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Cardiovascular Disease Risk in Older Colorectal Cancer Survivors
New data suggest that older patients who were treated for early-stage colorectal cancer (CRC) have a higher than expected risk for cardiovascular disease (CVD) and heart failure. In an analysis derived from the linked SEER-Medicare database, 72,000 individuals over the age of 65 diagnosed and treated for nonmetastatic CRC between 2000 and 2011 were compared with a matched cohort of Medicare patients without cancer. The 10-year cumulative incidences of new-onset CVD and heart failure were more than twofold higher in patients treated for CRC. Risk increased with age and was influenced by exposure to fluoropyrimidines and preexisting comorbidities such as hypertension and diabetes. These findings provide evidence to support close medical surveillance for heart failure and CVD in older CRC cancer survivors, particularly those with preexisting hypertension and diabetes.
Adjuvant Chemotherapy for Upper Urinary Tract Urothelial Carcinoma
The outcome is generally poor for high-risk patients with urothelial carcinoma of the upper urinary tract. Preliminary results from the Peri-Operative chemotherapy versus sUrveillance in upper Tract urothelial cancer (POUT) trial found that adjuvant chemotherapy prolonged disease-free survival compared with surveillance followed by chemotherapy for recurrent disease. For high-risk patients who have undergone nephroureterectomy, we suggest adjuvant chemotherapy.
Androgen Receptor Antagonists for Non-Metastatic Castration-Resistant Prostate Cancer
Patients with non-metastatic castration-resistant prostate cancer, as manifested by a rising serum prostate-free antigen (PSA) despite androgen deprivation therapy (ADT), are at high risk for the development of metastatic disease. Two phase III trials of androgen receptor antagonists, the PROSPER trial with enzalutamide and the SPARTAN trial with apalutamide, demonstrated significantly prolonged metastasis-free survival for the intervention arm compared with placebo. The use of an androgen receptor antagonist in combination with ADT provides an important treatment option for patients with castration-resistant prostate cancer.
Heated Intraperitoneal Chemotherapy for Treatment of Unresectable Ovarian Cancer
Neoadjuvant chemotherapy (NACT) followed by interval cytoreduction and postoperative chemotherapy is an option in ovarian, fallopian tube, or peritoneal cancer (EOC) cases when optimal cytoreduction is not feasible. In a randomized trial of interval cytoreduction with or without the addition of heated intraperitoneal cisplatin therapy (HIPEC) in over 200 women with stage III EOC who had at least stable disease after three cycles of neoadjuvant chemotherapy, the addition of HIPEC lowered mortality (50 versus 62 percent) at a median follow-up of 4.7 years, increased median recurrence-free survival (14 versus 11 months) and overall survival (46 versus 34 months), with similar rates of serious adverse events. It is unclear whether the favorable effects of HIPEC were due to the additional dose of chemotherapy, the intraperitoneal route, or heated therapy. A limitation of HIPEC is that it requires specialized technical expertise.
Immunotherapy for Desmoplastic Melanoma
Desmoplastic melanoma is a rare variant of cutaneous melanoma. A multicenter analysis of 60 patients with desmoplastic melanoma found a high rate of durable responses in patients who were treated for metastatic disease with either a PD-1 or PD-L1 inhibitor (predominantly pembrolizumab or nivolumab). Although specific trials in patients with desmoplastic melanoma are not available, we believe that immunotherapy is an important therapeutic option for these patients, as it is for other advanced cutaneous melanomas.
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