Oncology Care

JOURNAL SNAPSHOT
An Assortment of Journal Abstracts to

Enhance Oncology Care
G
iven the abundance of new research, it can be challenging to stay logistic regression, patients who went to hospice or post-acute care were
current on the latest advancements and findings. Oncology Times older, lived alone, and had impaired mobility compared to patients who
is here to help with summaries of the newest studies to ensure were discharged home. Additionally, they experienced longer hospital
you are up-to-date on the latest innovations in oncology practice. stays, as well as higher scores for physical outcomes and depression.
Given these results, researchers concluded that “these patients may ben-
Whole-genome sequencing reveals breast cancers with mismatch efit from interventions to enhance their quality of life and care.”
repair deficiency
Mutational signature analysis found mismatch repair (MMR)-deficient Endothelial activation and blood-brain barrier disruption in
breast cancer tumors, which could potentially be targeted with PD-1 neurotoxicity after adoptive immunotherapy with CD19 CAR-T cells
immune checkpoint inhibitors, according to a recently published study Researchers have discovered new potential biomarkers and a novel al-
(Can Res 2017; doi:10.1158/0008-5472.CAN-17-1083). Researchers gorithm that could help identify patients at increased risk of suffer-
used previously published whole genome sequencing data of ing from severe neurotoxicity after receiving CD19 CAR T-cell therapy
Breast Cancer
breast cancer tumors from 640 patients and analyzed patterns of (Can Discov 2017; doi:10.1158/2159-8290.CD-17-0698). Researchers
mutagenesis. They also looked for mutations in multiple genes analyzed data from 133 adults with relapsed and/or refractory
CAR T-Cell Therapy
known to be associated with MMR deficiency: MLH1, MSH2, CD19 B-cell ALL, non-Hodgkin lymphoma, or chronic lympho-
MSH6, PMS2, PMS1, SETD2, MYH11, EPCAM, TGFBR2, MLH3, cytic leukemia who were treated with lymphodepletion chemo-
and MUTYH, in order to identify the defects responsible for the therapy followed by infusion of JCAR014, a type of CD19 CAR
MMR deficiency. Findings showed that 11 of 640 tumors har- T-cell therapy. Within 28 days of treatment, 53 patients (40%) de-
bored the MMR deficiency in variable amounts. In addition veloped grade 1 or higher neurologic adverse events and of these
to base substitution mutational signatures specific to MMR- 28 (21%) had grade 3 or higher neurotoxicity; alterations in neu-
deficient tumors, they also found an average of 20,870 small in- rologic status completely resolved in a majority of cases. Four of
sertions/deletions in the 11 MMR-deficient breast cancer tumors the 133 patients (3%) developed fatal neurotoxicity. Investigators
compared to only a fraction, 270 on average, in the non-MMR-deficient found that patients with an early onset of cytokine release syn-
tumors. Due to its high degree of sensitivity and specificity to classify drome were at increased risk of subsequently developing severe
tumors, mutational signature analysis might be a better biomarker for neurotoxicity. According to researchers, patients who experienced
use in future clinical trials, according to study authors. neurotoxicity were mostly younger and had B-cell ALL, higher
tumor burden, and more CD19-positive cells in the bone marrow com-
Association of alterations in main driver genes with outcomes of pared with those who did not develop this side effect. Researchers devel-
patients with resected pancreatic ductal adenocarcinoma oped a predictive classification tree algorithm based on the side effects,
Alterations in four main genes are responsible for how long patients including fever, and high serum IL-6 and MCP-1, to identify patients
survive with pancreatic cancer, according to a new study (JAMA within the first 36 hours after CAR T-cell infusion, who are at increased
Oncol 2017; doi:10.1001/jamaoncol.2017.3420). The study included risk for severe neurotoxicity.
356 patients with resected pancreatic adenocarcinoma. After
Pancreatic Cancer
the tumors were removed, scientists extracted DNA from the Delay in radiotherapy is associated with an increased risk of disease
cancerous tissue and nearby normal tissue, and conducted next- recurrence in women with ductal carcinoma in situ
generation DNA sequencing on the specimens. The analysis cen- New findings suggest delaying radiotherapy by more than 12 weeks
tered on the activity of the KRAS, CDKN2A, SMAD4, and TP53 is associated with an increased risk for ipsilateral breast tumor recur-
genes. Results showed that patients who had three or four of the rence among women who underwent breast-conserving surgery
altered genes had worse disease-free survival and overall sur- for ductal carcinoma in situ (DCIS) (Cancer 2017; doi:10.1002/
Ductal Carcinoma in Situ
vival (OS) compared to patients with one or two altered genes. cncr.30972). A prospectively maintained database was utilized
Five-year OS was 18.4 percent for patients with 0-2 gene altera- to identify women (n=1,323) with DCIS who underwent breast-
tions, 14.1 percent for individuals with three alterations, and 8.2 conserving surgery and radiotherapy between 1980 and 2010.
percent for those with four alterations, investigators reported. Investigators compared recurrence rates among patients who
Pancreatic cancer is aggressive and generally has poor survival began radiotherapy less than 8 weeks after surgery, 8-12 weeks
odds. Patients who can undergo surgery as part of treatment after, and more than 12 weeks after surgery to evaluate the asso-
often survive longer, and some patients fare best when they can receive ciation between timing of radiotherapy and recurrence. Median
chemotherapy prior to surgery. “But having customized, molecular follow-up was 6.6 years and 311 patients were followed for 10
information will provide an even greater understanding of how the or more years. Researchers categorized patients by radiotherapy
disease is likely to progress in each patient,” researchers noted. timing with most patients (61%; n=806) receiving radiotherapy
within 8 weeks of surgery. Twenty-nine percent (n=386) received
Predictors of posthospital transitions of care in patients with radiotherapy at 8-12 weeks and 10 percent (n=131) at more than
advanced cancer 12 weeks after surgery. The 5- and 10-year recurrence rates were
Recent findings show patients with advanced cancer who are dis- 5.8 percent and 13.0 percent, respectively, for patients who started
charged to post-acute or hospice care demonstrated greater symptom radiotherapy fewer than 8 weeks after surgery; 3.8 percent and
burdens and impaired physical function, in addition to worse 7.6 percent, respectively, for radiotherapy starting between 8-12 weeks
Post-Acute Care
survival, than those discharged to the home (J Clin Oncol 2017; after surgery; and 8.8 percent and 23.0 percent, respectively, for a ra-
doi:10.1200/JCO.2017.74.0340). A prospective study was con- diotherapy delay of greater than 12 weeks after surgery (P = .004). OT
ducted among 932 patients with advanced cancer who had un-
planned hospitalizations between September 2014 and March
2016. The primary outcome was discharge location and the sec- Share New Research!
ondary outcome was survival. Among the enrolled patients, the Is there a study you think your fellow oncologists
majority (77.9%; n=726) were discharged home without hospice, should know about? Send new and innovative
while 12.7 percent (n=118) were discharged to post-acute care,
research to pam.tarapchak@wolterskluwer.com
and 9.4 percent (n=88) were discharged to hospice. According to
oncology-times.com Oncology Times 25

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JOURNAL SNAPSHOT

An Assortment of Journal Abstracts to

oncology-times.com Oncology Times 25

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