Mgus And Smoldering Multiple Myeloma
These are premalignant clonal plasma cell disorders that are diagnosed incidentally in most patients. The disorders included in this category are called MGUS and smoldering multiple myeloma. In the majority of patients, these disorders are asymptomatic and do not require treatment. However, in some patients these disorders can lead to complications, including peripheral neuropathy and renal disorders called monoclonal gammopathy of renal significance .
Maintenance Therapy With Olaparib Slows The Growth Of Metastatic Pancreatic Cancer With Brca Mutations
A phase III clinical trial called POLO showed that using olaparib after initial chemotherapy kept metastatic pancreatic cancerlinked with a BRCA gene mutation from worsening for a longer time. BRCA gene mutations are inherited and increase the risk of developing several other types of cancer, including ovarian, breast, and prostate cancers. About 5% to 6% of pancreatic cancers are caused by a BRCA gene mutation.
Olaparib is a type of targeted therapy called a PARP inhibitor. PARP inhibitors block an enzyme that repairs damaged DNA inside cancer cells, leading to cell death and slowing or stopping tumor growth. Olaparib is approved by the FDA as a treatment for breast and ovarian cancer related to a BRCA gene mutation.
This study included 154 people with metastatic pancreatic cancer who had already received chemotherapy. Four to 8 weeks after chemotherapy ended, all participants received either olaparib or a placebo. A placebo is an inactive drug.
Olaparib was linked with more serious side effects: 40% of people taking the drug experienced side effects, compared with 23% of those taking the placebo. About 6% of participants stopped taking olaparib due to these side effects, compared with just under 2% of those who received the placebo.
Fda Pipeline: Priority Reviews In Multiple Myeloma Prostate Cancer
2/17/2020 3:23:44 PM
Over the past week, the U.S. Food and Drug Administration granted Priority Review to treatments for multiple myeloma and prostate cancer gave Fast Track designation to a targeted gene therapy for lung cancer granted Orphan Drug designation to a combination therapy for hepatocellular carcinoma and issued a 501 marketing clearance to a device designed to relieve the symptoms of lymphedema.
Priority Review for Belantamab Mafodotin in Relapsed or Refractory Multiple Myeloma
The FDA granted Priority Review to a biologics license application seeking approval of belantamab mafodotin for the treatment of patients with relapsed or refractory multiple myeloma whose prior therapy included an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 antibody.
Belantamab mafodotin is an investigational immunoconjugate comprising a humanized antiB-cell maturation antigen monoclonal antibody conjugated to the cytotoxic agent auristatin F via noncleavable linker. In 2017, belantamab mafodotin was granted Breakthrough Therapy designation by the FDA.
The BLA is based on data from the pivotal DREAMM-2 study, recently published in The Lancet Oncology, which enrolled heavily pretreated patients who had actively progressing multiple myeloma that had worsened despite current standard of care.
Priority Review for Olaparib in Metastatic Castration-Resistant Prostate Cancer
Fast Track Designation for Gene Therapy that Targets Lung Cancer
Recommended Reading: When Should You Get Your Prostate Checked
For Connecting And Sharing During A Cancer Journey
Anyone with cancer, their caregivers, families, and friends, can benefit from help and support. The American Cancer Society offers the Cancer Survivors Network , a safe place to connect with others who share similar interests and experiences. We also partner with CaringBridge, a free online tool that helps people dealing with illnesses like cancer stay in touch with their friends, family members, and support network by creating their own personal page where they share their journey and health updates.
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Zoledronic Acid In Treating Patients With Metastatic Breast Cancer Metastatic Prostate Cancer Or Multiple Myeloma With Bone Involvement
| The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. |
| First Posted : March 25, 2009Results First Posted : November 7, 2018Last Update Posted : November 7, 2018 |
| Intervention/treatment | Phase |
|---|---|
| Breast AdenocarcinomaDS Stage I Plasma Cell MyelomaDS Stage II Plasma Cell MyelomaMetastatic Malignant Neoplasm to the BonePainMusculoskeletal ComplicationUrinary Complications | Drug: zoledronic acid |
PRIMARY OBJECTIVES:
I. To determine whether every-12-week therapy with zoledronic acid is not inferior to every-4-week therapy for patients with metastatic breast cancer, metastatic prostate cancer, or multiple myeloma involving bone, as measured by the proportion who experience at least one skeletal related event within 24 months after randomization.
