Research Round Up NEWS FOR PATIENTS FROM THE 2015 ASCO ANNUAL MEETING

BLOOD CANCERS Obinutuzumab Controls Growth of Slow-Growing CONTENTS Blood Cancers...... 1

Non-Hodgkin Lymphoma A Word From The President...... 2

In an ongoing study, types of NHL received Brain Metastases...... 5 researchers found that adding either bendamustine only a new targeted therapy to or bendamustine plus Breast Cancer...... 6 chemotherapy controls non- obinutuzumab followed Childhood Cancer...... 8 Hodgkin lymphoma (NHL) by obinutuzumab given by growth for more than twice as itself. Researchers found that Head and Neck Cancers...... 10 long as only chemotherapy. The obinutuzumab controlled NHL patients who participated in this growth for more than twice as Liver Cancer...... 12 study had indolent, or slow- long as bendamustine (about Lung Cancer...... 13 growing, NHL. The standard 29 months compared with 14 first treatment for this common months). Melanoma...... 14 type of NHL is a combination Prostate Cancer...... 16 of bendamustine (Treanda) and What this means for patients rituximab (Rituxan). For most “The overall goal of treatment Sarcoma...... 18 patients, rituximab eventually for indolent lymphoma is to stops working to control NHL increase the amount of time Skin Cancer Prevention...... 18 growth. patients remain symptom-free Tumor Genetics...... 20 Like rituximab, and in remission. The fact that obinutuzumab (Gazyva) is this new approach doubled The ideas and opinions expressed in Research a type of targeted therapy. average remission time marks Round Up do not necessarily reflect the opinions of the American Society of Clinical Oncology Targeted therapy is a treatment a major step forward for our (ASCO). The information in Research Round Up that targets the cancer’s specific patients,” said lead study author is not intended as medical or legal advice, or as a substitute for consultation with a physician genes, proteins, or the tissue Laurie Helen Sehn, MD, MPH, or other licensed health care provider. Patients environment that contributes a medical oncologist at the BC with health care-related questions should call or see their physician or other health care provider to cancer growth and survival. Cancer Agency in Vancouver, promptly and should not disregard professional Specifically, obinutuzumab Canada. “Obinutuzumab may medical advice, or delay seeking it, because of information encountered on the website. The targets a protein on lymphoma offer patients the chance to mention of any product, service, or treatment in cells that causes some cells to die stay well for a significantly Research Round Up should not be construed as an ASCO endorsement. ASCO is not responsible and makes others more sensitive longer period of time, putting for any injury or damage to persons or property to chemotherapy. off the need for additional arising out of or related to any use of ASCO’s patient education materials, or to any errors or As part of this study, chemotherapy.” omissions. 396 patients with different Continued on page 2

ASCO is the world’s leading professional organization representing physicians who treat people with cancer. A WORD FROM THE PRESIDENT Dear Friends, New Treatment, Welcome to the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting. Pacritinib, Helps The research presented at this year’s meeting highlights innovative and technological advances Ease Myelofibrosis that can improve every aspect of cancer care– from prevention, to diagnosis, to treatment, to survivorship. This year’s theme, Illumination and Innovation, reflects Symptoms ASCO’s role in taking the knowledge gained through research to A recent study showed that the improve cancer care. drug pacritinib works better To help you, the patient, learn about the latest advances in cancer for myelofibrosis than current care and what they mean for you, ASCO provides summaries of the treatments. Myelofibrosis is a research highlighted at the 2015 ASCO Annual Meeting in Chicago, rare blood cancer that develops Illinois, from May 29 through June 2, 2015. when the bone marrow is unable I am optimistic about the progress described here. Cancer involves to make enough blood cells. As an entire community of health professionals and caregivers working a result, the spleen takes over the together on all aspects of treatment. Together, we are making a world role of making blood cells but of difference in cancer care. For more information about cancer, please becomes quite enlarged. Patients visit Cancer.Net, ASCO’s patient information website. also often experience tiredness, weakness, shortness of breath, Sincerely, fever, and weight loss because of an enlarged spleen. In addition, myelofibrosis turns into acute leukemia in about a third of patients with this disease. Peter Paul Yu, MD, FACP, FASCO There is currently no cure ASCO President for myelofibrosis. Treatment usually involves a range of treatments that are not specific for this disease. Examples include BLOOD CANCERS thalidomide (Synovir, Thalomid) and lenalidomide (Revlimid), Obinutuzumab Controls with your doctor for more epoetin (Epogen, Eprex, Procrit) information. n and darbepoetin (Aranesp), Growth of Slow-Growing and hydroxyurea (Droxia, Questions to Ask Your Doctor Hydrea). The only treatment Non-Hodgkin Lymphoma approved by the U.S. Food and Continued from page 1 ƒƒ What type of NHL do I have? Drug Administration (FDA) is In this study, the most What does this mean? ruxolitinib (Jakafi), which is not common side effects ƒƒ What are my treatment an option for patients who have of bendamustine and options? Will rituximab be a a low level of platelets. Platelets obinutuzumab included low treatment option? are the cells that help the blood white blood cell levels and ƒƒ What are my options if to clot. reactions where the drug rituximab stops working? As part of this study, 327 was given. Obinutuzumab is ƒƒ What clinical trials are open patients received either pacritinib currently approved along with to me? How do I find out or other treatments listed above, chemotherapy to treat chronic more about them? except for ruxolitinib. Because lymphocytic leukemia. Talk this study included patients 2 RESEARCH ROUND UP with very low platelet levels, What this means for patients receiving other treatments as part ruxolitinib was not considered “There is a huge unmet need of this study were switched to a safe option for those patients. for patients with myelofibrosis. pacritinib because of the benefits Researchers found that after six Only one drug is currently FDA- of the drug. The most common months, about 19% of patients approved for the disease, and it side effects of pacritinib were receiving pacritinib had a is not safe for patients with low diarrhea, nausea, and vomiting. reduction in the size of their platelet counts,” said lead study The symptoms typically lasted spleens, compared with almost author Ruben A. Mesa, MD, less than one week and few 5% receiving other treatments. Deputy Director of the Mayo patients needed to stop treatment This was considered a success Clinic Cancer Center in Scottsdale, because of the side effects. of treatment. For the patients AZ. “We were encouraged to Pacritinib is currently not who had the lowest levels of see that pacritinib was safe and approved by the FDA and may platelets, 33% had their spleens effective, even in patients with be available only in clinical trials. shrink compared with none severely low blood counts.” Talk with your doctor for more of the patients receiving other Most patients who were information. n treatments. In addition, patients receiving Questions to Ask Your Doctor pacritinib had less weight loss, night sweats, fever, and bone ƒƒ What are my treatment options for myelofibrosis? pain. Pacritinib also increased red ƒƒ What are the risks and benefits of each treatment option? blood cell levels, helping about ƒƒ Do I have very low platelet levels? What does this mean? 26% of patients avoid regular red ƒƒ What clinical trials are open to me? How do I find out more about them? blood cell transfusions.

