Nov 2015 cancer current awareness1

Clinical Librarian Service Musgrove Park Academy

Current Awareness

Cancer This monthly Current Awareness Bulletin is produced by the Clinical Librarian, Musgrove Park Academy, to provide Hope Directorate staff with a range of cancer/haematology related resources to support practice. It includes recently published guidelines and research articles, news and policy items.

This guide provides a selection of resources relevant to the subject area and is not intended to be a comprehensive list. All websites have been evaluated and details are correct at the time of publication. Details correct at time of going to print. Please note that resources are continuously updated. For further help or guidance, please contact a member of library staff.

This guide has been compiled by: Terry Harrison MLGS Clinical Librarian, HOPE Directorate Musgrove Park Hospital Library Service Terence.Harrison@tst.nhs.uk

Issue 1 November 2015

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Contents Click on a section title to navigate contents Page Recent journal articles

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New books

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Cochrane Reviews

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Evidence updates

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Cancer in the News

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Reports, publications and resources

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Training & Networking Opportunities, Conferences, Events

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Literature & Evidence search services

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Training and Athens

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Library contact details: Library Musgrove Park Academy Musgrove Park Hospital Taunton Somerset TA1 5DA Email: Library@tst.nhs.uk Tel: 01823 34 (2433) Fax: 01823 34 (2434) Clinical Librarian email: Terence.Harrison@tst.nhs.uk

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JOURNAL ARTICLES BACK TO TOP This is a list of journal articles on the topic of cancer. Some are available in the library or on-line via an Athens password by following the full text link. If you would like an article which is not available as full text then please contact library staff; Library@tst.nhs.uk

A. General Mole Count on One Arm Predicts Total Body Mole Count Kelly Young; Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD British Journal of Dermatology (MS only) The number of moles, or nevi, on one's arm is predictive of the number of moles on the rest of the body — which in turn is associated with melanoma risk — according to a study in the British Journal of Dermatology. Researchers conducted full-body skin examinations, focusing on 17 body sites, on nearly 3700 twin white females in the U.K. and 415 white male and female controls. Nevi on the arms were most predictive of total body nevus counts in both groups. In the twin study, women with more than seven nevi on the right arm had nearly nine times the risk for having over 50 total body nevi, relative to those who had fewer than seven on the arm. In addition, those with more than 11 on the arm had nine times the risk for over 100 total body nevi, "that is in itself a strong predictor of risk for melanoma." The researchers conclude: "This fast clinical evaluation should be used for a quick estimation of melanoma risk in general practices."

Calcium and Vitamin D to Prevent Colorectal Adenomas J.A. Baron and Others N Engl J Med 2015; 373:1519-1530, October 15, 2015DOI: 10.1056/NEJMoa1500409 In this placebo-controlled trial involving patients with recently diagnosed adenomas, daily supplementation with vitamin D3 (1000 IU), calcium (1200 mg), or both did not reduce the risk of recurrent colorectal adenomas over 3 to 5 years.

Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study BMC Medicine 2015, 13:235.

In a nutshell: This study aims to determine the association between place of death, health services used, and pain, feeling at peace, and grief intensity. The authors determined factors influencing death at home, and associations between place of death and pain, peace, and grief. Findings suggest that dying at home is better than hospital for peace and grief, but requires a discussion of preferences, GP home visits, and relatives to be given time off work.

Extended RAS Gene Mutation Testing in Metastatic Colorectal Carcinoma to Predict Response to Anti-Epidermal Growth Factor Receptor Monoclonal Antibody Therapy

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CJ Allegra, RB Rumble, SR Hamilton, PB Mangu, N Roach, A Hantel, RL Schilsky J. Clin. Oncol 2015 Oct 05;[EPub Ahead of Print], This is a provisional clinical opinion update concerning the use of extended RAS gene mutation testing in metastatic colorectal carcinoma (mCRC) patients to detect resistance to anti-EGFR therapy.

The authors pooled results from the original provisional clinical opinion, 11 systematic meta-analyses, 2 retrospective studies, and 2 health technology assessments based on a systematic review. The authors suggest that every mCRC patient eligible for anti-EGFR therapy should first undergo extensive tumor testing for mutations in KRAS and NRAS exons 2, 3, and 4. Note: Anti-EGFR therapy should only be considered as a treatment option for mCRC patients whose tumors test negative for RAS mutations following extensive genetic testing.

B3 to the Rescue Hensin Tsao, MD, PhD Reviewing Chen AC et al., N Engl J Med 2015 Oct 22; 373:1618 Oral nicotinamide effectively reduced the development of new nonmelanoma skin cancers and actinic keratoses in high-risk patients. Nicotinamide, a form of vitamin B3 available without prescription, has been shown in various studies to mitigate some of the deleterious effects of ultraviolet (UV) radiation.

The mechanism of action occurs through stopping UV-related ATP depletion and glycolytic blockade.

