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MANAGING OLDER PATIENTS WITH ALL TABLE 2. Outcome Data Concerning Older Patients with Acute Lymphoblastic Leukemia Group/Study Age No. of Patients CR Rate (%) OS (at 3 to 8 Yrs) Author UK NCRI 55-64 100 70 19% at 8 yrs Sive 2012 CALGB 60 129 57 12% at 3 yrs Larson 2005 MD Anderson 60 44 79 17% at 5 yrs Kantarjian 2000 SWOG 8419 50-84 85 41 Not reported Petersdorf 2001 GIMEMA 0208 50-60 121 68 15% at 8 yrs Annino 2002 PETHEMA ALL96 56-67 33 58 39% at 5 yrs Sancho 2007 SWOG 9400 50-65 43 63 23% at 5 yrs Pullarkat 2008 EWALL 56-73 40 85 Not reported Gokbuget 2008 Abbreviations: CR, complete remission; OS, overall survival; Yrs, years. data in patients who are less intensively treated. It is likely that some of those patients will also be MRD negative; this gives the option of escalating or de-escalating therapy. Most available MRD data uses molecular techniques; MRD data using flow cytometric techniques require further standardization and prospective evaluation. This latter technology is more frequently used in the United States. UNITED KINGDOM DATA Issues with the Data Fewer patients in this age group are enrolled in trials, and they are clearly a selected group and are probably unrepresentative of newly diagnosed older patients with ALL. The chance of early death is high as is refractoriness to chemotherapy. FIGURE 1. Survival of Adults with Acute Lymphoblastic Leukemia by Age Group Adapted from Rowe JM et al. Blood. 2005;106:3760-3767. SIVE ET AL The United Kingdom Medical Research Council (MRC)/ Eastern Cooperative Oncology Group (ECOG) collaborative group reported outcomes of therapy in 100 patients older than age 55 out of a total of 1,914 recruited to United Kingdom ALL XII/ECOG2993 (median age 56, range 55 to 65). 10 Patients were treated with the full protocol as detailed in Goldstone et al, 7 with no planned dose reductions. Compared with younger patients on study (younger than age 55), more were female, Ph-pos (28% vs. 17%, p 0.02) and slightly more were in a high-risk cytogenetic group (46% vs. 35%, p 0.07). The chance of CR was reduced by 20% (73% vs. 93%, p 0.001). Strikingly, 5-year overall survival was 21% in the older group compared with 41% in the younger group (Fig. 2). Induction mortality was higher (18% vs. 4%) and infections were more frequent (81% vs. 70%, p 0.05). A reported infection was associated with higher mortality, particularly if it occurred in both phases of induction. Bacterial infections also occurred at a 50% greater frequency in the older age group. Forty-six percent of older patients had dose reductions compared with 28% in the younger group (p 0.0009). The most common reason for dose attenuations was hepatic derangement and asparaginase was the drug most often omitted. Reductions in chemotherapy dose were not signifıcantly associated with worse outcomes but numbers were small. Importantly, Sive et al concluded that the induction protocol used in this study was too intensive for many older patients with ALL. They further stated that stratifying patients based on their disease risk and fıtness for therapy might be a way of individualizing therapy; those who are less fıt should be treated less aggressively. Although unproven, using MRD to guide decision making may also be valuable. ALL 60 Recognizing the lack of prospective data to inform decision making, the United Kingdom National Cancer Research Institute ALL group initiated a prospective study in patients with ALL older than age 60 with the goal of informing how physicians and patients use information about comorbidities and performance status at diagnosis to determine therapy. Comorbidity information is being collected using a variety of tools that have been validated in other groups of infırm patients including many with cancer. There is also a noninterventional registration arm (of patients not wishing to participate) that will enable the estimation of the proportion of older patients with ALL willing to enter prospective trials. asco.org/edbook | 2015 ASCO EDUCATIONAL BOOK e345
DAVID I. MARKS FIGURE 2. Survival of Patients by Age at Entry to Study Showing (A) Overall Survival and (B) Event-Free Survival in All Patients and (C) Overall Survival in Just Those Who Received Chemotherapy Adapted from Sive JI et al. Br J Haematol. 2012;157:463-471. e346 2015 ASCO EDUCATIONAL BOOK | asco.org/edbook
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AMERICAN SOCIETY OF CLINICAL ONCOLO
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American Society of Clinical Oncolo