either ibrutinib and BR or a Adding Ibrutinib to Standard Treatment Lowers the placebo and BR. A placebo is an inactive treatment. After about Risk of Dying from Chronic Lymphocytic Leukemia a year and a half, the patients receiving ibrutinib were 80% In a large, ongoing study, new targeted therapy, ibrutinib, less likely to have the disease researchers found that a approved by the U.S. Food and worsen or die from the disease. combination of ibrutinib Drug Administration (FDA) In addition, patients receiving (Imbruvica) and standard in 2014, has helped control the ibrutinib experienced less fatigue treatment slows the growth of growth of CLL for patients related to the CLL. chronic lymphocytic leukemia when other treatments have (CLL) and lowers patients’ risk stopped working. Targeted What this means for patients of dying from the disease. The therapy is a treatment that “This was one of the most standard treatment for CLL targets the cancer’s specific rigorous clinical trials ever is usually a combination of genes, proteins, or the tissue conducted in CLL and it bendamustine (Treanda) and environment that contributes truly validates ibrutinib as an rituximab (Rituxan), a regimen to cancer growth and survival. important drug for this cancer,” called BR. Specifically, ibrutinib targets a said lead study author Asher These treatments help control protein that helps lymphocytes Chanan-Khan, MD, a professor CLL growth for many years, but grow. of medicine at Mayo Clinic in they cannot cure it. Eventually, As part of this study, 578 Jacksonville, FL. “We found treatment stops working for all patients who already had that ibrutinib can be safely patients with CLL. Adding the treatment for CLL received Continued on page 4 RESEARCH ROUND UP 3 BLOOD CANCERS patients receiving ibrutinib Adding Ibrutinib to Standard Questions to Ask Your Doctor experienced, those who were Treatment Lowers the receiving the placebo were ƒƒ What type of leukemia do I later given ibrutinib in addition have? Risk of Dying from Chronic to the BR regimen. Since the ƒƒ What treatments have I Lymphocytic Leukemia FDA has approved ibrutinib, already received? this drug may be a treatment ƒƒ What options are available if Continued from page 3 option for you. The most the current treatment stops paired with existing therapy to common side effects noticed working? powerfully prolong remissions in this study were low levels ƒƒ What clinical trials are open and improve patients’ well- of blood cells and nausea. Talk to me? How do I find out being.” with your doctor for more more about them? Because of the benefits information. n

who would otherwise be Adding Immune-Based Drug to Standard Treatment offered lenalidomide and dexamethasone, addition of Controls the Growth of Multiple Myeloma for Longer this new targeted drug makes the outcomes even better,” said As part of an ongoing study, (Revlimid) and dexamethasone lead study author Sagar Lonial, researchers found that a new (multiple brand names), MD, Chief Medical Officer of immune-based treatment or standard treatment plus the Winship Cancer Institute controlled the growth of elotuzumab. of Emory University School of multiple myeloma for longer Researchers found that Medicine, and Professor and than standard treatment. This adding elotuzumab to treatment Executive Vice Chair of the new treatment, elotuzumab, controlled the growth of multiple Department of Hematology and works in two different ways myeloma for longer than standard Medical Oncology of Emory to treat myeloma. It is able treatment only (about 19 months University School of Medicine in to directly target multiple compared with nearly 15 Atlanta, GA. “It was particularly myeloma cells and boost a part months). In addition, elotuzumab striking that the difference of the immune system that helps appeared to work as well for between the elotuzumab and control the growth of cancer patients with genetic changes standard treatment seems to get cells. usually linked with less successful bigger over time, which really This study included 646 treatment as for those who did speaks to the power of this patients with multiple myeloma not have those genetic changes. immune-based approach.” that had come back, or relapsed, In this study, elotuzumab after treatment. They received What this means for patients did not add many additional either a standard treatment, “It appears that, for patients side effects. Some patients had which was lenalidomide with relapsed multiple myeloma a mild reaction where the drug was given for the first few Questions to Ask Your Doctor doses. Elotuzumab is still being researched and may only be ƒƒ What type of multiple myeloma do I have? What does this mean? available in clinical trials. n ƒƒ What are my treatment options? ƒƒ Is elotuzumab an option for me? Is it only available in clinical trials? ƒƒ What treatment do you recommend? Why? ƒƒ What is my chance of recovery?

4 RESEARCH ROUND UP environment that contributes to a hematologist at Levine Cancer Daratumumab May Be an cancer growth and survival. Institute/Carolinas Healthcare In this study, 106 patients System in Charlotte, NC. “Our Effective Treatment for whose disease had worsened after hope is that daratumumab will at least three previous treatments help fill the unmet need of received daratumumab as the patients who have exhausted Multiple Myeloma only treatment. Researchers available treatment approaches.” According to a recent small found that after about nine In this study, the most study, the drug daratumumab months, daratumumab slowed common side effect was a may work well as a treatment the cancer’s growth for 29% reaction in the area where for multiple myeloma after other of patients. In addition, three daratumumab was given. Other treatments have not worked. patients had a complete remission, side effects included fatigue, low About 26,000 Americans which means that they had no blood counts, back pain, and are diagnosed with multiple signs of the cancer. cough. Daratumumab is still myeloma every year. Despite being researched and may only be recent advances, treatments What this means for patients available through a clinical trial. usually stop working to control “The efficacy we’re seeing is Talk with your doctor for more the cancer’s growth. quite impressive for a clinical information. n Daratumumab is a type of trial of multiple myeloma, given targeted therapy. Targeted that many patients had already Questions to Ask Your Doctor therapy is a treatment that undergone five or more types targets the cancer’s specific of treatment,” said lead study ƒƒ What are my treatment genes, proteins, or the tissue author Saad Zafar Usmani, MD, options for multiple myeloma? More Information: Blood Cancers ƒƒ What treatments have I already received? ƒƒ Guide to Acute Myeloid Leukemia (www.cancer.net/aml) ƒƒ If the current treatment stops ƒƒ Guide to Chronic Lymphocytic Leukemia (www.cancer.net/cll) working, what options are ƒƒ Guide to Multiple Myeloma (www.cancer.net/myeloma) available? ƒƒ Guide to Myelodysplastic Syndromes (www.cancer.net/mds) ƒƒ What clinical trials are open ƒƒ Guide to Non-Hodgkin Lymphoma (www.cancer.net/nhl) to me? How do I find out ƒƒ Targeted Treatments (www.cancer.net/targetedtreatments) more about them?

