More than 30,000 oncologists from around the world gathered in Chicago, Illinois, from June 3-7 for the 47th Annual Meeting of the American Society of Clinical Oncology (ASCO). With its “Patients, Pathways, Progress” theme, the conference showcased the latest clinical advances in oncology research. OncLive Nursing has sifted through the thousands of abstracts presented at ASCO and identified studies to highlight for you. Our abstract selection process focused on research with the potential to change practice, important studies that failed to meet expectations, and topics particularly relevant to oncology nurses. Here is our special ASCO coverage, including personal perspectives from oncology nurses.
Side Effects Not Prohibitive to Using Exemestane for Breast Cancer Prevention
In media reports and interviews, oncologists have expressed excitement about the MAP.3 trial’s findings, and note that exemestane may be an alternative to tamoxifen or bilateral prophylactic mastectomy in reducing breast cancer risk in high-risk postmenopausal women.
In the trial, side effects that were increased with exemestane use included hot flashes, fatigue, insomnia, gastrointestinal effects, and arthritis. However, the absolute differences in side-effect occurrence between the 2 arms were small, with the exception of hot flashes. Forty percent of the exemestane cohort reported hot flashes versus 32% of the placebo arm.
The study arms showed no difference in cardiovascular events, clinical skeletal fractures, osteoporosis, and other malignancies. Additionally, exemestane has fewer side effects compared with other agents used to prevent breast cancer, such as tamoxifen.
One notable limitation of the MAP.3 study was that the median follow-up duration was only 3 years.
Flaxseed Falls Short
Hot flashes affect quality of life in those who have experienced menopause and its aftereffects, as well as those who are undergoing therapy for breast cancer. Flaxseed was seen as a possible relief for hot flashes in a phase III randomized trial at the Mayo Clinic, whose disappointing results were discussed at ASCO by its principal investigator, Sandhya Pruthi, MD, PhD.
In a pilot study, flaxseed did show an association with decreased number and intensity of hot flashes. However, when compared to a placebo in the phase III trial, the differences were not significant.
Flaxseed can still be looked at as a healthy component in foods, lending its omega-3 essential fatty acids, its lignans with estrogen and antioxidant qualities, and fiber, both soluble and insoluble.
Find out more >>> Flaxseed Ineffective in Controlling Hot Flashes
Ipilimumab’s Unique Side Effects
Ipilimumab is very unlike chemotherapy in regard to what nurses usually deal with in the infusion room. The drug stimulates the patient’s immune system to go after the cancer, which can also affect other organs. So you can see things as [simple] as a rash when the drug affects the skin cells, or more severe symptoms, such as colitis, which at first people think of as just diarrhea, but it can turn into a very serious, life-threatening situation. Ipilimumab can have similar harmful effects on the liver, as well as the thyroid, adrenal, and pituitary glands.
Because it is the immune system causing the side effects, it is not just a matter of a drug clearing out of a patient’s system…so nurses have to intervene right away. We developed a patient checklist to monitor patients that goes over things such as number of daily bowel movements, skin integrity, fatigue levels, and more. The goal is to prevent patients receiving ipilimumab from reaching a grade 3 toxicity. There are a lot of times when patients get severe enough grade 3 reactions that we can’t give them any more ipilimumab. With early intervention, however, we can manage the side effects and safely continue the treatment.
Find out more >>> Two Studies Herald New Era in Melanoma Therapy
Genetic Research Is Changing Clinical Practice in Lung Cancer Treatment
Although genetic research has made great advances in many other cancer types, the genetic/genomic understanding of lung cancer remains somewhat limited. This appears to be changing, as genetic research results presented at ASCO promise to have a significant impact not only at a level of discovery, but also on the potential to reduce the annual prevalence of lung cancer, as well as have a positive impact on patient quality of life, survivorship, and our society’s economy.
Preliminary results from the Lung Cancer Mutation Consortium (LCMC) reported at ASCO support pivotal practice changes in lung cancer involving the identification of gene mutations and planning treatment.
As advancements in targeting cancer behaviors continue, so do the complexities of patient care. These complexities offer the oncology nursing profession complex challenges and unique opportunities. Among the challenges are potential barriers to patient understanding (culture, religion, knowledge, and level of literacy and language) and patient access to timely and appropriate care. Opportunities include expanding professional knowledge, education of peers and patients, nursing research, and advocacy at the patient, physician, payer, and government (local and federal) levels.
Additional items for oncology nurses to understand as genetic testing changes clinical practice in lung cancer treatment are:
- The genomic mechanism of action aspects of lung cancer and how to interpret medical science language for patient understanding
- The complexities of access to genetic testing and advocating for this important scientific measure
- The importance of a standardized approach for specimen collection processes to ensure efficiencies in testing and reporting
- Important clinical trials and current treatment regimens available to be prepared to answer patient questions
- Survivorship issues
Find out more >>> Genetic Testing Delivers Personalized Lung Cancer Therapy
New Treatment Option for Ovarian Cancer
With deaths in 2011 resulting from ovarian cancer estimated at more than 15,000, researchers have been working diligently to provide improved outcomes. In the phase III OCEANS trial, not only was there a progression-free survival (PFS) benefit of >4 months in the bevacizumab arm, but those women also had significant tumor shrinkage and a more durable response. In addition, complete response (CR) was seen in 8% more of the women with the addition of bevacizumab.
The response was not without difficulty. Although both groups had some adverse events, the bevacizumab group had a higher rate of serious adverse events, including 8% higher rates of grade 3-5 adverse events. These more serious events were typical of known adverse events with bevacizumab, namely hypertension, proteinuria, and bleeding/thrombotic events. However, one of the most harmful side effects of bevacizumab, gastrointestinal perforation, was not seen at all in the women receiving bevacizumab in this trial.
Given the improved PFS, CR, and duration of response with OCEANS, the bevacizumab combination should be considered as a viable option for women with recurrent platinum-sensitive ovarian cancer. Oncology nurses should be aware of the risks associated with bevacizumab therapy and be diligent in their assessments and education regarding adverse events. Preventative measures for bleeding/thrombosis should be initiated with treatment and education regarding symptoms and precautions for bleeding/thrombosis, hypertension, and proteinuria are imperative for better patient outcomes.
Targeted Population Could Salvage Iniparib
In the phase III study of iniparib in patients with triple-negative breast cancer, there was no significant difference between the 2 arms. This was particularly interesting given the positive phase II trial results. We do find, however, that as we give certain drugs to more people, it may change the outlook or the efficacy of the drug.
It would be interesting to see if those who did benefit from adding iniparib had something in common, such as age at diagnoses, the other treatments they had previously received, nationality or race, etc. Sometimes when drugs are new, we find that they may not work for the entire population but only in a particular subset.