The role of Bevacizumab in combination with chemotherapy for patients with advanced Non Small Cell Lung Cancer is well established. However the safety of Bevacizumab in this patient population with brain metastases has been unclear with the potential risk of CNS bleed. This issue was addressed in the PASSPORT trial which enrolled nonsquamous histology Non Small Cell Lung Cancer patients with treated brain metastases. The addition of bevacizumab to conventional chemotherapy or erlotinib in this trial was associated with a low incidence of CNS bleed suggesting that bevacizumab could be safely given for patients with Non Small Cell Lung Cancer with treated brain metastases.
Author: RR
Oncoprescribe Blog Will BRAF trump KRAS testing in Metastatic Colon Cancer?
Testing for KRAS mutations is presently the standard of care prior to treatment with anti EGFR monoclonal antibodies such as cetuximab and panitumumab, as KRAS mutant colorectal tumors do not respond to anti EGFR monoclonal antibodies. However it is becoming clear that BRAF which is involved in intracellular signaling and cell growth and a principal downstream mediator of KRAS, when mutated resulted in shorter progression free survival and overall survival regardless of KRAS status. Targeted therapy may be taking a turn for the better making treatment more personalized.
Oncoprescribe Blog REMS for Romiplostim (Nplate®) and Eltrombopag (PROMACTA®)
The approval of Romiplostim (Nplate®), as well as Eltrombopag (PROMACTA®) included a mandatory Risk Evaluation and Mitigation Strategy (REMS) for the following reasons. There has been some concern raised with regards to long term risks associated with TPO receptor agonists, in particular bone marrow reticulin formation and risk for bone marrow fibrosis. These adverse events however were not noted in the phase III clinical trials. The Risk Evaluation and Mitigation Strategy is intended to ensure that the product is safely used with proper informed consent. It is therefore mandatory that all parties including the prescribers, patients, as well as institutions and pharmacies that wish to provide these drugs, register through the Nplate NEXUS (Network of Experts Understanding and Supporting Nplate and Patients) program for Romiplostim (Nplate®) and through PROMACTA® CARES for Eltrombopag (PROMACTA®) respectively. These patient registries are meant to monitor long term safety of these agents. REMS will soon be be mandated for ESA’s as well.
Oncoprescribe Blog TCH Adjuvant Therapy for Breast Cancer
BCIRG OO6 – Adjuvant TCH for Breast Cancer presented at the SABCS 2009 by Slamon, D et al. is ready for review.
In summary, here are the findings:
The authors concluded that the addition of trastuzumab to either an anthracycline or non-anthracycline based chemotherapy regimens provides similar and significant benefit both in terms of disease free survival and overall survival and this benefit is seen in both low and high risk patients .
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Oncoprescribe Blog PROMACTA® (Eltrombopag) for Chronic ITP
The long-term safety and efficacy of (PROMACTA® (Eltrombopag) was evaluated in an open label phase III extension study (EXTEND STUDY) and this study demonstrated that Eltrombopag (PROMACTA®) given for up to two years appears to have consistent benefit in raising the platelet counts without any significant adverse events. A new paradigm has emerged with the availability of a new class of agents such as PROMACTA®, targeting platelet production. Additional trials are underway evaluating the role of this agent in chemotherapy induced thrombocytopenia as well as Myelodysplastic Syndromes and the results are eagerly awaited with renewed interest.
Oncoprescribe Blog Just added Synopsis/Clinical Relevance for ARZERRA for CLL
We’ve just completed a write up for ARZERRA for CLL, including a recap of the research presented at ASCO 2009 by Kipps, T. et al.
In a nutshell, here are the findings:
*The authors concluded that single agent therapy with Ofatumumab (ARZERRA®) acheives a high overall response rate and improves disease symptoms as well as hematologic parameters in heavily pretreated CLL patients presenting with double refractory and bulky Fludarabine orefractory disease, irrespective of prior therapy with Rituximab.*u
To view the entire Synopsis and Clinical Relevance, log on to www.oncoprescribe.com – if aren’t registered yet; the subscription is free.
Oncoprescribe Blog N9831 trial
Timing of Trastuzumab administration when given along with chemotherapy in an adjuvant setting, is gaining more clarity. Updated information presented at the 2009 San Antonio Breast Cancer Symposium suggests that, as was administered in group C of the N9831 trial, Trastuzumab started concurrently with taxane resulted in a better outcome, with improvement in Disease Free Survival compared to sequentially administering Trastuzumab following completion of taxane chemotherapy. This should clearly be more appealing to patients, as the duration of adjuvant parenteral therapy would be shortened by approximately 3 months in addition to the decrease in the risk of disease recurrence.
Oncoprescribe Blog Dual HER-2 blockade in metastatic Breast Cancer
An updated analysis of the phase III EGF 104900 trial demonstrated some interesting findings. Combining Trastuzumab with Lapatinib – dual HER blockade, in patients with metastatic breast cancer who had progressed on anthracyclines, taxanes and trastuzumab, improved overall survival without significant adverse events. This is in spite of a 50% cross over from the control group to the dual HER blockade group. This may be a telling tale of how individuals with advanced metastatic breast cancer can benefit with targeted therapy.
Oncoprescribe Blog Anthracyclines in Breast Cancer
Should we be in a hurry to abandon anthracyclines due to cardiotoxicity concerns? Think again. Weigh the risk benefits. More to come.
Oncoprescribe Blog Targeted Agents in Oncology and Personalized Medicine
How do mutations and overexpression of certain oncogenes impact treatment decisions? So, Here is an answer the Oncoprescribe way.
If a patient with colon cancer has a tumor with KRAS mutation Erbitux or Vectibix ( EGFR targeted monoclonal antibodies ) will not work.
However if a patient with Non Small Cell Lung Cancer has a tumor with mutations involving exon 19 or exon 21, small molecule Tyrosine Kinase Inhibitors such as Tarceva (Erlotinib) may be more effective than chemotherapy.
Tumors in patients with Non Small Cell Lung Cancer with high ERCC 1 gene expression are resistant to platinum compounds and non-platinum combination regimens should be a serious consideration.