BRAIN METASTASES

Radiosurgery is a type of The Side Effects of Whole Brain Radiation Therapy radiation therapy that aims radiation directly and only to for Brain Metastases May Outweigh the Benefits for the parts of the brain where there is cancer. It is a common Some Patients way to treat brain metastases when there are just a few areas In a recent study, researchers and memory problems than where the cancer has spread. found that radiation therapy to just radiosurgery. Even though Regular surgery to remove the the whole brain after radiosurgery the additional radiation therapy metastases is only an option for for cancer that has spread to controlled the cancer’s growth, it a few patients because of the the brain causes more thought did not lengthen patients’ lives. Continued on page 6 RESEARCH ROUND UP 5 BRAIN METASTASES BREAST CANCER The Side Effects of Whole Buckner, MD, a professor of oncology at Mayo Clinic in New Targeted Drug Slows Brain Radiation Therapy Rochester, MN. “We expect for Brain Metastases May that practice will shift to reserve Growth and Spread of the use of whole brain radiation Outweigh the Benefits for therapy for later treatment and Metastatic Breast Cancer Some Patients palliative care.” Radiation therapy to the whole A large phase III study has found Continued from page 5 brain may still be an appropriate that a new targeted therapy, risk of damage to the brain. At option for patients. Talk with called palbociclib (Ibrance), some point, most patients with your doctor about the goals of delayed the growth and spread brain metastases receive radiation treatment, in addition to your of advanced hormone receptor- therapy to the whole brain to treatment options. n positive breast cancer by roughly control the cancer’s growth or five months when combined with reduce symptoms caused by the Questions to Ask Your Doctor the standard hormonal therapy cancer. fulvestrant (Faslodex). This As part of this study, ƒƒ What type of cancer do I combination could become a 213 patients received either have? What does this mean? new treatment option for women radiosurgery alone or ƒƒ Has the cancer spread with hormone receptor-positive, radiosurgery followed by anywhere else? HER2-negative breast cancer radiation therapy to the whole ƒƒ What are my treatment that has spread to other parts of brain. All patients had one to options? the body. three small brain metastases. ƒƒ What are the goals of Palbociclib is a new drug that After three months, researchers treatment? Is it to eliminate is given as a pill to swallow. It found that more patients who the cancer, help me feel targets specific proteins, called received radiation therapy to the better, or both? cyclin dependent kinases (CDKs) whole brain had thought and ƒƒ What are the side effects of 4 and 6, that contribute to breast memory problems than those each treatment? cancer’s growth and survival. who just received radiosurgery This type of treatment blocks the alone (92% compared with 64%). growth and spread of cancer cells More Information: while limiting damage to healthy What this means for patients Brain Metastases cells. “We used to offer whole brain For this study, 521 women radiation early on, but now ƒƒ What is Radiation with hormone receptor-positive, we know that the side effects Therapy? (www.cancer.net/ HER2-negative breast cancer of this therapy are worse for radiationtherapy) received either fulvestrant and the patient than cancer growth ƒƒ What is Cancer Surgery? palbociclib or fulvestrant and or recurrences in the brain,” (www.cancer.net/surgery) an inactive substance called a said senior study author Jan C. placebo. All of the participants had metastatic cancer that had grown, spread, or come back after receiving hormonal therapy. PRE-ACT: AN ONLINE TOOL ABOUT CLINICAL TRIALS When the researchers analyzed PRE-ACT (Preparatory Education About Clinical Trials) is an the data collected during the online education program that provides free access to a series study, they found that the of videos that helps patients and their caregivers learn about combination of fulvestrant and clinical trials and address barriers to participation. Learn about palbociclib kept breast cancer this exciting new tool at www.cancer.net/preact from growing or spreading for more than nine months compared 6 RESEARCH ROUND UP with less than four months for in London, United Kingdom. phase II study. Talk with your fulvestrant treatment alone. “This relatively easy-to-take doctor for more information. The researchers also noted that new drug can substantially delay In this study, less than 3% of the benefits of the combination the point when women need to women had to stop treatment treatment were similar whether start chemotherapy, making this with fulvestrant and palbociclib the women had been through an exciting new approach for because of side effects. The menopause or not. More time women.” most common side effects of is needed to find out whether Earlier this year, the U.S. this combination were abnormal the fulvestrant and palbociclib Food and Drug Administration blood counts. Many of the combination will help women approved treatment with women in this study developed with metastatic hormone palbociclib in combination with low white blood cell counts, but receptor-positive, HER2- letrozole (Femara) under its very few (less than 1%) developed negative breast cancer live longer. accelerated approval program the more serious side effect of based on the results of a previous febrile neutropenia. n What this means for patients “After initial hormonal therapy Questions to Ask Your Doctor stops working in metastatic breast cancer, the next step is typically ƒƒ What type and stage of breast cancer do I have? What does this mean? chemotherapy, which can be ƒƒ What is the hormone status of my tumor? What is my HER2 status? effective, but the side effects are How will this affect my treatment options? often very difficult for women,” ƒƒ Is palbociclib an option for me? Why or why not? said lead study author Nicholas C. ƒƒ What treatment plan do you recommend? Why? Turner, MD, PhD, a consultant ƒƒ What clinical trials are open to me? medical oncologist at The Royal ƒƒ What are the possible side effects of each treatment, and how can they Marsden and a team leader at be managed? The Institute of Cancer Research

ovaries from making estrogen. Anastrazole Helps Reduce Breast Cancer Risk after This is the first study to compare anastrazole with DCIS for Postmenopausal Women tamoxifen after treatment for DCIS. More than 3,000 A large clinical trial suggests that hormone receptor-positive women who had already had anastrazole (Arimidex) may be a DCIS. However, another type a lumpectomy and radiation new option for preventing breast of hormonal therapy, known as therapy for hormone receptor- cancer after treatment for ductal aromatase inhibitors (AIs), is an positive DCIS volunteered to carcinoma in situ (DCIS). DCIS option for women who have gone participate in the study. Half of is a non-invasive type of breast through menopause. these women took tamoxifen cancer. DCIS can usually be Hormone receptor-positive every day for five years, and the eliminated with a lumpectomy breast cancer depends on other half took anastrazole. followed by radiation therapy. estrogen to grow and spread. More than eight years after However, women with DCIS are Both tamoxifen and AIs like starting treatment, 94% of women at increased risk for developing anastrazole block the estrogen in this study who took anastrazole invasive breast cancer in the same growth signal, but they do it in remained breast cancer-free or opposite breast. different ways. Tamoxifen keeps compared with 89% who took Tamoxifen has typically estrogen from getting into cancer tamoxifen. However, the survival been used to reduce breast cells, while anastrazole stops rates were similar for both cancer risk for women with tissues and organs other than the Continued on page 8 RESEARCH ROUND UP 7 BREAST CANCER CHILDHOOD CANCER Anastrazole Helps Reduce stiffness, vaginal dryness, increased cholesterol, heart Improved Care and Breast Cancer Risk after DCIS disease, weakening bones, and for Postmenopausal Women bone breaks. The side effects of Treatment Helps Children tamoxifen include hot flashes, Continued from page 7 vaginal discharge or dryness, leg treatments (93% for anastrazole cramps, and, rarely, blood clots with Cancer Live Longer and 92% for tamoxifen). and a slightly increased risk of Additional analysis of the data uterine cancer. Talk with your and Better suggests that anastrazole may not doctor for more information. n A recent analysis of information provide additional benefits over from more than 34,000 tamoxifen for women who are Questions to Ask Your Doctor children who participated in older than 60. the Childhood Cancer Survivor ƒƒ What type and stage of Study shows that modern cancer What this means for patients breast cancer do I have? care is reducing deaths from “The good news is—tamoxifen What does this mean? cancer and long-term side effects. and anastrazole are both very ƒƒ Is my breast cancer hormone Previous research has shown that effective, but it seems that receptor-positive? What does up to 18% of childhood cancer women have a better chance of this mean? survivors die within 30 years of staying well with anastrazole,” ƒƒ What are the chances that diagnosis. While deaths from said lead study author Richard the breast cancer will return? worsening or recurrent cancers G. Margolese, MD, a professor of ƒƒ Do you recommend tend to slow over time, deaths surgical oncology at The Jewish hormonal therapy after from other health-related reasons, General Hospital at McGill surgery and radiation such as long-term side effects University in Montreal, Canada. therapy? Why or why not? tend to increase. “Women should also consider ƒƒ What is my menopausal In this study, researchers found differences in side effects when status now, and how does that 6% of children diagnosed discussing treatment options this affect my options for with cancer in the 1990s died with their doctors.” treatment? within 15 years of diagnosis, AIs and tamoxifen have ƒƒ What are the benefits and compared with 12% of those slightly different side effects, risks of hormonal therapy? diagnosed in the early 1970s. In although they are often similar ƒƒ How do the side effects of addition, about 2% of survivors in severity. The side effects AIs compare with tamoxifen? diagnosed in the 1990s died from of AIs include joint pain and other health-related reasons, compared with almost 4% of those More Information: Breast Cancer diagnosed in the early 1970s. Researchers also found children ƒƒ Guide to Breast Cancer (www.cancer.net/breast) diagnosed with Wilms tumor, ƒƒ Hormonal Therapy for Hormone Receptor-Positive Breast Cancer Hodgkin lymphoma, and acute (www.cancer.net/recommendations) lymphoblastic leukemia (ALL) ƒƒ Targeted Treatments (www.cancer.net/targetedtreatments) had the highest decrease in the ƒƒ Coping With Fear of Recurrence (www.cancer.net/survivorship) risk of death from long-term side effects. One major factor that may be responsible for the improved ASCO Answers: Managing the Cost of Cancer Care offers long-term health of cancer practical guidance, information about the Affordable Care Act, survivors is that doctors have a list of financial resources, and more. Download this booklet reduced treatments for childhood at www.cancer.net/managingcostofcare. cancers that are less aggressive without making the treatment 8 RESEARCH ROUND UP less effective. For example, in the lead study author Gregory detection, and treatment of late the 1970s, 86% of patients with T. Armstrong, MD, MSCE, a effects, like new cancers and heart ALL received radiation therapy pediatric oncologist at St. Jude and lung disease, have played an to the head, compared with only Children’s Research Hospital important role in extending their 22% in the 1990s. The dose in Memphis, TN. “While lifespan as well.” of radiation therapy has also the modernization of cancer been reduced for the treatment therapy has probably made the Dr. Armstrong was a recipient of of Hodgkin lymphoma and most significant difference, a Conquer Cancer Foundation of Wilms tumor. And, the dose of improvements in supportive care ASCO Career Development Award a type of chemotherapy called for survivors, and screening, in 2008. n anthracyclines that are linked with heart problems has also Questions to Ask Your Doctor decreased for children diagnosed with Hodgkin lymphoma, Wilms IF YOU ARE A CHILDHOOD CANCER SURVIVOR tumor, and ALL. ƒƒ When was I diagnosed with cancer? ƒƒ What treatments did I receive? What this means for patients ƒƒ What are the long-term side effects? How can they be managed? “Fifty years ago, only one in five children would survive IF YOUR CHILD HAS BEEN DIAGNOSED WITH CANCER cancer, and today over 80% are ƒƒ What type of cancer does my child have? alive five years after diagnosis. ƒƒ What is the chance of recovery? Yet, these survivors still grow ƒƒ What are the treatment options? up with increased risk of dying ƒƒ What are the long-term side effects of each treatment option? from late effects, like heart ƒƒ What can be done to lower the risk of long-term side effects? disease and second cancers,” said

