) in patients with previously untreated mCRPC, investigators randomized asymptomatic or mildly asymptomatic patients to dual AR/AKT blockade or placebo plus the combination AR inhibitor (controls). Patients were stratified to PTEN loss as determined by immunohistochemistry (≥50% of the tumor cells having no detectable PTEN staining). Median radiographic progression-free survival (rPFS) was statistically significantly better in the dual AR/AKT blockade arm when compared with controls (18.5 months vs 16.5 months). In patients with PTEN loss, median rPFS was 19.1 months in the dual AR/AKT blockade arm, compared with 14.2 months in controls. However dual AR/AKT was associated with more toxicity when compared with placebo, leading to dose reduction in 39.9% (vs 6.2%) and discontinuation in 21.1% (vs 5.1%).
No Benefit With Hysterectomy After Intraoperative Node Detection
The optimal management of patients with intraoperatively detected positivity of pelvic lymph nodes remains unclear. With the combination of extensive surgical dissection in the pelvis followed by pelvic radiotherapy shown to be associated with high morbidity rates, investigators sought to determine whether radical hysterectomy completion improves oncological outcomes of such patients, researchers analyzed oncological outcome and major prognostic factor data on patients with cervical cancer who were found upon operation to be LN positive and referred for primary surgery with a curative intent at 51 institutions in 19 countries from 2005-2015. Patients were grouped by those with completion or abandonment of the planned hysterectomy. Prognostic factors were balanced between the groups and included tumor size and type and disease stage. No significant differences were observed between the groups in risk of recurrence (hazard ratio [HR], 1.154), local recurrence (HR, 0.836), or mortality (HR, 1.064). No cohort was found upon subgroup analyses to have a survival benefit with radical surgery completion. Across all participants, increasing FIGO stage and tumor size of 4 cm or larger were identified as major prognostic factors for recurrence and survival.