ASCO 2017: Oncology Leaders Pick Their Top Abstracts

The 2017 ASCO Annual Meeting will soon unveil top-line findings across the field of oncology. Pivotal research in immunotherapy, targeted agents, and supportive care are among the much-discussed abstracts this year.

Key opinion leaders spoke with OncLive to share the top-5 abstracts they find to be the most exciting and/or potentially practice-changing across breast cancer, lung cancer, genitourinary cancers, gastrointestinal cancers, hematologic malignancies, and supportive care.

LUNG CANCER

H. “Jack” West, MD, thoracic oncologist, Swedish Cancer Institute at Swedish Medical Center

Alectinib (Alecensa) versus crizotinib (Xalkori) in treatment-naive advanced ALK-positive non—small cell lung cancer (NSCLC): primary results of the global phase III ALEX study (LBA9008)

H. Jack West, MD

The open-label study (NCT02075840) randomized treatment-naïve patients with ALK-positive NSCLC in a 1:1 ratio to alectinib or crizotinib. Progression-free survival (PFS) was the primary endpoint of the international study. Genentech (Roche), the developer of the second-generation ALK inhibitor alectinib, announced in April 2017 that the study had met its primary endpoint.

“Coming on the heels of the smaller, Japanese-only J-ALEX trial that demonstrated overwhelmingly clear superiority of alectinib over crizotinib in terms of extracranial and intracranial efficacy, as well as better tolerability with alectinib (at a lower dose of alectinib than is the current standard around the world), the ALEX trial results will change our standard of care for first-line treatment of ALK-positive advanced NSCLC to alectinib if the results are even in the ballpark of the remarkable benefits seen with alectinib in the J-ALEX trial.”

Gefitinib (Iressa) versus vinorelbine+cisplatin as adjuvant treatment in stage II-IIIA (N1-N2) NSCLC with EGFR-activating mutation (ADJUVANT): a randomized, phase III trial (CTONG 1104; Abstract 8500)

CTONG 1104 marks the first randomized trial to compare the EGFR tyrosine kinase inhibitor (TKI) gefitinib with vinorelbine/cisplatin—the standard of care in the adjuvant setting for patients with stage II-IIIA NSCLC with EGFR mutations. Prior studies, including BR19 and RADIANT, have shown that EGFR TKIs have not demonstrated benefit in the adjuvant setting for patients with unselected resected NSCLC. In CTONG 1104, gefitinib significantly prolonged disease-free survival (DFS) versus standard chemotherapy.

“These provocative findings may be interpreted as supporting use of an EGFR TKI as adjuvant therapy, but many might favor an approach of giving sequential adjuvant chemotherapy, as an established standard of care with a demonstrated survival benefit, followed by EGFR TKI therapy. At the same time, this trial will raise the critical question of whether we need to see a significant improvement in overall survival (OS) before adopting a new therapy approach in the curative setting—especially when we are considering recommending years of treatment, with the attendant side effects and costs, for patients who may well already be cured without it.”

Nivolumab (Opdivo) with or without ipilimumab (Yervoy) in advanced small cell lung cancer (SCLC): first report of a randomized expansion cohort from CheckMate-032 (Abstract 8503)

This phase I/II study is exploring multiple regimens of nivolumab with or without ipilimumab across several solid tumors, one of which is advanced SCLC. Following standard first-line platinum-based chemotherapy, patients with SCLC have a poor prognosis and limited treatment options. Early results demonstrated tolerability and efficacy for both the immunotherapy combination and nivolumab alone in patients with SCLC.

“Though only reporting results from a phase II trial, this presentation will have an outsized impact because nivolumab, with or without ipilimumab, is now being widely adopted as a leading treatment consideration in relapsed SCLC based on the inclusion of this option in the NCCN guidelines and the lack of enthusiasm felt for standard second-line topotecan. With immunotherapy more readily available than other potentially promising treatments only available in clinical trials, these results will be of great interest despite the lack of systematic evaluation of immunotherapy compared to better established standards in this setting.”

Impact of atezolizumab (Tecentriq) treatment beyond disease progression in advanced NSCLC: results from the randomized phase III OAK study (Abstract 9001)

In the primary analysis of OAK, a study of atezolizumab versus docetaxel in second- and third-line NSCLC, OS was improved with atezolizumab (HR, 0.73; 95% CI, 0.62-0.87); however, there was a similar PFS between the 2 arms (HR, 0.95; 95% CI, 0.82-1.10). Findings from this subanalysis of the OAK trial showed that atezolizumab had a clinical benefit in patients who received the PD-L1 inhibitor beyond progression.

