New research was presented at ASCO 2021, the online American Society of Clinical Oncology Annual Meeting, from June 4-8. The features below highlight some of the studies that emerged from the conference.
Few Patients With Ovarian Cancer Undergo Genetic Testing
Testing for mutations in BRCA1 and BRCA2 is recommended for all women with ovarian cancer, given important implications for treatment and prognosis. Despite this recommendation, studies show that a small percentage of patients with ovarian cancer undergo genetic testing (GT). Researchers evaluated rates of genetics referral, counseling, and testing among patients with ovarian cancer at an academic medical center. They sought to identify factors associated with lower rates of GT, with specific emphasis on the association between race and GT, given limited existing data. Overall, 44.7% of patients were referred for genetic counseling and 39.8% received testing. Among patients who did receive GT, the percentages of deleterious BRCA1 and BRCA2 mutations identified were 11% and 8.8%, respectively. Variables correlating with higher likelihood of genetics discussion, referral, and testing included serous histology, White or Asian race, and seeing a medical oncologist. Notably, while fewer Black women were referred for GT, those who did undergo GT were found to have higher rates of BRCA1 and BRCA2 mutations when compared with White patients.
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High Intensity Interval Training for Advanced NSCLC
Prior research indicates that patients with advanced non-small cell lung cancer (NSCLC) experience fatigue and physical deconditioning, altering their quality of life (QoL). However, the safety and feasibility of high intensity exercise in this patient population has not yet been explored. To address this, investigators conducted a single-center, prospective, two-arm study in which patients were allocated to either an intervention arm consisting of kinesiologist-supervised, high-intensity interval training (HIIT) or a control arm of home exercise guided by an informative pamphlet. At 6 weeks, 70% of patients were evaluated and 47% completed the 12-week follow-up, with equal distribution in each group. The study team found no significant differences at 12 weeks in the physical assessment nor the overall QoL scores between both groups. However, patients in the HIIT group demonstrated a significant improvement at 12 weeks in the Lung Cancer Symptoms domain on 28 points (22.3 vs 19.8), as well as the Physical Wellbeing domain on 28 points (23.6 vs 20.6) when compared with the control group. No significant exercise-related complications were reported. Following the study, 64% of patients who completed the HIIT program continued to exercise virtually with a kinesiologist, in contrast to none in the control group.
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Incidence of Cervical Cancer Has Decreased
With a lack of current data, researchers examined incidence trends of human papillomavirus (HPV)-related from data obtained from the U.S. Cancer Statistics program from 2001 to 2017. They found that for women, the overall incidence of HPV-related cancers was 13.68/100,000, 52% of which were cervical cancer (7.12/100,000 in 2017). The incidence of cervical cancer decreased at an annual percent change (APC) of 1.03%, while the incidence rates of oropharyngeal cancer, anal and rectal cancer, and vulvar squamous cell carcinoma increased (APCs, 0.77%, 2.75%, and 1.27%, respectively). The incidence of anal and rectal cancer approached that of cervical cancer among older women. By 2025, the incidence of anal and rectal cancer is expected to surpass that of cervical cancer for every age group older than 55. The incidence of all HPV-related cancers in men was 11.0/100,000 in 2017; 81% were associated with oropharyngeal cancer. From 2001-2017, men had an overall annual increase in HPV-related cancers of 2.36% per year. “Without standardized screening, HPV-related cancers, such as oropharyngeal cancers and anal rectal cancers, are increasing,” the presenting author said in a statement. “In order to reduce these trends and achieve success comparable to what we’re seeing with cervical cancer we must develop effective screening strategies and determine vaccine efficacy in these patient populations.”
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Salvage Therapy-Related Survival Predictors Identified for Relapsed/Refractory Classic Hodgkin’s Lymphoma
Although previous studies suggest positive outcomes with novel salvage therapies for patients with relapsed/refractory classic Hodgkin’s lymphoma who are eligible for autologous stem cell transplant, the efficacies and outcomes of different salvage therapies in this patient population remain unestablished. Investigators analyzed data on consecutive patients with autologous stem cell transplant-eligible relapsed/refractory classic Hodgkin’s lymphoma at three Mayo Clinic sites between January 2008 and May 2020, identifying six groups of salvage therapy: ifosfamide, carboplatin and etoposide, bendamustine/brentuximab, brentuximab vedotin (BV), gemcitabine-based therapy, checkpoint inhibitor, and others. No differences in progression-free or overall survival rates were observed by salvage therapy type. However, BV maintenance (BVm) after autologous stem cell transplant was associated with increased progression-free survival (hazard ratio [HR], 0.3) when compared with no BVm, and higher number of salvage therapies was associated with lower overall survival (HR, 2.0) upon multivariate modeling.
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Palliative Care & Coping In Patients With Acute Myeloid Leukemia
For a non-blinded, multi-site randomized trial of Integrated palliative and oncology care (IPC) versus usual care for hospitalized patients with AML receiving induction therapy, participants completed the Functional Assessment of Cancer Therapy-Leukemia scale, the Hospital Anxiety and Depression Scale, and the Brief COPE questionnaire, to assess quality of life (QOL), mood, and coping at baseline and weeks 2, 4, 12, and 24. To facilitate analysis, coping strategies were categorized into “approach-oriented” or “avoidant.” Causal mediation regression models were used to examine whether changes in coping during the initial hospitalization mediated intervention effects on QOL, depression, and anxiety symptoms at week 2. Patients randomized to IPC reported more approach-oriented coping and less avoidant-oriented coping at week 2. Intervention effects on approach-oriented coping were sustained up to week 24, but not on avoidant-oriented coping. Changes in approach-oriented coping and avoidant-oriented coping during hospitalization partially mediated the intervention effects on week 2 QOL, depression, and anxiety symptoms. Changes in approach- and avoidant-oriented coping accounted for 78% of the total palliative care intervention effect on QOL, 66% of the intervention effect on depression, and 35% of the intervention effect on anxiety.
