Independent News for the Oncologist and Hematologist/Oncologist CLINICALONCOLOGY.COM • March 2015 • Vol. 10, No. 3
CURRENT PRACTICE Plasma-based biopsies can help guide therapy .............. 4
SOLID TUMORS Vogl, NY: Ultrasound-guided biopsies should be done the same day as imaging whenever possible ...................................... 8 Report from GI Cancers Symposium: What is optimal timing for post-radiation surgery in rectal cancer patients? ..... 12
HEMATOLOGIC DISEASE Pediatric Oncology: Immune therapies promising in acute lymphoblastic leukemia ................................... 14 Jennifer Brown, MD, PhD: How I manage deletion 17p chronic lymphocytic leukemia ................................. 16
by the
numbers 1.0 No family history
2.3 One first-degree relative with CRC
4.3 More than one first-degree relative with CRC 0
1
2
3
4
Relative risk for CRC. CRC, colorectal cancer Source: National Cancer Institute (based on SEER Program data).
5
Contralateral Prophylactic Mastectomy Debate
Controversy Swirls Around Rising Rates Of CPM Surgeries San Antonio—For more than a decade, the rate of contralateral prophylactic mastectomy (CPM) has been rising in patients with unilateral breast cancer. At the San Antonio Breast Cancer Symposium (SABCS), clinicians discussed the controversy and some of the drivers behind this trend. CPM rates have skyrocketed in the United States, from an estimated 1.9% in 1998, to 4.5% in 2003 and 11.2% in 2011 ((J Clin Oncol 2007;25[33]:52035209, PMID: 17954711; JAMA Surg see MASTECTOMY, Y page 10
Breast tumor cluster; for women with dense breasts, MRI can add to the sensitivity of mammography; story on page 7.
Prostate Cancer:
Paying for Cancer Care: Part 1
Study Stresses Need To Better Stratify Pts At Intermediate Risk
Something’s Got To Give P
Orlando, Fla.—Patients with intermediate-risk prostate cancer who undergo active surveillance are four times more likely than those with low-risk disease to die of prostate cancer within 15 years, according to a study of 1,000 patients. “More research is needed to better characterize those intermediate-risk patients who can safely be monitored on a surveillance program,” said investigator D. Andrew Loblaw, MD, a radiation oncologist at Sunnybrook Health Sciences Centre, in Toronto, Canada, who presented the study at the 2015 Genitourinary Cancers Symposium (abstract 163). Active surveillance is a globally see INTERMEDIATE RISK, K page 9
hysicians, patients, payors and politicians all want to see reform for the entire U.S. health care system, but nowhere is reform needed more than in the area of cancer care. The rising costs of cancer care today are unsustainable. In this series, Clinical Oncology News takes an in-depth look at the problem, as well as solutions that might help cure what ails health care in America.
The rising costs of health care in the United States are unsustainable. When one considers that the median annual household income for a family of four in the United States is around $52,000 and a family’s annual health care costs, including insurance premiums, were about $23,215 in 2014 (Milliman Research Report May 2014), it is easy to see that individuals cannot afford wellness, let alone a serious illness. Although employers bear the brunt of health care costs in this country because they pay a higher percentage of an employee’s health insurance premiums, families can still expect high contributions and out-of-pocket expenses totaling a median of almost $10,000 a year, just under one-fifth of their annual wages. Nowhere is the cost of care more apparent than in the oncology sector, where annual direct medical costs are expected to increase to more than $173 billion in 2020 from $104 billion in 2006, according to “The State of Cancer Care in America: 2014,” a report see CANCER CARE, E page 6
NEW this month:
Essential Oncology™
Prostate Cancer by Leonard Gomella, MD Thomas Jefferson University
To download the Essential Oncology app go to: essentialoncology.com 60 Cancer Types