Transforming the Delivery of Cancer Care
Publications & Articles
Our latest publications and articles
Pharmacogenomics in cancer supportive care: key issues and future directions
August 1, 2021
Jai Patel, Ian Olver & Fredrick Ashbury
The complexity of cancer care has changed dramatically in the past decade. Advances in genomic science and proteomics have resulted in approvals of companion diagnostics, next generation sequencing (NGS) platforms, and novel immunotherapies and targeted therapies, which offer more precise treatments in contrast to the “one-size-fits-all” chemotherapy model. Patel, Olver and Ashbury describe and discuss how these novel agents have toxicities that require different management strategies. Moreover, pharmacogenomics (PGx) research shows that a better understanding of how cancer drugs and supportive agents are metabolized by patients is essential to inform clinical decision-making.
Challenges adopting next-generation sequencing in community oncology practice
June 28, 2021
Fredrick D. Ashbury, Keith Thompson, Casey Williams & Kirstin Williams
Innovative tools to support clinical decision making, including next-generation sequencing (NGS), make this an exhilarating time in oncology. The genomic characterization of tumors can also give direction to the development of novel drugs. The authors describe challenges to the adoption of NGS in community oncology practice so mitigation strategies can be developed to improve patient outcomes.
Germline alterations among Hispanic men with prostate cancer
May 28, 2021
Justin Shaya, Sarah M. Nielsen, Kathryn E. Hatchell, Edward D. Esplin, Robert L. Nussbaum, Nicole Weise, Lisa Madlensky, James D. Murphy, Ellena Martinez & Rana R. McKay
In this analysis, the Pathogenic/Likely Pathogenic alteration rate among Hispanic men was 7.1%, a much higher rate than has been previously reported, and the germline genomic landscape was similar to that of NHW men. The VUS rate was significantly higher among Hispanic men, a known consequence of under-testing among minority populations. These data support germline testing in Hispanic men with prostate cancer and emphasize the importance of improving testing rates.
Covid-19 and supportive cancer care: key issues and opportunities
April 30, 2021
Fredrick D. Ashbury
The disruption to people’s lives, including financial impacts, morbidity and loss of life caused by Covid-19 requires a dramatic transformation of cancer care delivery, including supportive care. Ashbury highlights implications for clinical practice during and post-Covid-19, including the durability of practice adaptations and opportunities for research into mechanisms to support supportive care post the pandemic, including e-Health technologies and alternative models of care.
Targeted Neoadjuvant Therapies in HR+/HER2-Breast Cancers: Challenges for Improving pCR
January 26, 2021
Nandini Dey, Jennifer Aske & Pradip De
A strong association of pCR (pathological complete response) with disease-free survival or overall survival is clinically desirable. The association of pCR with disease-free survival or overall survival in ER+/HER2-breast cancers following neoadjuvant systemic therapy (NAT) or neoadjuvant endocrine therapy (NET) is relatively low as compared to the other two subtypes of breast cancers, namely triple-negative and HER2+ amplified. On the bright side, a neoadjuvant model offers a potential opportunity to explore the efficacy of novel therapies and the associated genomic alterations, thus providing a rare personalized insight into the tumor's biology and the tumor cells' response to the drug. Several decades of research have taught us that the disease's biology is a critical factor determining the tumor cells' response to any therapy and hence the final outcome of the disease. Here we propose two scenarios wherein apoptosis can be induced in ER+/HER2- breast cancers expressing wild type TP53 and RB genes following combinations of BCL2 inhibitor, MDM2 inhibitor, and cell-cycle inhibitor. The suggested combinations are contextual and based on the current understanding of the cell signaling in the ER+/HER2- breast cancers. The two combinations of drugs are (1) BCL2 inhibitor plus a cell-cycle inhibitor, which can prime the tumor cells for apoptosis, and (2) BCL2 inhibitor plus an MDM2 inhibitor.
