Most Read Articles
Dr Margaret Shi, 18 May 2020

A blood test is shown to be feasible and safe for early detection of multiple cancers in women with no current or known history of cancer, enabling early treatment with curative intent in a subset of individuals.

Christina Lau, 20 Apr 2020

Hippocampal avoidance during whole-brain radiotherapy (HA-WBRT), together with memantine, better preserves cognitive function vs WBRT plus memantine in patients with brain metastases, without compromising survival, a multi-institutional phase III trial has shown.

Natalia Reoutova, 20 May 2020

Cancer patients infected with coronavirus disease 2019 (COVID-19) appear to be at higher risk of severe outcomes, including death, but cancer type and treatment serve as better predictors, according to recent research presented at the American Association for Cancer Research (AACR) 2020 Virtual Annual Meeting I.

At the time of writing, COVID-19 has spread to more than 200 countries and territories, affecting an estimated 4.5 million people and killing over 300,000. Cancer, on the other hand, is newly diagnosed in 18 million people and takes the lives of 10 million every year.

“We have invited physician scientists who are at the epicentre of the COVID-19 pandemic, taking care of patients with cancer. They gathered prospective information to understand the effects of COVID-19 on patients with cancer, are testing new treatments, and are making this knowledge available to the global research community, so we can all benefit from their experience,” said Professor Antoni Ribas from UCLA Medical Center, Los Angeles, California, US, chairperson of the COVID-19 and cancer plenary session of the meeting.

Natalia Reoutova, 28 May 2020

Fasting-mimicking diet (FMD) cycles in combination with endocrine therapy (ET) cause metabolic changes in hormone receptor (HR)-positive breast cancer patients analogous to those observed in animal models, where they are associated with anticancer activity.

Hippocampal avoidance in WBRT better preserves cognitive function without compromising survival

Christina Lau
20 Apr 2020

Hippocampal avoidance during whole-brain radiotherapy (HA-WBRT), together with memantine, better preserves cognitive function vs WBRT plus memantine in patients with brain metastases, without compromising survival, a multi-institutional phase III trial has shown.

In the NRG Oncology CC001 trial, 518 adult patients (median age, 61.5 years; primary lung cancer, 57.7 percent) with brain metastases outside a 5 mm margin around either hippocampus were randomized to receive HA-WBRT (n=257) or WBRT (n=261), together with memantine. HA-WBRT was delivered using intensity-modulated radiotherapy (IMRT) technique. In both groups, the prescribed WBRT dose was 30 Gy in 10 fractions. [J Clin Oncol 2020;38:1019-1029]

After a median follow-up of 7.9 months for patients who remained alive, the primary analysis showed a significantly lower risk of cognitive failure (defined as decline determined by reliable change index on ≥1 cognitive test) in the HA-WBRT vs WBRT arm (hazard ratio [HR], 0.76; 95 percent confidence interval [CI], 0.60 to 0.98; p=0.03). A significant treatment effect in favour of HA-WBRT plus memantine (HR, 0.74; 95 percent CI, 0.58 to 0.95; p=0.02) was found in the adjusted cause-specific analysis.

The better preservation of cognitive function with HA-WBRT vs WBRT was attributable to lower rates of deterioration in executive function at 4 months (23.3 percent vs 40.4 percent; p=0.01), as well as learning (11.5 percent vs 24.7 percent; p=0.049) and memory (16.4 percent vs 33.3 percent; p=0.02) at 6 months.

Importantly, overall survival (OS) and intracranial progression-free survival (PFS) did not differ significantly between the HA-WBRT and WBRT arms. Median OS was 6.3 months vs 7.6 months (HR, 1.13; 95 percent CI, 0.90 to 1.41; p=0.31), while median intracranial PFS was 5.0 months vs 5.3 months (HR, 1.14; 95 percent CI, 0.93 to 1.41; p=0.21).

Of note, there were fewer HA regional relapses in the HA-WBRT vs WBRT arm (11 vs 16).

No significant difference in grade ≥3 toxicity was reported between the HA-WBRT and WBRT arms.

In terms of symptom burden and quality of life, patients in the HA-WBRT arm experienced fewer cognitive symptoms (p=0.01) and less interference of neurologic symptoms in daily activities (p=0.008) at 6 months than those in the WBRT arm.

At 6 months, patients in the HA-WBRT arm reported less difficulty in remembering things (p=0.01), less difficulty in speaking (p=0.049), and less fatigue (p=0.04) than those in the WBRT arm.

“To our knowledge, this trial provides the first definitive clinical evidence that the hippocampal neuroregenerative niche is important to the pathophysiology of RT-induced cognitive decline,” the investigators wrote. “Our results provide confirmation that conformal avoidance of the hippocampal neuroregenerative stem-cell niche using IMRT during WBRT better preserves cognitive function and [reduces] patient-reported symptoms, with no significant difference observed in toxicity, intracranial PFS or OS.”

In the trial, the benefit of HA-WBRT emerged robustly with ≥4 months of follow-up, the investigators noted. For patients with life spans <4 months, previous trials showed that cognitive decline likely resulted from disease progression or other factors that contributed to shorter survival. [JAMA 2016;316:401-409; J Clin Oncol 2014;32:3810-3816] “Therefore, it seems reasonable to forgo HA during WBRT in patients with expected survival of <4 months,” they suggested.

“With these findings, HA-WBRT plus memantine should be considered a standard of care for patients with good performance status who plan to receive WBRT for brain metastases, with no metastases in the HA region,” they concluded.

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Most Read Articles
Dr Margaret Shi, 18 May 2020

A blood test is shown to be feasible and safe for early detection of multiple cancers in women with no current or known history of cancer, enabling early treatment with curative intent in a subset of individuals.

Christina Lau, 20 Apr 2020

Hippocampal avoidance during whole-brain radiotherapy (HA-WBRT), together with memantine, better preserves cognitive function vs WBRT plus memantine in patients with brain metastases, without compromising survival, a multi-institutional phase III trial has shown.

Natalia Reoutova, 20 May 2020

Cancer patients infected with coronavirus disease 2019 (COVID-19) appear to be at higher risk of severe outcomes, including death, but cancer type and treatment serve as better predictors, according to recent research presented at the American Association for Cancer Research (AACR) 2020 Virtual Annual Meeting I.

At the time of writing, COVID-19 has spread to more than 200 countries and territories, affecting an estimated 4.5 million people and killing over 300,000. Cancer, on the other hand, is newly diagnosed in 18 million people and takes the lives of 10 million every year.

“We have invited physician scientists who are at the epicentre of the COVID-19 pandemic, taking care of patients with cancer. They gathered prospective information to understand the effects of COVID-19 on patients with cancer, are testing new treatments, and are making this knowledge available to the global research community, so we can all benefit from their experience,” said Professor Antoni Ribas from UCLA Medical Center, Los Angeles, California, US, chairperson of the COVID-19 and cancer plenary session of the meeting.

Natalia Reoutova, 28 May 2020

Fasting-mimicking diet (FMD) cycles in combination with endocrine therapy (ET) cause metabolic changes in hormone receptor (HR)-positive breast cancer patients analogous to those observed in animal models, where they are associated with anticancer activity.