The OBR Blog

January 28, 2011 - 10:01 am Posted in Featured comments0 Comments

As a continuation of the collaboration between OBR and MDoutlook, we will be presenting you with a series of detailed post-ASH and post-SABCS trends research into the immediate clinical impact and integration of research presented at both meetings. The trends research is based on a series of Quick Polls across the MDoutlook platform of 47,000 cancer treaters globally. Feedback was collected within one week of each meeting and from more than 500 cancer treaters (approx 40% of respondents were attendees). No financial incentives were provided to participants.

This report covers T-cell Lymphomas.

Expanded Use of Romidepsin into Peripheral T-cell Lymphoma (PTCL) Will Have an Important Impact on Clinical Practice

Key Conclusions

  • Just over half of oncologists rated Abstract 114 High or Very High
    • Only 2% rated it Low
  • Suggests most will consider using romidepsin in PTCL when appropriate
    • Dependent on clinical suitability of patient AND regulatory approval / availability

 Abstract Title

  • Abstract 114: “Final Results From a Pivotal, Multicenter, International, Open-Label, Phase 2 Study of Romidepsin In Progressive or Relapsed Peripheral T-Cell Lymphoma (PTCL) Following Prior Systemic Therapy”

When Available and Used, Romidepsin is Only Used in a Limited Number of Patients with Cutaneous T-cell Lymphoma (CTCL)

 

Key Conclusions

  • Even with access to it, most oncologists have either used romidepsin in no or very few patients with CTCL
  • Low number may reflect rarity of this lymphoma

 Additional Information

  • “Not Available to me” is based on all responses; percentages for number of patients based only on those for whom it is available

Expanded Use of Pralatrexate into Cutaneous T-cell Lymphoma (CTCL) Will Have an Important Impact on Clinical Practice

Key Conclusions

  • About half of oncologists rated Abstracts on the use of pralatrexate in CTCL as High or Very High
    • Only 3% rated it Low
  • Suggests most will consider using pralatrexate in CTCL when appropriate
    • Dependent on clinical suitability of patient AND regulatory approval / availability

Abstract Titles

  • Abstract 1762: “Pralatrexate Is An Effective Treatment for Heavily Pretreated Patients with Relapsed/Refractory Transformed Mycosis Fungoides (tMF)”
  • Abstract 2800: “Identification of An Active, Well-Tolerated Dose of Pralatrexate In Patients with Relapsed or Refractory Cutaneous T-Cell Lymphoma (CTCL): Final Results of a Multicenter Dose-Finding Study”

Pralatrexate is Commonly Used in the Treatment of Peripheral T-cell Lymphoma (PTCL) When Available

Key Conclusions

  • Most oncologists with access to pralatrexate have used it in a limited number of their PTCL patients
  • Low numbers may reflect rarity of this lymphoma

Additional Information

  • “Not Available to me” is based on all responses; Percentages for # of patients based only on those for whom it is available

When Available and Used, Romidepsin is Only Used in a Limited Number of Patients with Cutaneous T-cell Lymphoma (CTCL)

Key Conclusions

  • Good awareness about these new therapeutics for T-cell lymphomas
    • High level of awareness may reflect the limited availability of highly effective treatments for these diseases
  • Most likely that these additional agents will be used in specific patient populations
    • May reflect the diversity of the T-cell lymphomas

Additional Information

  • Respondents indicated the type and extent each drug would impact the treatment landscape (or if unaware of the drug) in T-cell lymphomas
    • May have different impacts in other therapeutic areas

Conclusions from the ASH 2010 Quick Poll on T-cell Lymphomas

  • Presentations on the use of romidepsin in PTCL and pralatrexate in CTCL are seen as having a high clinical impact
  • Where available, both romidepsin and pralatrexate are being widely used by oncologists in T-cell lymphomas for which they already have FDA approval, albeit in a low number of patients
    • Romidepsin is currently approved for CTCL
    • Pralatrexate is currently approved for PTCL
  • Low numbers may reflect rarity of these lymphomas
  • Oncologists report they decide on the use of a drug for a particular tumor type independently of its use in other tumor types
  • With those it has an importance, drives increased use of 1st indication
  • While new drugs for T-cell lymphomas discussed at ASH are fairly widely known, they are expected to impact only a subset of patients

Final Thoughts

Quick polls are a fast way of measuring expected acceptance of clinical data post major medical meetings, and perhaps can be used to make some assumptions about adoption amongst providers. In today’s information hungry environment, the speed at which these polls can be conducted and analyzed can be advantageous for market planning and “pressure testing” acceptance of data amongst key stakeholders.

