memo - Magazine of European Medical Oncology

Steurer, Michael

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0173-5

Pall, Georg

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0162-8

Feistritzer, Clemens; Wildner, Sophie Maria

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0157-5

Venous thromboembolism is associated with substantial morbidity and mortality. Furthermore, the subsequently indicated anticoagulation treatment puts the patient at risk of possible bleeding complications. Therefore, improving treatment strategies as well as diagnostic approaches can optimize patient care. During the 55th Annual Meeting 2013 of the American Society of Hematology the Choosing Wisely® campaign was presented. An expert committee recommends against the test for thrombophilia after venous thromboembolism occurring in the setting of major transient risk factors to avoid over treatment in these patients. Other presentations focused on the use of the direct oral anticoagulants in patients with cancer-associated thromboembolism. However, specific studies comparing direct oral anticoagulants with the state-of the art treatment with low molecular heparins in cancer-associated thromboembolism are still missing. Finally, age-adjusted cut-off levels can increase the specificity of D-Dimer in older patients. Consequently, using clinical probability assessment in the combination with age-adjusted D-dimer cut-off levels may be associated with a larger number of patients in whom pulmonary embolism can be ruled out.

Nösslinger, Thomas

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0148-6

Recent clinical data presented at the annual meeting of the American Society of Hematology challenge the predominance of R-CHOP in the first line treatment of diffuse large B cell lymphoma. New therapeutic agents such as lenalidomide and ibrutinib are tested successfully in clinical trials in combination with established therapies. Interesting results from the Austrian non-Hodgkin lymphoma (NHL)-13 trial underline the possible relevance of rituximab maintenance in specific patient subgroups. New data on unfavorable subtypes, such as double hit lymphomas, NHL at risk for central nervous system relapse, and refractory disease with CD30 expression were reported. Finally some promising therapeutic options for the unfavorable subset of extranodal NK/T-cell lymphoma were presented.

Burgstaller, Sonja

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0158-4

Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases characterized by ineffective haematopoiesis and cytopenias in peripheral blood. Transformation into acute myeloid leukaemia is a common complication of MDS. Life expectancy varies between nearly normal and early death. MDS were an important issue at last year’s annual meeting of the American Society of Hematology. Like in the years before, the majority of contributions dealt with preclinical aspects. In addition to that, several interesting clinical studies regarding diagnosis and treatment were presented.

Schmidt, Stefan

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0168-2

At the 2013 annual meeting of the American Society of Hematology, the role of calreticulin in essential thrombocythemia and primary myelofibrosis as well as safety aspects in second-generation tyrosin kinase inhibitor treatment of chronic myeloid leukemia have been major issues in the field of myeloproliferative neoplasms.

Steurer, Michael

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0174-4

At the annual meeting of the American Society of Hematology 2013, the focus in the field of chronic lymphocytic leukemia (CLL) and indolent lymphomas was again dominated by compelling data generated in clinical trials exploring the use of novel drugs targeting the B-cell receptor pathway. The results observed in early trials, e.g., with the Bruton’s tyrosine kinase inhibitor ibrutinib (formerly PCI-32765) and PI3Kδ inhibitor idelalisib (formerly CAL-101) have been consolidated. In view of these data, new clinical standards have been set up for the treatment of relapsed/refractory CLL. However, with the presentation of several randomized trials new standards concerning the use of immunochemotherapy are being suggested underscoring the importance of immunochemotherapeutic strategies despite the upcoming era of tyrosine kinase inhibitor treatment of CLL and indolent lymphoma.