“David Gandara, MD, and colleagues report that in the OAK trial of atezolizumab versus docetaxel as second-line therapy for advanced NSCLC, half of the patients demonstrating RECIST progression on atezolizumab continued it beyond progression. Among these 168 patients, 7% demonstrated a subsequent response, 44% achieved stable disease on later scans, and the median overall survival beyond progression was a rather impressive 12.7 months.

“There is obviously some selection bias of which patients were recommended to continue immunotherapy beyond progression, but it underscores the importance of distinguishing between RECIST progression and clinically significant progression, especially in a setting in which further treatment options are limited and the treatment is well tolerated, and immunotherapy may be particularly amenable to delayed benefits.

“It is important, however, for clinicians to avoid overgeneralizing to the conclusion that immunotherapy should be continued beyond progression in most or all patients, regardless of the degree of progression seen or the range of subsequent treatment options available.”

Impact of MET inhibitors on survival among patients with MET exon 14 mutant NSCLC (Abstract 8511)

For patients with NSCLC who have activating mutations that lead to MET exon 14 (METdel14) skipping, responses to MET inhibitors have been observed. In this abstract, researchers report findings from their multicenter retrospective analysis of patients with METdel14-mutant NSCLC, in which receiving a MET inhibitor was associated with an OS benefit.

“Though MET is not among the molecular markers routinely tested for in advanced NSCLC yet, work such as this will likely further drive the increasing trend toward broader genomic testing as the list of clinically relevant markers continues to grow. It argues that oncologists should seek to pursue MET inhibitor therapy, ideally in the setting of a clinical trial, in patients who have MET exon 14 mutation—positive advanced NSCLC.”

HEMATOLOGIC MALIGNANCIES, SUPPORTIVE CARE

Michael A. Thompson, MD, PhD, medical director for the Early Phase Cancer Research Program, Patient-Centered Research at the Aurora Research Institute

Overall survival results of a randomized trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment (Abstract LBA2)

This late-breaking abstract will unveil findings that have not yet been disclosed; however, Thompson explains the study will be of interest to multiple sectors of oncology.

Michael A. Thompson, MD, PhD

“This is somewhat of a departure from a plenary session drug study. It is of interest to patients, pharma [pharmaceutical companies], and the FDA. I previously chaired a session at the [2015 ASCO Annual Meeting] where Laura Strong, PhD, discussed this—‘The Past, Present, and Future of Patient-Reported Outcomes (PRO) in Oncology.’ PRO can be used in the short term for toxicity as well as for long-term events.”

Routine molecular screening of advanced refractory cancer patients: an analysis of the first 2490 patients of the PROFILER Study (LBA100)

PROFILER is a nonrandomized, multicenter, cohort study that aims to implement a personalized cancer medicine approach by proposing to establish the genetic and immunologic profile of patients’ malignant tumors, in order to define a map of genetic and immunologic profiles for all studied types of cancer (NCT01774409). It calls for a different therapeutic management of patients, including targeted agents or immunotherapy, based on recommendations of a multidisciplinary molecular tumor board.

“This large precision medicine study from France should be of interest due to the large numbers of patients with advanced refractory cancer. This and the follow up SHIVA OS analyses (abstract 11515) will not resolve all issues in precision medicine, but may be informative about patient selection.”

Next-generation sequencing in community oncology practice: beneficial or economical burden? (Abstract 102)

Researchers sought to examine the benefits and economical burden of using next-generation sequencing, especially in a nonacademic setting outside of a clinical trial, in this retrospective chart analysis of patients treated at a large community practice who had next-generation sequencing in 2015 and 2016.

“This study in the Clinical Science Symposium includes 209 patients with NGS testing in the community setting. These studies interest me, wearing the hat of Chair of the ASCO Research Community Forum and as a co-director of an Oncology Precision Medicine molecular tumor board and clinic in a large health system. I also noted the affiliation of one author as: Secamour High School, Indianapolis, IN. That is great to see.”

