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USPSTF Recommendations for Colorectal Cancer Screening
The United States Preventive Services Task Force (USPSTF) issued new guidelines for colorectal cancer screening in average risk adults. The guidelines make a strong recommendation for screening, starting at age 50 years and continuing to age 75 for most patients, but in a departure from prior recommendations do not give preference for any one of seven screening test strategies over another. Options for screening are shown in a table. We agree with this screening test strategy based on shared decision making. Incorporating patient personal preferences may increase the likelihood that ongoing screening will occur.
Imatinib for Advanced GIST With a D842V Mutation
The tyrosine kinase inhibitor (TKI) imatinib is an effective first-line treatment for most patients with advanced gastrointestinal stromal tumor (GIST), but clinical response correlates with tumor genotype. Prior studies have suggested that some mutations (particularly the D842V mutation in the platelet-derived growth factor receptor alpha [PDGFRA]) confer absolute refractoriness to imatinib. In contrast, a preliminary report of a retrospective series presented at the 2016 annual American Society of Clinical Oncology (ASCO) meeting noted two partial responses among 16 patients with the D842V mutation who were treated with first-line imatinib, with a median time to tumor progression of eight months. While the response rate appears low, imatinib is less toxic for the majority of patients than are other TKIs, and can be tried prior to other agents.
Sequential Chemotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma
The role of sequential (induction) chemotherapy prior to concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma is uncertain. In a phase III trial organized by the Sun Yat-sen University, induction chemotherapy significantly improved overall survival at three years compared with concurrent chemoradiotherapy alone. These results require confirmation from other ongoing phase III trials before sequential therapy can be considered the standard of care.
Radiation Plus Temozolomide in Patients With 1p19q Non-Co-Deleted Anaplastic Gliomas
Two previous randomized trials in patients with anaplastic oligodendroglial tumors found that postoperative treatment with radiation plus PCV (procarbazine, lomustine, and vincristine) improved survival compared with radiation alone. However, the benefit of PCV was primarily seen in patients whose tumors contained co-deletion of chromosomes 1p and 19q. The CATNON trial enrolled 748 patients with newly diagnosed anaplastic gliomas without 1p19q co-deletion and randomly assigned them to one of four treatment arms: radiation alone, radiation with concurrent temozolomide (TMZ), radiation with concurrent and 12 cycles of adjuvant TMZ, and radiation with 12 cycles of adjuvant TMZ. In an interim analysis with a median follow-up of over two years, patients who were randomized to receive 12 cycles of adjuvant TMZ had improved overall survival compared with those who received radiation without adjuvant TMZ (hazard ratio 0.65). Based on these results, we now recommend radiation plus chemotherapy in all patients with newly diagnosed anaplastic gliomas, rather than just those with 1p19q co-deleted tumors. The choice between PCV and TMZ should be individualized based on molecular characteristics of the tumor and patient preferences.
Olanzapine for Prevention of Nausea and Vomiting Induced By Highly Emetogenic Chemotherapy Regimens
The antipsychotic olanzapine may be a particularly useful agent for preventing delayed chemotherapy-induced nausea and vomiting, which is often poorly controlled with conventional antiemetics. The effectiveness of adding olanzapine to a standard antiemetic regimen was shown in a trial in which 380 patients receiving highly emetogenic chemotherapy (cisplatin or doxorubicin/cyclophosphamide for breast cancer) were randomly assigned to dexamethasone, an NK1R antagonist, and a 5-HT3 receptor antagonist plus either olanzapine (10 mg daily orally on days 1 through 4) or placebo. The proportion of patients with no chemotherapy-induced nausea (the primary endpoint) was higher with olanzapine both in the first 24 hours after chemotherapy and in the delayed period. Rates of complete response (no emesis and no use of rescue medication) were also higher with olanzapine over a five-day period. Patients receiving olanzapine had more sedation on day 2 (severe in 5 percent), which resolved despite continued olanzapine. On the basis of this trial, we now suggest the addition of olanzapine on days 1 through 4 to standard antiemetic therapy for patients receiving highly emetogenic chemotherapy.