heterozygosity on chromosomes Children with stage III and stage Adding to Standard 1p and 16q (LOH 1p and 16q). IV disease received vincristine, This change occurs only in the dactinomycin, doxorubicin, and Treatment Increases the cancer cells and can be found by radiation therapy. Then, four testing the tumor. Tumors with cycles of cyclophosphamide Number of Children Cured this change have a higher chance (Neosar) and etoposide (Toposar, of coming back. In these studies, VePesid) were added. 35 children with stage I and stage After about four years, almost of Wilms Tumor II disease and 52 with stage III 84% of children with stage I and Two phase III Children’s and stage IV disease had tumors stage II disease and about 92% Oncology Group studies found with LOH 1p and 16p. of children with stage III and that using additional drugs with Each child participating stage IV disease had not had a standard therapy lowered the in these studies who had a relapse. For comparison, previous chance that Wilms tumor with a tumor with the LOH 1p and research has shown that 75% of specific genetic change returned 16q genetic change received children with stage I or stage II after treatment. Wilms tumor is a a standard treatment for their disease and 66% of those with rare type of cancer that begins in stage of cancer plus additional stage III and stage IV disease do a child’s kidney. When it comes treatment. Children with stage not have a relapse within four back after treatment, it is called a I and stage II disease received years after standard treatment. relapse or recurrence. vincristine (Vincasar) and Pediatric oncologists have The genetic change looked at dactinomycin (Cosmegen) plus been working for years to find in this study is known as loss of doxorubicin (Adriamycin). Continued on page 10 RESEARCH ROUND UP 9 CHILDHOOD CANCER HEAD AND NECK CANCERS Adding to Standard Treatment the other hand, we want to add to therapy for those patients who Early Research Increases the Number of are at higher risk of relapse so we can hopefully increase the chance Shows Potential of Children Cured of Wilms Tumor for cure,” said lead study author Continued from page 9 David B. Dix, MD, a physician at ways to give the right amount the British Columbia Children’s Pembrolizumab as of chemotherapy and radiation Hospital in Vancouver, Canada. therapy for each patient based on “Our study is an example of Head and Neck Cancer estimates of recurrence. Recently successfully adding treatments doctors are using less treatment for patients with a high risk of Treatment for children with a low risk relapse. We were very encouraged Results from a phase I clinical of recurrence while boosting to see that adding to treatment trial show that pembrolizumab treatments for children with a can overcome the negative (Keytruda) is able to shrink very high chance of recurrence. influence of a genetic change in head and neck cancer that has To do this well, doctors and children with Wilms tumor.” spread to other parts of the body researchers are learning which In this study, there were or come back after treatment. patients have a low risk of few short-term side effects for These findings suggest that recurrence and which have a children who received treatment immunotherapy may fill a large higher risk of recurrence. for stage I and stage II disease. unmet need for better treatments For those who received treatment for recurrent and advanced head What this means for patients for stage III and stage IV disease, and neck cancer. “Tailoring therapy to match each there was a lowering of the Immunotherapy is a type of patient’s risk for relapse has been a number of blood cells made by treatment designed to boost the major focus of pediatric oncology. the bone marrow. In addition, body's natural defenses to fight For cancers with a low risk of children who received treatment the cancer. Pembrolizumab recurrence, we strive to decrease for stage III and stage IV disease helps improve immune system therapy and minimize exposure will be more likely to have function by blocking a protein to potentially toxic agents. On fertility problems in the future. n called PD-1. PD-1 is found on the surface of T-cells, which are Questions to Ask Your Child’s Doctor a type of white blood cell that directly helps the body’s immune ƒƒ What stage of Wilms tumor does my child have? What does this mean? system fight disease. Because ƒƒ Was my child’s tumor tested for any genetic changes? If so, how do PD-1 keeps the immune system these affect his or her treatment options and chance of recovery? from destroying cancer cells, ƒƒ What treatment options are available? stopping PD-1 from working ƒƒ What are the risks and benefits of each treatment option? allows the immune system to ƒƒ What is my child’s risk of relapse? better eliminate the disease. In this study, 132 people with recurrent or metastatic squamous More Information: Childhood Cancer cell carcinoma of the head and neck received treatment with ƒƒ Guide to Wilms Tumor (www.cancer.net/wilms) pembrolizumab. One in four ƒƒ Cancer in Children (www.cancer.net/children) (25%) people had tumors that ƒƒ Survivorship (www.cancer.net/survivorship) noticeably shrank. More than ƒƒ Late Effects of Childhood Cancer (www.cancer.net/children) half (57%) experienced some ƒƒ Managing Late Effects of Childhood Cancer (www.cancer.net/ decrease in tumor size. The children) researchers will continue to watch the participants to see how 10 RESEARCH ROUND UP these benefits affect how long that immunotherapy will change Dr. Seiwert was a recipient of a people live. the way we treat head and neck Conquer Cancer Foundation of Interestingly, infection with cancer.” ASCO Young Investigator Award the human papillomavirus In this study, the most in 2006. n (HPV) did not affect how much common side effects of participants benefitted from pembrolizumab were fatigue, treatment. Recent research has rash, and itching. A small number Questions to Ask Your Doctor shown that HPV infection can of participants experienced more influence how a tumor responds serious immune-related side ƒƒ What type and stage of head to existing treatments like effects, such as inflammation of and neck cancer do I have? cetuximab (Erbitux). lungs and colon. Less than 10% What does this mean? of people experienced serious side ƒƒ Is it important to find out What this means for patients effects. whether the tumor was “The efficacy we saw was Currently, pembrolizumab is caused by HPV? Why or remarkable—pembrolizumab only approved by the U.S. Food why not? seems to be roughly twice as and Drug Administration (FDA) ƒƒ What are my treatment effective, when measured by to treat advanced melanoma options? response, as our only targeted that has not responded to other ƒƒ What are the risks and therapy cetuximab,” said lead standard treatments. Researchers benefits of each treatment study author Tanguy Seiwert, are also studying other types option? MD, an assistant professor of of PD-1 immunotherapy for ƒƒ What clinical trials are open to medicine and Associate Head and recurrent and metastatic head me? How do I find out more Neck Cancer Program Leader and neck cancer in clinical trials. about them? at the University of Chicago in Talk with your doctor for more Illinois. “We have high hopes information.

