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  Table of Contents  
NEWS
Year : 2021  |  Volume : 58  |  Issue : 4  |  Page : 635-637
 

News from the world of oncology



Date of Submission21-Dec-2021
Date of Acceptance12-Dec-2021
Date of Web Publication31-Dec-2021

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.ijc_1509_21

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How to cite this article:
. News from the world of oncology. Indian J Cancer 2021;58:635-7

How to cite this URL:
. News from the world of oncology. Indian J Cancer [serial online] 2021 [cited 2022 Jan 28];58:635-7. Available from: https://www.indianjcancer.com/text.asp?2021/58/4/635/334636





  Neoadjuvant Chemotherapy – Standard of Care in Esophageal Cancer? Top


Esophageal cancer (EC) is the eighth most frequent cancer in the world. Upfront surgery has been the cornerstone of treatment for non-metastatic disease for a long time, albeit with poor results, especially in locally advanced cases. This has led to a rationale for multi-modality therapy for esophageal cancer. In addition, esophageal carcinoma is a heterogeneous entity histologically [adenocarcinoma (AC) and squamous cell carcinoma (SCC)] and anatomically [thoracic (TE) and gastroesophageal junction (GEJ)]. Most trials have not separated these entities, leading to difficulties in daily practice for personalized care based on these characteristics.

The MANATEC-02 collaborative group recently published a meta-analysis in the European Journal of Cancer (https://doi.org/10.1016/j.ejca. 2021.08.014), titled “Individual patient data meta-analysis of neoadjuvant chemotherapy followed by surgery versus upfront surgery for carcinoma of the esophagus or the gastro-esophageal junction.” The aim was to investigate the benefits of neoadjuvant chemotherapy (NACT) in locally advanced EC with special consideration with respect to histology and anatomical site.

A total of 12 trials with 2478 patients were included in the final analysis with a median follow-up of 5.6 years for overall survival (OS), which was the primary endpoint. All analyses were conducted on an intent-to-treat basis. Pretreatment clinical T and N stages were rarely reported in these trials due to the extended period over which they were conducted.

The median age was 62 with most patients being male.

NACT followed by surgery was associated with an improved OS compared to surgery alone, with a hazard ratio (HR) of 0.83 and P < 0.0001. This translated into an absolute benefit of 6.1% at 5 years from 14.8% to 20.9%. There was no difference in the outcomes of adenocarcinoma (HR 0.73) and squamous cell carcinoma (HR 0.91). However, a more pronounced effect was seen in GEJ (HR 0.68) versus TE (HR 0.87) tumors. In addition, disease-free survival (DFS) improved with NACT (HR 0.74). Moreover, fewer local and distant recurrences were noted in patients treated with NACT.

Several limitations of this study include the inability to retrieve individual patient data for all identified trials, large inclusion period from the 1990s to 2016 leading to variability in supportive care and surgical techniques, and different chemotherapy regimens used although all were platinum-based. Despite the random-effects models, the heterogeneity of data will always remain. The toxicity data are also limited. The major implications of this study are the confirmation of the benefit of neoadjuvant chemotherapy in these patients and the lack of difference between adenocarcinoma and squamous carcinoma. Trials are ongoing to compare NACT with neoadjuvant chemoradiation.

Sushant Mittal


  Breast Cancer is not end of Reproductive Life Top


Being a mother is an important, crucial, and memorable milestone in a woman's life journey. Although breast cancer generally occurs in non-reproductive life-years, it is not uncommon during reproductive years of life. In the modern era, delayed childbirth and lesser conceptions in one's life partly explain the surge of breast cancer in this age group. The discussion of fertility in a patient with breast cancer takes a backseat for various reasons. Some of the reasons are cancer being a deadly disease, social stigma, fear of health risk to child and mother, and lack of awareness. With improvements in healthcare and increasing survival rates, the emphasis on quality-of-life issues after cancer treatment is the need of the hour.

In a recent study published in Journal of Clinical Oncology, Volume 39, Issue 29-3293, “Pregnancy After Breast Cancer: A Systematic Review and Meta-Analysis” (https://doi.org/10.1200/JCO.21.00535), Matteo et al. retrospectively reviewed the records of 8,093,401 women from the general population and 112,840 patients with breast cancer, of whom 7505 had a pregnancy after diagnosis. They came up with very exciting and encouraging data enabling an oncologist to provide optimistic counseling to non-metastatic breast cancer follow-up patients. Compared to patients with breast cancer without subsequent pregnancy, those with a pregnancy had 34% better DFS and 44% better OS. Similar results were observed irrespective of patient, tumor, and treatment characteristics; pregnancy outcome; and timing of pregnancy.