Australian investigators performed a randomized, placebo-controlled trial of oral nicotinamide (500 mg twice daily) in high-risk skin cancer patients (those with at least 2 nonmelanoma skin cancers [NMSCs] in the previous 5 years). The primary endpoint was the number of new NMSCs (squamous cell and basal cell carcinomas [SCCs and BCCs]), that developed during the treatment period (12 months). They also assessed the number of new actinic keratosis during the treatment period, the number of new NMSCs in the 6 months after treatment, and drug-related adverse effects. The rate of all new NMSCs was 23% lower in nicotinamide recipients than placebo recipients at 12 months, a statistically significant decrease. Individual rates of SCCs, BCCs, and actinic keratosis also decreased, but benefits subsided when treatment ended. Adverse effect rates were similar in nicotinamide and placebo recipients.

Adjuvant Erlotinib Versus Placebo in Patients With Stage IB-IIIA Non–Small-Cell Lung Cancer (RADIANT): A Randomized, Double-Blind, Phase III Trial Karen Kelly⇑, Nasser K. Altorki, Wilfried E.E. Eberhardt, et al.

American Society of Clinical Oncology. (in press) This phase III trial sought to determine whether adjuvant treatment with erlotinib could improve disease-free survival (DFS) in 973 patients with completely resected, EGFR-positive, stage IB to IIIA, non–small cell lung cancer (NSCLC). Overall, there was no significant difference in DFS between the erlotinib- (50.5 months) and placebo-treated (48.2 months) groups. There appeared to be an improvement in DFS with erlotinib in a subgroup of patients whose tumors expressed mutant EGFR, but this did not reach statistical significance (DFS, 46.4 vs 28.5 months for erlotinib vs placebo, respectively) due to the hierarchical testing procedure. Adjuvant therapy with erlotinib did not improve DFS in NSCLC patients with EGFR-positive tumors, or in a subgroup of patients with mutant EGFR.

Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial.

Badwe, Rajendra et al.

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The Lancet Oncology , Volume 16 , Issue 13 , 1380 – 1388.

This was an international, single-center, open-label trial including 350 women with previously untreated, de novo metastatic breast cancer to determine whether treatment of the primary breast tumor and lymph nodes would result in improved outcomes. There was no difference in median overall survival between the locoregional and non-locoregional treatment groups (OS, 19.2 vs 20.5 months, respectively). Interestingly, there was a significant difference in distant progression-free survival in women who received locoregional treatment compared with those who did not.

A palliative radiation oncology consult service’s impact on care of advanced cancer patients with symptomatic bone metastases.

Sanders Chang, Cardinale B. Smith, R. Sean Morrison, Kenneth Rosenzweig, Kavita Vyas Dharmarajan; Icahn School of Medicine at Mount Sinai, New York, NY; Mount Sinai Medical Center, New York, NY J Clin Oncol 33, 2015 (suppl 29S; abstr 110) Identified 334 patients. Patients were more likely to have SF-RT (OR 2.2, 95% CI [1.2-3.8], p = 0.007), or hypo-RT (OR 3.0, 95% CI [1.8-4.7], p < 0.001) after establishment of PROC. Conclusions: Establishment of a PROC service nearly doubled utilization of SF-RT and hypo-RT while maintaining pain improvement, and was associated with an increased use of palliative care consult services, decreased inpatient PRT use, and decreased length of stay. A dedicated service combining palliative care principles and radiation oncology improved quality of palliative cancer care.

Defining high-quality palliative care in oncology practice: An ASCO/AAHPM Guidance Statement J Clin Oncol 33, 2015 (suppl 29S; abstr 108) Panelists endorsed the highest proportion of palliative care service items in the domains of End-ofLife Care (81%); Communication and Shared Decision-Making (79%); and Care Planning (78%).

Lowest proportions were in: Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea and pain. Under the domain of Appropriate Palliative Care and Hospice Referral, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients with an expected survival of under 3 months or poor performance status (Zubrod 3-4) to hospice. Conclusions: This statement describes highquality palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find the guidance useful to inform operational changes and quality improvement efforts.

Review: The doseâ&#x20AC;&#x201C;response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies Tingting Li, Shaozhong Wei, Yun Shi, Shuo Pang1, Qin Qin, Jieyun Yin, Yunte Deng, Qiongrong Chen, Sheng Wei, Shaofa Nie, Li Liu. Br J Sports Med doi:10.1136/bjsports-2015-094927 A total of 71 cohort studies met the inclusion criteria and were analysed. Binary analyses determined that individuals who participated in the most physical activity had an HR of 0.83 (95% CI 0.79 to 0.87) and 0.78 (95% CI 0.74 to 0.84) for cancer mortality in the general population and among cancer

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survivors, respectively. There was an inverse non-linear dose–response between the effects of physical activity and cancer mortality. In the general population, a minimum of 2.5 h/week of moderate-intensity activity led to a significant 13% reduction in cancer mortality. Cancer survivors who completed 15 metabolic equivalents of task (MET)-h/week of physical activity had a 27% lower risk of cancer mortality. A greater protective effect occurred in cancer survivors undertaking physical activity postdiagnosis versus prediagnosis, where 15 MET-h/week decreased the risk by 35% and 21%, respectively. This meta-analysis supports that current physical activity recommendations from WHO reduce cancer mortality in both the general population and cancer survivors. It is inferred that physical activity after a cancer diagnosis may result in significant protection among cancer survivors.

