GI CANCERS

Several oncology experts discuss the FDA approvals they found most significant in 2018.

Tanios Bekaii-Saab, MD, discusses how community oncologists can play an important role in the advancement of gastrointestinal (GI) cancers despite not having access to major trials.

Cathy Eng, MD, discusses the current paradigm of GI cancers, specifically sharing insight on colorectal cancer and hepatocellular carcinoma.<br /> &nbsp;

During a&nbsp;<em>Targeted Oncology</em>case-based peer perspectives program, John Marshall, MD, reviewed his clinical considerations for the management of pancreatic cancer. Marshall discussed his treatment options and other factors that go into his decision making with the group during the meeting based on 2 case scenarios of patients with pancreatic adenocarcinoma.

There may be pros and cons for screening people who do not have symptoms of pancreatic cancer, but the evidence clearly supports screening those at a high risk for developing the disease,&nbsp;Vivek Kaul, MD, told his audience at the 2018 American College of Gastroenterology Annual Meeting.

The FDA has granted an&nbsp;accelerated approval to larotrectinib (Vitrakvi)&nbsp;for use in adult and pediatric patients with solid tumors that have an <em>NTRK</em> gene fusion without a known acquired resistance mutation, are metastatic or where surgical resection is likely to result in severe morbidity, and have no satisfactory alternative treatments or that have progressed following treatment.

Recent advancements in systemic therapies are changing the treatment landscape for patients with pancreatic cancer. New therapeutics and treatment strategies are emerging, meaning more patients than ever are candidates for curative procedures.

Amol K. Narang, MD, discusses the improvement in systemic therapy for treatment of pancreatic cancer in recent years. He says that the combination of various chemotherapies are showing potential in a number of trials.

Stephanie K. Dougan, MD, assistant professor, Dana-Farber Cancer Institute and Harvard Medical School, discusses the idea of augmenting T cell immunity in tumors that are poorly immunogenic, such as pancreatic cancer.

Anthony F. Shields, MD, PhD, discusses pivotal data from the IDEA pooled analysis, consisting of 6 international, noninferiority, phase III colon cancer studies.

Al B. Benson III, MD, FACP, FASCO,&nbsp;discusses the treatment landscape for advanced and metastatic CRC and how molecular profiling can play a vital role in selecting the optimal treatment plan for each patient. He also emphasizes the importance of participation in clinical trials to further understand these patients.

In a presentation at the 2018 International Society of Gastrointestinal Oncology Annual Meeting, Yung-Jue Bang, MD, PhD, discusses the most promising biomarkers and treatment approaches for patients with GEJ cancer, highlighting recent and ongoing trials of immunotherapy.

Hendrik-Tobias Arkenau, MD, PhD, discusses the rationale for using TAS-102 (trifluridine/tipiracil; Lonsurf) as a treatment for patients with gastric cancers.

Milind Javle, MD, discusses findings with the selective pan-FGFR kinase infigratinib in patients with intrahepatic cholangiocarcinoma and how they highlight&nbsp;the role of molecular profiling.

Ben George, MD,&nbsp;discusses the findings from the phase III TAGS study and how these data can impact the treatment landscape of metastatic gastric cancers.

Thor Halfdanarson, MD, discusses his takeaway message on neuroendocrine tumors (NETs) at the 2018 ISGIO Annual Conference.

Weijing Sun, MD, discusses a major topic in locally advanced gastroesophageal junction adenocarcinoma covered at the 2018 ISGIO Annual Conference in Arlington, Virginia.

James L. Wade III, MD, FACP, FASCO, discusses the importance of clinical trials in the community.

Based on data from the&nbsp;phase III TAGS trial,&nbsp;a supplemental new drug application seeking approval for TAS-102&nbsp;(trifluridine/tipiracil; Lonsurf)&nbsp;for use in previously treated patients with advanced or metastatic gastric adenocarcinoma,&nbsp;including cancer of the gastroesophageal junction, has been granted a priority review by the FDA.

I think one of the most important advancements in biomedical technology that has improved our understanding of the complexities of cancer is the ability to sequence the cancer genome for any individual patient, in a rapid and cost-effective manner, to help us make treatment decisions in the clinic.

According to a presentation at the 2018 ESMO Congress, risk of death was reduced with trifluridine/tipiracil versus placebo in patients with&nbsp;heavily pretreated gastric or gastroesophageal junction cancer.&nbsp;Lead TAGS trial author Hendrik-Tobias Arkenau, MD, PhD, said there was also improvement in progression-free survival and disease control.

Groundbreaking developments in cancer therapies can change lives, extending survival and sending patients who previously thought their chances were slim into remission. But these therapies come at a cost, and many patients reel at the prospect of heavy financial burdens. To help patients and programs meet the challenges of affording cancer treatments, community cancer centers are expanding the role of financial advocates in their organizations.

Thomas A. Gallo, MS, MDA, president of the Association of Community Cancer Centers, discusses his mission as president to &ldquo;reflect, renew, and reignite&rdquo; in order to create a more resilient oncology team for the community.

Larotrectinib induced an objective response rate of 80% in patients with advanced solid tumors who harbored&nbsp;<em>NTRK&nbsp;</em>gene fusions, according to results pooled from 3 small trials of the TRK inhibitor. Results were presented during the 2018 ESMO Congress.

Rising prescription drug prices continue to add to the burden of paying for quality healthcare. In an effort to confront such costs, the Centers for Medicare &amp; Medicaid Services has rescinded a prohibition on step therapy for Medicare Advantage plans. But some contend such a policy will reduce patient access to optimal medication.