Daratumumab (Darzalex) in combination with carfilzomib (Kyprolis), lenalidomide (Revlimid), and dexamethasone (KRd) in patients with newly diagnosed multiple myeloma (MMY1001): an open-label, phase Ib study (Abstract 8000)

In this early-phase trial, patients with newly diagnosed multiple myeloma received daratumumab with KRd. The trial design called for the first dose of daratumumab to be split over 2 days. The addition of the CD38-targeting monoclonal antibody led to deep, durable responses, and the 4-drug regimen was well tolerated.

“This study may be the first to reference daratumumab split dosing (given in all patients on study) over 2 days. The infusion-related reaction rate was 27%. This regimen will be evaluated in the soon-to-activate amendment to the SWOG-1211 protocol in high-risk multiple myeloma of KRd with or without daratumumab.”

An open-label, single arm, phase IIa study of bortezomib (Velcade), lenalidomide, dexamethasone, and elotuzumab (Empliciti) in newly diagnosed multiple myeloma (Abstract 8002)

While elotuzumab was already approved by the FDA in November 2015 in combination with lenalidomide and dexamethasone, this phase IIa trial explored the efficacy of the novel agent with lenalidomide, subcutaneous bortezomib, and dexamethasone.

“Similar to the KRd plus daratumumab study, this 4-drug combination in newly diagnosed multiple myeloma has an overall response rate of 100%. These studies may iteratively get us closer to increasing the cure rate in multiple myeloma.”

GASTROINTESTINAL CANCERS

Tanios Bekaii-Saab, MD, medical oncologist, Mayo Clinic

OS analysis of the FOXFIRE prospective randomized studies of first-line selective internal radiotherapy (SIRT) in patients with liver metastases from colorectal cancer (Abstract 3507)

These 3 randomized studies evaluated the efficacy of combining first-line chemotherapy for metastatic colorectal cancer (mCRC) with SIRT using yttrium-90 (Y-90) resin microspheres in patients with liver metastases. The studies were designed for prospective, combined analysis of OS. Previously, phase III findings of the SIRFLOX study demonstrated a significant increase in hepatic depth of response with the addition of SIRT with Y-90 to standard frontline chemotherapy in patients with mCRC.

Tanios Bekaii-Saab, MD

“The long-awaited OS analysis of FOXFIRE, SIRFLOX and FOXFIRE-Global (FF-SF-FFG) randomized studies evaluating the efficacy of first-line chemotherapy for mCRC with SIRT using Y-90 resin microspheres in patients with liver metastases was disappointing. The addition of SIRT to first-line oxaliplatin-fluorouracil chemotherapy for patients with liver-only and liver-dominant mCRC did not improve OS or PFS, thus providing definitive evidence against the use of SIRT in this setting.”

Nivolumab with or without ipilimumab in patients with advanced/metastatic chemotherapy-refractory gastric, esophageal, or gastroesophageal junction cancer: CheckMate-032 study (Abstract 4014)

Earlier findings of this study showed promising clinical activity of the immunotherapy combination in Western patients with advanced chemotherapy-refractory gastric, esophageal, or gastroesophageal junction cancer. The updated findings include long-term follow-up of these patients.

“A recent phase III study (ONO-12) found a significant survival benefit with nivolumab in Asian patients with refractory gastro-esophageal cancer. In this study, nivolumab with ipilimumab led to durable responses and long-term OS in heavily pretreated Western patients with advanced G/E/GEJ cancer, which is consistent with the results of ONO-12 study. This study provides further support for the use of single-agent PD-1 inhibitors in patients with refractory G/E/GEJ cancer. It also supports further development of strategies incorporating CTLA-4 inhibitors in combination with PD-1 inhibitors in this group of diseases.”

Adjuvant capecitabine for biliary tract cancer: the BILCAP randomized study (Abstract 4006)

The phase III BILCAP trial aimed to determine whether capecitabine improves OS compared to observation following radical surgery in patients with biliary tract cancer, which typically has poor outcomes.

“This randomized study looked at the survival benefit of capecitabine versus observation in patients with completely resected cholangiocarcinoma or gallbladder cancer. In the per protocol analysis, capecitabine was found to improve survival and relapse-free survival significantly. Given the ease and wide availability of capecitabine, this study will lead to an immediate adoption of this agent into the treatment of patients with resected biliary cancer.”

Randomized trial of irinotecan and cetuximab (Erbitux) with or without vemurafenib (Zelboraf) in BRAF-mutant metastatic colorectal cancer (SWOG S1406; Abstract 3505)

In preclinical models, blockade of BRAF^V600 by vemurafenib causes feedback upregulation of EGFR, whose signaling activities can be impeded by cetuximab. In this study, patients with BRAF^V600—mutated and extended RAS wild-type mCRC were randomized to irinotecan and cetuximab with or without vemurafenib.

