Onc Daily: Nivolumab for Tough Tumor,
End-of-Life Wording

Nick Mulcahy

May 08, 2020

Here are the most important stories that Medscape Oncology's editors picked for you to read today:

Nivolumab for a Rare, Aggressive Tumor

Neoadjuvant nivolumab (Opdivo, Bristol-Myers Squibb) could improve outcomes for patients with high-risk resectable Merkel cell carcinoma (MCC), say researchers reporting the first trial of anti-PD-1 therapy in this patient population.

About half of a 30-patient cohort achieved a pathologic complete response (pCR) and/or a radiographic response, with a median follow-up of 19 months.

More clinical trial experience with more patients and longer follow-up are needed to assess whether this treatment approach should become standard in this setting, said investigator Suzanne Topalian, MD, Johns Hopkins Medicine, Baltimore, Maryland.

"Futile Treatment" Not Understood by Many Lay People

End-of-life discussions between patients and families and their physicians can be hampered by language difficulties, including "most" lay people's lack of understanding of the common phrases "futile" or "potentially inappropriate" treatment, according to the results of a focus-group study with 39 people from the Los Angeles area.

"Although it is difficult to recommend the discontinuation of life-sustaining treatment, it is crucial that physicians communicate to families when treatments are non-beneficial, will not change patient outcomes, and potentially prolong suffering," said Thanh H. Neville, MD, University of California, Los Angeles.

The study set out to gain insight into the public's understanding about the concept and implications of treatments that will not be effective.

Androgen Deprivation Tied to Much Lower COVID-19 Rates

Observational data on a treatment for prostate cancer suggest that androgens may be a biological variable that makes men more vulnerable to severe disease from COVID-19 than women.

Italian researchers raise that possibility, after having analyzed data from 68 hospitals in the Veneto region. When the team looked specifically at men with prostate cancer, they found, "strikingly," that only 4 out of 5273 patients receiving androgen deprivation therapy (ADT) developed SARS-CoV-2 infection and none died.

On the other hand, 114 out of 37,161 patients not receiving ADT developed the infection and 18 died.

"This is the first paper to suggest a link between ADT and COVID-19," commented lead author Andrea Alimonti, MD, PhD, Università della Svizzera Italiana in Lugano, Switzerland.

An expert not involved with the study observed that the study results were not adjusted for potential confounders such as age, body mass index, and cardiometabolic comorbidities, which are strong risk factors for SARS-CoV-2. Men taking ADT may also have been more likely to self-isolate, reducing infection risk.

No Better Time to Celebrate Our Nurses

"I would like to go on record stating that ICU nurses are the biggest heroes in this pandemic. They spend far more time in the rooms of COVID-19 patients than the physicians do," said a doctor commenting on Medscape recently.

That comment is timely, as the United States is in the midst of its annual National Nurses Week (May 6-May 12). In a news perspective, Medscape editor Laura Stokowski, RN, captures a mix of thoughts and feelings among American nurses concerning their work during this global healthcare crisis.

New Cancer Center Planned in New Jersey, Despite Economy

Despite the economic stress of the COVID-19 pandemic, the RWJBarnabas Health system is moving forward with plans for a $750 million cancer treatment and research facility in northern New Jersey, according to a report in The Wall Street Journal.

The facility will be located in New Brunswick, which is 39 miles outside New York City, the epicenter of the American outbreak. RWJBarnabas Health, which operates 11 acute-care hospitals, and collaborator Rutgers Cancer Institute of New Jersey, will build a 12-story, 510,000-square-foot facility, including nearly 100 acute-care beds.

RWJBarnabas Health has been under significant financial stress stemming from the high costs of treating COVID-19 patients, said president and CEO Barry Ostrowsky. Nevertheless, the project is a go. "Cancer isn't going away. It's not like cancer has gone on the sidelines waiting for the pandemic to pass," said Steven Libutti, MD, director of Rutgers Cancer Institute.

Reference Updates on Bladder Cancer 

The Medscape Reference materials for bladder cancer have been updated with the addition of the latest European Association of Urology guideline on muscle-invasive bladder cancer. In addition, the section on "Urine Tumor Markers in Bladder Cancer Diagnosis" has been updated with several new markers that have been recently identified, but unfortunately none of the new markers are ready yet for clinical use.

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