ASCO Education

2018 Annual Meeting raised the curtain on a new session type: ASCO Voices. These noncompete session feature presentations no longer than 7 minutes each and bring a variety of perspectives to the stage to share stories on oncology, medicine, and the world. From big ideas to personal passions, ASCO Voices present stories that differ significantly from the remainder of session types available at Annual Meeting. Dr. Trevor Bayliss is an oncologist in Pittsfield, Massachusetts and is affiliated with Berkshire Medical Center. He received his medical degree from Albany Medical College and has been in practice between 6-10 years. He is one of 6 doctors at Berkshire Medical Center who specialize in Oncology. In his ASCO Voices presentation, Dr. Bayliss shares his personal story of overcoming cancer and how it lead him to a career in oncology.  

Rachel Freedman, MD, MPH- Assistant Professor, Medicine, Harvard Medical School, Dana-Farber Cancer Institute presents a self-assessment question from an ASCO University course focusing on the treatment breast cancer.  AUDIO TRANSCRIPT Welcome to the self-evaluation episode of the ASCO University weekly podcast. My name is Rachel Friedman, and I'm a medical oncologist and clinical researcher in the Breast Oncology Center at Dana-Farber Cancer Institute. Today, we feature a self-evaluation question on the treatment of early stage breast cancer. We begin by reading the question stem. A 75-year-old woman with a past medical history of coronary artery disease and diabetes, with an ECOG performance status of 2, has been seen in the medical oncology office following a partial mastectomy for a 1 centimeter invasive breast cancer. The margins were clear and hormone receptors are reported as positive. The HER2/neu status is reported as negative. An Oncotype recurrence score is reported as 5. Which of the following is the best adjuvant therapy for this patient? Choice A, doxorubicin, cyclophosphamide, and weekly paclitaxel, followed by an aromatase inhibitor. B, docetaxel and cyclophosphamide for four cycles, followed by an aromatase inhibitor for five years with radiation therapy to the breast. C, radiation therapy to the breast and axilla, followed by an aromatase inhibitor. D, aromatase inhibitor. E, tamoxifen. The correct answer to this question is D, aromatase inhibitor. This patient has a poor performance status and high co-morbidity burden, with a higher likelihood of non-breast cancer deaths over breast cancer death, over time. The cancer is low risk, with a low likelihood for local and distant recurrence. Radiation and chemotherapy are unlikely to improve her outcome and will increase her toxicity risk. Further, we have multiple randomized trials to support safe omission of radiation and the setting of older age and stage 1 hormone receptor positive disease. Briefly, the benefit of adjuvant chemotherapy is anticipated to be negligible, and even harmful, in the setting of her low risk disease, advanced co-morbidity, poor functional status, and Oncotype score of 5. Chemotherapy should be avoided in this setting, making answers A and B incorrect. Although radiation should be considered and administered in most patients with invasive breast cancer, undergoing breast conservation, as mentioned earlier, we have prospective randomized controlled trial data, supporting omission of radiation in this clinical scenario, making option C also incorrect for this reason. Further, there is no indication for radiation to the axilla in a low risk breast cancer, such as the one described here, making option C incorrect for that reason as well. Option E, tamoxifen, is also a treatment option here, but may be less appealing in an older patient who lives a more sedentary lifestyle who may be at more risk for adverse events on tamoxifen, such as thrombosis, and where the use of aromatase inhibitors may be of a small incremental benefit over tamoxifen, with regard to risk for recurrences over time. Thank you for listening to this week's episode of the ASCO University weekly podcast. For more information on the treatment of breast cancer, including opportunities for self-evaluation and for a review, please visit the comprehensive eLearning center at university.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Karen M. Winkfield, MD, PhD, Associate Professor of Radiation Oncology, Comprehensive Cancer Center at Wake Forest Baptist Health discusses identifying factors associated with prognosis and staging in a MALT lymphoma and how to identify factors predicting local failure following H Pylori eradication therapy. 

2018 Annual Meeting raised the curtain on a new session type: ASCO Voices. These noncompete session feature presentations no longer than 7 minutes each and bring a variety of perspectives to the stage to share stories on oncology, medicine, and the world. From big ideas to personal passions, ASCO Voices present stories that differ significantly from the remainder of session types available at Annual Meeting. Dr. Loehrer is director of the Indiana University Melvin and Bren Simon Cancer Center, an IU Distinguished Professor, H.H. Gregg Professor of Oncology and associate dean for cancer research at Indiana University School of Medicine.   In his ASCO Voices presentation, Dr. Loehrer shares a personal story about coping with cancer diagnosis of a close colleague and friend.  

Dr. Jonathan Strosberg, section chief of the Neuroendocrine Tumor Division of the Moffitt Cancer Center, discusses the recent FDA approval of Lutetium Lu 177 dotatate for the treatment of somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

An interview with Dr. Paul Hesketh from Lahey Hospital and Medical Center on the antiemetics guideline update published in 2017. The guideline update expands the recommendations to include olanzapine and neurokinin 1 receptor antagonists. Read the full guideline at www.asco.org/supportive-care-guidelines

Rachel Freedman, MD, MPH- Assistant Professor, Medicine, Harvard Medical School, Dana-Farber Cancer Institute, presents a self-assessment question from an ASCO University course focusing on the treatment breast cancer.   

Rami Manochakian, M.D., a thoracic clinical oncologist at the Mayo Clinic in Florida, presents information on the recently approved drug in oncology, durvalumab for patients with stage III Non-Small Cell Lung Cancers (NSCLC) after the completion of radiation therapy.

Self-Evaluation: Karen M. Winkfield, MD, PhD, Associate Professor of Radiation Oncology, Comprehensive Cancer Center at Wake Forest Baptist Health, presents a self-assessment question from an ASCO University course focusing on, the appropriate first line therapy for newly diagnosed primary CNS lymphoma.

An interview with Dr. Alison W. Loren of Perelman School of Medicine of the University of Pennsylvania on the ASCO guideline update which provides current recommendations about fertility preservation for adults and children with cancer. Read the full guideline at www.asco.org/survivorship-guidelines