Submitted by Jan Heybroek, President, The Arcas Group

Email Jan Heybroek

January 26, 2011 - 11:01 am Posted in Featured comments3 Comments

For those of you who have been following this blog you will recall that I have spent a lot of time discussing cancer drug costs and the lack of any real control that CMS (Medicare) or private insurers have on determining what cancer drugs they will cover – regardless of their price. Although I have focused on Provenge®, which as predicted had a positive NCA hearing in November, the FDA withdrawal process of the Avastin breast cancer indication has also been very illustrative.

As many of you are probably aware, Avastin failed to show a survival benefit in 4 large randomized metastatic breast cancer studies: E2100, AVADO, RIBBON-1 and AVF2119g. The FDA issued a statement on December 16th recommending withdrawal of the breast cancer indication - “the data indicate that the drug does not prolong overall survival in breast cancer patients or provide a sufficient benefit in slowing disease progression to outweigh the significant risk to patients”(1). Genentech has indicated it will not voluntarily withdraw the indication and has asked for a hearing to present their rational for maintaining the indication. The debate concerns the fact that despite failing to demonstrate a survival benefit, a statistically significant improvement in progression-free survival (PFS) was observed in the studies. PFS essentially measures the duration of time a patient is in remission. The FDA considers overall survival (OS), which is the time until a patient dies, to be the “gold-standard” end-point for oncology drugs. Although many consider PFS to be a predictor of OS and patient benefit, it is prone to errors due to the subjective manner by which it is measured. Observing an OS benefit can also be difficult when testing a first-line treatment due to the influence of second and third line treatments that patients receive. My guess is that Genentech will argue that OS is not a feasible endpoint in first line metastatic breast cancer and that the results were confounded by 2nd and 3rd line treatment effects. Although this may be true, it does not change the fact that patients did not live longer - the benefit from Avastin was not sufficient to make a measurable difference and patients are at risk of side-effects. I predict that the FDA will withdraw the indication.

1. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm237172.htm

The fall-out from the FDA statement recommending withdrawal has been very interesting to say the least. In December the NCCN published an update to its breast cancer guidelines and compendia listing and remarkably its panel of experts decided unanimously to maintain usage of Avastin in breast cancer as a listed indication (evidence level 2A, 15-0 vote in favor) (2) . Remarkable, because this panel of experts came to a completely different conclusion than the independent FDA panel of experts. I suspect that the NCCN panel has a more “real-world” understanding of the impact of removing the indication and believe that an improvement in PFS is an important patient benefit. On the other side of the fence Palmetto GBA - a Medicare carrier and Regence BCBS - a private insurer, announced they would no longer cover Avastin in Breast cancer (3,4) .

2. http://www.nccn.org/professionals/drug_compendium/content/pdf/53_10_5_2010.pdf

3.http://www.palmettogba.com/palmetto/providers.nsf/docsCat/Providers~South%20Carolina%20Part%20B%20Carrier~Browse%20by%20Specialty~Oncology%20Hematology~Avastin%20Notice?open

4.  http://blue.regence.com/trgmedpol/drugs/dru215.pdf

You will re-call from my blog in October that CMS (and its carriers) and most private insurers are required by law to cover compendia listed indications regardless of whether or not they are approved by the FDA. As a Medicare Carrier Palmetto must adhere to this law, someone must have called them (perhaps a lawyer?) and remind them of this and the fact that the indication has not officially been withdrawn yet because the following day Palmetto redacted its announcement withdrawing coverage3 - ooops. Regence BCBS operates in Oregon which has a law that gives the state the ability to mandate coverage of compendia listed indications by an insurer if the insurer has denied coverage soley because of the absence of an FDA indication. I contacted Regence and they explained that their withdrawal was based on their determination that Avastin is not medically necessary for the treatment of breast cancer and so withdrawal of the FDA indication will not be their sole reason for denying coverage. This loophole makes the Oregon law mandating coverage of compendia listed off-label indications easy to bypass and ineffective. The state laws mandating private payer coverage of compendia listed indications apply to approximately 75% of the US population (5). Unfortunately, as the Oregon law demonstrates, they vary in their effectiveness. It will be interesting to watch and see whether other state laws will be able to maintain private payer coverage of Avastin when it officially becomes an “off-label” indication.