SECONDARY OBJECTIVES:
I. To compare pain scores of patients with metastatic breast cancer, metastatic prostate cancer, or myeloma involving bone receiving every 12 week dosing of zoledronic acid to those receiving every 4 week dosing.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
After completion of study treatment, patients are followed up every 4 weeks for 2 years from registration.
Asco Annual Meeting 201: Treatment Advances For Metastatic Prostate Cancer And Pancreatic Cancer Multiple Myeloma Survival Factors And Effects Of The Affordable Care Act On Cancer Care
The theme of the 2019 American Society of Clinical Oncology Annual Meeting is Caring for Every Patient, Learning from Every Patient. For the past year, ASCO President Monica M. Bertagnolli, MD, FACS, FASCO, has visited local groups across the United States to learn what patients and doctors truly experience when receiving and providing cancer care. As she writes in this years Clinical Cancer Advances report, Cancer treatment advances are only as good as patients ability to access them. This years ASCO Annual Meeting strikes the balance in Dr. Bertagnollis theme, bringing late-breaking research news to the public and exploring the ways that access to cancer care can be improved for patients.
More than 32,000 oncology professionals from around the world are at the ASCO Annual Meeting in Chicago, presenting and discussing the latest research in cancer treatment and patient care. Learn about the research released today:
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Enzalutamide lengthens lives of men with metastatic prostate cancer
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Maintenance therapy with olaparib slows the growth of metastatic pancreatic cancer with BRCA mutations
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Income, health insurance, and place of treatment affect how long people with multiple myeloma live
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ACA has led to earlier diagnosis and treatment of ovarian cancer
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Medicaid expansion allowed timely cancer treatment and improved racial equality in care
Watch a patient education video with Dr. Bertagnolli explaining how the ASCO Annual Meeting changes patients lives.
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What Is Multiple Myeloma
Cancer can start any place in the body. Multiple myeloma is a type of cancer that starts in plasma cells, which are in the bone marrow the soft, inner part of some bones. Normal plasma cells are a type of white blood cell that fight off infections by making antibodies that spot and attack germs.
When plasma cells grow out of control and become cancer cells, they can form a tumor, usually in a bone. If there is only one plasma cell tumor, it is called a solitary plasmacytoma. When there is more than one plasma cell tumor, it is called multiple myeloma.
Questions to ask the doctor:
- Why do you think I have cancer?
- Is there a chance I dont have cancer?
- Would you please write down the kind of cancer I have?
- What will happen next?
The Inhibition Of The Zol
To further assess the synergism at the molecular level, we evaluated several pathways in untreated or treated PC3 and DU145 cells by a multiplex phosphoprotein enzyme-linked immunosorbent assay assay. As shown in , within 24h, both agents, among several pathways examined , were able to modulate either AKT or ERK, depending on the cell line evaluated, with any interaction observed in the combination setting. In contrast, ZOL induced an 2- and 1.3-fold increase of p38-MAPK activation in PC3 and DU145 cells, respectively, compared with untreated cells , and this effect was completely abrogated by concomitant treatment with panobinostat. These results were confirmed by western blotting analysis that showed a sustained inhibition by panobinostat of the ZOL-induced p38-MAPK and heat shock protein-27 activation, the latter a well-known substrate of p38-MAPK, in both PC3 and DU145 cells . Conversely, the basal activity of p38-MAPK and HSP27 was only slightly modulated by panobinostat. Although less evident, similar results were obtained in KMS21BM cells .