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Controversies in Neoadjuvant Therap
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Clinical Trials of Precision Medici
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Managing Ovarian Cancer in the Olde
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Updates in the Multimodality Manage
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PEDIATRIC ONCOLOGY Real-Time Molecu
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2015 ASCO Annual Meeting Disclosure
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2015 Educational Book Expert Panel
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James Marshall, PhD Roswell Park Ca
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2015 Annual Meeting Supporters* MIS
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David Yurman Corporate Allies Conqu
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INVITED ARTICLES This year’s invi
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WONG, CAPASSO, AND ECKHARDT 3 3 sc
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WONG, CAPASSO, AND ECKHARDT terize
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STEPHEN T. SONIS portantly, patient
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HUSSAIN AND DIPAOLA TABLE 1. U.S. F
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ENG ET AL colorectal cancer. Indeed
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MICHAEL A. POSTOW Managing Immune C
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GYNECOLOGIC CANCER Managing Ovarian
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DUSKA, TEW, AND MOORE KEY POINTS A
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THERAPIES AND INDICATIONS FOR PH-NE
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LEUKEMIA, MYELODYSPLASIA, AND TRANS
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BEYOND SECOND-LINE TREATMENT FOR LU
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LUNG CANCER New Therapies for Histo
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GERBER, PAIK, AND DOWLATI a tumor t
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GERBER, PAIK, AND DOWLATI squamous
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GERBER, PAIK, AND DOWLATI gression
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BERNARDO H.L. GOULART lung-cancer/l
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LUNG CANCER Updates in the Multimod
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WOODARD AND JABLONS section, becaus
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NASSER HANNA Current Standards and
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NASSER HANNA At the 2014 ASCO Annua
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NASSER HANNA culty of this task. Va
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LYMPHOMA AND PLASMA CELL DISORDERS
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DAVID W. SCOTT Cell-of-Origin in Di
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CHEAH, OKI, AND FANALE Novel Treatm
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MOREAU AND TOUZEAU Multiple Myeloma
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MANAGEMENT OF CLL Up-Front Manageme
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MANAGEMENT OF CLL than 17p-/TP53mut
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MANAGEMENT OF CLL could be associat
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MANAGEMENT OF CLL tion by nonmalign
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MANAGEMENT OF CLL lymphocytic leuke
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PROGNOSTIC FACTORS AND ADJUVANT RAD
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MERKEL CELL CARCINOMA Merkel Cell C
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MERKEL CELL CARCINOMA 32. Leonard J
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PERFUSION AND INFUSION IN THE ERA O
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NEOADJUVANT THERAPY OF MELANOMA Neo
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MELANOMA/SKIN CANCERS Targeted Mole
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SULLIVAN ET AL FIGURE 1. Relevant S
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SULLIVAN ET AL Resistance to BRAF i
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SULLIVAN ET AL 17. Halait H, Demart
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SULLIVAN ET AL NRAS-mutant melanoma
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KLEPIN, RODIN, AND HURRIA Treating
