Current oncology reports
-
Immune checkpoint inhibitors (ICIs) have improved the survival of several cancers. However, they may cause a wide range of immune-related adverse events (irAEs). While most irAEs are manageable with temporary cessation of ICI and immunosuppression, cardiovascular toxicity can be associated with high rates of morbidity and mortality. As ICIs evolve to include high-risk patients with preexisting cardiovascular risk factors and disease, the risk and relevance of ICI-associated cardiotoxicity may be even higher. ⋯ Several cardiovascular toxicities such as myocarditis, stress cardiomyopathy, and pericardial disease have been reported in association with ICIs. Recent findings also suggest an increased risk of atherosclerosis with ICI use. ICI-associated myocarditis usually occurs early after initiation and can be fulminant. A high index of suspicion is required for timely diagnosis. Prompt treatment with high-dose corticosteroids is shown to improve outcomes. Although the overall incidence is rare, ICI cardiotoxicity, particularly myocarditis, is associated with significant morbidity and mortality, making it a major therapy-limiting adverse event. Early recognition and prompt treatment with the cessation of ICI therapy and initiation of high-dose corticosteroids are crucial to improve outcomes. Cardio-oncologists will need to play an important role not just in the management of acute cardiotoxicity but also to reduce the risk of long-term sequelae.
-
Current oncology reports · Feb 2021
ReviewThe Presence of Complementary and Alternative Medicine Recommendations in Head and Neck Cancer Guidelines: Systematic Review and Quality Assessment.
A high proportion of head and neck cancer (HNC) patients use complementary and alternative medicine (CAM), however, healthcare professionals generally have little knowledge about the safety and efficacy of these therapies. The purpose of this study was to determine the quantity and assess the quality of CAM recommendations across clinical practice guidelines (CPGs) for the treatment and/or management of HNC. ⋯ MEDLINE, EMBASE, and CINAHL were systematically searched for HNC CPGs published between 2009 and April 2020; the Guidelines International Network and the National Center for Complementary and Integrative Health websites were also were searched. Eligible CPGs containing CAM recommendations were assessed twice with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument, once for the overall CPG and once for the CAM sections. Of 305 unique search results, 7 CPGs mentioned CAM and 4 CPGs made CAM recommendations. The overall CPG scored higher than the CAM section for 4 of 6 domains (overall, CAM): scope and purpose (93.8%, 93.8%), clarity of presentation (88.2%, 64.6%), stakeholder involvement (68.8%, 39.6%), rigor of development (58.3%, 34.6%), editorial independence (42.7%, 42.7%), and applicability (51.6%, 19.8%). Quality varied within and between CPGs. Highly scoring CPGs serve as evidence-based resources that clinicians can use to inform their patients about safe and effective CAM use; CPGs achieving variable or lower scores could be improved in future updates based on currently available guideline development/implementation tools. Future research should identify CAM therapies supported by sufficient evidence to be included as part of HNC CPGs.
-
Current oncology reports · Aug 2020
ReviewStriving toward Improved Outcomes for Surgically Resectable Non-Small Cell Lung Cancer: the Promise and Challenges of Neoadjuvant Immunotherapy.
Immunotherapy has revolutionized the treatment of non-surgical stage III and stage IV non-small cell lung cancer (NSCLC). Here, we review emerging data on the safety, feasibility, and efficacy of neoadjuvant immunotherapy in the setting of earlier stage surgically resectable lung cancer. ⋯ Several small studies support the safety and feasibility of neoadjuvant immunotherapy, noting similar perioperative rates of morbidity and mortality compared with historical controls. Data from several phase II trials have shown high rates of major pathologic response (MPR), though it is unclear if this will correlate with a survival benefit. Phase III trials of neoadjuvant immunotherapy alone or in combination with chemotherapy are ongoing. Neoadjuvant immunotherapy offers a promising treatment modality in earlier stage NSCLC patients. Results of ongoing phase II and phase III trials will be essential in determining how to best integrate this treatment modality in the future.
-
Current oncology reports · Jul 2020
Correction to: The COVID-19 Pandemic and its Impact on the Cardio-Oncology Population.
In light of the recent retraction of the New England Journal of Medicine article entitled "Cardiovascular Disease, Drug Therapy, and Mortality in COVID-19" (Mehra et al., full citation provided below), the authors would like to remove the following statement, which appeared on page 2, under the heading Cardiovascular Disease and COVID-19.
-
Current oncology reports · Jun 2020
ReviewGut Microbiome Modulation Via Fecal Microbiota Transplant to Augment Immunotherapy in Patients with Melanoma or Other Cancers.
We review emerging evidence regarding the impact of gut microbes on antitumor immunity, and ongoing efforts to translate this in clinical trials. ⋯ Pre-clinical models and human cohort studies support a role for gut microbes in modulating overall immunity and immunotherapy response, and numerous trials are now underway exploring strategies to modulate gut microbes to enhance responses to cancer therapy. This includes the use of fecal microbiota transplant (FMT), which is being used to treat patients with Clostridium difficile infection among other non-cancer indications. The use of FMT is now being extended to modulate gut microbes in patients being treated with cancer immunotherapy, with the goal of enhancing responses and/or to ameliorate toxicity. However, significant complexities exist with such an approach and will be discussed herein. Data from ongoing studies of FMT in cancer will provide critical insights for optimization of this approach.