Altogether, these data showed that the inhibition of ZOL-induced p38-MAPK activation by panobinostat plays a critical role in the synergistic effects between the two drugs and confirmed previous findings that identified p38-MAPK as significantly involved in the sensitivity of cancer cells to the antitumor effect of ZOL., ,
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Prostate Cancer Leading To Monoclonal Gammopathy Of Undetermined Significance: A Case Report
This article is mentioned in:
Abstract
Introduction
Prostate cancer is the second most common cancer inmen following lung cancer, and the fourth most common cancer typeworldwide . Prostate cancerfrequently metastasizes to bone and can present as osteolytic orosteoblastic lesions . Monoclonalgammopathy of undetermined significance is a condition wherean abnormal protein is produced by plasma cells. The diagnosticcriteria for MGUS is M protein < 3 g/dl, clonal plasma cellpopulation in bone marrow > 10% and no end organ damage . MGUS has been documented to transforminto multiple myeloma or similar lymphoproliferative disordersat a rate of 1-3% per year, or 17, 34 and 39% at 10, 20 and 25years, respectively . In a prospective study performed in2009, all or nearly all cases of MM were preceded by MGUS . The 5 year survival rate for individualswith MM is ~45%. Therefore, it is essential that any condition,which increases the risk of developing MM be addressed. The presentstudy reported two cases where it is hypothesized that metastaticprostate cancer may have led to the condition of MGUS.
Case 1
Case 2
What Should You Tell The Patient About Prognosis
Localized prostate cancer
The prognosis for localized prostate cancer is excellent, and depends primarily on the serum PSA level at diagnosis, the clinical stage, and the Gleason grade. The goal of therapy is cure , which is achieved in about 30-70% of patients, although outcomes for patients treated by conservative measures are also good. Cancer-specific survival rates for patients receiving optimal local therapy exceed 80% at 20 years. Even in men who are treated conservatively , 10-year cancer-specific survival rates exceed 90%.
Biochemically-recurrent prostate cancer
Although there are generally no curative therapies for men with biochemically-recurrent prostate cancer after local therapy, outcomes for these patients are also excellent. Prognosis is guided by two main clinical factors: the Gleason score at the time of diagnosis , and the PSA doubling time . Overall, median metastasis-free survival in these patients is about 10 years, and median overall survival is about 20 years .
Metastatic prostate cancer
In patients with metastatic prostate cancer, the goals of therapy are palliative and focus on treatment or prevention of pain and other skeletal-related complications. Prognosis is primarily determined by the extent of metastases , and by the location of metastases . Overall, median survival with appropriate therapies in these patients is about 5-7 years.
Castration-resistant prostate cancer
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In Vivo Activity Of Panobinostat/zol Combined Treatment In A Pca Xenograft Model
To assess whether the synergistic antitumor effects demonstrated in vitro could be confirmed in vivo, we used a DU145 xenograft flank model. As shown in , tumors in untreated mice grew rapidly and reached the end point size within 3 weeks of treatment. In the ZOL-treated group, the average tumor volume was slightly increased compared with untreated mice, whereas panobinostat treatment produced a measurable but modest tumor volume reduction compared with untreated mice . However, a significant inhibition of tumor growth was found in the panobinostat/ZOL group . Moreover, the resulting tumor growth delay induced by the combination reached a peak of almost 40% compared with 20% in the panobinostat group, indicating that the rate of tumor growth in the control was almost 1.6-fold higher than in the combination setting . The combined treatment was well tolerated, as shown by the maintenance of body weight and by the absence of other signs of acute or delayed toxicity.
Figure 4
Finally, as shown in , we confirmed by western blotting analysis that panobinostat also suppresses basal and ZOL-induced p38-MAPK and HSP27 activation in xenografted tumors.
Beware Of Other Conditions That Can Mimic Prostate Cancer:
Prostate adenocarcinoma is by far the most common type of prostate cancer histology, and most of the information contained in this chapter relates to this histology. However, there are other rare cancer histologies that can be found in the setting of a prostate mass/enlargement.
These other unusual histologies include transitional carcinoma of the prostate, neuroendocrine carcinoma of the prostate, small-cell carcinoma of the prostate, signet-ring carcinoma of the prostate, squamous cell carcinoma of the prostate, and sarcomas of the prostate. These histologies portend a much poorer prognosis, and often require different treatment.
