Onc Daily: 'Staging the Aging,' Immuno-Combo for Lung Cancer

Jennifer Smith

May 18, 2020

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

"Staging the Aging" Cancer Benefits Proven. Payment Coming?

Three randomized trials suggest that comprehensive geriatric assessment, or "staging the aging," can improve outcomes in patients with cancer. These studies were highlighted in a recent press briefing and will be presented at the upcoming 2020 ASCO virtual annual meeting.

One trial showed that a comprehensive approach to geriatric assessment improved quality of life, reduced unplanned hospital admissions, and decreased early treatment discontinuation. Two other trials showed that comprehensive geriatric assessment reduced grade 3-5 treatment-related toxicity when compared with usual care.

There is no reimbursement for geriatric assessment in the United States, but researchers are hoping the findings from these trials prove the value of 'staging' the aging patient with cancer, according to William Dale, MD, PhD, a geriatrician at City of Hope in Duarte, California.

FDA Approves Immunotherapy Combo for Lung Cancer

The US Food and Drug Administration (FDA) has approved the combination of two immunotherapies, nivolumab (Opdivo, Bristol-Myers Squibb) and ipilimumab (Yervoy, Bristol-Myers Squibb), as first-line treatment for patients with metastatic, EGFR-negative, ALK-negative non-small cell lung cancer that is positive for PD-L1 (≥ 1%), as detected by an FDA-approved test.

The approval was based on results from the CHECKMATE-227 study. The agency also approved a companion diagnostic device, the PD-L1 IHC 28-8 pharmDx, that can be used to identify patients who are positive for PD-L1.

US Hospices Offering Less Palliative Chemotherapy and Radiation

Hospices in the United States have cut back on palliative chemotherapy and radiation in recent years, according to a new analysis published in JAMA Oncology.

Researchers found the number of Medicare-certified freestanding hospices increased from 2404 in 2011 to 2948 by 2018. Over the same time period, total expenses for hospices increased from $1.2 billion to $15 billion. However, chemotherapy expenses declined from $12.3 million to $1.3 million, and radiation expenses decreased from $6.3 million to $1.3 million.

COVID-19 Diary Week 4: The "New Normal" Is Not Temporary

Don S. Dizon, MD, compares the "new normal" after the COVID-19 outbreak to the "new normal" for patients who survive cancer. Cancer survivors "are not the people they were before cancer; priorities have shifted and relationships have changed," writes Dizon, director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital.

Similarly, Dizon says, "opening up businesses and lifting shelter-in-place restrictions aren't going to bring back the lives we all enjoyed before the pandemic." Dizon ponders what this "new normal" will look like for him, both personally and professionally, and wonders if "anything good" will come from the COVID-19 pandemic.

Updated Info on Liver Cancer 

The Medscape reference team has updated the information on hepatocellular carcinoma (HCC) to include the superior results reported for the combination of atezolizumab plus bevacizumab, when compared to standard of care sorafenib, in the treatment of unresectable HCC.

"My Cancer Doesn't Care About the Coronavirus"

A patient with cancer who needs treatment in a hospital currently has a choice of either risking exposure to the coronavirus [SARS-CoV-2] or postponing or forgoing the cancer treatment.

In an opinion piece in the New York Times, Richard Goggin, who has cancer of the prostate that has spread to the lymph nodes, describes his experience receiving cancer treatment in the COVID-19 era.

"I've seen a new layer of anxiety, and heroism, during my lonely treatment visits," he writes.

At the hospital entrance, Goggin is asked for identification, has his temperature taken, and gets quizzed about COVID-19 symptoms. Goggin notes that patients' loved ones must wait in the parking garage because they aren't allowed in the hospital.

To avoid one hospital visit, Goggin received his second shot of androgen-deprivation therapy at home. However, he has since journeyed to the hospital for CT and MRI scans, and he will soon begin radiation treatment — 5 days a week for 8 weeks.  

Goggin comments that a mere 2 hours in the hospital was "nerve-wracking," but "it is amazing what you learn to live with."

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