Zach, Otto; Clausen, Johannes

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0169-1

Treatment of patients with acute leukemia is based on antineoplastic drug therapy (mainly chemotherapy) and/or immunotherapy, such as allogeneic stem cell transplantation, both associated with the risk of severe toxicity, including treatment-related mortality. Therefore, the extent of therapy should ideally be adapted to the patient’s individual relapse risk. The latter can be estimated taking into account leukemia subtype as well as conventional and molecular cytogenetics, as determined at the time of diagnosis. Furthermore, particularly in acute lymphoblastic leukemia (ALL), early and subsequent assessment of treatment response is routinely incorporated into the global risk stratification. Multiparameter flow cytometry and molecular methods allow for the detection of minimal residual disease that remains obscure to conventional cytology. While molecular monitoring of the treatment efficacy has entered clinical routine in chronic myelogenous leukemia, acute promyelocytic leukemia and ALL, this concept is still evolving in acute myeloid leukemia. This short review is aimed to give an overview of current methods as well as established and candidate indications of molecular disease monitoring in patients with acute leukemia.

Skalska-Sadowska, Jolanta; Derwich, Katarzyna

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0163-7

Venous thromboembolism (VTE) occurs in 0.95–36 % of children with acute lymphoblastic leukemia almost exclusively during chemotherapy. It is most commonly associated with concurrent l-asparaginase and steroid therapy, central venous line use, and inherited thrombophilia. Clinical manifestations regarding the location of VTE include central nervous system thrombosis (sinus venous thrombosis, cerebral infarct/stroke), upper-/lower-limb deep venous thrombosis, pulmonary embolism, and right atrial/intracardiac and superficial venous thrombosis and can be both symptomatic and asymptomatic. The majority of thrombotic events are central catheter related. Doppler ultrasound, venography, computed tomography, magnetic resonance imaging, magnetic resonance angiography, ventilation/perfusion scans, and echocardiogram are the methods used in VTE detection. The standard management is l-asparaginase discontinuation and low-molecular-weight heparin (LMWH) at 1 mg/kg/dose twice a day (enoxaparin initial therapeutic dose) followed by achieving a serum anti-Xa level of 0.5–1.0 IU/ml for 1–3 months and maintaining this level at 0.1–0.3 IU/ml until the reversible risk factors are resolved. The restarted l-asparaginase treatment associated with the highest risk of VTE recurrence should be covered with LMWH prophylaxis. The cerebral sinus venous thrombosis is associated with the most unfavorable prognosis and requires aggressive therapy. Thrombosis prevention in pediatric acute lymphoblastic leukemia is warranted, but the standards of methods and schedules are unknown.

Munzone, Elisabetta; Colleoni, Marco

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0159-3

Maintenance treatment is generally administered to patients without progression after an initial chemotherapy regimen of standard duration, with the aim of increasing the time to progression of disease. The aims of this strategy include prolongation of survival with good quality of life and symptom control. The duration of the treatment is generally based on patient responsiveness and individual tolerability as well as physician preferences. As breast cancer is a heterogeneous disease with different biological characteristics, the strategy of maintenance therapy may be adapted accordingly. Metronomic chemotherapy has been investigated particularly in advanced hormone receptor negative breast cancer and resulted as an interesting and valid alternative for maintenance therapy in this setting of patients. Recent results of a meta-analysis of randomized trials with maintenance chemotherapy showed a slight benefit in the overall survival and a more significant benefit in the progression free survival. However, this benefit should be balanced with toxicities and the use of the regimen with the best risk-benefit ratio should be preferred. Communication between the oncologist and the patient may help to determine the appropriate treatment choice and the correct duration of the treatment on an individual basis.

Lakshmaiah, K. C.; Das, Umesh; Babu, K. Govind; Suresh, T. M.; Lokanatha, D.; Jacob, Linu A.; Babu, Suresh; Mukherjee, G.; Vijayakumar, M.

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0153-9

Neate, Colin; Strasak, Alexander; Burger, Hans Ulrich; Tong, Barbara; Kaiser, Lee

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0164-6

Wöll, Ewald

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0170-8

Soft tissue sarcoma is a rare and very heterogeneous disease. The prognosis of these cancers is mainly influenced by histological grading size location and type of histology. Many aspects argue in favor of neoadjuvant chemotherapy but no singular trial could unambiguously prove an advantage of neoadjuvant therapy. This short review has a focus on neoadjuvant chemotherapy as induction therapy prior to chemoradiation or neoadjuvant chemotherapy alone.