5. The Rising Price of New Oncology Drugs. Source: Peter B. Bach, M.D., M.A.P.P. N Engl J Med. 2009;360:626-633

The internet has lit up with stories on the subject from patient advocacy groups and even the right-right-wing tea folks like Rush Limbaugh. Understandably, the patient groups are demanding that the indication be maintained so that patients who are currently benefitting from Avastin can continue receiving it and maintain their insurance coverage. Interestingly, the National Breast Cancer Coalition has sided with FDA and noted that “we need to focus advocacy, public policy and resources on saving lives and doing more good than harm” (6). The right-right-wing types, including Rush Limbaugh, are pointing to the withdrawal of the indication as the first step in the enactment of Obamacare “death-panels” (7). Wow – they really do like to scare people with misinformation. There was not a conspiracy by the government to influence the independent FDA panel that reviewed the data last July nor will most patients be losing their insurance coverage. The fact remains that with-out a change in federal and state law, the compendia listing really controls what cancer drug indications are covered by CMS (Medicare) and most 3rd party private payers respectively. Is that a good thing? Probably. It keeps the decision about treatment in the hands of the patient and physician while improving care by eliminating the “cowboy” use of drugs for indications where no data exists. Although, the tax and health insurance payer in me does wonder how we will be able to pay for it over the long term. This issue illustrates the political conundrum in our country today. Coverage of clinically proven cancer drug indications are a necessity, we must be prepared to pay for them or find ways to control their costs so that they remain affordable. I will leave that subject to another blog…

6. http://www.stopbreastcancer.org/about/press-room/press-releases/2010/nbcc-responds-to-fda-decision-on-avastin.html

7. http://www.rushlimbaugh.com/home/daily/site_092410/content/01125111.guest.html

Update 2/2/11

Because of the high volume of traffic on the blog we have added a few interview quotes related to the Avastin topic that we have from the San Antonio Breast Cancer Symposium.

These comments, made prior to the FDA’s recommendation to withdraw the Avastin indication, were taken from OBR interviews conducted at SABC:

I mean the big elephant in the room is the cost. If this drug was completely affordable you would not be asking me about Avastin – nobody talks about it, but that’s the problem. Further, detractors or proponents agree that we have not a good job in developing biomarkers, or tests that will tell you in what patients you should or should not use Avastin.

Carlos L. Arteaga, M.D.
Donna S. Hall Chair in Breast Cancer
Professor of Medicine and Cancer Biology
Interim Director, Division of Hematology/Oncology
Vanderbilt-Ingram Cancer Center
Vanderbilt University, Nashville, TN

The FDA is not immune from politics and they are not also immune from the legal constraints in which they operate. I still consult with the FDA, and I’ve been on the ODAC, so I have a little experience, a little appreciation that they don’t live in a vacuum.

John T. Carpenter, MD
Professor, Hematology & Oncology
University of Alabama at Birmingham

I do generally give bevacizumab when I’m starting my first line chemo – I haven’t changed that because I don’t really believe that the weekly paclitaxel/bevacizumab data has fallen apart. I am disappointed though that RIBBON 1 and 2 trials, and AVADO, although positive, weren’t stronger, but the FDA reversing the label for breast would be unprecedented, and in my mind unwarranted.

Julie Gralow, MD
Clinical Research Division, Associate Member, Fred Hutchinson Cancer Research Center; Oncology Specialist,
Professor, Medical Oncology Division
University of Washington School of Medicine, Seattle

I think that certain patients do indeed benefit, and I think that part of the differences in trials may just be that the type of chemotherapy that is combined with bevacizumab actually matters, and maybe weekly taxanes are really the best pair for bevacizumab. …the question is how to best identify what drug to pair with bevacizumab in breast cancer, and what is the best patient.

Alberto Montero, M.D.
Assistant Professor of Medicine
Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami

I think among the breast cancer community, we would love to continue to be able to use this agent, and do feel that it is an active agent that met its primary endpoint in three well conducted, large randomized Phase III trials. It could be withdrawn, of course, and if that happens, I don’t think anyone in the breast cancer community thinks that that’s a scientific decision, but a decision based more on politics and economics.

