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Checkpoint Inhibitor Immunotherapy for Advanced Cutaneous Squamous Cell Carcinoma
Therapeutic options are limited for patients with locally advanced or metastatic cutaneous squamous cell carcinoma. A phase I-II study with the experimental anti-programmed cell death-1 (PD-1) antibody cemiplimab found a 47 percent objective response rate in patients with metastatic disease, with more than 80 percent still responding at the time of data cutoff. While checkpoint inhibitor immunotherapy for advanced cutaneous squamous cell carcinoma remains experimental, these findings are promising for this therapeutic approach.
Multiparametric MRI in Men With Suspected Prostate Cancer
For men suspected of having prostate cancer based on either an elevated serum prostate-specific antigen (PSA) and/or abnormal digital rectal examination, transrectal ultrasound (TRUS)-guided biopsy has typically been performed for further evaluation. The use of multiparametric magnetic resonance imaging (mMRI), with or without targeted biopsy, was compared with TRUS-guided biopsy in the randomized PRECISION trial; biopsy was performed in the mMRI group for lesions that were suspicious for clinically significant prostate cancer (Gleason 3+4 or greater) and was not performed for MRI results not suggestive of prostate cancer. Targeted biopsy based on mMRI detected an increased number of clinically significant prostate cancers and decreased the number of men undergoing biopsy. As access to mMRI and expertise in interpreting these studies increases, the role of this technology in prostate cancer diagnosis will likely increase.
Treatment for Helicobacter Pylori and Risk of Metachronous Gastric Cancer
Helicobacter pylori infection is a well-defined risk factor for gastric cancer. For patients who have undergone endoscopic resection of early gastric cancer and who have H. pylori infection, treatment for H. pylori appears to reduce the risk of subsequent cancer. In a single-center randomized trial including 396 patients who had undergone endoscopic resection for early gastric cancer or high-grade adenoma, patients treated for H. pylori infection were less likely to develop a metachronous cancer after a mean follow-up of six years compared with those given placebo (7 versus 13 percent). H. pylori eradication therapy is recommended for patients with early gastric cancer who are found to be infected.
Guidelines for Colorectal Cancer Screening in Adults With Cystic Fibrosis
Individuals with cystic fibrosis have an increased risk for colorectal cancer and other digestive tract cancers. The Cystic Fibrosis Foundation (CFF) has developed new guidelines for screening for colorectal cancer in this population. The guideline recommends screening colonoscopy beginning at age 40 years, or at 30 years for those who have had an organ transplant, and describes an intensive bowel preparation protocol that should be used for cystic fibrosis patients.
High Rates of Regression of Cervical Intraepithelial Neoplasia, Grade 2
Management of high-grade cervical intraepithelial neoplasia (CIN 2 or 3) has evolved over time, and current guidelines encourage expectant management rather than conization for young women, based on high regression rates. In a meta-analysis including over 3000 women with untreated CIN 2 lesions managed conservatively, lesions regressed in 50 percent, persisted in 32 percent, and progressed in 18 percent at 24 months. Regression rates were even higher in women younger than 30 years: lesions regressed in 60 percent, persisted in 23 percent, and progressed in 11 percent. Most cases of progression were to CIN 3+; there were 15 cases of cervical adenocarcinoma. This study provides the most robust data to date in support of expectant management of CIN 2, particularly for younger women.
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