B. Articles (in brief) (Note: if full text not available, contact Library to request copy of article) 

Launching an Interactive Cancer Projects Map: A Collaborative Approach to Global Cancer Research and Program Development

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Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer

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Actionable Gene Mutations Identified in Traditionally Treatment-Resistant Lung Cancer

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Lenalidomide in Chronic Lymphocytic Leukemia (in press)

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Increased Cancer-Specific Death in Men With High-Grade Prostate Cancer With Very Low PSA

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Using Amplicon-Based Next-Generation Sequencing in Therapeutic Decision-Making

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Safety and Efficacy of Radioembolization in Elderly and Younger Patients With Unresectable Liver-Dominant Colorectal Cancer

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Diagnosing symptomatic cancer in the NHS

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Use of the English urgent referral pathway for suspected cancer and mortality in patients with cancer: cohort study

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Long-Term Follow-Up of Chemotherapy-Induced Ovarian Failure in Young Breast Cancer Patients: The Role of Vascular Toxicity

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Prospective Biomarker Analysis of the Randomized CHER-LOB Study Evaluating the Dual AntiHER2 Treatment With Trastuzumab and Lapatinib Plus Chemotherapy as a Neoadjuvant Therapy for HER2-Positive Breast Cancer

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Diastolic Dysfunction Following Anthracycline-Based Chemotherapy in Breast Cancer Patients: Incidence and Predictors

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Prospective Clinical Utility Study of the Use of the 21-Gene Assay in Adjuvant Clinical Decision Making in Women With Estrogen Receptor-Positive Early Invasive Breast Cancer

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Molecular Phenotype of Breast Cancer According to Time Since Last Pregnancy in a Large Cohort of Young Women

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BRCAPRO 6.0 Model Validation in Male Patients Presenting for BRCA Testing

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Defining Breast Cancer Intrinsic Subtypes by Quantitative Receptor Expression

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PD-1: More Than Immunity in Melanoma

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Prostate cancer survivorship: a nurse-led service model

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Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials

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Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials

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State-of-the-Art Hysterectomy for Malignancy — Are Some Women Shut Out?

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Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS)

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Blood Pressure Tablets Offer Radiotherapy Protection For ...

For tables of contents: Oncology – click here Haematology – click here.

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NEW BOOKS BACK TO TOP If you are unable to find a book, or require a book that is not on this list, please ask library staff who will be able to locate the book for you using interlibrary loan.

Oxford handbook of clinical haematology (4th ed) (2015), Provan, Drew The Oxford Handbook of Clinical Haematology provides core and concise information on the entire spectrum of blood disorders affecting both adults and children. Updated for its fourth edition, it includes all major advances in the specialty, including malignant haematology, haematooncology,coagulation, transfusion medicine, and red cell disorders, with a brand new chapter on rare diseases.

Clinical oncology (2015) Jyoti, Babita; Kleidi, Eleftheria This book encloses the latest clinical reviews on medical and surgical oncology from highly recognised authors around the world, as those were recently published in the British Medical Journal.

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Oxford handbook of oncology (4th ed) (2015) Cassidy, Jim Now fully revised and in its fourth edition, the Oxford Handbook of Oncology has been the essential go-to guide for students and practitioners in oncology for over a decade. The scientific basis and diagnosis of cancers is covered, as well as drugs, biomarkers, and the presentation and psychosocial aspects of oncology.

Cancer and cancer care (2015) Wyatt, Debbie; Hulbert-Williams, Nicholas 'This book creates new ground for all health professionals working in cancer care to read, enjoy, look at and question their practice.' Caroline Adcock, Clinical Practice Educator - Haematology and Oncology, Royal Shrewsbury Hospital Cancer and Cancer Care is a complete study of cancer, the care of people with the disease and its impact on everyday life. Addressing the physical and psychosocial aspects of the illness in detail, it covers all fundamental aspects of cancer diagnosis, treatment, survival and aspects of psychosocial support for all those affected by cancer: patients, their families, and their healthcare providers.

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COCHRANE REVIEWS/UPDATES BACK TO TOP

New and Updated Cochrane Systematic Reviews A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation Authors' conclusion: We found low- to moderate-grade evidence that a therapeutic-only platelet transfusion policy is associated with increased risk of bleeding when compared with a prophylactic platelet transfusion policy in haematology patients who are thrombocytopenic due to myelosuppressive chemotherapy or HSCT. There is insufficient evidence to determine any difference in mortality rates and no evidence of any difference in adverse events between a therapeutic-only platelet transfusion policy and a prophylactic platelet transfusion policy. A therapeutic-only platelet transfusion policy is associated with a clear reduction in the number of platelet components administered.

Oral tapentadol for cancer pain Authors' conclusions: Information from RCTs on the effectiveness and tolerability of tapentadol was limited. The available studies were of moderate or small size and used different designs, which prevented pooling of data. Pain relief and adverse events were comparable between the tapentadol and morphine and oxycodone groups.

Interventions to enhance return-to-work for cancer patients Authors' conclusions: We found moderate quality evidence that multidisciplinary interventions enhance the RTW of patients with cancer.

Lymphadenectomy for the management of endometrial cancer Authors' conclusions: This review found no evidence that lymphadenectomy decreases risk of death or disease recurrence compared with no lymphadenectomy in women with presumed stage I disease.