Sztankay, Arpad

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0161-9

Intraoperative radiation therapy (IORT) delivers a high single-dose radiation during surgery, which in combination with perioperative conventional fractionated external beam radiation therapy enables increase the total dose to the tumor bed without increasing normal tissue morbidity. Therefore, it can improve local tumor control. Numerous clinical studies have proved the feasibility and efficacy of IORT in patients with sarcomas of the trunk and extremities, as well as retroperitoneal tumors. In this publication, theoretical and practical essentials regarding the utilization of IORT in the multimodal treatment of sarcoma will be discussed.

Perathoner, Alexander; Kafka-Ritsch, Reinhold; Zitt, Matthias

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0155-7

Abdominal soft tissue sarcomas (ASTS) represent a rare malignancy of the abdomen. Diagnosis is often delayed because ASTS tend to be asymptomatic for a long time. Typical clinical symptoms such as pain and augmentation of the abdominal girth develop as a result of the compressing and displacing rather than infiltrating growth pattern of large ASTS. Treatment of patients with ASTS should be managed interdisciplinarily in a tumourboard. Surgery (i.e. wide excision with negative margins) represents the only potentially curative treatment option. Multimodal treatment with radiotherapy and/or chemotherapy, however, is indispensable to reduce the rather high local recurrence rate in these patients despite complete resection. A preoperative core needle biopsy is recommended if diagnosis and hence also therapy are unclear: the biopsy pathway should be chosen in accordance with the surgeon, and the excision has to be performed afterwards within primary surgery. The aggressiveness of surgery is still under debate and ranges from a tissue/organ-sparing approach to an extensive approach with compartmental resection. Thus, the oncologic surgeon must be able to handle complex multivisceral resection as well as extensive vascular reconstruction. Surgery for local recurrence has been shown to be feasible, and the presence of distant metastases usually represents a contraindication for surgery.

Balmelli, Cathrin; Mark, Michael; Spirig, Christian; Spataro, Vito; Pederiva, Stefanie; Monnerat, Christian; Zippelius, Alfred; Wicki, Andreas

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0156-6

Vemurafenib is a targeted therapy against metastatic melanoma. It specifically inhibits the V600 mutated BRAF kinase in the mitogen-activated protein kinase pathway. Only limited data are available on long-term tolerability and efficacy of this drug. Here, we report and discuss six patients from our own clinical practice who were treated with vemurafenib for 16–27 months. Overall, these long-term responders tolerated vemurafenib well during the prolonged period of therapy. Most of the side-effects occurred during the first 6 months of treatment and were transient. The most common persistent side-effect was phototoxicity, which was manageable by precautionary measures or with dose reduction. Interestingly, even permanent dose reductions of 50 % of the standard dose did not abrogate long lasting remissions but improved tolerability, which is a prerequisite of long-term therapy. In addition to our own clinical experience, this article reviews current study results regarding the tolerability and efficacy of long-term vemurafenib therapy.

Bergmeister, Paul; Lang, Alois Hermann

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0154-8

At the moment cancer screening is a hot topic which is widely discussed in scientific as well as in popular press. The expected benefits, improvement of prognosis and the reduction of mortality, must be weighed against potential harms, such as the risk of over-diagnosis, false-positive findings, and complications of invasive screening examinations. Screening for breast, cervical, and colorectal cancer has proven to be effective and is therefore recommended by major medical societies and international guidelines. Different tests for colorectal cancer screening are available. Besides established strategies using fecal occult blood test and colonoscopy new and potentially less invasive techniques are on the rise. Our aim is to discuss different strategies for colorectal cancer screening and to present the available screening tests. According to the World Health Organization prevention is the most cost-effective long-term strategy for the fight against cancer. Almost half of all cancer deaths are related to preventable causes. In general, life style modification and some dietary advices can be recommended, but the role of micronutrient supplements remains unclear. There is mounting evidence that some drugs such as nonsteroidal anti-inflammatory drugs, statins, or metformin may have a chemoprotective effect, but is there enough evidence to give general recommendations?