The Arc of Therapy: From Cure to Humbling Legacy

{This is not research, but is a very insightful reflection on the experience of long term survivorship. The physician-author has a history of Hodgkin lymphoma, radiation therapy, breast cancer, a thyroid nodule, and lung cancer. It acknowledges the uncertainty of living with long term survivorship in ways that may speak to others similarly situated.}

https://ascopubs.org/doi/full/10.1200/JCO.19.00666

In a similar vein, here is a commentary on the frustration physicians experience as a result of "not having a crystal ball."

https://connection.asco.org/blogs/modern-day-cassandras-reflections-asco19

Pyrotinib Plus Capecitabine for HER2+ Metastatic Breast Cancer

Interview with Lee S. Schwartzberg MD, FACP Interview by Farzanna S Haffizulla MD, FACP, FAMWA

one of the key studies presented this year looks at the novel compound pyrotinib for HER2+ breast cancer.

Double-blinded, double randomized controlled study in patients who were HER2+, metastatic breast cancer, had previously been exposed to taxane and trastuzumab, and the results of the study showed that the progression-free survival, the primary endpoint was more than doubled, to about 11 months, from four months, with the addition of pyrotinib. That was quite good, and has a ratio of less than 0.2, so more than 80% improvement overall, highly statistically significant, and that was a very positive result, I think, we can say.

Not a very large study, under 300 patients, so by phase III standards it was somewhat small, but the results are very strong

Pyrotinib, like other ERBB inhibitors, tend to have diarrhea as a common side effect, and that was also seen here as the most common toxicity, and of course capecitabine, of course, is hand-foot syndrome, which was the other common toxicity here.

... this will be, potentially, the third small molecule TKI that would come to market, potentially. What we don't know, though is the relative benefit of one versus the other{s}. ...where does pyrotinib fit? I don't think we know ....It has attractive biochemical properties and it could potentially find a place in the armamentarium of HER2 therapy.

https://www.practiceupdate.com/C/84876/56?elsca1=emc_enews_topic-alert

NIH Leader Shuns All-Male Panels. Many Applaud the Gesture, but Not All.

Francis Collins won't participate in those so-called manels anymore. Many scientists see that as a constructive move toward inclusiveness, but a critic calls the stance unscientific political theater.

https://www.chronicle.com/article/NIH-Leader-Shuns...

{Requires subscription. I will see if I can find a free report on same subject matter.}

Clinical Challenges: Lymphedema in Breast Cancer

Risks have been reduced, but condition remains problematic

Article discusses standards of care, "prehabilitation" -- that is, maximizing patients' physical functioning prior to treatment; efforts toward education "about the procedure they are undergoing, as well as lymphedema risk reduction principles"; non-treatment risk factors; diagnosed and treated in a timely manner. "And that's important because chronic lymphedema is thought to be a condition that can be irreversible and lead to quality of life altering changes like infections and hospitalization, and other morbidities."

There are links to "results of an interim analysis of the PREVENT trial, a randomized trial evaluating bioimpedance spectroscopy versus tape measurement in the prevention of lymphedema following treatment for breast cancer."

https://www.medpagetoday.com/clinical-challenges/asco-challenges-in-breast-cancer/80471?xid=nl_mpt_DHE_2019-06-15&eun=g1278169d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202019-06-15&utm_term=NL_Daily_DHE_Active

The Worst Patients in the World

Americans are hypochondriacs, yet we skip our checkups. We demand drugs we don't need, and fail to take the ones we do. No wonder the U.S. leads the world in health spending.

{Present company excepted, I am sure! But it's an interesting perspective.}

https://www.theatlantic.com/magazine/archive/2019/07/american-health-care-spending/590623/?utm_source=feed

ASCO 2019: KRISTINE Suggests Role for Chemotherapy-Sparing Regimen in HER2-Positive Breast Cancer

Combining trastuzumab-emtansine (T-DM1) with pertuzumab may be an effective chemotherapy-sparing regimen for some women with operable HER2-positive breast cancer, but identifying which women are good candidates for this approach and which would fare better with chemotherapy remains a challenge, according to the results of the KRISTINE trial presented here at the Annual Meeting of the American Society of Clinical Oncology, which took place from May 31 to June 4 (2019).

https://www.practiceupdate.com/C/85097/56?elsca1=emc_enews_topic-alert

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Neoadjuvant Trastuzumab and Pertuzumab Plus Chemotherapy Versus T-DM1 and Pertuzumab in HER2+ Breast Cancer

Interview with Lee S. Schwartzberg MD, FACP Interview by Farzanna S Haffizulla MD, FACP, FAMW

https://www.practiceupdate.com/C/84837/56?elsca1=emc_enews_topic-alert

{includes video}