“The results of this study demonstrate a significant clinical benefit of the triplet (vemurafenib, cetuximab, and irinotecan) in patients with treatment-refractory BRAF^V600 mutated mCRC. This study supports the continued development of rational multiagent [regimens] in this molecular subset and a large phase III study (BEACON) will be evaluating the role of BRAF/MEK/EGFR inhibitors in this setting.”

SUNSHINE: Randomized double-blind phase II trial of vitamin D supplementation in patients with previously untreated metastatic colorectal cancer (Abstract 3506)

SUNSHINE was a multicenter double-blind phase II trial that randomized untreated patients with mCRC to standard treatment with mFOLFOX6 plus bevacizumab (Avastin) with 1:1 randomization to concurrent high vitamin D (vitamin D3 po 8000 IU/d every 2 weeks as loading dose followed by 4000 IU/d) or low vitamin D (standard vitamin D3 400 IU/d) until disease progression, unacceptable toxicity, or withdrawal of consent. The primary endpoint was PFS.

“Initial observations suggest that in mCRC patients, higher plasma levels of 25-hydroxyvitamin D are associated with improved outcome. The SUNSHINE study assessed the role of vitamin D supplementation in addition to standard chemotherapy in patients with mCRC. The study met its primary endpoint, with patients randomized to high vitamin D experiencing longer PFS compared to those randomized to low vitamin D. These very intriguing results warrant further confirmatory phase III randomized studies.”

GENITOURINARY CANCERS

Toni K. Choueiri, MD, clinical director, Lank Center for Genitourinary Oncology, director, Kidney Cancer Center, senior physician, Dana-Farber Cancer Institute

First-line avelumab (Bavencio) plus axitinib (Inlyta) therapy in patients with advanced renal cell carcinoma (RCC): results from a phase Ib trial (Abstract 4504)

Updated results of the phase Ib JAVELIN Renal 100, exploring the safety and clinical activity of avelumab combined with axitinib in treatment-naïve patients with advanced RCC will be reported at the meeting.

Toni K. Choueiri, MD

“Axitinib, a standard VEGFR inhibitor, can be combined with the PD-L1 inhibitor avelumab and result in acceptable toxicity with a response rate close to 60%, suggesting potential synergistic activity, justifying an ongoing phase III trial of this combination.”

IMmotion150: a phase II trial in untreated mRCC patients of atezolizumab and bevacizumab versus and following atezolizumab or sunitinib (Sutent; Abstract 4505)

The phase II IMmotion150 study randomized patients with untreated mRCC to atezolizumab plus bevacizumab, atezolizumab alone, or sunitinib alone. Crossover to atezolizumab plus bevacizumab was allowed following progression on single-agent atezolizumab or sunitinib.

“Bevacizumab, a VEGF ligand inhibitor, showed encouraging activity when combined with the PD-L1 inhibitor atezolizumab, especially in a biomarker driven population (PD-L1+ patients). The combo was also tolerated, justifying an ongoing phase III study with that combination.”

A phase I/II study to assess the safety and efficacy of pazopanib (Votrient) and pembrolizumab (Keytruda) in patients with advanced RCC (Abstract 4506)

Pazopanib is approved as a single agent for the treatment of patients with RCC. Its efficacy and safety as part of a combination regimen with a PD-1 inhibitor is explored in this abstract.

“Pazopanib in combination with the PD-1 inhibitor pembrolizumab showed significant hepatotoxicity and this combo is not suitable to test in a larger cohort.”

Randomized phase III trial of adjuvant pazopanib versus placebo after nephrectomy in patients with locally advanced RCC (PROTECT; Abstract 4507)

In PROTECT, researchers explored the efficacy and safety of pazopanib versus placebo in patients with locally advanced RCC post-nephrectomy. To improve tolerability, the starting dose following the treatment of 403 patients was lowered from 800 mg/daily to 600 mg/daily, and the primary endpoint was changed to DFS with pazopanib at 600 mg (n = 1135). The analysis was performed after 350 DFS events in the intent-to-treat 600-mg pazopanib group, and DFS follow-up analysis was performed after an additional 12 months.

