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USPSTF Prostate Cancer Screening Guidelines Updated
Whether to screen for prostate cancer is a subject of much research and discussion. The US Preventive Services Task Force (USPSTF) updated its recommendations, saying to individualize decision-making about prostate cancer screening for men ages 55 to 69, including informing each man about the potential benefits and harms of screening and eliciting his values and preferences for screening. The USPSTF continues to recommend against screening men 70 years and older, and concluded that evidence was insufficient to make a specific recommendation regarding screening discussions for higher-risk groups: African-American men and those with a family history of prostate cancer. The USPSTF concluded that new evidence shows screening offers a small potential benefit for reducing prostate cancer mortality and metastatic disease, although many men will experience harms, including false-positive results, overdiagnosis, overtreatment, and treatment complications.
Ramucirumab Extends Survival in Advanced Hepatocellular Cancer With High AFP Level
Ramucirumab is a recombinant monoclonal antibody that binds to vascular endothelial growth factor receptor 2 (VEGFR-2), blocking receptor activation. The placebo-controlled REACH trial had suggested a potential survival benefit in a subset of patients with hepatocellular carcinoma (HCC) who were previously treated with sorafenib and had high serum levels of alfa-fetoprotein (AFP). In a preliminary report of the follow-up placebo-controlled REACH-2 trial, which was restricted to patients with AFP >400 ng/mL, second-line ramucirumab improved overall survival. However, the magnitude of benefit over placebo alone was numerically less than that seen in the REACH trial high AFP subset (1.2 versus 3.6 months). The objective response rate with ramucirumab was low (5 versus 1 percent), but the overall disease control rate (objective response plus stable disease) was 60 percent (versus 39 percent with placebo). One potential advantage of ramucirumab over other molecularly targeted second-line therapies for HCC is the absence of hand-foot skin reaction.
Apalutamide and Enzalutamide for Nonmetastatic Castration-Resistant Prostate Cancer
Men with nonmetastatic castration-resistant prostate cancer, as manifested by a rising serum prostate-free antigen (PSA) despite androgen deprivation therapy (ADT), are at high risk for developing metastatic disease. Two phase III trials of androgen receptor antagonists, the PROSPER trial with enzalutamide and the SPARTAN trial with apalutamide, demonstrated prolonged metastasis-free survival for the intervention compared with placebo. Largely based upon these results, both apalutamide and enzalutamide have been approved by the US Food and Drug Administration for treatment of nonmetastatic castration-resistant prostate cancer.
Observation After Surgery for Early Stage Uterine Leiomyosarcoma
For women with early stage uterine leiomyosarcoma (LMS), it is unclear whether adjuvant chemotherapy improves outcomes after surgery. Although a randomized trial in women with high-grade stage I uterine LMS was closed due to slow accrual, adjuvant chemotherapy did not improve progression-free or overall survival over observation among the 38 patients enrolled. These data support our approach of surveillance only after surgery, rather than treatment with adjuvant chemotherapy.
Global Burden of Melanoma Attributable to UV Radiation
Ultraviolet (UV) radiation is a known carcinogen and a recognized risk factor for melanoma and other skin cancers, especially in individuals with light complexion and poor tanning ability. A study aimed at quantifying the global population attributable fraction of melanomas due to UV radiation estimated that 168,000 new melanoma cases in 2012 were attributed to excess exposure to UV radiation, representing approximately 76 percent of all new melanoma cases worldwide. This finding provides further support to the recommendation that individuals at increased risk of melanoma and those highly exposed to sunlight should be counseled about adopting sun protection measures, including wearing sun-protective clothing and applying a broad-spectrum sunscreen daily and thoroughly before going out during daylight hours.
Cancer Predisposition Syndromes in Patients With Medulloblastoma
Medulloblastoma has been observed in association with several rare cancer predisposition syndromes, but the full spectrum of genetic risk has not been well characterized. In a study that analyzed clinical and molecular genetic data on more than 1,000 patients with medulloblastoma, 6 percent of patients had a germline pathogenic variant in one of six cancer predisposition genes: TP53 (Li-Fraumeni syndrome); PTCH1 or SUFU (Gorlin syndrome); APC (familial adenomatous polyposis); and BRCA2 or PALB2 (hereditary breast and ovarian cancer syndromes). The prevalence of a predisposing mutation was highest in patients with sonic hedgehog (SHH) subgroup tumors. More than half of patients had no family history or clinical signs of a cancer predisposition syndrome. Guidelines for genetic testing and counseling in patients with medulloblastoma are proposed based on these findings.
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