Evidence on serious adverse events suggests that women who undergo lymphadenectomy are more likely to experience surgery-related systemic morbidity or lymphoedema/lymphocyst formation.

Currently, no RCT evidence shows the impact of lymphadenectomy in women with higher-stage disease and in those at high risk of disease recurrence.

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More Cochrane items: Comparison of a restrictive versus liberal red cell transfusion policy for patients with myelodysplasia, aplastic anaemia, and other congenital bone marrow failure disorders Yisu Gu, Lise J Estcourt, Carolyn Doree, Sally Hopewell, Paresh Vyas

Different doses of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation Estcourt Lise J; Stanworth Simon Cochrane Database of Systematic Reviews

Combination chemotherapy versus single-agent chemotherapy during preoperative chemoradiation for resectable rectal cancer Resende Heloisa M; Jacob Luiz Felipe Pitzer; Quinellato Luciano Vasconcellos, et al Cochrane Database of Systematic Reviews

Tests to assist in the diagnosis of keratinocyte skin cancers in adults: a generic protocol Dinnes Jac; Wong Kai Yuen; Gulati Abha, et al Cochrane Database of Systematic Reviews

Wound drainage after plastic and reconstructive surgery of the breast Khan Sameena M; Smeulders Mark J C; Van der Horst Chantal M, et al Cochrane Database of Systematic Reviews

Tests to assist in the diagnosis of cutaneous melanoma in adults: a generic protocol Dinnes Jac; Matin Rubeta N, Moreau Jacqueline F, et al Cochrane Database of Systematic Reviews

Chemotherapy for advanced non-small cell lung cancer in the elderly population Santos Fรกbio N; de Castria Tiago B; Cruz Marcelo RS; Riera Rachel Cochrane Database of Systematic Reviews

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Additional plerixafor to granulocyte colony-stimulating factors for haematopoietic stem cell mobilisation for autologous transplantation in people with malignant lymphoma or multiple myeloma Hartmann Tim; HĂźbel Kai; Monsef Ina, et al Cochrane Database of Systematic Reviews

Surgery for localised small cell lung cancer Barnes Hayley; See Katharine; Barnett Stephen; Manser RenĂŠe Cochrane Database of Systematic Reviews This is the protocol for a review and there is no abstract. The objectives are as follows:To determine whether, in patients with limited SCLC, surgical resection of cancer improves disease-specific and allcause survival compared with radiotherapy or chemotherapy, or a combination of radiotherapy and chemotherapy, or best supportive care.

Acupuncture for cancer pain in adults Paley Carole A; Johnson Mark I; Tashani Osama A; Bagnall Anne-Marie Cochrane Database of Systematic Reviews

Robotic versus open radical cystectomy for bladder cancer in adults Aboumarzouk Omar M; Bondad Jasper; Ahmed Kamran, et al Cochrane Database of Systematic Reviews This is the protocol for a review and there is no abstract. The objectives are as follows:To assess the effects of robotic radical cystectomy compared with open radical cystectomy in adults with bladder cancer.

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EVIDENCE UPDATES BACK TO TOP A. Up-to-date: Rolapitant for prevention of chemotherapy-induced nausea and vomiting (September 2015)

Rolapitant is a potent selective neurokinin 1 receptor (NK1R) antagonist with a longer plasma halflife than either aprepitant or fosaprepitant. It has been approved in adults, in combination with other antiemetic agents, to prevent delayed nausea and vomiting associated with emetogenic cancer chemotherapy. Safety and efficacy were established in three randomized double-blind trials in which rolapitant in combination with granisetron plus dexamethasone was compared with a control therapy (placebo with the same dose and schedule of granisetron and dexamethasone) in a total of 2800 patients receiving highly or moderately emetogenic chemotherapy [41,42]. Patients treated with rolapitant had a significantly greater reduction in delayed vomiting and significantly less use of rescue medication for both nausea and vomiting. Unlike other NK1R antagonists, rolapitant does not inhibit CYP3A4, and therefore adjustment of dexamethasone dose is not required.

Rolapitant does inhibit the CYP2D6 enzyme, and concurrent use of drugs that are metabolized by this pathway (eg, thioridazine) is not recommended. (See "Prevention and treatment of chemotherapy-induced nausea and vomiting", section on 'Rolapitant'.)

Trifluridine-tipiracil for refractory metastatic colorectal cancer (September 2015) Trifluridine-tipiracil (TAS-102) is an oral cytotoxic agent that consists of the nucleoside analog trifluridine (which inhibits thymidylate synthetase and causes DNA strand breaks), and tipiracil, a potent thymidine phosphorylase inhibitor which inhibits trifluridine metabolism and has antiangiogenic properties as well. Benefit in metastatic colorectal cancer (mCRC) was suggested in the phase III trial (RECOURSE) in which 800 patients who were refractory to or intolerant of fluoropyrimidines, irinotecan, oxaliplatin, bevacizumab, and agents targeting the epidermal growth factor receptor (EGFR) were randomly assigned to trifluridine-tipiracil or placebo [10]. Trifluridine-tipiracil was associated with a significant prolongation in median overall survival, and this benefit was independent of prior regorafenib use. The most frequently observed toxicities were gastrointestinal and hematologic.

