Oncology Education the American

A Peer-Reviewed Resource for Oncology Education The American O F Journal of L A N T R H U Hematology/ E O O J F L F A I I C Oncology® BREAST CANCER Commentary—Redefining HER2-Equivocal Breast Cancers: Lessons Learned from Genomic Pathology Shelly Gunn, MD, PhD GASTRIC CANCER The Role of Radiotherapy in the Management of Gastric Cancer Michael C. Repka, MD; Mohamed E. Salem, MD; and Keith R. Unger, MD NEOADJUVANT CHEMOTHERAPY Case Study—Pathologic Complete Response Following a Single Cycle of Neoadjuvant Chemotherapy Isolina R. Rossi, BS; Paolo Gattuso, MD; Katherine B. Kabaker, MD; Andrea Madrigrano, MD; and Katherine A. Kopkash, MD TRIPLE-NEGATIVE BREAST CANCER Immunotherapy for Triple-Negative Breast Cancer: A Focus on Immune Checkpoint Inhibitors Isha Dua, MD, and Antoinette R. Tan, MD, MHSc LYMPHOMA CME CME-certified enduring materials sponsored by Physicians’ Education Resource®, LLC Current Treatment Options in Marginal Zone Lymphoma Peter Martin, MD, MS ajho ISSN 1939-6163 (print) Volume 13 Number 5 5.17 www.AJHO.com ISSN 2334-0274 (online) Table of Contents 4 BREAST CANCER Commentary—Redefining HER2-Equivocal Breast Cancers: Lessons Learned from Genomic Pathology Shelly Gunn, MD, PhD Despite the availability of 2 FDA approved tests to determine a patient’s HER2 status, there remains a subset of high-risk breast cancer patients (>20%) whose status is “equivocal”—an assessment that provides no useful information about treatment guidance. Dr Gunn suggests that the current challenge is not to introduce a new HER2 assay into the clinical laboratory, but rather to develop a strategy for reporting unequivocal, biologically accurate results using existing FDA approved testing methods. 8 GASTRIC CANCER The Role of Radiotherapy in the Management of Gastric Cancer Michael C. Repka, MD; Mohamed E. Salem, MD; and Keith R. Unger, MD The overall prognosis for patients with gastric cancer remains poor, with approximately 30% of patients surviving 5 years past their initial diagnosis. In this article, the investigators review the evidence for the different treatment paradigms with a focus on the role of radiotherapy. 16 NEOADJUVANT CHEMOTHERAPY Case Study—Pathologic Complete Response Following a Single Cycle of Neoadjuvant Chemotherapy Isolina R. Rossi, BS; Paolo Gattuso, MD; Katherine B. Kabaker, MD; Andrea Madrigrano, MD; and Katherine A. Kopkash, MD Pathologic complete response (pCR) is the absence of residual cancer following neoadjuvant chemotherapy. Rossi and colleagues describe pCR of a woman with HER2-positive breast cancer following a single cycle of treatment. Their findings suggest that research focusing on fewer than the current standard number of cycles of neoadjuvant therapy may help define the optimal treatment to obtain pCR in HER2-positive breast cancer. 20 TRIPLE-NEGATIVE BREAST CANCER Immunotherapy for Triple-Negative Breast Cancer: A Focus on Immune Checkpoint Inhibitors Isha Dua, MD, and Antoinette R. Tan, MD, MHSc The paucity of actionable targets, lack of targeted therapies, and relatively poor prognosis of patients with triple-negative breast cancer (TNBC) has created ample opportunity to evaluate novel treatment approaches, including checkpoint inhibitors. This review focuses on the emerging data of immune checkpoint inhibitors in the treatment of TNBC. 28 LYMPHOMA CME CME-certified enduring materials sponsored by Physicians’ Education Resource®, LLC Current Treatment Options in Marginal Zone Lymphoma Peter Martin, MD, MS Dr Martin offers his insights on current and emerging treatment approaches in patients with marginal zone lymphoma (MZL), with a focus on mild forms of the disease and patients with refractory or relapsed MZL. SEARCHING FOR A PAST ARTICLE? GET SOCIAL! Visit www.gotoper.com/publications/ajho Visit us on: and find it in the archives. AJHO ® Editorial Board / PER® Executive Board The American Journal of Hematology/Oncology® is the official journal of Physicians’ Education Resource®, LLC. Edward Ambinder, MD Benjamin Levy, MD Roman Perez-Soler, MD Clinical Professor Clinical Director, Medical Oncology Chairman, Department of Oncology Division of Medicine, Hematology, and Medical Director, Thoracic Oncology Montefiore Medical Center Medical Oncology Johns Hopkins Kimmel Cancer Center, Bronx, NY Mount Sinai Hospital Sibley Memorial Hospital New York, NY Washington, DC Antoni Ribas, MD, PhD Professor of Medicine Patrick I. Borgen, MD Thomas J. Lynch Jr, MD Professor of Surgery Chairman, Department of Surgery CEO and Chairman University of California, Los Angeles Maimonides Medical Center Massachusetts General Physicians Los Angeles, CA Director, Brooklyn Breast Cancer Program Organization Brooklyn, NY Massachusetts General Hospital Naiyer Rizvi, MD Boston, MA Director of Thoracic Oncology and