Erica L. Mayer, M.D.
Instructor, Department of Medicine, Harvard Medical School
Director, Clinical Research (Faulkner Hospital), Dana-Farber Cancer Institute
Boston, MA

David is a veteran of the cancer business with 15+ years of experience commercializing several well known oncology therapeutics. He is currently a consultant and lives in San Diego. Please send your questions and comments to davidguy1@gmail.com.

January 25, 2011 - 10:01 am Posted in Featured comments0 Comments

As a continuation of the collaboration between OBR and MDoutlook, we will be presenting you with a series of detailed post-ASH and post-SABCS trends research into the immediate clinical impact and integration of research presented at both meetings. The trends research is based on a series of Quick Polls across the MDoutlook platform of 47,000 cancer treaters globally. Feedback was collected within one week of each meeting and from more than 500 cancer treaters (approx 40% of respondents were attendees). No financial incentives were provided to participants.

The second report covers Multiple Myeloma.

ASH 2010 Annual Meeting: Immediate Impact on Current Clinical Practices Multiple Myeloma (MM)

Lenalidomide Maintenance Will be Used in Half of Multiple Myeloma (MM) Patients, Regardless of the Patient’s Age

Key Conclusions

  • Half of patients with MM are expected to receive lenalidomide maintenance therapy in 2011
    • 20%-25% of oncologists expect to be using lenalidomide in all / nearly all MM patients
    • >10% will not be using any
  • Patient age will have minimal effect; an expected slight decrease in use after the age of 75

 Additional Information

  • Respondents selected the percentage of MM patients in each age group that they treat who they expect to use lenalidomide maintenance therapy for in 2011

The Use of Lenalidomide as Maintenance Therapy for Multiple Myeloma (MM) Continues to be Important in Clinical Practice

Key Conclusions

  • 5 out of 6 respondents rated Abstract 37 as having a High or Very High clinical importance
    • Only 2% rated it Low
  • Suggests strong enthusiasm for the use of lenalidomide maintenance therapy for MM

 Abstract Title

  • Abstract 37: “Phase III Intergroup Study of Lenalidomide Versus Placebo Maintenance Therapy Following Single Autologous Hematopoietic Stem Cell Transplantation (AHSCT) for Multiple Myeloma: CALGB 100104”

Lenalidomide Maintenance Therapy for Multiple Myeloma (MM) is Very Positively Rated by the Oncology Community

Key Conclusions

  • Even with some concerns of secondary malignancies with its use, lenalidomide maintenance therapy for MM is very highly rated by most oncologists
    • Nobody rated lower than 3
  • Average rating = 7.6

*Rating was done on a 10 point scale; 1= lowest to 10 = highest

Abstract Title

  • “Phase III Intergroup Study of Lenalidomide Versus Placebo Maintenance Therapy Following Single Autologous Hematopoietic Stem Cell Transplantation (AHSCT) for A Phase 3 Study Evaluating the Efficacy and Safety of Lenalidomide Combined with Melphalan and Prednisone In Patients ≥ 65 Years with Newly Diagnosed Multiple Myeloma (NDMM): Continuous Use of Lenalidomide Vs Fixed-Duration Regimens

Pomalidomide is Expected to Play an Important Role in the Future Management of Multiple Myeloma (MM)

Key Conclusions

  • Most oncologists (~90%) are aware about the development of pomalidomide as a therapeutic for MM
  • It is widely expected that pomalidomide will have a very important clinical impact in those patients for whom it is used
    • Relatively even split between beliefs pomalidomide will be used in a majority or only a specific subset of myeloma patients

Abstract Title

  • Abstract 859: “Phase 2 Study of 2 Modalities of Pomalidomide (CC4047) Plus Low-Dose Dexamethasone as Therapy for Relapsed Multiple Myeloma. IFM 2009-02”

Carfilzomib is Expected to Play an Important Role in the Future Management of Multiple Myeloma (MM)

Key Conclusions

  • Most oncologists (>85%) are aware about the development of carfilzomib as a therapeutic for MM
  • It is widely expected that carfilzomib will have an important clinical role in MM
    • Unsure if carfilzomib will have a large impact on small group of patients or a small impact on large group of patients

