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Cancer Journal

Prashant Kapoor, S Vincent Rajkumar
Smoldering multiple myeloma (SMM) is an asymptomatic, intermediate stage positioned between the plasma cell disorders of monoclonal gammopathy of undermined significance and overt multiple myeloma (MM). Although the patients with SMM have a higher risk of progression to MM in comparison to their counterparts with monoclonal gammopathy of undermined significance, their clinical course can be highly variable. The standard of care for SMM, irrespective of the risk status, continues to be observation due to paucity of high-level evidence demonstrating survival or quality-of-life benefit with early intervention...
January 2019: Cancer Journal
Shaji K Kumar
There has been a paradigm shift in the treatment of myeloma triggered by intense exploration of the disease biology to understand the basis of disease development and progression and the evolution of newly diagnosed myeloma to a multidrug refractory state that is associated with poor survival. These studies have in turn informed us of potential therapeutic strategies in our ongoing effort to cure this disease, or at a minimum convert it into a chronic disease. Given the clonal evolution that leads to development of drug resistance and treatment failure, identification of specific genetic abnormalities and approaches to target these abnormalities have been on the top of the list for some time...
January 2019: Cancer Journal
Jill Corre, Hervé Avet-Loiseau
Although therapeutic strategies have been adapted to age and comorbidities of myeloma patients for a long time, all patients currently experiment the same treatment whatever their genomic risk. However, high-risk patients should benefit right now from the most efficient drugs combinations. Herein, we review and discuss how to optimally define risk to adapt treatment and why a modern multiparametric definition of genomic risk is urgently needed. Minimal residual disease status will probably also take a growing place in patient's management, including in treatment adaptation...
January 2019: Cancer Journal
Raphaël Szalat, Nikhil C Munshi
The therapeutic landscape of multiple myeloma (MM) has dramatically changed in the last 15 years with the advent of immunomodulatory drugs and proteasome inhibitors. However, majority of MM patients relapse, and new therapies are needed. Various agents with diverse mechanisms of action and distinct targets, including cellular therapies, monoclonal antibodies, and small molecules, are currently under investigation. In this review, we report novel drugs recently approved or under advanced investigation that will likely be incorporated in the future as new standard for MM treatment, focusing on their mechanisms of action, cellular targets, and stage of development...
January 2019: Cancer Journal
Jacalyn Rosenblatt, David Avigan
Cellular immunotherapy for myeloma has the unique potential both to potently kill the malignant clone and to evoke a memory response to protect from relapse. Understanding the complex interactions between the malignant clone and the microenvironment that promote immune escape is critical to evoke effective antimyeloma immunity. Tremendous progress has been made in the area of cancer vaccines and adoptive T-cell therapy in recent years. Careful study of the mechanisms of response and of immune escape will be critical to developing novel combination therapies and ultimately to improve outcomes for patients with myeloma...
January 2019: Cancer Journal
Joshua Richter, Sundar Jagannath
With 10 novel therapies approved across the decade, the multiple myeloma (MM) treatment paradigm continues to evolve in breadth and complexity. The current gestalt of the day has been the emergence of data to support 3-drug combinations over their 2-drug counterparts. Current guidelines and consensus statements support this approach. With the recent incorporation of monoclonal antibodies into the fray of myeloma therapy, we have begun to ask what the roles of 4-drug combinations are in both the upfront and the relapsed and refractory settings...
January 2019: Cancer Journal
Ajay K Nooka, Sagar Lonial
Over the last 2 decades, thalidomide analogs have induced significant antimyeloma effects via immune-modulation, antiangiogenesis and antiproliferative effects. While the exact molecular mechanism of the targets or the mediators of thalidomide activity were not known, a seminal discovery of cereblon as a thalidomide-binding protein led to explaining the mechanistic basis of antimyeloma activity for this class of agents. Identification of the mechanisms of resistance for immunomodulatory agents (IMiDs), which will have significant clinical implications, remains poorly understood...
January 2019: Cancer Journal
Giada Bianchi, Kenneth C Anderson
Multiple myeloma (MM) is a cancer of plasma cells, characterized by abundant synthesis of monoclonal immunoglobulins and/or free light chains. Although MM remains incurable, median overall survival has considerably improved over the past 2 decades largely due to the introduction of novel agents, including proteasome inhibitors (PIs) and immunomodulatory drugs. Bortezomib, a reversible boronate PI, was the first Food and Drug Administration-approved PI in MM and subsequently mantle cell lymphoma. Carfilzomib and ixazomib, the former an irreversible epoxyketone and the latter an orally bioavailable reversible PI, have been subsequently approved in MM...
January 2019: Cancer Journal
Ioannis Ntanasis-Stathopoulos, Evangelos Terpos, Meletios A Dimopoulos
In the modern era of multiple myeloma therapeutics, proteasome inhibitor (PI) and immunomodulatory drugs (IMiDs) have replaced chemotherapy regimens for newly diagnosed multiple myeloma patients. Treatment combinations that comprise both first- and next-generation PIs, including bortezomib, carfilzomib, and ixazomib and IMiDs, including thalidomide and lenalidomide, have been evaluated in phases II and III clinical trials and have shown significant efficacy with manageable toxicity profiles. Bortezomib or carfilzomib with lenalidomide and dexamethasone (VRD and KRD) are the most promising regimens resulting in significant survival improvement...
January 2019: Cancer Journal
Nikhil C Munshi
No abstract text is available yet for this article.