“Joining ASSURE, the PROTECT study of adjuvant pazopanib in high-risk resected RCC did not show a difference in DFS over the control arm placebo in a 1500+ patient trial. One interesting finding is the better DFS with the higher dose of 800 mg/day, though this was a secondary analysis.”

Phase III trial of adjuvant sunitinib in patients with high-risk RCC: validation of the 16-gene Recurrence Score in stage III patients (Abstract 4508)

In the S-TRAC trial, adjuvant therapy with sunitinib compared with placebo prolonged DFS in patients with high-risk RCC. Moreover, the 16-gene Recurrence Score was developed and validated to predict risk of recurrence of RCC after nephrectomy in 2 cohorts of stage I-III pts. This abstract further validates the Recurrence Score results in high-risk stage III pts from S-TRAC.

“The prognostic value of the 16-gene assay was confirmed in the adjuvant S-TRAC, though this test is not predictive of benefit from sunitinib, but more so has prognostic value.”

BREAST CANCER

Francisco J. Esteva, MD, PhD, director of the Breast Medical Oncology program at Perlmutter Cancer Center, NYU Langone School of Medicine

Francisco J. Esteva, MD, PhD

APHINITY trial (BIG 4-11): A randomized comparison of chemotherapy plus trastuzumab (Herceptin) plus placebo versus chemotherapy plus trastuzumab plus pertuzumab (Perjeta) as adjuvant therapy in patients with HER2-positive early breast cancer (Abstract LBA500)Adding pertuzumab to trastuzumab and chemotherapy in the adjuvant setting was found to reduce the risk of recurrence of invasive disease or death in patients with HER2-positive early breast cancer in the phase III APHINITY study, which is the confirmatory trial for the September 2013 accelerated approval of pertuzumab for use in combination with trastuzumab and docetaxel as a neoadjuvant treatment for patients with HER2-positive, locally advanced, inflammatory, or early stage breast cancer.

“The addition of pertuzumab to trastuzumab-based chemotherapy improved DFS in the adjuvant setting for patients with early-stage HER2 positive breast cancer. Double antibody therapy using trastuzumab and pertuzumab is commonly used in the neoadjuvant setting, but long-term outcomes data were lacking. Results from the APHINITY trial support the use of pertuzumab in the adjuvant setting, especially in women at high risk of distant metastases.”

OlympiAD: Phase III trial of olaparib (Lynparza) monotherapy versus chemotherapy for patients with HER2-negative metastatic breast cancer and a germline BRCA mutation (Abstract LBA4)

AstraZeneca, the manufacturer of olaparib, announced in February that the PARP inhibitor olaparib improved PFS versus standard chemotherapy in patients with BRCA-positive, HER2-negative breast cancer, according to findings from the phase III OLYMPIAD trial that will be presented at the meeting.

“The PARP inhibitor olaparib may offer a new therapeutic option for patients with HER2-negative metastatic breast cancer who carry a germline BRCA mutation. Substituting olaparib for chemotherapy would be an important development in breast oncology, especially for patients with triple-negative breast cancer.”

MONARCH 2: Abemaciclib in combination with fulvestrant in patients with HR+/HER2- advanced breast cancer who progressed on endocrine therapy (Abstract 1000)

These phase III results of the MONARCH 2 trial will include the full findings of the CDK 4/6 inhibitor abemaciclib in combination with fulvestrant in patients with HR-positive/HER2-negative advanced breast cancer after progression on endocrine therapy.

“This study showed that the combination of abemaciclib and fulvestrant is an effective treatment in patients with HR+/HER2- advanced breast cancer who progressed on endocrine therapy. The study showed significant improvements in PFS and response rates compared to fulvestrant alone. This study confirms the strong potential of CDK 4/6 inhibitors to improve the efficacy of endocrine therapy in the metastatic setting.”

Overall survival results from the randomized phase II study of palbociclib (Ibrance) in combination with letrozole versus letrozole alone for frontline treatment of ER+/HER2- advanced breast cancer (PALOMA-1; TRIO-18; Abstract 1001)

The final OS results from this pivotal trial—which led to the accelerated FDA approval of palbociclib as a frontline treatment for postmenopausal women with ER-positive, HER2-negative metastatic breast cancer—will be presented.

“Palbociclib added to endocrine therapy has been integrated in the management of patients with ER/PR-positive, HER2-negative metastatic breast cancer, based on significant improvements in PFS rates compared with endocrine therapy alone. A trend towards an improvement in OS in the original PALOMA-1 trial is promising. OS data for the larger randomized trials (PALOMA-2, PALOMA-3) are highly awaited.”