David R. Gandara, MD Director of Immunotherapeutics Professor of Medicine Maurie Markman, MD Columbia University Medical Center Director, Thoracic Oncology Program President, Medicine and Science New York, NY Senior Advisor to the Director National Director, Medical Oncology Division of Hematology/Oncology Cancer Treatment Centers of America Gilles A. Salles, MD, PhD UC Davis Comprehensive Cancer Center Philadelphia, PA Professor of Medicine Sacramento, CA Hospices Civils de Lyon John L. Marshall, MD Lyon, France Andre Goy, MD, MS Chief, Hematology and Oncology Chairman and Director Director, Otto J. Ruesch Center for the Heather A. Wakelee, MD Chief of Lymphoma Cure of Gastrointestinal Cancers Associate Professor, Medicine (Oncology) Director, Clinical and Translational Lombardi Comprehensive Cancer Center Stanford University Medical Center Cancer Research Georgetown University Medical Center Stanford, CA John Theurer Cancer Center at Washington, DC Hackensack University Medical Center Jeffrey S. Weber, MD, PhD Hackensack, NJ Franco Muggia, MD Senior Member and Director Professor of Medicine Donald A. Adam Comprehensive Omid Hamid, MD New York University Langone Medical Melanoma Research Center Chief, Translational Research and Center Moffitt Cancer Center Immunotherapy New York, NY Tampa, FL Director, Melanoma Therapeutics Joyce A. O’Shaughnessy, MD The Angeles Clinic and Research Institute Anas Younes, MD Co-Director, Breast Cancer Research Los Angeles, CA Chief, Lymphoma Service Baylor Charles A. Sammons Cancer Memorial Sloan Kettering Cancer Center Center Roy S. Herbst, MD, PhD New York, NY Texas Oncology Ensign Professor of Medicine (Medical The US Oncology Network Oncology) Dallas, TX Professor of Pharmacology Chief of Medical Oncology Daniel P. Petrylak, MD Associate Director for Translational Professor of Medicine (Medical Oncology) Research Professor of Urology Yale Cancer Center Co-Director, Signal Transduction Research Yale School of Medicine Program New Haven, CT Yale Cancer Center and Smilow Cancer Hospital New Haven, CT PER®’s Mission Physicians’ Education Resource®, LLC (PER®), is dedicated to advancing prevention, screening and early detection, and practice management. cancer care through professional education. Accredited by the Accredi- PER® plans, develops, implements, and evaluates educational activities tation Council for Continuing Medical Education (ACCME) and approved using a wide variety of formats targeted to the needs of the healthcare as a nursing continuing education provider by the California Board of providers we serve. Our CME/CE-certified activities enable healthcare Registered Nursing, PER® is the educational resource of choice for live and providers to remain current and responsive to advances in medical care for online activities focusing on oncology and hematology. Based on identified patients with cancer, from diagnosis through treatment, with the ultimate needs and practice gaps, PER® provides high-quality, evidence-based ac- goal of improving patient outcomes. tivities featuring leading national and international faculty, with a focus on PER® serves the oncology healthcare community, including physicians, practice-changing advances and standards of care in treatment and disease nurses, nurse practitioners, physician assistants, pharmacists, and other management. Activities may also include topics on emerging strategies healthcare providers who are involved in the treatment and management currently under investigation, supportive care, diagnosis and staging, of patients with cancer. Chairman’s Letter his month’s issue of the American Journal of Hematology/Oncology® addresses various T topics involving breast cancer, including human epidermal growth factor receptor 2 (HER2) assays, pathologic complete response (pCR), and the potential role of immunotherapy in triple-negative breast cancer (TNBC). Rounding out the issue is a manuscript that addresses radiotherapy in gastric cancer. In a commentary by Shelly Gunn, MD, PhD, of Targeted Genomics and Precision Pathology Services, the topic of HER2 testing that results in an “equivocal” assessment is Michael J. Hennessy, Sr discussed. Her manuscript, “Redefining HER2-Equivocal Breast Cancers: Lessons Learned From Genomic Pathology,” raises the following questions: are immunohistochemistry and dual-probe in situ hybridization tests giving the wrong answer 20% of the time or, could these tests be giving the correct answers and we are misinterpreting the data? Dr Gunn suggests that a strategy for reporting unequivocal biologically accurate results using existing FDA-approved testing methods is preferable to developing new HER2 assays. Isolina R. Rossi, BS, a student at Rush Medical College, Chicago, and colleagues describe

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