study received either END or Choosing Lymph Node Surgery Earlier May Be a Better TND. Researchers found that 80% Option for Some Patients with Oral Cancer of patients who received END were alive three years after A new study provides clarification comes back. The other option is diagnosis, compared with about on the best time for patients to called therapeutic neck dissection 68% of those who received receive lymph node surgery for (TND), which is surgery to TND. In addition, about 70% early-stage oral cancer. Oral remove the lymph nodes after of patients who received END cancer is often successfully the cancer has come back. were still cancer-free three treated with surgery to remove In this study, researchers years after diagnosis, compared the tumor. However, the cancer found that END lengthens with almost 46% of those who can come back and spread to the patients’ lives and lowers the received TND. lymph nodes in the neck. risk of the cancer coming back, Generally, patients have two called a recurrence. This study What this means for patients opportunities for surgery to included 596 patients with early “Our study is the first to prove remove groups of lymph nodes in squamous cell oral cancer. This that more lives can be saved the neck, called neck dissection. is the most common type of with elective neck dissection. One option is called elective oral cancer, which begins in the This answers a question doctors neck dissection (END), which flat, squamous cells found in the have been asking for 50 years, is choosing surgery to remove lining of the mouth and throat. for the treatment of thousands lymph nodes before the cancer The patients participating in this Continued on page 12 RESEARCH ROUND UP 11 HEAD AND NECK CANCERS Choosing Lymph Node “Armed with the results of this in that arm, which can interfere study, doctors will be able to with daily functioning and Surgery Earlier May Be confidently counsel patients that work. Talk with your doctor adding neck surgery to their about the risks and benefits a Better Option for Some initial treatment is worthwhile.” of all your treatment options, Patients with Oral Cancer Neck dissection is linked with including surgery. n Continued from page 11 side effects common with any surgery, such as infection and More Information: of patients” said lead study bleeding. Also, the nerve that Head and Neck Cancers author Anil D’Cruz, MBBS, controls a larger shoulder muscle MS, FRCS, Professor and is damaged during surgery for up ƒƒ Guide to Head and Neck Chief, Department of Head and to 40% of patients. This nerve Cancer (www.cancer.net/ Neck Surgery at Tata Memorial damage can cause shoulder pain headneck) Hospital in Mumbai, India. and limit the range of motion ƒƒ Guide to Oral Cancer (www.cancer.net/oral) Questions to Ask Your Doctor ƒƒ What is Immunotherapy? (www.cancer.net/ ƒƒ What type of oral cancer do I have? What is the stage? immunotherapy) ƒƒ What are my treatment options? ƒƒ What is Cancer Surgery? ƒƒ Has the cancer spread to the lymph nodes? (www.cancer.net/surgery) ƒƒ Do you recommend surgery to remove any lymph nodes, either now or ƒƒ HPV and Cancer in the future? Why? (www.cancer.net/ ƒƒ What are the risks and benefits of each treatment option? prevention)

LIVER CANCER Nivolumab is a type of nivolumab. Overall, 19% of the Nivolumab Shows immunotherapy, which is a participants had tumors that treatment designed to boost the responded to the treatment. Promise as a Treatment body's natural defenses to fight Eight people had tumors that the cancer. Nivolumab helps shrank by more than 30%, and improve immune system function two had complete remissions. A Option for Advanced by blocking a protein called PD- remission is when cancer cannot 1. PD-1 is found on the surface of be detected in the body and there Liver Cancer T-cells, which are a type of white are no symptoms. These benefits In an early-stage study, nivolumab blood cell that directly helps lasted for more than a year for (Opdivo) has shown encouraging the body’s immune system fight four participants. In addition, results as a treatment for advanced disease. Because PD-1 keeps the nivolumab stopped tumors liver cancer. Liver cancer is the immune system from destroying from growing for 48% of the leading cause of cancer deaths cancer cells, stopping PD-1 from participants. worldwide, accounting for more working allows the immune The one-year survival rate was than 600,000 deaths each year. system to better eliminate the 62%. The one-year survival rate People diagnosed with advanced disease. is the percentage of people who liver cancer especially need new As part of this study, 42 people live at least one year after starting treatment options, as there is with advanced hepatocellular treatment. currently only one drug approved carcinoma (HCC), the most by the U.S. Food and Drug common type of liver cancer What this means for patients Administration (FDA). diagnosed in adults, received “We are encouraged to see that 12 RESEARCH ROUND UP LUNG CANCER nivolumab lived an average of Nivolumab Extends the Lives of People with the Most one year compared with nine months for docetaxel treatment. Common Type of Lung Cancer This difference was even higher for people with tumors that had A phase III clinical trial has working allows the immune high levels of a protein called shown that nivolumab (Opdivo) system to better eliminate the PD-L1. Earlier research has is an effective treatment option disease. suggested that the protein PD- for people with non-squamous, More than 580 people L1 helps predict which tumors non-small cell lung cancer with advanced non-squamous are more likely to respond to (NSCLC). Nivolumab is a type NSCLC that grew or spread PD-1 immunotherapy. In this of immunotherapy, which is a after receiving platinum-based study, the researchers found that treatment designed to boost the chemotherapy volunteered to people with tumors that had high body's natural defenses to fight participate in this study. They levels of PD-L1 generally lived the cancer. Nivolumab helps were divided into two groups. for about a year and a half after improve immune system function One group received nivolumab, nivolumab treatment. Overall, by blocking a protein called PD- and the other group received people who received nivolumab 1. PD-1 is found on the surface of docetaxel (Docefrez, Taxotere) had a 27% lower risk of death T-cells, which are a type of white chemotherapy. compared to those who received blood cell that directly helps The researchers found that the docetaxel. the body’s immune system fight people in the nivolumab group disease. Because PD-1 keeps the lived an average of three months What this means for patients immune system from destroying longer than those in the docetaxel “This is the first phase III study cancer cells, stopping PD-1 from group. People who received Continued on page 14

the response rate, as well as In this study, treatment cancer. Talk with your doctor preliminary survival data, look with nivolumab caused mild about all of your treatment quite promising,” said lead study to moderate side effects. The options, including participating in author Anthony B. El-Khoueiry, most common side effects were a clinical trial. n MD, an associate professor elevated liver enzyme levels, of clinical medicine and the rash, and high levels of amylase Questions to Ask Your Doctor Phase I Program Director at the and lipase. However, abnormal University of Southern California liver enzymes and elevated ƒƒ What stage of liver cancer do Norris Comprehensive Cancer amylase and lipase levels did not I have? What does this mean? Center in Los Angeles. “While cause any significant symptoms. ƒƒ What are my treatment we have to verify this early signal Nivolumab is currently options? in larger studies, this is one of the only FDA-approved to treat ƒƒ What clinical trials are open first signs that immunotherapy advanced melanoma that has to me? Where are they with immune checkpoint not responded to other standard located, and how do I find out inhibitors will have a role in the treatments and advanced more about them? treatment of liver cancer.” squamous non-small cell lung ƒƒ What treatment do you recommend? Why? More Information: Liver Cancer ƒƒ What are the possible side effects of each treatment, ƒƒ Guide to Liver Cancer (www.cancer.net/liver) and how can they be ƒƒ What is Immunotherapy? (www.cancer.net/immunotherapy) managed?