A randomized, double-blind, phase III study comparing SB3 (trastuzumab biosimilar) with originator trastuzumab in patients treated by neoadjuvant therapy for HER2-positive early breast cancer; Double-blind, randomized phase III study to compare the efficacy and safety of CT-P6, trastuzumab biosimilar candidate, versus trastuzumab as neoadjuvant treatment in HER2-positive early breast cancer (Abstracts 509, 510)

Both clinical trials explore the efficacy of trastuzumab biosimilars as neoadjuvant therapy for patients with HER2-positive breast cancer.

“These studies showed that SB3 and CT-P6 are similar in safety and efficacy to the originator trastuzumab. The neoadjuvant setting offers the opportunity to test novel biosimilars in early-stage breast cancer. Both studies [that will be] presented at ASCO showed pathologic response rates within the prespecified range to show biosimilarity. In my opinion, pathologic complete response is an acceptable surrogate endpoint for efficacy of HER2-targeted antibodies. The development of high-quality clinical data is critical for approval of therapeutic monoclonal antibodies in breast cancer, especially in early stages of the disease. The availability of trastuzumab biosimilars is expected to expand access to this life-saving therapy across the globe.”

BREAST CANCER, SURVIVORSHIP

Deanna Attai, MD, assistant clinical professor of surgery at the David Geffen School of Medicine at the University of California Los Angeles

Axillary management in early breast cancer: surgeon attitudes in a population-based study (Abstract 561)

Deanna Attai, MD

Researchers surveyed physicians regarding their attitudes toward axillary lymph node dissection in patients with 1 to 2 positive sentinel nodes since the publication of the landmark study Z0011. Among the surgeons surveyed, 49% endorsed axillary node dissection for Z0011-eligible patients with 1 sentinel node macrometastasis, and 63% endorsed axillary node dissection for Z0011-eligible patients with 2 sentinel node macrometastases.

“As the bulk of cancer care is delivered in community settings, this study stresses the need for continuing physician education, especially for surgeons who may not treat a large number of breast cancer patients. Patients should also be encouraged to ask questions of their surgeon including case volume, whether or not there has been multidisciplinary input, and rational for axillary dissection if that procedure is recommended.”

Self-reported financial stress among patients evaluated at a community cancer program (Abstract 6553)

These are the findings of patient-reported financial stress, quality of life, and quality of health at an outreach cancer program located in a federally qualified health center. Just over 50% of patients reported some degree of financial stress, and 12% of patients reported extreme financial stress. (See comment below abstract 6512 summary.)

How costs get discussed (or not) in routine oncology practice (Abstract 6512)

On both abstracts 6553 and 6512: “As physicians, we can no longer ignore the financial impact that our recommended treatments have on our patients. These studies should serve as a call to physicians to educate themselves about the costs of various treatments, and the financial burdens that impact our patients.”

Survivorship care plans: recommended versus delivered care (Abstract 10076)

The American College of Surgeons Commission on Cancer and the National Accreditation Program for Breast Centers call for survivorship care plans to be distributed to patients upon completion of therapy. Survivorship care plans, Attai explains, are important for patients to summarize their treatment and to inform them of recommended follow-up as well as potential treatment side effects and signs and symptoms of recurrence. In addition, these plans can be helpful for the patient’s primary care physician.

“The authors of abstract 10076 noted that despite the delivery of survivorship care plans to patients, primary care physicians were often not notified, and many patients underwent redundant and unnecessary testing due to lack of care coordination and communication.”

What do social media-savvy cancer survivors tell us about the completeness of survivorship care plans? (Abstract 10063)

After surveying an online breast cancer community, the investigators found that only a small percentage of patients received a survivorship care plan, and none received a complete one.

“Care coordination remains important, even after active cancer treatment ends. Oncology team members need to do a better job communicating with primary care physicians during and after treatment, and patients need to be better informed regarding posttreatment surveillance guidelines and side effect management.”

Researchers reviewed audio recordings of a cross-section of medical oncology conversations to determine frequency, patterns, and attitudes of patients and providers on cost. Of 151 audio-recorded consultations between patients and oncologists, only 28% contained any mention of cost, and the average length of any cost discussion was less than 2 minutes. Patients usually initiated cost discussions.