Abstract Titles

  • Abstract 985: “Results of PX-171-003-A1, An Open-Label, Single-Arm, Phase 2 (Ph 2) Study of Carfilzomib (CFZ) In Patients (pts) with Relapsed and Refractory Multiple Myeloma (MM)”
  • Abstract 3031: “Baseline Peripheral Neuropathy Does Not Impact the Efficacy and Tolerability of the Novel Proteasome Inhibitor Carfilzomib (CFZ): Results of a Subset Analysis of a Phase 2 Trial In Patients with Relapsed and Refractory Multiple Myeloma (R/R MM)”

Conclusions from the ASH 2010 Quick Poll on Multiple Myeloma (MM)

  • Maintenance therapy with lenalidomide is seen as a highly important advance in the management of MM
  • In 2011, it is expected that half of MM patients will receive lenalidomide maintenance therapy
  • Double the percentage of oncologists who will use it in all / nearly all of their MM patients as compared with those who will use it none of their MM patients
  • Little influence of patient’s age, although slightly less use in those over 75 years of age
  • Two new drugs being developed for MM, the IMiD palmalidomide and the proteasome inhibitor carfilzomib, are both widely expected to have a very positive impact on the clinical landscape

Final Thoughts

Quick polls are a fast way of measuring expected acceptance of clinical data post major medical meetings, and perhaps can be used to make some assumptions about adoption amongst providers. In today’s information hungry environment, the speed at which these polls can be conducted and analyzed can be advantageous for market planning and “pressure testing” acceptance of data amongst key stakeholders.

Submitted by Jan Heybroek, President, The Arcas Group

Email Jan Heybroek

January 19, 2011 - 07:01 am Posted in ASCO Conference Coverage comments0 Comments

A sneak preview of four studies to be presented at the upcoming ASCO GI (American Society of Oncology Gastrointestinal cancer) meeting in San Francisco (January 20-22) shows that the era of personalized medicine has arrived.  The studies, respectively, focused on intensity –modulated radiation therapy (IMRT) as a safer alternative to conventional radiotherapy for the treatment of  anal cancer, sorafenib as a third-line treatment option for gastrointestinal stromal tumors (GIST) resistant to both imatinib and sunitinib, a new gene signature test to identify patients with colorectal cancer at high risk for recurrence, and early use of  positron-emission tomography (PET) imaging to identify poor prognosis patients with a rare form of esophageal cancer.

IMRT in Anal Cancer

A small phase II study of 52 patients with stage II and III anal cancer showed that chemotherapy combined with IMRT was as effective but much less toxic compared with the same chemotherapy combined with conventional radiation after 2 years of follow-up.

Conventional radiation plus concurrent 5-fluorouracil and mitomycin-C is the standard of care for non-metastatic anal cancer, but conventional radiotherapy leads to significant toxicity due in part to the large area of the body that is radiated. By contrast, IMRT targets the radiation dose directly to the tumor and lymph nodes affected with cancer but spares healthy adjacent tissues, explained lead author Lisa Kachnic, MD, Boston University. The conformal radiation IMRT delivers is also referred to as “dose painted IMRT.”

Safety and efficacy results of the phase II RTOG 0529 study were compared with historical results from another study by the same group of investigators: RTOG 9811. At a median follow-up of 26.7 months, 2-year disease-free survival (DFS) was 77% and overall survival (OS) was 86% in RTOG 0529 compared with 75% DFS and 91% OS in RTOG 9811.  However, use of IMRT resulted in significantly less stage 3 or higher skin and GI toxicity; in fact, grade 3 or higher GI toxicity was 15% less, grade 3 or high skin toxicity was 50% less, and Grade 2 or h igher hematologic toxicity was about 13% less when IMRT was used compared with conventional radiation.

Because 85% of stage II and III patients with anal cancer are cured with radiotherapy plus chemotherapy, researchers have turned their attention to strategies to avoid toxicity, explained session moderator Jennifer Obel, MD. IMRT limits radiation to nearby tissues, which should improve quality of life. If results of this study are confirmed by future studies using IMRT as a treatment platform, “IMRT may emerge as a key treatment modality for anal cancer,” Dr. Obel predicted.

Sorafenib in Worsening GIST

A separate phase II trial found that sorafenib was a valuable third-line strategy in 38 patients with GIST resistant to first-line imatinib and second-line sunitinib.  Six patients were resistant to imatinib and 32 were resistant to both drugs. Sorafenib achieved tumor control (i.e., partial response or stable disease) in 68% of patients. One-year survival was 44%, and 2-year survival was 21%.