RESEARCH ROUND UP 13 MELANOMA

Recently, researchers found melanoma. Both nivolumab Nivolumab Slows that nivolumab (Opdivo) either and ipilimumab are types of given as a single treatment or in immunotherapy that block Melanoma Growth Better combination with ipilimumab two proteins called PD-1 and (Yervoy) is more effective than CTLA-4. By blocking these two treatment with ipilimumab proteins, the drugs are able to than just Ipilimumab alone for people with advanced boost the body’s immune system to fight the cancer. The PD-1 protein on the LUNG CANCER body’s immune cells attaches to another protein called PD-L1, Nivolumab Extends the Lives group. Earlier this year, the U.S. which is found on the surface Food and Drug Administration of some cancer cells. Previous of People with the Most (FDA) approved nivolumab as a research has suggested that PD-1 treatment for advanced squamous therapy works better for patients Common Type of Lung Cancer cell NSCLC. Talk with your who have PD-L1 on the tumor Continued from page 13 doctor for more information. n cells. to show that immunotherapy is For this study, 945 patients effective against non-squamous Questions to Ask Your Doctor who had not yet received cell NSCLC and appears to be treatment for advanced melanoma particularly active in patients with ƒƒ What type and stage of lung were given either ipilimumab, PD-L1-positive tumors,” said lead cancer do I have? What does nivolumab, or a combination study author Luis Paz-Ares, MD, this mean? of both. The researchers found PhD, a professor of medicine at ƒƒ What are my treatment that nivolumab controlled the the Hospital Universitario 12 options? growth of the melanoma for de Octubre in Madrid, Spain. ƒƒ Is nivolumab an option more than twice as long as “While nivolumab appears to for me? ipilimumab (about 7 months be more potent against this ƒƒ What clinical trials are open compared with about 3 months). most common lung cancer, it is to me? Where are they The combination of nivolumab important to note that it is also located, and how do I find out and ipilimumab controlled the far easier on patients compared more about them? cancer’s growth for longer, about to the standard second-line ƒƒ What treatment do you 12 months. treatment, docetaxel.” recommend? Why? Researchers also found that In this study, only one in 10 ƒƒ What are the possible side nivolumab by itself seemed to people in the nivolumab group effects of each treatment, work as well for cancer with PD- experienced serious side effects and how can they be L1 as nivolumab and ipilimumab compared with more than managed? combined. However, for patients half of people in the docetaxel with cancer without PD-L1, the combination of nivolumab and More Information: Lung Cancer ipilimumab worked better than just nivolumab. ƒƒ Guide to Lung Cancer (www.cancer.net/lung) ƒƒ What is Immunotherapy? (www.cancer.net/immunotherapy) What this means for patients ƒƒ FDA Approval of Nivolumab for Lung Cancer (www.cancer.net/blog) “Our study also suggests that patients with a specific tumor marker appear to benefit the most from the combination treatment, whereas other patients may do just as well with nivolumab 14 RESEARCH ROUND UP alone. This will help doctors previous research has shown that Questions to Ask Your Doctor provide important insight for the benefits of immunotherapy patients on which treatment is continue even after the drug is ƒƒ What stage of melanoma do I right for them,” said lead study stopped. have? What does this mean? author Jedd Wolchok, MD, Ipilimumab and nivolumab ƒƒ What are my treatment PhD, Chief of Melanoma and are both approved by the U.S. options? Immunotherapeutics Service at Food and Drug Administration ƒƒ What clinical trials are open Memorial Sloan Kettering Cancer (FDA) for melanoma that cannot to me? Center in New York, NY. be removed with surgery and ƒƒ Was my tumor tested In this study, about one- advanced melanoma when other to learn more about my third of patients taking the treatments stop working. Talk treatment options? combination of nivolumab and with your doctor about your ƒƒ What are the possible side ipilimumab needed to stop treatment options, the risks and effects of each treatment treatment because of the side benefits of these options, as well option? How can they be effects. However, for patients as other concerns about managing managed? that can continue treatment, your care. n

lymph nodes of 15% of the Some People with Melanoma May Not Need Extensive people in the observation group compared with 8% in the CLND Lymph Node Surgery group. However, the same number of people in both groups According to the results of a infection, nerve damage, and had melanoma that eventually recent study, people who have lymphedema. spread to other parts of the body. surgery to remove lymph nodes To find out if the benefits of There was also no difference in near a melanoma tumor live the a CLND outweigh the risks, how long people lived between same amount of time as those researchers divided 483 people the two groups. This means that who are watched closely for signs with stage III melanoma and having more extensive surgery of cancer. Lymph nodes are tiny, a positive lymph node biopsy did not help people live longer bean-shaped organs that fight into two groups. One group than having regular check-ups. infection. During melanoma had a CLND after melanoma surgery, doctors look for cancer surgery. The other group was What this means for patients that has spread to the lymph closely monitored for signs that This study may conclude a long- nodes. If melanoma is found in the cancer had come back. This standing debate over the role of these lymph nodes, there is a meant having an ultrasound CLND in the care of people with higher risk of the cancer coming exam of the lymph nodes every melanoma. back after treatment. three months and a computed “This is the first study to Most doctors around the tomography (CT or CAT) scan, offer solid evidence that many world recommend that people magnetic resonance imaging patients with melanoma don’t with evidence of melanoma (MRI), or positron emission need extensive lymph node in their lymph nodes have a tomography (PET) scan every surgery,” said ASCO expert complete lymph node dissection six months. The participants in Lynn Schuchter, MD, FASCO, (CLND). During a CLND, the the CLND group followed this a professor of hematology/ doctor removes entire groups same schedule of check-ups after oncology at the University of of lymph nodes. This surgery is their CLND. Pennsylvania in Philadelphia. extensive and can cause serious After nearly three years, “The findings should reduce the long-term side effects, including doctors found cancer in the Continued on page 16 RESEARCH ROUND UP 15 PROSTATE CANCER therapy and hormone therapy. Adding Chemotherapy Improves Survival for Men A month after radiation therapy, one group also received 18 weeks with High-Risk, Localized Prostate Cancer of docetaxel chemotherapy, while the other received an inactive A recent study shows that adding Currently, the standard substance called a placebo. docetaxel (Docefrez, Taxotere) treatment for men with high- The four-year survival rate chemotherapy to the standard risk, localized prostate cancer is was 93% in the docetaxel group treatment of hormone therapy radiation therapy plus two years compared with 89% in the standard and radiation therapy helps men of hormone therapy. In this study, treatment group. The four-year with high-risk, localized prostate the researchers wanted to find survival rate is the percentage of cancer live longer. Having a out if adding chemotherapy after people who live at least four years high-risk, localized prostate radiation therapy would lower the after receiving treatment. Adding cancer means that the tumor has risk of the cancer coming back docetaxel also reduced the risk of grown throughout the prostate and help men live longer. This the cancer coming back. Five years gland, the tumor has a high is called adjuvant chemotherapy, after treatment, 73% of men in the grade or Gleason score, and the and it is a common treatment docetaxel group had no signs of man has a high prostate-specific approach for many other cancers, prostate cancer compared with 66% antigen (PSA) level. The Gleason including lung, breast, and in the standard treatment group. score is based on how much colorectal cancers. the tumor looks like healthy For this study, 562 men with What this means for patients tissue when viewed under a high-risk, locally advanced “This study is the first indication microscope. prostate cancer received radiation that chemotherapy has a role

MELANOMA

Some People with Melanoma Questions to Ask Your Doctor May Not Need Extensive ƒƒ What stage of melanoma do I have? What does this mean? ƒƒ Is it likely that the melanoma has spread? Why or why not? Lymph Node Surgery ƒƒ Will surgery be able to remove all of the cancer? Continued from page 15 ƒƒ Will I have a sentinel lymph node biopsy to find out if cancer has spread use of an approach that we have to the lymph nodes? long assumed to be optimal. This ƒƒ If the melanoma has spread to the lymph nodes, will I need to have is great news for patients, who additional surgery? can forego extensive surgeries ƒƒ What are the potential risks and benefits of a complete lymph node without compromising their dissection? survival chances.” n