However, breast cancer survivors were 60% less likely to have a subsequent pregnancy compared with the general population, which may partially be due to the reasons mentioned above. Risks of cesarean section, low birth weight, preterm birth, and small for gestational age were significantly higher in breast cancer survivors, particularly in those with previous chemotherapy exposure, compared with the general population. No significantly increased risk of congenital abnormalities or other reproductive complications were observed. These results provide reassuring evidence on the safety of conceiving in breast cancer survivors. Patients' pregnancy desire should be considered a crucial component of their survivorship care plan.

This study is one of the rare studies talking about the survivorship plan and the reproductive quality of life. Once a cancer is diagnosed, the entire focus shifts to the radical treatment of cancer. Breast cancer being a hormone-driven cancer, the prolonged use of hormone blockade further reduces the chances of fertility opportunities. Although the majority of breast cancer patients do not fall in the reproductive age bracket or are hormone-receptor-positive requiring long-term therapy which contraindicates conception while triple-negative patients have higher recurrence rates, this data is relevant for a fraction of breast cancer patients. It definitely gives a newer viewpoint to the oncologists caring for them. Ongoing studies are looking at the outcome impacts of conception while temporarily interrupting the long-term adjuvant hormone blockade therapy.

H S Darling

ORCID iD: https://orcid.org/0000-0001-7557-0292


  Adjuvant Targeted Therapy in Hormone Receptor (HR)-Positive Early Breast Cancer (EBC). Are We There Yet? Top


Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors given with endocrine therapy (ET) have improved outcomes in patients with hormone receptor (HR)-positive, HER2-negative metastatic breast cancer. Some small studies have suggested some activity of CDK4/6 inhibitors in EBC when used preoperatively. Their benefit in the adjuvant setting, however, has remained unknown till now.

Results of the global, phase III, randomized, open-label trial (MonarchE) comparing adjuvant ET for at least 5 years with or without abemaciclib for 2 years in patients with HR-positive, HER2-negative, node-positive, high-risk EBC were recently published by Harbeck N et al. in Annals of Oncology (https://doi.org/10.1016/j.annonc. 2021.09.015). There were two cohorts. Cohort 1 had patients with either 4 positive axillary lymph nodes (ALNs), or 1–3 positive ALNs with tumor size 5 cm or histologic grade 3. Cohort 2 included patients with 1–3 positive ALNs, tumor size <5 cm, grade <3, and a centrally assessed Ki-67 of at least 20%. Abemaciclib was given at a dose of 150 mg twice daily for 2 years with ET as per the physician's choice for at least 5 years. The primary endpoint was invasive DFS (IDFS).

A total of 5637 patients were randomized, 2808 to abemaciclib + ET and 2829 to only ET arms. Cohort 1 contained 5120 patients. High Ki-67 index was noted in 44.3% of all randomized patients and 39.1% of cohort 1 patients. Ki-67 was unavailable in 23.5% of patients in cohort 1. In cohort 1, the frequency of grade 3 tumors was higher in patients with Ki-67-high tumors, while the proportion of patients with 4 positive lymph nodes was higher in the Ki-67-low population. The prespecified primary outcome analysis (PO) done at a median follow-up of 19 months showed an absolute improvement of 3.0% in the 2-year IDFS as well as distant relapse-free rates in favor of abemaciclib + ET (92.3% and 93.8%) versus ET alone (89.3% and 90.8%), respectively. Analysis at additional follow-up of 8 months (median follow-up of 27 months) continued to demonstrate benefit with addition of abemaciclib with an absolute improvement of 5.4% for 3-year IDFS (abemaciclib + ET: 88.8% versus ET alone: 83.4%) and 4.2% for 3-year DRFS (abemaciclib + ET: 90.3% versus ET alone: 86.1%). The benefit of abemaciclib was seen irrespective of the Ki-67 value, although the magnitude of benefit seemed more in patients with higher Ki-67 confirming the prognostic value of Ki-67 in breast cancer.

The trial concluded that adjuvant abemaciclib when combined with ET improved IDFS in high-risk HR-positive, HER2-negative early breast cancer. The data for overall survival remain immature at this time.

Amol Dongre

ORCID iD: 0000-0003-4675-2876






 

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