Largely based upon these results, trifluridine-tipiracil was approved in the United States for treatment of patients with mCRC who have been previously treated with fluoropyrimidines, oxaliplatin, and irinotecan-based chemotherapy, an anti-angiogenic biologic product, and an anti-EGFR monoclonal antibody, if RAS wild-type [11]. (See "Systemic chemotherapy for nonoperable metastatic colorectal cancer: Treatment recommendations", section on 'Trifluridine-tipiracil' and "Systemic chemotherapy for metastatic colorectal cancer: Completed clinical trials", section on 'Trifluridine-tipiracil'.)

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Vemurafenib in hairy cell leukemia (September 2015) Two phase 2 multicenter studies evaluated the efficacy of the BRAF inhibitor vemurafenib in patients with hairy cell leukemia (HCL) relapsed after or refractory to treatment with purine analogs [4].

Responses were seen in the vast majority of patients with a substantial minority achieving complete response (35 to 42 percent). A deeper response was associated with superior outcomes, and the median treatment-free survival following complete response was 25 months. Most toxicities were mild; however, 14 percent developed secondary cutaneous tumors (a known complication of BRAF inhibitors). Until further data are available, we generally reserve vemurafenib for patients with HCL enrolled in clinical trials. (See "Treatment of hairy cell leukemia", section on 'BRAF inhibition (vemurafenib)'.)

Monoclonal antibodies in relapsed multiple myeloma (June 2015, MODIFIED September 2015) Two investigational monoclonal antibodies, elotuzumab (anti-SLAMF7) and daratumumab (antiCD38), have demonstrated efficacy in multiple myeloma (MM): ● In an open-label, multicenter, phase III trial (ELOQUENT-2), 646 patients with MM relapsed after one to three prior lines of therapy were randomly assigned to receive standard-dose oral lenalidomide plus dexamethasone (Rd) with or without elotuzumab [28]. After a median follow-up of 24 months, the addition of elotuzumab resulted in a higher overall response rate and improved progression-free survival (median 19 versus 15 months). Infusion reactions occurred in 10 percent of patients and rarely resulted in drug discontinuation. ● In a dose-escalation phase I/II trial, patients with multiply relapsed or refractory MM demonstrated an overall response rate of 36 percent and median progression-free survival of six months following administration of high-dose daratumumab [29].

Further follow-up is needed to assess the impact of both of these agents on survival and evaluate for long-term toxicities. (See "Treatment of relapsed or refractory multiple myeloma", section on 'Clinical trials'.)

Paclitaxel as albumin-bound nanoparticles with carboplatin for untreated non-small-cell lung cancer (terminated appraisal) - guidance (TA362) ...untreated non‐small‐cell lung cancer when potentially curative surgery or radiation...untreated non‐small‐cell lung cancer when potentially curative surgery or radiation...untreated non‐small‐cell lungcancer when potentially curative surgery or radiation...

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Idelalisib for treating chronic lymphocytic leukaemia - guidance (TA359) ...scores from the Functional Assessment of Cancer Therapy: Leukaemia (FACT‐Leu) instrument...ofatumumab is no longer available through the Cancer Drugs Fund and is not recommended for use...Lymphoma Association Association of Cancer Physicians Cancer Research UK Royal...

Also: 

Pembrolizumab for treating advanced melanoma after disease progression with ipilimumab

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Low-energy contact X-ray brachytherapy (the Papillon technique) for early-stage rectal cancer

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Preoperative high dose rate brachytherapy for rectal cancer

BMJ Evidence: Note: you may need to logon to BMJ Evidence to see these items.

Germ Cell Cancer and Multiple Relapses: Toxicity and Survival.

J Clin Oncol Cabozantinib versus Everolimus in Advanced Renal-Cell Carcinoma.

N Engl J Med Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer.

N Engl J Med A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation.

Cochrane Database Syst Rev A Bedside Risk Calculator to Preoperatively Distinguish Follicular Thyroid Carcinoma from Follicular Variant of Papillary Thyroid Carcinoma.

World J Surg Randomized Phase II Trial Comparing Obinutuzumab (GA101) With Rituximab in Patients With Relapsed CD20+ Indolent B-Cell Non-Hodgkin Lymphoma: Final Analysis of the GAUSS Study.

J Clin Oncol Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy.

Eur Urol

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Bisphosphonates in Women with Early Breast Cancer Reference - Lancet 2015 Oct 3;386(10001):1353 (level 2 [mid-level] evidence) 

In postmenopausal women with early breast cancer, bisphosphonates may reduce breast cancer mortality and bone recurrence

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In premenopausal women with early breast cancer, bisphosphonates do not appear to reduce breast cancer mortality or bone recurrence

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Overall, bisphosphonates may reduce risk of fracture

For women with breast cancer, bisphosphonates are recommended for the treatment of metastatic disease with evidence of bone destruction (J Clin Oncol 2011 Mar 20;29(9):1221, and NCCN website). However, the American Society of Clinical Oncology does not currently recommend bone-modifying agents in women without evidence of bone metastasis, even if other extraskeletal metastases are present. While previous randomized trials have suggested that bisphosphonates may reduce recurrence and increase survival women with early breast cancer (N Engl J Med 2011 Oct 13;365(15):1396, N Engl J Med 2009 Feb 12;360(7):679, Lancet Oncol 2012 Jul;13(7):734), two systematic reviews have found no significant association (Cochrane Database Syst Rev 2012 Feb 15;(2):CD003474, J Natl Compr Canc Netw 2010 Mar;8(3):279). To further investigate the impact of bisphosphonates on breast cancer outcomes, the Early Breast Cancer Trialists’ Collaborative Group performed an individual patient data meta-analysis including 18,766 women with early breast cancer from 26 randomized trials comparing adjuvant bisphosphonates vs. control. The mean treatment duration was 3.4 years and 97% of women were treated for 2-5 years.