Download Cancer.Net’s More Information: Melanoma award-winning app at www.cancer.net/app to ƒƒ Guide to Melanoma (www.cancer.net/melanoma) get interactive tools in ƒƒ What is Cancer Surgery? (www.cancer.net/surgery) English and Spanish that can help ƒƒ What is Immunotherapy? (www.cancer.net/immunotherapy) you get answers to important ƒƒ Making Decisions About Cancer Treatment (www.cancer.net/ questions, track side effects, and treatmentdecisions) manage medications. ƒƒ Lymphedema (www.cancer.net/lymphedema)

16 RESEARCH ROUND UP in the adjuvant treatment of localized prostate cancer, and we Adding Docetaxel to Standard Prostate Cancer also expect to see an even bigger survival advantage over time,” Treatment Lengthens Lives said lead study author Howard Sandler, MD, a professor of A large, ongoing study showed prostate cancer, those who radiation oncology at the Cedars- that men with advanced prostate received docetaxel lived almost Sinai Medical Center in Los cancer who received docetaxel two years longer than those who Angeles, CA. “This finding could (Docefrez, Taxotere) in addition received only standard treatment. extend the lives of thousands to standard prostate cancer Docetaxel also reduced the risk of men. At the same time, treatment lived longer than those of the cancer coming back after chemotherapy carries a modest who received only standard treatment. increase in side effects, so it is hormone therapy. The study also Men who received only important that physicians discuss showed that including zoledronic zoledronic acid in addition to the balance of benefits and risks acid (Zometa) along with standard treatment lived about as with their patients.” docetaxel and standard hormone long as those who received only The side effects of therapy did not offer additional the standard treatment. Also, chemotherapy depend on the benefits. those who received docetaxel individual and the dose used, but The results provided here are and zoledronic acid in addition they can include fatigue, risk of only one portion of this large, to standard treatment lived about infection, nausea and vomiting, ongoing study on prostate cancer as long as those who received hair loss, loss of appetite, and and its treatment. This portion only docetaxel plus standard diarrhea. These side effects can includes 2,962 men newly treatment. This indicates that often be prevented or managed diagnosed with prostate cancer adding zoledronic acid appeared and usually go away once who started long-term hormone to have little effect on how long treatment is finished. Take time to therapy. The men participating men lived after diagnosis. learn about all of your treatment in this portion of the study options, and talk with your doctor received one of the four different What this means for patients about what you can expect while treatments listed below: “We hope our findings will receiving treatment. n ƒƒ Standard prostate cancer encourage doctors to offer treatment, which includes at docetaxel to men newly Questions to Ask Your Doctor least three years of hormone diagnosed with metastatic therapy, with radiation therapy prostate cancer, if they are healthy ƒƒ What stage of prostate for some patients enough for chemotherapy. cancer do I have? What does ƒƒ Standard prostate cancer Men with locally-advanced, this mean? treatment plus docetaxel non-metastatic prostate cancer ƒƒ What is my chance of ƒƒ Standard prostate cancer may also consider docetaxel as recovery? treatment plus zoledronic acid part of upfront therapy, as it ƒƒ What treatment plan do you ƒƒ Standard prostate cancer clearly delays relapse,” said lead recommend? Why? treatment plus docetaxel and study author Nicholas David ƒƒ What are the possible side zoledronic acid James, MD, PhD, Director of effects of each treatment, the Cancer Research Unit at both in the short term and Researchers found that men who the University of Warwick in the long term? received standard treatment plus Coventry, United Kingdom and ƒƒ How can these side effects docetaxel lived about ten months Consultant in Clinical Oncology be prevented or managed? longer than those who received at Queen Elizabeth Hospital ƒƒ What is the risk of the cancer only standard treatment. For the Birmingham. “It’s also clear that coming back after treatment? men who had prostate cancer zoledronic acid does not benefit that had spread, called metastatic Continued on page 18 RESEARCH ROUND UP 17 PROSTATE CANCER SARCOMA Adding Docetaxel to Standard called liposarcoma. Eribulin Helps People In the current study, Prostate Cancer Treatment 452 people with advanced with Two Rare Types leiomyosarcoma or adipocytic Lengthens Lives sarcoma volunteered to Continued from page 17 participate. Leiomyosarcoma, these patients and should not be of Soft-Tissue Sarcoma which starts in smooth muscle, offered as an upfront treatment and adipocytic sarcoma, which for advanced prostate cancer.” Live Longer starts in fatty tissue, are difficult- Men who received docetaxel Approximately 12,000 people will to-treat cancers. All of the had some additional side effects, be diagnosed with a soft-tissue participants had cancer that had compared with those who sarcoma in the United States grown or spread after receiving received only the standard this year. Currently, there are two or more previous treatments. treatment. However, very few treatment options available, The researchers divided the few patients stopped receiving especially for tumors that grow participants into two groups. docetaxel because of the side or spread to other parts of the One group received eribulin, effects, which means that, in body during treatment. However, and the other group received general, the side effects were recent research has shown that the standard chemotherapy manageable. n the chemotherapy eribulin dacarbazine (DTIC-Dome). The (Halaven) may be a promising researchers found that the people Questions to Ask Your Doctor new treatment option for people in the eribulin group lived two with two types of rare soft-tissue months longer than the people in ƒƒ What stage of prostate sarcomas: leiomyosarcoma and the dacarbazine group (14 months cancer do I have? What does adipocytic sarcoma, which is also compared with 12 months). this mean? ƒƒ What are my treatment options? SKIN CANCER PREVENTION ƒƒ Is docetaxel an option for me? ƒƒ What treatment do you sun protection campaigns, skin recommend? Why? Common Vitamin May cancer is continuing to increase ƒƒ What are the possible side worldwide. In the United States, effects of each treatment and Lower the Risk of more than four million people how can they be managed? develop non-melanoma skin Skin Cancer cancer each year. In Australia, where this study was done, more More Information: A recent study showed that than half the population develops Prostate Cancer people who took a form of non-melanoma skin cancer vitamin B3 called nicotinamide during their lifetime. ƒƒ Guide to Prostate Cancer developed fewer non-melanoma This study included 386 (www.cancer.net/prostate) skin cancers. Nicotinamide is patients with a high risk of ƒƒ What is Chemotherapy? a low-cost vitamin supplement skin cancer. This means that (www.cancer.net/ available over the counter. they had developed at least two chemotherapy) Previous research has suggested skin cancers in the five years ƒƒ Hormone Therapy for that nicotinamide helps protect before the study began. As part Advanced Prostate skin cells from the sun and repair of the study, they took either Cancer (www.cancer.net/ sun damage. nicotinamide twice a day by recommendations) The primary cause of non- mouth in pill form or a placebo melanoma skin cancer is sun for 12 months. A placebo is an exposure. Despite intensive inactive treatment. 18 RESEARCH ROUND UP According to the authors, this our patients have access to, the Questions to Ask Your Doctor is the first randomized phase III better the chance of improving study to show an improvement their life expectancy.” ƒƒ What type of sarcoma do I in survival for people with these The U.S. Food and Drug have? What does this mean? hard-to-treat diseases. Administration (FDA) approved ƒƒ What are my treatment eribulin as a treatment for options? What clinical trials What this means for patients advanced breast cancer in 2010. are open to me? “Soft-tissue sarcomas are However, eribulin is currently ƒƒ Is eribulin an option for me? relatively rare and can be very not FDA-approved to treat soft- Is it only available in clinical difficult to treat. The efficacy of tissue sarcoma. Talk with your trials? available drugs for initial therapy doctor about all of your treatment ƒƒ What treatment do you is very unsatisfactory, and patients options, including participating in recommend? Why? whose disease progresses despite a clinical trial. ƒƒ What are the potential two or more lines of treatment In this study, the most risks and benefits of this have a very poor prognosis,” common side effects of eribulin treatment? said lead study author Patrick were low white blood cell counts, ƒƒ What is my chance of Schöffski, MD, MPH, Head fatigue, nausea, hair loss, and recovery? of the Department of General constipation. n Medical Oncology at University Hospitals Leuven in Belgium. More Information: Sarcoma “For a disease where such few treatment options exist, a two- ƒƒ Guide to Soft Tissue Sarcoma (www.cancer.net/sarcoma) month improvement in survival is ƒƒ What is Chemotherapy? (www.cancer.net/chemotherapy) significant. The more treatments

