Santosh Rao, MD, the medical director of integrative medicine at Banner MD Anderson Cancer Center in Gilbert, Arizona, told ONCOLOGY he is excited about the advances made in integrative oncology. He and his colleagues foresee the inclusion of integrative medicine approaches in cancer management guidelines in the near future.
“Every year, there’s an increase in interest in integrative medicine. In 1996, integrative medicine was not well accepted,” he said. “We have come a long way in the last 20 years. More and more, positions are looking [to be filled by] clinicians and researchers who practice integrative oncology, and there will be more and more need as evidence grows. It’s definitely becoming more popular.”
Among many notable integrative oncology studies in 2018, Rao noted one that evaluated the effects of yoga on cognitive function in breast and ovarian cancer survivors as a standout. Lapen et al found that restorative yoga was better for the learning and processing of new information, whereas vigorous yoga was better at enhancing functions with regard to past memories.
Rao also highlighted a study by Chen et al that examined the effects of Quxie capsules, a type of traditional Chinese medicine used in antiquity to treat various tumor types, on colorectal cancer. The researchers found that, in mouse models, Quxie capsules suppressed the growth of colorectal cancer, in part mediated by alterations in the gut microbiome. Moreover, possibly secondary to changes in the gut microbiome, Quxie capsules also upregulated the expression of myosin 11, which might play a role in tumor inhibition.
Donald Abrams, MD, an integrative oncologist and professor of medicine at the University of California San Francisco’s Osher Center for Integrative Medicine, noted research published in JAMA Oncology in October of this year that made waves in the field—but in a much more negative light. Conducted by Johnson et al of Yale School of Medicine, researchers found that cancer patients who utilized complementary medicine were more likely to refuse conventional treatment, and therefore had a higher risk of death compared with those who did not use complementary medicine. According to Abrams, the study was unbalanced in that it compared a significantly smaller cohort of patients utilizing complementary therapies (258) compared with control (1,901,557), and the results thus “suggested that it [complementary medicine] was detrimental.”
The combination of either pembrolizumab or atezolizumab with chemotherapy made waves in the treatment of lung cancer in 2018, according to Apar K. Ganti, MD, an associate professor in the Department of Internal Medicine, Division of Oncology/Hematology, at the University of Nebraska Medical Center in Omaha.
With respect to metastatic non-squamous non–small-cell lung cancer (NSCLC), a global randomized controlled trial conducted by Paz-Ares et al found that adding pembrolizumab to chemotherapy (pemetrexed and carboplatin) nearly doubled the objective response rate (ORR) in patients. They also concluded that this combination proffers a tolerable safety profile.
In the Hoffman-La Roche phase III IMpower132 study, researchers showed that the combination of atezolizumab plus chemotherapy (cisplatin or carboplatin plus pemetrexed) reduced the chances of disease progression or death vs sole chemotherapy in first-line treatment of advanced NSCLC.
Tomasz M. Beer, MD, deputy director, Grover C. Bagby Endowed Chair for Prostate Cancer Research, and professor of medicine at OSHU Knight Cancer Institute in Portland, Oregon, told ONCOLOGY that the introduction of two new agents for the treatment of high-risk, non-metastatic, castration-resistant prostate cancer was particularly important. Apalutamide and enzalutamide were approved by the FDA based on the findings of the SPARTAN and PROSPER trials, respectively.
In the SPARTAN trial, apalutamide decreased the risk of developing metastasis and death by 72% vs placebo. In the PROSPER trial, enzalutamide lowered the chances of metastasis or death by 71% vs placebo. In both studies, men were treated with ongoing androgen deprivation therapy.[15,16] On a historical note, the FDA approval of apalutamide was a first for patients with non-metastatic, castration-resistant prostate cancer.
“For me, the big story in radiation [in 2018] was the emerging use of radiotherapy—most often SBRT [stereotactic body radiation therapy] for the treatment of oligometastatic disease,” James Yu, MD, MHS, director of Yale Medicine’s Prostate & Genitourinary Cancer Radiotherapy Program, told ONCOLOGY. “Several major studies presented at [the] ASTRO [American Society for Radiation Oncology meeting] or ESMO [the European Society for Medical Oncology meeting] are starting to validate the idea that aggressive treatment of disease with radiation and other local therapy such as surgery—even when [the cancer is] metastatic—may potentially improve outcomes.”
Yu specifically cited a phase II randomized controlled study in which Gomez et al found that local consolidative therapy plus or minus maintenance therapy for patients with three or fewer metastases from NSCLC that did not progress following initial systemic therapy enhanced PFS vs maintenance therapy alone. These findings indicate that aggressive local therapy has the potential to become a standard treatment alternative for these patients.
Financial Disclosure: The authors have no significant financial interest in or other relationship with the manufacturer of any product or provider of any service mentioned in this article.
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8. US Food & Drug Administration. FDA approves olaparib for germline BRCA-mutated metastatic breast cancer. https://www.fda.gov/drugs/informationondrugs/approveddrugs/ucm592357.htm. Published January 12, 2018. Accessed December 19, 2018.
9. US Food & Drug Administration. FDA approves rucaparib for maintenance treatment of recurrent ovarian, fallopian tube, or primary peritoneal cancer. https://www.fda.gov/drugs/informationondrugs/approveddrugs/ucm603997.htm. Published April 6, 2018. Accessed December 19, 2018.
10. Lapen K, Benusis L, Pearson S, et al. A feasibility study of restorative yoga versus vigorous yoga intervention for sedentary breast and ovarian cancer survivors. Int J Yoga Therap. 2018;28:79-85.
11. Chen D, Yang Y, Yang P. Quxie Capsule Inhibits the Colon Tumor Growth Partially Mediated by Modulating the Gut Microbiome and Myosin11; poster #2. Presented at the Gulf Coast Consortia 2nd Annual Antimicrobial Resistance and Gut Health Symposium; June 15, 2018; Houston, Texas.
12. Johnson SB, Park HS, Gross CP, et al. Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers. JAMA Oncol. 2018;4:1375-81.
13. Paz-Ares LG, Luft A, Tafreshi A, et al. Phase 3 study of carboplatin-paclitaxel/nab-paclitaxel (Chemo) with or without pembrolizumab (Pembro) for patients (Pts) with metastatic squamous (Sq) non-small cell lung cancer (NSCLC). Presented at the American Society of Clinical Oncology Annual Meeting; June 3, 2018, Chicago, Illinois. Abstract 105.
14. Papadimitrakopoulou VA, Cobo M, Bordoni R, et al. IMpower132: PFS and Safety Results with 1L Atezolizumab + Carboplatin/Cisplatin + Pemetrexed in Stage IV Non-Squamous NSCLC. Presented at the International Association for the Study of Lung Cancer 19th World Conference on Lung Cancer; September 23-26, 2018; Toronto, Canada.
15. Small EJ, Saad F, Chowdhury S, et al: SPARTAN, a phase 3 double-blind, randomized study of apalutamide versus placebo in patients with nonmetastatic castration-resistant prostate cancer. Abstract 161. Presented at the 2018 Genitourinary Cancers Symposium; February 8, 2018; San Francisco, California.
16. Hussain M, Fizazi K, Saad F, et al: PROSPER: A phase 3 randomized, double-blind, placebo-controlled study of enzalutamide in men with nonmetastatic castration-resistant prostate cancer. Abstract 3. Presented at the 2018 Genitourinary Cancers Symposium; February 8, 2018; San Francisco, California.
17. Gomez DR, Blumenschein GR Jr, Lee JJ, et al. Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study. Lancet Oncol. 2016;17:1672-82.