During the median follow-up of 5.6 years, 3,453 women experienced a first recurrence and 2,106 died. Estimated 10-year event rates for recurrence, distant recurrence, bone recurrence, and breast cancer-specific mortality were calculated. Overall, women taking bisphosphonates had a significantly lower risk of a bone recurrence and also had a small, but statistically significant, reduction in breast cancer-specific mortality. However, in subgroup analyses examining demographic, disease-related, and treatment-related factors, bisphosphonate response was influenced by age and menopausal status.

For the analysis by menopausal status, there were 11,767 postmenopausal women and 6,171 premenopausal women. Comparing bisphosphonates vs. control in analyses of postmenopausal women, the 10-year breast cancer-specific mortality (14.7% vs. 18%, p = 0.002) and risk of bone recurrence (6.6% vs. 8.8%, p = 0.0002) were significantly lower with adjuvant bisphosphonate therapy. In premenopausal women, there were no significant differences in 10-year risk of breast cancer-specific mortality (20.6% vs. 20.7%) or bone

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recurrence (10.3% vs. 10.3%) comparing bisphosphonates vs. controls. Bisphosphonates were also associated with a reduced risk of fracture in an analysis of 13,341 women from studies reporting this outcome.

The results of this meta-analysis contradict two previous systematic reviews finding no significant associations between bisphosphonate treatment and breast cancer recurrence or bone metastases (Cochrane Database Syst Rev 2012 Feb 15;(2):CD003474, J Natl Compr Canc Netw 2010 Mar;8(3):279). These systematic reviews were limited by their inclusion of both early and advance breast cancer patients and more importantly, they did not take into account menopausal status. The current meta-analysis, which used individual patient data rather than trial-level data, found menopausal status significantly influences the effect of bisphosphonates on women with early breast cancer, with positive effects in postmenopausal women only. These results are consistent with one prior systematic review finding no significant difference overall comparing bisphosphonates vs. placebo in women with early breast cancer, but a significant increase in survival in a subgroup analysis of menopausal women (PLoS One 2013;8(8):e70044). Altogether, these results suggest bisphosphonates may be an appropriate adjuvant treatment to help increase survival in postmenopausal women with early breast cancer.

For more information, see the Bone-modifying agents in breast cancer topic in DynaMed Plus (you will need to logon).

Management of hormone-sensitive metastatic prostate cancer Updated 2015 Oct 05 06:59:00 AM: addition of docetaxel to ADT may increase overall survival in men with metastatic, hormone-sensitive prostate cancer (N Engl J Med 2015 Aug 20) View update

DynaMed users click here.

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CANCER IN THE NEWS BACK TO TOP A. General

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Bowel cancer is four distinct diseases Armed with this new knowledge, doctors might better determine which patients need the most aggressive treatment, the Institute of Cancer Research team say. They looked at laboratory and clinical data from more than 3,000 patients with bowel cancer to see if they could better classify the disease. Nearly all of the tumours could be sorted into the four groups. The groups focus on the genes a tumour contains, rather than just the type of bowel tissue that it affects or how far it has spread - although those factors are important too.

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WHO Says Processed Meat Can Cause Cancer, Red Meat Might

By Kelly Young; Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD The World Health Organization's International Agency for Research on Cancer has declared that processed meat is carcinogenic. The group said there was sufficient evidence showing that processed meat — which has been cured, salted, fermented, or smoked — is associated with increased risk for colorectal cancer. The group also reported a positive association between processed meat and stomach cancer. Meanwhile, red meat is probably carcinogenic, the group stated, based on "the substantial epidemiological data showing a positive association between consumption of red meat and colorectal cancer and the strong mechanistic evidence." However, red meat did not get the highest carcinogenic rating because some high-quality studies found no association, and confounding could not be ruled out in others. Increases in risk for pancreatic and prostate cancer have also been observed with red meat consumption.