Sixty-one percent of patients required dose reductions of sorafenib, mainly for hand-foot syndrome and hypertension – two common side effects of this agent.

“Many of these patients whose tumors progressed or worsened on two lines of therapy had nothing left to try. Some of the patients in this study were treated with sorafenib for up to 3 years and did quite well. These results suggest that sorafenib is an additional option,” said lead author Nicholas P. Campbell, MD, University of Chicago, IL. Although sorafenib is not yet approved by FDA as third-line therapy for GIST, NCCN guidelines recommend sorafenib as a third-line option for GIST, and is typically covered by insurers, Dr. Campbell noted.

At the Presscast, Dr. Obel said: “Understanding the mechanisms involved in GIST has allowed great strides in treating this disease, with two new treatments over the past decade. This study suggests that sorafenib is now another option. Patients who progress on imatinib and sunitinib can consider sorafenib as well as enrolling in a clinical trial.”

ColoPrint Discriminates High- versus Low-Risk Colorectal Cancer

ColoPrint — an 18-gene signature test — correctly identified patients with stage II colorectal cancer at high risk of progression. Of the 235 patients included in the study, ColoPrint identified 73% as low risk and 27% as high risk. At a median follow-up of 97 months, only 5%of those identified as low risk had a recurrence compared with 20% of those deemed high risk

ColoPrint’s results were independent of the predictive value of most traditional clinical factors associated with recurrence. “There was a clear discordance between ASCO risk factors [e.g, T4, high grade, performance status, <12 lymph nodes assessed) and ColoPrint results, although there was a small degree of overlap. ColoPrint was the only factor to predict distant metastasis in stage II patients,” said lead author Robert Rosenberg, MD, University Hospital, Technical University, Munich, Germany. . ColoPrint could potentially be used to determine which patients can be safely managed without chemotherapy, he noted.

An ongoing prospective, international, multicenter study called PARSC is comparing ColoPrint versus clinical risk factors to predict risk of recurrence in stage II colon cancer.

ColoPrint is investigational, and the price of the test remains to be determined. Another genetic test for stage II colorectal cancer called Oncotype DX is commercially available and costs about $3000. Both tests have the same intent, Dr. Rosenberg explained. A major difference between them is that the 18 genes used in ColoPrint were based on an unselected review of the genome, while Oncotype DX was developed using a candidate gene. ColoPrint is a binary test – identifying low versus high risk -- while Oncotype DX discriminates between low, intermediate, and high risk with a lesser degree of sensitivity.

Dr. Obel said, “Both tests help to identify patients at high risk for recurrence, but neither test tells us who will benefit from chemotherapy with 5FU and oxaliplatin. At this point, we know the tests differ based on the way genes and datasets were derived, and ColoPrint is performed on fresh tissue while Oncotype DX is performed on frozen tissue.”

PET Assessment of Early Response in Esophageal Cancer

The prospective MUNICON II study found that using positron-emission tomography (PET) imaging to assess response early in the course of chemotherapy is an important prognostic tool for patients with locally advanced cancer of the esophagogastric junction. In the study, 56 patients were treated with 2 courses of chemotherapy and then underwent PET assessment to categorize them as responders (n=33) or non-responders (n=23). Responders continued chemotherapy for 3 additional months before surgery, while non-responders were treated with radiotherapy in hopes of shrinking the tumor size prior to surgery.

Twenty-seven of 33 responders (82%) were able to undergo complete resection versus 16 of the 22 non-responders (70%).  At a median follow-up of 38 months, median event-free survival and median OS had not yet been reached in responder, but rates were 15.4 months and 18.3 months, respectively, in non-responders.

PET-guided therapy has been used for other cancers, including lymphoma and lung. According to lead author Florian Lordick, MD, Klinikum Braunschweig, Brunswick, Germany, this is the first study to use early PET results to change treatment strategy in esophageal cancer.

“Unfortunately, our study showed that radiation was not an effective salvage treatment for non-responders. Prognosis in non-responders is still poor because of poor tumor biology,” he said.

The European Organization for Research and Treatment in Cancer (EORTC) plans to use early PET assessment to explore alternative treatment approaches for non-responders, Dr. Lordick said.

By Alice Goodman

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