June 6, 2011
City Of Hope Researchers To Present Rectal Cancer, Palliative Care, Benchmarking Studies At ASCO
City of Hope researchers participated in more than 50 studies on improvements to cancer treatment, patient care and clinical trials to be presented at the 2011 Annual Meeting of the American Society of Clinical Oncology (ASCO) in Chicago, running from June 3 through 7.
Research highlights include:"Impact of neoadjuvant chemotherapy following chemoradiation on tumor response, adverse events and surgical complications in patients with advanced renal cancer treated with TME."
Monday, June 6, 8 a.m. to 12 p.m.
McCormick Place E450b
Discussion: 11:30 a.m. to 12:30 p.m., McCormick Place Hall D1
Study reveals rectal cancer patients benefit from having additional chemotherapy prior to surgery. Total mesorectal excision, in which a large portion of the bowel is removed, is considered the gold standard treatment for rectal cancers. Prior to surgery, patients often undergo neoadjuvant therapy with combined chemotherapeutic and radiation treatments. Patients who achieve a pathologic complete response to the neoadjuvant therapy have better expected outcomes from surgery, but a majority of patients do not show complete response, which prompts physicians to proscribe additional chemotherapy after surgery. Julio Garcia-Aguilar, M.D., Ph.D., chair of City of Hope's Department of Surgery, is the lead author of the multicenter study that examined how increasing cycles of chemotherapy in addition to chemoradiation prior to the surgery would impact a patient's complete response, treatment side effects and possible complications from surgery.
Three sequential phase II clinical trials enrolled a total of 175 patients with either stage II or III rectal cancer. The patients were treated with neoadjuvant chemoradiation, and then received different specified cycles of neoadjuvant chemotherapy, followed by total mesorectal excision.
"Patients who receive additional chemotherapy before their surgical procedures may achieve a greater rate of pathologic complete response without increases in side effects or complications compared to the standard approach, which can lead to better outcomes and no need for additional chemotherapy after surgery," said Garcia-Aguilar. "We're currently investigating whether providing all adjuvant chemotherapy before surgery rather than after may be an improved approach to treatment."
"Palliative care for patients with advanced lung cancer."
J Clin Oncol 29: 2011 (suppl; abstr e19610)
Patients have unmet needs and gaps in care when palliative medicine is not an integrated part of their treatment plan. Palliative care focuses on addressing physical, psychological, emotional and spiritual issues that patients face as they undergo treatment for their diagnosis. Marianna Koczywas, M.D., assistant professor in City of Hope's Department of Medical Oncology & Therapeutics Research, is the lead author of a National Institutes of Health study that examined lung cancer patients' experience of treatment with and without integrated palliative care. Patients with late-stage lung cancer were followed for six months and were assessed on four dimensions of quality of life. Eighty patients were enrolled in the group that received usual care without integrated palliative care. The key unaddressed symptoms patients reported were lack of energy, difficulty in sleeping, worrying and pain. Chart audits of the patients revealed limited use of advance directives or palliative care consultations.
"There is a significant gap in supportive care for lung cancer patients where we can provide better care for the issues that patients face alongside their cancer," said Koczywas. "These findings help us in developing a comprehensive educational intervention and resources to meet the needs of our patients."
"Benchmarking oncology clinical trials metrics across AACI member centers."
J Clin Oncol 29: 2011 (suppl; abstr e16613)
Douglas C. Stahl, Ph.D., vice president of Clinical Research Operations, is the lead author on a benchmarking study that was conducted as part of the Association of American Cancer Institutes (AACI) Clinical Research Initiative. The study was designed to document the time required for various clinical trial review and approval processes, capture best practices, and identify common challenges among participating centers. The research team reviewed 1,161 clinical trials reviewed at 14 different cancer centers during a one year period. Results showed a high degree of variability among participating centers, with contract negotiation requiring the greatest amount of time compared to all other review and approval processes. The study also revealed widespread challenges associated with incomplete and inconsistent capture of timing metrics for key process milestones.
"Opening an oncology clinical trial is a complex, time consuming process that is highly variable and inconsistently documented," said Stahl. "Our research has identified opportunities for process standardization and improvement that can be collaboratively developed and disseminated throughout the AACI."
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