January 2019: Cancer Journal
Ross Pinkerton, Leigh Donovan, Anthony Herbert
Meeting shortfalls in the provision of care to adolescents and young adults with cancer has focused largely on improving outcomes and psychosocial support. A significant percentage of adolescents and young adults with cancer will die of disease because of initial poor prognosis conditions or disease relapse. In adults, progress has been made in the concept of an integrated cancer/palliative care service. In pediatric oncology, the application of this philosophy of care has lagged behind somewhat. In the case of adolescents, particularly those with advanced cancer, the palliative care needs, in a broader sense than only end-of-life care, are often not adequately met, irrespective of whether treatment is delivered in a pediatric or adult cancer service...
November 2018: Cancer Journal
H Irene Su, Yuton Tony Lee, Ronald Barr
Adolescents and young adults aged 15 to 39 years who are diagnosed with cancer (AYA survivors) undergo a range of therapies for cancer cure but subsequently may be at risk of treatment-related infertility, and for female AYA survivors, adverse pregnancy outcomes. Future fertility is important to AYA survivors. Meeting their fertility goals requires awareness of this importance, knowledge of cancer treatment-related fertility risks, appropriate fertility counseling on these risks, and access to fertility care...
November 2018: Cancer Journal
Anthony Penn, Aura Kuperberg
Various forms of psychosocial support have been suggested in working with adolescents and young adults (AYAs) as they attempt to cope with cancer, including peer-based interventions, individual psychoeducational counseling, and skill-based interventions. More recently, modern electronic applications created technology-based ways to deliver information and support and have grown in popularity to satisfy AYA needs for information and support. Such support should be offered routinely rather than in a response to a crisis...
November 2018: Cancer Journal
Giovanna Sironi, Ronald D Barr, Andrea Ferrari
Adolescents and young adults (AYAs) with cancer constitute a particular group of patients with unique features, whose needs during and after treatment are poorly met. A standardized model of care for them has yet to be established, as neither the pediatric nor the adult oncology systems seamlessly fit their needs. Regardless of the setting in which they are treated, their health care providers should be aware of the impact that the disease and its treatments have on these especially vulnerable patients. Simple ways of improving the AYA experience should be considered: reducing isolation through connections with peers, adapting the staff's approach to the emotional and developmental needs of this age group, and modifying the hospital environment making it more age appropriate...
November 2018: Cancer Journal
Lorna A Fern, Archie Bleyer
Inclusion in cancer clinical trials is considered the optimal standard of care, offering improved patient experience and progressive survival gains for subsequent generations of patients. Adolescent and young adult (AYA) patients are underrepresented in cancer research; consequently, improvements in outcomes for AYAs lag behind their pediatric and adult counterparts. Despite international evidence of underrepresentation in research, systematically tested interventions to improve recruitment for AYAs do not exist, and recruitment rates for AYAs continue to be lower than those for children...
November 2018: Cancer Journal
Andrea Ferrari, Patrizia Gasparini, Jonathan Gill, Richard Gorlick
Clinical management of adolescents and young adults with bone and soft tissue sarcomas is quite challenging, mainly because of different chemotherapy approaches adopted by pediatric and adult oncologists and tumor-associated factors related to this peculiar age group. Overcoming these barriers is essential for adolescent and young adult patients, whose survival and long-term physical effects are worse than their pediatric counterparts. Nowadays, constant efforts from international collaborations between pediatric and adult oncologists of sarcoma groups have optioned in converging toward a common therapeutic strategy, while improving quality of treatment, as well as research advances dedicated to this at-risk age group of patients with sarcomas...
November 2018: Cancer Journal
Jessica Hochberg, Mitchell S Cairo
Lymphomas in adolescents and young adults represent approximately one quarter of all cancers in this age group. Historically, adolescent and young adult cancer patients represent a unique population with diverging issues surrounding psychosocial hardships/barriers, economics, and lack of standardization of therapeutic approaches.Furthermore, the biologic differences within the adolescent and young adult population seen in various lymphoma subtypes likely play a role in overall outcomes for this group. Without an organized approach to clinical and translational research for adolescent and young adult patients within specialized treatment centers, this population may continue to experience inferior results...
November 2018: Cancer Journal
Elizabeth J Cathcart-Rake, Kathryn J Ruddy, Rebecca H Johnson
INTRODUCTION: Breast cancer is the most common malignancy among adolescents and young adults (AYAs) women aged 15 to 39 years at diagnosis. An improved understanding of modifiable factors that mitigate the risks of the development of breast cancer may allow for future strategies to reduce the incidence of AYA breast cancer. METHOD: A literature review was conducted to report upon associations between modifiable lifestyle factors and breast cancer risk. RESULTS: Higher levels of physical activity, lower red meat intake, and higher intake of plants appear to decrease the risk of developing AYA breast cancer, whereas associations between obesity and AYA breast cancer risk were less straightforward...
November 2018: Cancer Journal
James V Tricoli, Archie Bleyer
Adolescent and young adult (AYA) patients with cancer have not attained the same improvements in overall survival as either younger children or older adults. One possible reason for this disparity may be that the AYA cancers exhibit unique biologic characteristics, resulting in differences in clinical and treatment resistance behaviors. Our current understanding of the unique biological/genomic characteristics of AYA cancers is limited. However, there has been some progress that has provided clues about the biology of AYA cancers...
November 2018: Cancer Journal
Annalisa Trama, Laura Botta, Eva Steliarova-Foucher
Cancer burden in adolescents and young adults (AYAs) is expressed through a large proportion of the quality of life lost on individual level and also causes losses to the society in terms of a decreased productivity and social structure. A specific cancer spectrum and distinctive needs of AYA patients require targeted studies and cancer control measures. Incidence is intermediate between that for children and for older adults, and two-thirds of the AYA cancers affect women. Cancers of the breast and cervix uteri, representing a large portion of the burden, are amenable to prevention...
November 2018: Cancer Journal
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