The area of oncology in 2018 was full of events and news, new studies results, some of them were practice-changing. Here we publish selected interesting news of this year. Of course, there were many more of them. We look forward to new discoveries in the upcoming 2019!

 Most women with early stage breast cancer could forgo chemotherapy after genetic testing

The results of phase III clinical trial TAILORx with approximately 10 thousand patients enrolled demonstrated that in ~70% women with hormone receptor-positive, HER2-negative, axillary lymph node­-negative breast cancer, treatment with chemotherapy and hormone therapy after surgery is no more beneficial than treatment with hormone therapy alone.  Genetic test which determines 21 genes expression for the risk of relapse assessment will allow many women to forgo excess treatment and its side effects.

More details in the publication by the National Cancer Institute: https://www.cancer.gov/news-events/press-releases/2018/tailorx-breast-cancer-chemotherapy.

Full text of the publication in the New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa1804710.

 Gut microbiome and antitumor therapy efficacy 

Many studies of the gut microbiome’s role in oncology patients are emerging, i.e., that its composition may influence the efficacy of cancer immunotherapy. It was shown (http://science.sciencemag.org/content/359/6371/97) that there is a significant difference in gut microbiome composition and diversity in responders and non-responders to anti-PD-1 immunotherapy among patients with melanoma. Therefore, keeping normal gut microbiome may become an important part of successful antitumor treatment strategies.

Another study (https://ash.confex.com/ash/2018/webprogram/Paper116967.html) demonstrated poor overall survival in patients after hematopoietic cells transplantation (HCT) with low pre-HCT gut microbiome diversity.

Current data form a basis for further research of the gut microbiome’s role and development of interventional strategies for improving oncology patients’ treatment outcomes.

Screening for prostate cancer: what about PSA test? 

Another study doubts the necessity of a single prostate-specific antigen (PSA) test for prostate cancer screening. In a randomized clinical trial CAP which enrolled over 400 thousand men between 50 and 69 years old and a median follow-up of 10 years, single PSA screening intervention had no significant effect on prostate cancer mortality, even though it detected more prostate cancer cases. Moreover, more tumors with a Gleason grade of 6 or lower were identified in the intervention group. These findings do not support single PSA testing for population-based screening.

More details in the publication by the Cancer Research UK: https://scienceblog.cancerresearchuk.org/2018/03/06/why-a-one-off-psa-test-for-prostate-cancer-is-doing-men-more-harm-than-good/.

Full text of the publication in JAMA: https://jamanetwork.com/journals/jama/fullarticle/2673968

Obesity as a risk factor for cancer

According to a Cancer Research UK report (https://www.cancerresearchuk.org/about-us/cancer-news/press-release/2018-09-24-obesity-could-overtake-smoking-as-biggest-preventable-cause-of-cancer-in-women-0), in the upcoming 25 years obesity will overtake smoking as the biggest preventable cause of cancer among UK women. Taking into account that 4 in 10 cancers in the UK can be attributed to known risk factors (https://www.nature.com/articles/s41416-018-0029-6), prevention with lifestyle interventions (first of all, smoking cessation and overweight/obesity control) may have a significant effect on the population.

Novel drug approval for solid tumors with a rare genetic alteration

Among the new drugs and combinations in oncology approved by the Food and Drug Administration (FDA)  (https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm279174.htm), special attention is brought to the second drug approval, agnostic to a tumor type (https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm626720.htm).

On November 26, 2018, FDA granted accelerated approval to larotrectinib for patients with solid tumors that have NTRK gene fusion. The approval was based on clinical data in patients with 12 different cancer types that have this genetic alteration.

The first similar approval based on a biomarker only was granted to pembrolizumab for MSI-H/dMMR tumors in 2017 (https://www.fda.gov/drugs/informationondrugs/approveddrugs/ucm560040.htm).

In the case of tissue-agnostic indications, the drug is given based on tumor molecular profiling with no reference to tumor localization. This is another step to precision oncology advancement.  

Combination therapy with CAR-T cells and checkpoint inhibitors

While the scientific community is accumulating data for adoptive immunotherapy with chimeric antigen receptor T-cells (CAR-T) long-term efficacy assessment, which was approved in 2017, first studies of its combination with checkpoint inhibitors appear. The first results demonstrate that the combination may be used for the treatment of children with relapsed B-ALL as a strategy to improve CAR-T cells efficacy and persistence. However, further evidence of its efficacy and safety is needed.

More details in the publication by the American Society of Clinical Oncology (ASCO): http://www.ascopost.com/News/59529.

Full-text abstract at the American Society of Hematology Congress (ASH 2018): https://ash.confex.com/ash/2018/webprogram/Paper112572.html

Nobel Prize 2018 in physiology and medicine: immune-oncology

Two outstanding scientists, whose discoveries formed the basis of modern cancer immunotherapy, became laureates of the 2018 award in the field of physiology and medicine. The prize was awarded to James P. Allison (USA) and Tasuku Honjo (Japan) for their discovery of cancer therapy by inhibition of negative immune regulation. Their research formed a separate pillar of anticancer treatment, which demonstrates high efficacy in some patients with specific tumors, leading in some cases to long-lasting remissions and even possible cure.

This story illustrates how scientific discoveries may eventually revolutionize clinical practice.

More details at http://www.rakfond.org/en/2018/10/01/2018-nobel-prize-medicine/

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