WHO news release (Free PDF)

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A new guidance statement to define high-quality primary palliative care delivery in medical oncology has been developed by the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine (AAHPM). The two organizations have partnered to develop these recommendations to help medical oncology practices identify essential palliative care services and deliver high-quality primary palliative care to all patients with cancer. http://www.medscape.com/viewarticle/852423?nlid=89024_1842&src=wnl_edit_medp_wir&uac=1 77048FX&spon=17&impID=857264&faf=1

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Venous thromboembolism in cancer patients: The All-Party Parliamentary Thrombosis Group has published Venous thromboembolism (VTE) in cancer patients: cancer chemotherapy and clots. Published on World Thrombosis Day, this report seeks to further establish the known link between the treatment of cancer patients and the increased risk of venous thromboembolism (VTE). It aims to identify both individual hospitals where death rates for patients with cancer and VTE are particularly high, and to paint an overall 18

national picture. Furthermore, it is hoped that it will reveal a breakdown of which cancers (and their treatments) are associated with particularly high rates of VTE. Finally, it will identify if hospitals provide advice (both verbal and written) to cancer patients about the risks of VTE; and if appropriate pathways are followed to treat affected patients. Additional link: Direct link to pdf version of the report

B. Via Medscape: 

Colorectal Cancer Screening: Overview of Existing Programs

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Psychosexual Care in Prostate Cancer Survivorship

C. NHS Behind the Headlines 

Too soon to say being tall increases cancer risk

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Too soon for 'aspirin doubles cancer survival' claim

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Tiny 'cancer trap' could stop cancer spread

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Radiotherapy - does it really do more harm than good?

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Just one drink a day 'may raise breast cancer risk'

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Aspirin lowers risk of hereditary bowel cancer in obese people

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Contraceptive pill 'cuts womb cancer risk'

D. Via Trip Database             

FDA Approves Oncolytic Viral Agent for Melanoma Female Sex Hormones: No Role in Multiple Myeloma Risk? (CME/CE) Biomarker May Guide Breast Ca Tx: Cancer Network and OncoTherapy News Quitting Cigarettes Before Surgery Risky (CME/CE) Catalyst jumps on the ‘overservicing’ bandwagon Newly approved cancer drugs go untested Meat and cancer: some perspective for doctors Troubleshooting tips for doctors Here’s some perspective on barbie-stopping meat report Medical Radiation Doses Sometimes High (CME/CE) How Cancer Wreaks Havoc on Family Finances Breast cancer hits harder in younger women Vit B3 may prevent non-melanoma skin cancers

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REPORTS, PUBLICATIONS AND RESOURCES

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Making a step change in cancer services – Professor Sean Duffy NHS England’s National Clinical Director for Cancer, Sean Duffy, looks again at the report of the Independent Cancer Taskforce and some key areas for early progress. More here.

Rethinking cancer: the big ‘C’: quantifying the social and economic impact: This report quantifies the cost of cancer to the UK economy, its families and its communities. It outlines the changes required to increase survivorship and better support those living with and beyond cancer, their employers, families, friends and relatives. Report

Cancer Statistics - House of Commons Briefing Paper: How has the prevalence of cancer in the UK changed over time? How does it vary between different UK countries and regions? Which cancers are most common? How do mortality rates vary by age and location? How do survival rates vary between cancers? A summary of the House of Commons Briefing Paper on Cancer Statistics available HERE

Cancer Data: Childhood cancer mortality in the UK / Ovarian cancer in England Public Health England National Cancer Intelligence Network has published the following documents: • Childhood Cancer Mortality in the UK and Internationally, 2005-2010: this report presents mortality data for cancer among children under 15 years of age in the UK and 53 other countries up to 2010.

• Specialist surgery for ovarian cancer in England: This analysis examined the extent to which there had been an increase in specialised ovarian cancer surgery since the 1999 recommendation that Surgery for ovarian cancer should be carried out by specialised gynaecological oncologists at Cancer Centres.

To view the above documents click on the above link and then view most recent.

Faster cancer diagnosis by 2020 The government has pledged that from 2020, people with suspected cancer will be diagnosed within 28 days of being referred by a GP. The government has committed to spend up to £300 million more on diagnostics every year over the next 5 years to help meet the new 28 day target. Health Education England will start a new national training programme that will provide 200 additional staff with the skills and expertise to carry out endoscopies by 2018. This is in addition to the extra 250 gastroenterologists the NHS has already committed to train by 2020. The newly trained staff will be able to carry out almost a half a million more endoscopy tests on the NHS by 2020. The NHS will

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identify 5 hospitals across the UK to pilot the new target before the programme is rolled out nationally by 2020. Additional link: BBC News report

Routes to cancer diagnosis data Public Health England has published Routes to Diagnosis 2006-2013, preliminary results. This document presents the preliminary results from the fourth iteration of the Routes to Diagnosis project.

Updated data cover 2006 to 2013, with 2011-2013 data being published for the first time. These data show the proportion of patients diagnosed by route and by year in England. The report shows that proportion of cancers diagnosed as a result of emergency presentation at hospital has decreased; at the same time, the proportion of cancers diagnosed through urgent GP referral with a suspicion of cancer has increased.

Cancer Drugs Fund The National Audit Office has published the findings from its Investigation into the Cancer Drugs Fund. The government set up the Fund in 2010 to improve access to cancer drugs that would not otherwise be routinely available on the NHS. The key findings of this investigation include: the Fund has improved access to cancer drugs not routinely available on the NHS; 51% of the patients supported by the Fund between April 2013 and March 2015 accessed drugs that were appraised by NICE but not recommended for routine NHS commissioning; due to a lack of data, it is not possible to evaluate the impact that the Fund has had on patient outcomes, such as survival; NHS England has taken action to control the rapid growth of the cost of the Fund, including removing drugs on the grounds of cost; and all parties agree that the Fund is not sustainable in its current form.