Cancers may also arise in other adjacent sites and invade into the prostate gland, mimicking conventional prostate adenocarcinoma. Examples of this include urothelial carcinoma of the prostatic urethra which invade into the prostate gland. Distant metastases to the prostate gland are extremely rare.
In addition, there are several types of prostate adenocarcinoma variants. The usual type of prostate adenocarcinoma is acinar adenocarcinoma which arises in the prostatic acini. Other adenocarcinoma histologies include ductal adenocarcinoma , and mucinous adenocarcinoma . Although these adenocarcinoma variants are not necessarily treated differently from conventional acinar prostate adenocarcinoma, they usually portend an inferior prognosis.
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Income Health Insurance And Place Of Treatment Affect How Long People With Multiple Myeloma Live
A recent study analyzing information from the National Cancer Database found that certain socioeconomic factors, especially living in an area of higher incomes, having private health insurance, and receiving treatment at an academic institute, are linked with how long people with multiple myeloma live after diagnosis.
For this study, researchers gathered information on 117,926 people living with multiple myeloma between 2005 and 2014. They found that the following socioeconomic factors contributed to how long people survived:
According to researchers, these findings suggest that it may be harder for people with lower incomes to afford the medications used to treat multiple myeloma, which can be very expensive. In addition, people often need to continue taking these drugs over the long term to keep the cancer from coming back. People who have difficulty paying for their medications may be more likely to stop treatment or take a break from treatment, which can reduce its effectiveness.
lead study author Kamal Chamoun, MDUniversity Hospitals Seidman Cancer CenterCleveland, Ohio
What Therapies Should You Initiate Immediately
There are very few situations in which patients with prostate cancer require immediate or emergent treatment. Some examples are listed below:
Acute urinary obstruction
If patients have large-volume localized prostate cancer , they may present with complete bladder outflow obstruction caused by an enlarged prostate resulting in external compression of the bladder base or prostatic urethra.
The most important initial management of these patients involves placement of a urinary catheter to relieve the outflow obstruction. If it is impossible to place a trans-urethral catheter due to a severe obstruction, a suprapubic catheter may need to be inserted surgically.
Hydronephrosis
If there is extension of the prostate cancer to the bladder base, or if there are bulky pathological lymph nodes in the pelvis, this may result in unilateral or bilateral hydroureter and/or hydronephrosis.
In rare cases, patients may also demonstrate impaired renal function as manifested by a reduced creatinine clearance. Immediate management options for such patients may involve insertion of percutaneous external nephrostomy tubes . If there is persistent ureteral obstruction, internal ureteric stents may be inserted at a later time .
Spinal cord compression
Hypercalcemia of malignancy
Recommended Reading: Survival Rates Of Prostate Cancer
What Laboratory And Imaging Studies Should You Order To Characterize This Patient’s Tumor How Should You Interpret The Results And Use Them To Establish Prognosis And Plan Initial Therapy
Determining the initial treatment approach for prostate cancer depends on accurate classification into different risk-groups based on 3 diagnostic parameters:
Combinations of these 3 parameters allow classification of patients into high-risk, intermediate-risk, low-risk groups.
PSA level
A peripheral blood sample for measurement of serum total PSA should be performed in all patients. Knowing the prior history of PSA values may also help to determine the rate of change of PSA over time.
Gleason score
This is determined by a pathologist from prostate biopsy tissue. Before the selection of primary therapy, patients should undergo a 12-core transrectal ultrasound-guided prostate biopsy. The Gleason score is a measure of the tumor grade . Each biopsy core is evaluated for the presence of cancer, and is then assigned a primary and secondary Gleason score if cancer is present.
The primary Gleason score reflects the tumor grade/differentiation which is the most prevalent in that biopsy specimen. The secondary Gleason score reflects the tumor grade/differentiation that is the second most prevalent pattern.
The Gleason sum is the most informative aspect of the Gleason score, and guides prognosis and treatment. If multiple biopsy cores are assigned a Gleason sum, the highest Gleason score should be used for determining prognosis and treatment options.
Risk stratification
Locally advanced disease
Patients are considered to have locally advanced prostate cancer if they have:
Staging