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KLEPIN, RODIN, AND HURRIA plication
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PARTRIDGE, JACOBSEN, AND ANDERSEN w
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PARTRIDGE, JACOBSEN, AND ANDERSEN v
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LESLIE R. SCHOVER Sexual Healing in
Page 782 and 783:
LESLIE R. SCHOVER tinuous ADT in pr
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LESLIE R. SCHOVER 12. Potosky AL, H
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CATHERINE H. VAN POZNAK TABLE 1. Wo
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CATHERINE H. VAN POZNAK (tamoxifen,
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CATHERINE H. VAN POZNAK TABLE 3. FD
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CATHERINE H. VAN POZNAK premenopaus
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SHARI GOLDFARB KEY POINTS Brea
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SHARI GOLDFARB and friction with va
Page 798 and 799:
SHARI GOLDFARB importance both duri
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PATIENT AND SURVIVOR CARE Moving Su
Page 802 and 803:
MAYER ET AL TABLE 1. Quality Metric
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MAYER ET AL to enhance the quality
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MAYER ET AL FIGURE 2. (A) Infertili
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MAYER ET AL efıcial suggests that
Page 810 and 811:
PATIENT AND SURVIVOR CARE The Chall
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BRUERA AND PAICE Choice of Opioid a
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BRUERA AND PAICE toxicity and proce
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BRUERA AND PAICE effective. Basic s
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PEDIATRIC ONCOLOGY Real-Time Molecu
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CARROLL, RAETZ, AND MEYER KEY POINT
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CARROLL, RAETZ, AND MEYER most are
Page 824 and 825:
CARROLL, RAETZ, AND MEYER markers a
Page 826 and 827:
PEDIATRIC ONCOLOGY Translating Surv
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REDUCING THE BURDEN OF LATE EFFECTS
Page 830 and 831:
Page 832 and 833:
Page 834 and 835:
Page 836 and 837:
PROFESSIONAL DEVELOPMENT The Challe
Page 838 and 839:
ADVANCES IN WEBSITE INFORMATION RES
Page 840 and 841:
Page 842 and 843:
Page 844 and 845:
Page 846 and 847:
COMMUNICATION AND TECHNOLOGY: IT’
Page 848 and 849:
Page 850 and 851:
Page 852 and 853:
PATIENT-REPORTED OUTCOMES IN ONCOLO
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PATIENT-REPORTED OUTCOMES IN ONCOLO
Page 856 and 857:
PROFESSIONAL DEVELOPMENT Trends, An
Page 858 and 859:
CLINICAL ONCOLOGY PRACTICE 2015 FIG
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CLINICAL ONCOLOGY PRACTICE 2015 (6.
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CLINICAL ONCOLOGY PRACTICE 2015 Pro
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ADJUVANT/NEOADJUVANT MEDICAL THERAP
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Page 868 and 869:
Page 870 and 871:
INDICATIONS FOR ADJUVANT RADIATION
Page 872 and 873:
Page 874 and 875:
Page 876 and 877:
Page 878 and 879:
SARCOMA Latest Advances in Systemic
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SYSTEMIC THERAPY FOR OSTEOSARCOMA A
Page 882 and 883:
SYSTEMIC THERAPY FOR OSTEOSARCOMA A
Page 884 and 885:
RETHINKING TREATMENT FOR CHONDROSAR
Page 886 and 887:
Page 888 and 889:
Page 890 and 891:
Page 892 and 893:
BONE SARCOMAS IN ADULTS local disea
Page 894 and 895:
BONE SARCOMAS IN ADULTS structure a
Page 896 and 897:
SARCOMA Well-Differentiated and Ded
Page 898 and 899:
ABBAS MANJI ET AL ticular region. 7
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ABBAS MANJI ET AL MYXOID (ROUND CEL
Page 902 and 903:
ABBAS MANJI ET AL versus doxorubici
Page 904 and 905:
SHLUSH AND HERSHKOVITZ Clonal Evolu
Page 906 and 907:
SHLUSH AND HERSHKOVITZ FIGURE 1. Ti
Page 908 and 909:
TUMOR BIOLOGY New Strategies to Und
Page 910 and 911:
KNAPP, DHAWAN, AND OSTRANDER in dog
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KNAPP, DHAWAN, AND OSTRANDER TABLE
Page 914 and 915:
KNAPP, DHAWAN, AND OSTRANDER 14. Fe
Page 916 and 917:
SOURBIER, SRINIVASAN, AND LINEHAN M
Page 918 and 919:
SOURBIER, SRINIVASAN, AND LINEHAN F
Page 920 and 921:
SOURBIER, SRINIVASAN, AND LINEHAN T
Page 922:
Author Index Abbas Manji, Gulam ...
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