Achieving world-class cancer outcomes The Royal College of Radiologists (RCR) has published Turning the ambition into action How the Cancer Strategy 2015â&#x20AC;&#x201C;2020 can be implemented. This report by the college is a response for action to implement the English Cancer Strategy 2015-2020 published in July 2015. The RCR sets out what it can do to help deliver the strategy and explains where immediate action is required by the Government and health bodies. The College warns that without such action the strategy will rapidly become unachievable and patients will continue to suffer from late diagnosis and delayed treatment.

National Head and Neck Cancer Audit The Health and Social Care Information Centre has published the results from the National Head and Neck Cancer Audit 2014. The aim of the Audit is to improve quality of care to those patients with head and neck cancer by raising standards of care to match those of the best performing teams.

Among the findings, the audit has found that the four year crude survival rate from the head and neck group of cancers ranged from over 60 per cent in patients diagnosed with cancer of the voice box (larynx) to only 33 per cent in patients with cancer of the hypopharynx.

Additional links: Audit website & HSCIC press release

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A new guidance statement to define high-quality primary palliative care delivery in medical oncology has been developed by the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine (AAHPM). The two organizations have partnered to develop these recommendations to help medical oncology practices identify essential palliative care services and deliver high-quality primary palliative care to all patients with cancer.

More: http://www.medscape.com/viewarticle/852423?nlid=89024_1842&src=wnl_edit_medp_wir&uac=1770 48FX&spon=17&impID=857264&faf=1

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TRAINING & NETWORKING OPPORTUNITIES, CONFERENCES, EVENTS BACK TO TOP UKONS 24 Hour Triage Risk Assessment Tool Training Workshop – Mount Vernon Cancer Centre November The UKONS 24 Hour Triage Tool is a widely utilised and recognised tool that is used to perform a risk assessment for patients who have:   

Received systemic anti-cancer therapy including chemotherapy in the previous 6-8 weeks Recently received radiotherapy Disease related immunosuppression

Mount Vernon Cancer Centre is hosting a training workshop which will focus on the standards required to ensure that the tool is used effectively in order to support safe care.

Date: Tuesday 10 November 2015 Venue: Lecture Hall, Postgraduate Centre, Mount Vernon Cancer Centre Time: 8.30 – 14.30 Cost: Free of charge To book your place at the workshop (and for further information) please click HERE

BAUN Advanced Prostate Cancer Study Day – Manchester - January 2016 This day provides opportunity to update knowledge and understanding of advanced prostate cancer treatment options, drug sequencing, supportive treatments and understanding of the dilemmas men face when living with the disease. This event is FREE to the first 50 delegates (£60 thereafter). The day is aimed at a multi-professional audience of nursing, medical and allied healthcare professionals.

Programme highlights include:       

Treatment pathways ADT, its impact and the nursing role Management of castrate resistant prostate cancer Trials – what’s new?

Patient stories Psychological impact Palliative and end of life care

For more information and to register please visit: www.eventsforce.net/baunapjan2016

Living With and Beyond Cancer: a masterclass for primary care – London, December People living with and beyond cancer often have ongoing physical, social and psychological needs related to their diagnosis and/or treatment which are sometimes not addressed for a variety of reasons. This masterclass in cancer survivorship being held at The Royal Society of Medicine on

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Wednesday 16 December is aimed at those health care professionals working in General Practice who play a vital role in managing patients after a diagnosis of cancer. There will be a series of experts from primary care, the hospital setting and from respected charities speaking about advances in this area of medicine and will present how we as health care professionals can better support cancer survivors with a view to improving the patient experience and outcomes. Experts by experience will be not only invited to the day to share their views, but will be part of the program formally presenting their perspective. Topics such as signposting patients with common medical problems, the role of exercise and supporting patients with psychological morbidity following a diagnosis of cancer, along with the extensive work Macmillan Cancer Support has done in this area will be presented. For further information, please click HERE

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OTHER SERVICES BACK TO TOP A. Literature & Evidence searches 

Are you looking for the latest evidence-based research, but haven’t got time to trawl the databases?

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Do you need a literature search carried out?

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Do you need to find evidence to support an improvement?

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Do you want to know how something has been done elsewhere and whether it worked?

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Library staff provide a literature and evidence search service for busy clinicians who are pressed for time.

To request a search, please complete and return this form, providing as much information as possible.

Alternatively if you would like an assisted search training session, where we will sit down with you and go through the steps of a literature search, then please contact the library.

B. Journal clubs

Do you have a journal club or are thinking of starting one up? If so, please contact the Library. Our Clinical Librarian will be happy to attend any new or existing journal club in a contributory or facilitating role.

TRAINING AND ATHENS BACK TO TOP Most electronic resources are available via an Athens password. You can register for this via the Library intranet page, or from home at http://www.swice.nhs.uk/ and following the link for Athens selfregistration.

Please note that registering from home will take longer as it will need to be verified that you are NHS staff/student on placement.

The library offers training on how to access and use Athens resources, as well as an introductory course on critical appraisal. You can book a course through the Learning and Development intranet page, or by contacting the library directly.

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