Researchers found that the be immediately translated into Questions to Ask Your Doctor patients who took nicotinamide clinical practice,” said senior were less likely to develop non- study author Diona Damian, ƒƒ What is my risk of skin cancer? melanoma skin cancer than MBBS, PhD, a professor of ƒƒ What can I do to lower my risk? those who took the placebo. For dermatology at the Dermatology ƒƒ Would I benefit from taking example, patients who received University of Sydney in this form of vitamin B3? nicotinamide developed 23% Australia. “However, people at ƒƒ How can I make sure I am fewer skin cancers than those high risk for skin cancer will taking the correct form of who received the placebo. still need regular check-ups with vitamin B3 in an appropriate In addition, patients who their doctor.” dose? took nicotinamide had fewer In this study, there were no ƒƒ Are there any possible risks of taking this vitamin? precancerous growths, called serious side effects of taking actinic keratosis, as early as three nicotinamide. Nicotinamide is months into the study. easy to confuse with another More Information: form of vitamin B3 called Skin Cancer Prevention What this means for patients nicotinic acid, which is known ƒƒ Guide to Skin Cancer “This is the first clear evidence to cause side effects. This is one (Non-Melanoma) that we can reduce skin cancers reason why it is important to (www.cancer.net/skin) using a simple vitamin, together talk with your doctor before ƒƒ Vitamins and Minerals with sensible sun protection. starting any new vitamin or (www.cancer.net/prevention) We hope that these findings can supplement. n RESEARCH ROUND UP 19 TUMOR GENETICS repair problem. Overall, 62% of Genetic Changes May Help Predict Who Will Benefit colorectal cancer tumors with the DNA repair problem shrank, Most from PD-1 Immunotherapy while none without the repair problem decreased in size. Results from a small phase II Immunotherapy is designed to The response rate for other study suggest that the PD-1 boost the body’s natural defenses types of cancer with this DNA immunotherapy, pembrolizumab to fight the cancer. Drugs like repair problem was similar (Keytruda), works better when pembrolizumab improve immune (60%). This included advanced tumors have a large number of system function by blocking a endometrial cancer and several genetic changes or mutations. protein called PD-1. PD-1 is types of advanced gastrointestinal Cancer begins when found on the surface of T-cells, cancers, including ampullary, healthy cells change and grow which are a type of white blood duodenal, cholangiocarcinoma, uncontrollably, forming a mass cell that directly helps the body’s and gastric cancers. Few called a tumor. Sometimes these immune system fight disease. treatment options exist for people changes cause problems with the Because PD-1 keeps the immune with these diseases. The last time process that repairs mistakes in system from destroying cancer data was analyzed, these responses the DNA of cancer cells. This cells, stopping PD-1 from were continuing for all but happens in 15% to 20% of non- working allows the immune one person, and many of these inherited colorectal cancers and system to better eliminate the responses have been ongoing for nearly all colorectal cancers disease. more than a year. associated with Lynch syndrome. In this study, 48 people This DNA repair problem also with metastatic cancer that What this means for patients occurs in other types of cancer, had grown or spread despite “This study is really about such as stomach, small bowel, previous treatment received bridging immunotherapy and endometrial, prostate, and ovarian pembrolizumab. Thirty-eight had genomics for the benefit of cancers. colorectal cancer that had spread patients, and it has implications By not being able to fix genetic to other parts of the body, while for a broad range of cancers,” mistakes, mutations start to 10 had other types of cancer. said lead study author Dung T. build up in a tumor’s DNA. In About five months after Le, MD, an assistant professor this study, tumors with a DNA treatment, the researchers found of oncology at Johns Hopkins repair problem had an average of that tumors that were unable to Kimmel Cancer Center in 1,782 mutations compared with repair DNA mistakes responded Baltimore, MD. “Opening the 73 mutations in tumors without better to pembrolizumab door to this effective new therapy this repair issue. According to treatment. Ninety-two percent would be a breakthrough for this the researchers, the immune (92%) of colorectal cancer group of patients with metastatic system is more likely to recognize tumors with the DNA repair colon cancer and other hard-to- and destroy a tumor with problem shrank or stopped treat cancers.” thousands of mutations, which growing after pembrolizumab Testing for the DNA repair could help treatments like PD-1 treatment compared with 16% problem reported in this study immunotherapy work better. of tumors without this DNA is widely available. If these

More Information: Tumor Genetics

ƒƒ The Genetics of Cancer (www.cancer.net/genetics) ƒƒ What is Immunotherapy? (www.cancer.net/immunotherapy) ƒƒ What is Personalized Cancer Medicine? (www.cancer.net/treatment) ƒƒ Explaining Cancer Genome Research (www.cancer.net/research)

20 RESEARCH ROUND UP results are confirmed in larger studies, this type of testing may help doctors figure out which people might benefit the most from treatment with pembrolizumab and other PD-1 immunotherapies in the future. Pembrolizumab is currently only approved by the U.S. Food and Drug Administration (FDA) to treat advanced melanoma DISCOVER THE CANCER.NET BLOG that has not responded to Cancer.Net has an interactive blog that shares information in a more other standard treatments. timely manner and responds to current events, including breaking Another PD-1 immunotherapy, news about cancer advances and other topics important to people nivolumab (Opdivo), is approved affected by cancer. Cancer.Net Blog posts provide practical tips for living for advanced melanoma and with cancer, suggestions to help patients and families cope with the advanced squamous non-small disease, and research news and guidelines from ASCO. The blog also cell lung cancer. Talk with features guest posts by ASCO experts, stories from patients and patient your doctor about whether advocates, podcasts, and interviews. Check out the latest posts at your tumor should be tested for www.cancer.net/blog. genetic changes and whether the results will affect your treatment options. ASCO Answers: Cancer Survivorship helps Dr. Le was a recipient of a Conquer patients transition into life after active treatment Cancer Foundation of ASCO has finished. In addition to information on Career Development Award in the challenges survivors may face and the 2008. n importance of follow-up care, it includes a blank treatment summary and survivorship care form Questions to Ask Your Doctor that patients can fill out with the help of their health care team. Download this booklet at ƒƒ What type and stage of www.cancer.net/survivorship. cancer do I have? What does this mean? ƒƒ What are my treatment options based on my diagnosis? ƒƒ Are there tests available that can help guide my treatment choices? ƒƒ What clinical trials are open to STAY UP-TO-DATE WITH THE NEW RESOURCES AVAILABLE me? Where are they located, ON CANCER.NET and how do I find out more It is easier than ever to get the latest cancer information on your about them? computer or mobile device by subscribing to the Cancer.Net Blog ƒƒ What are the risks and at www.cancer.net/blog, or on Cancer.Net’s Facebook possible side effects of (www.facebook.com/CancerDotNet), Google+ (plus.google.com), treatment, both in the short and YouTube (www.youtube.com/CancerDotNet) pages, and at term and the long term? CancerDotNet on Twitter (www.twitter.com/CancerDotNet).

RESEARCH ROUND UP 21 For more information, visit ASCO’s patient website, www.cancer.net, or call 888-651-3038.

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