Surviving survival – challenge accepted: perspectives on survivorship in pediatric oncology
December 1, 2020
Max J. Coppes & Leontine C. M. Kremer
Until about a century ago, surviving childhood cancer was unconceivable. Over 7 decades ago, Ladd and Gross noted that in children with renal cancer, while mortality was still high, “a review indicates that about 25% of patients can be cured.” Over the next 25 years, standard approaches to specific childhood cancers were developed, initially locally, but soon afterwards involving multiple institutions. This led, initially in North America and Europe, to the creation of very large multidisciplinary study groups that set out to cure childhood cancers through high-quality research. Today, almost 80% of children and teenagers diagnosed with cancer who have access to appropriate care can expect to become long-term survivors. That of course is great news. There are, however, 2 caveats to the good news. First, over 80% of children do not have access to standard treatments, mostly related to where (the country) they live. As a result, worldwide survival to childhood cancer is only 20%. The second qualification to the good news is that for those who have access to appropriate therapies, there is a cost to survival, often considerable.
Opportunities for pharmacogenomics-guided supportive care in cancer
November 16, 2020
Jai N. Patel
Patel describes the large inter-individual variability in response to drugs used to manage myriad cancer-related symptoms. For example, pain affects more than 75% of cancer patients with advanced disease, but less than one-third achieve pain improvement with conventional strategies within 1 month. Depression affects about one-third of cancer patients and has been linked to poorer prognosis and survival. Despite newer generation antidepressants, about half experience nonresponse to treatment with a first-line antidepressant. Uncontrolled cancer-related symptoms may increase emergency room visits, reduce patient satisfaction, and disrupt cancer treatments.
Innovation-based optimism for lung cancer outcomes
November 11, 2020
Erin L. Schenk, Tejas Patil, Jose Pacheko & Paul Bunn Jr.
Lung cancer is the leading cause of cancer death in both males and females in the U.S. and worldwide. Owing to advances in prevention, screening/early detection, and therapy, lung cancer mortality rates are decreasing and survival rates are increasing. These innovations are based on scientific discoveries in imaging, diagnostics, genomics, molecular therapy, and immunotherapy. Outcomes have improved in all histologies and stages. This review provides information on the clinical implications of these innovations that are practical for the practicing physicians, especially oncologists of all specialities who diagnose and treat patients with lung cancer.
Management of Immune-Related Cutaneous Adverse Reactions to PD-1 and PD-L1 Inhibitors for the Inpatient Dermatologist
September 29, 2020
Simran Chadha, Andrew J. Para & Jennifer Choi
Programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors are immunotherapeutic agents associated with a range of auto-inflammatory cutaneous toxicities. This paper reviews the clinical approach to the diagnosis and management of immune-related cutaneous adverse events (irCAEs) to PD-1 and PD-L1 inhibitors, with emphasis on disease processes practitioners may encounter in hospitalized patients. Non-steroidal immunomodulatory agents are being increasingly utilized for moderate to severe cutaneous reactions and present an opportunity for further research into safe and effective therapies.
Uncertainty upon uncertainty: supportive Care for Cancer
and COVID-19
July 2, 2020
Anne M Young, Fredrick D. Ashbury, Lidia Schapira, Florian Scotté, Carla I Ripamonti & Ian N Oliver
A recent publication, co-authored by VieCure’s Chief Scientific Officer, Fred Ashbury PhD, and VieCure Clinical Advisory Council member, Dr. Ian Olver, and other experts, titled “Uncertainty upon uncertainty: supportive Care for Cancer and COVID-19,” highlights two key issues that cancer patients face, which have been exponentially amplified as a result of COVID-19, anxiety and distress. The authoring team encourages healthcare professionals, policy makers and patient groups to acknowledge, take action and extend additional support to cancer patients and their families during these unprecedented times, paying particular attention to the increasing psychosocial pressures brought about by the pandemic.
Cancer survivorship care during COVID-19 - perspectives and recommendations from the MASCC Survivorship
Study Group
May 25, 2020
Alexandre Chan, Fred Ashbury, Margaret Fitch, Bogda Koczwara, Raymond Javan Chan, On behalf of the MASCC Survivorship Study Group
Most respondents advocated for the wider use of telehealth and online platforms for post-treatment survivorship follow-up after the pandemic is resolved. Other suggestions to improve care after the pandemic included the routine use of virtual exams to observe images (e.g., mammography, CT scan), and the use of effective triaging of survivors’ needs over the phone, as well as strategies to improve the acceptability of telehealth among patients (such as the use of telehealth only after the first face-to-face appointment).