Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist

For patients with isolated liver metastases from colorectal cancer who are not candidates for potentially curative resections, non-surgical local treatments may be useful. Non-surgical local treatments are classified according to how the treatment is administered. Local treatments are applied directly on hepatic parenchyma, such as radiofrequency, microwave hyperthermia and cryotherapy. Locoregional therapies are delivered through the hepatic artery, such as chemoinfusion, chemoembolization or selective internal radiation with Yttrium 90 radioembolization. The purpose of this review is to describe the different interventional therapies that are available for these patients in routine clinical practice, the most important clinical trials that have tried to demonstrate the effectiveness of each therapy and recommendations from principal medical oncologic societies.

February 16, 2005—Seeking Witness

The main theme of this dialogue is Nell’s slow movement toward death and her frustration at the delay. Her physical status is declining and she is visibly deteriorating. Since it is difficult for her to travel by car, we decided to meet in her home. She is frightened by her appearance changes and declares she looks like a beetle, with a bloated body and sticklike appendages. She longs for a witness to her bodily changes and yet is reluctant to ask her spouse Al to look at her. She is disappointed there is nowhere she can find the comfort of someone’s witness to her physical changes. She has met with her medical oncologist and come away frustrated because he has said death is not imminent and yet she is ready. Even so, Nell’s sense of humor is intact and she laughs about completing her income taxes: “Now I can die!” She has had an initial negative encounter with hospice and expresses her concern about their competence. She finds comfort in guided imagery introduced to her by her dear friend Mary, geographically distant but regularly present via phone call.

Clinical Annotations for Prostate Cancer Research: Defining Data Elements, Creating a Reproducible Analytical Pipeline, and Assessing Data Quality

Background: Routine clinical data from clinical charts are indispensable for retrospective and prospective observational studies and clinical trials. Their reproducibility is often not assessed. Objective: To develop a prostate cancer-specific database with a defined source hierarchy for clinical annotations in conjunction with molecular profiling and to evaluate data reproducibility. Design, setting, and participants: For men with prostate cancer and clinical-grade paired tumor-normal sequencing, we performed team-based retrospective data collection from the electronic medical record at a comprehensive cancer center. We developed an open-source R package for data processing. We assessed reproducibility using blinded repeat annotation by a reference medical oncologist. Outcome measurements and statistical analysis: We evaluated completeness of data elements, reproducibility of team-based annotation compared to the reference, and impact of measurement error on bias in survival analyses. Results and limitations: Data elements on demographics, diagnosis and staging, disease state at the time of procuring a genomically characterized sample, and clinical outcomes were piloted and then abstracted for 2,261 patients (with 2,631 samples). Completeness of data elements was generally high. Comparing to the repeat annotation by a medical oncologist blinded to the database (100 patients/samples), reproducibility of annotations was high to very high; T stage, metastasis date, and presence and date of castration resistance had lower reproducibility. Impact of measurement error on estimates for strong prognostic factors was modest. Conclusions: With a prostate cancer-specific data dictionary and quality control measures, manual clinical annotations by a multidisciplinary team can be scalable and reproducible. The data dictionary and the R package for reproducible data processing are freely available to increase data quality in clinical prostate cancer research.

Abiraterone prescribed by medical oncologist versus urologist in patients with metastatic castration-resistant prostate cancer: Real-world data from a public institution in Peru.

e18793 Background: Abiraterone, an androgen synthesis inhibitor, is used in the treatment of metastatic castration resistant prostate cancer (mCRPC) worldwide. Today, in some centers systemic treatment is indicated by both clinical and surgery oncologist, we aimed to evaluate if benefit with abiraterone differs between medical oncologist and urologist in a national cancer center. Methods: A single institution retrospective cohort was carried out. The medical records was queried for mCRPC population from 2019 to 2020 were reviewed. The main endpoint was progression-free survival (PFS). Descriptive statistics was used to summarize data. Chi2 test, estimating p-values, was used to compare the different variables with the type of service. Cox regression was performed for time to progression (months) with type of service, Hazard estimates and a 95% confidence interval (95% CI). Results: : Sixty-seven patients were included, 26 from clinical oncology and 41 from urology department. Mean age was 69 years in both groups. All patients received abiraterone. Forty-three patients (64.2%) had ECOG 0-1. Eighteen (69.2%) patients from clinical oncology and twenty five (60.9%) from urology departments had regular follow-up (every 3 months) with CT scans. Patients from clinical oncology and urology departments received abiraterone from second line in 65.3% and 17%, respectively. Sixteen patients had adverse events (23.1% in clinical oncology group and 24.4% in urology group). Six patients had grade 3-4 adverse events [3 (11.5%) belonged to clinical oncology and 3 (7.3%) to urology (HR 0.46, IC 95% 0.07-2.87; p=0.405)]. Seventeen (41.5%) patients from urology department lost sight during treatment meanwhile seven (26.9%) of patients from clinical oncology lost sight, mainly due to coronavirus pandemic. Fifty-one patients (76.1%) progressed in both groups, 80.8% belonged to clinical oncology and 73.2% to urology department. Mean time of progression was 5.1 months in patients from clinical oncology and 4.3 months from urology department (HR = 0.85; IC: 0.48 a 1.51; p=0.578). Conclusions: Although there is a slight difference in the patients who were lost from sight, the differences were not statistically significant between the groups. However, we highlight that patients with mCRPC had a worse progression-free time in both groups than in other international reports and it is necessary to explore the factors involved.[Table: see text]

Patient care in medical oncology

Dr. Sanatani is a medical oncologist at the London Regional Cancer Program at Victoria Hospital. Originally interested in general medicine, he then changed routes to medical oncology. We had the opportunity to talk to Dr. Sanatani about the field of medical oncology at LHSC, in Canadian healthcare, and the significance of the patient-physician relationship within the field.

First-Line Palliative Chemotherapy for Esophageal and Gastric Cancer: Practice Patterns and Outcomes in the General Population

PURPOSE: Clinical trials have shown that palliative chemotherapy (PC) improves survival in patients with incurable esophageal and gastric cancer; however, outcomes achieved in routine practice are unknown. We describe treatment patterns and outcomes among patients treated in the general population of Ontario, Canada. METHODS: The Ontario Cancer Registry was used to identify patients with esophageal or gastric cancer from 2007 to 2016, and data were linked to other health administrative databases. Patients who received curative-intent surgery or radiotherapy were excluded. Factors associated with the receipt of PC were determined using logistic regression. First-line PC regimens were categorized, and trends over time were reported. Survival was determined using the Kaplan-Meier method. RESULTS: The cohort included 9,848 patients; 22% (2,207 of 9,848) received PC. Patients receiving PC were younger (mean age, 63 v 74 years; P < .0001) and more likely male (71% v 65%; P < .0001). Thirty-seven percent of non-PC patients saw a medical oncologist in consultation. Over the study period, utilization of PC increased (from 11% in 2007 to 19% in 2016; P < .0001), whereas the proportion of patients receiving triplet regimens decreased (65% in 2007 to 56% in 2016; P = .04). In the PC group, the median overall and cancer-specific survival from treatment initiation was 7.2 months. CONCLUSION: One fifth of patients with incurable esophageal and gastric cancer in the general population receive PC. Median survival of patients treated in routine practice is inferior to that in clinical trials. Only one third of patients not treated with PC had consultation with a medical oncologist. Further work is necessary to understand low utilization of PC and medical oncology consultation in this patient population.