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ENG ET AL colorectal cancer. Indeed there are plans to open an NCIsponsored ASSIGN trial to test targeted agents in molecular subsets as second-line therapy of metastatic colon cancer. Although critically important to fınding and validating new targeted agents for colorectal cancer, the diffıculty in getting such a trial activated is daunting and would still leave the many other GI sites lacking this level of trial access. Although studies have shown that the cost of care for patients in cancer clinical trials is not substantially greater than the costs of routine care, insurance 16 companies have not universally embraced clinical trials as a component of standard care for patients with cancer. Legislative efforts such as SB37 in California have mandated that insurers pay for the routine care costs for patients to participate in a clinical trial and cannot deny access to a trial. However, loopholes exist. Nearly 30% of California adults are uninsured, which makes us hopeful that ACA will provide coverage for and access to clinical trials for those who were previously uninsured. In the 2014 ASCO Educational Book, the use of social media to improve clinical trial accrual was discussed. 17 Another creative use of the Internet is crowd sourcing for feedback on how to improve the design and accrual of a particular clinical trial. Leiter et al 18 used a Web-based platform that allowed participants to comment on the design of a clinical trial using metformin in prostate cancer. Hyperlinks were posted to social networking sites. The platform was available for 6 weeks, and this crowd-sourcing exercise resulted in 9 changes to the protocol, 4 of which were major changes. Certainly the potential of the Internet and social media to improve awareness of and accrual to trials remains relatively untapped. Patient advocacy groups may positively influence clinical trial accrual. The Pancreatic Cancer Action Network (PANCAN) has reported that although only 3% of patients with pancreatic cancer in the United States enroll in trials, 16% of those patients have called a help line to participate in clinical trials. Although an obvious selection bias favors patients and families who want more information, we would contend that the effect is real and that PANCANs advocacy for trials has an effect, even if not fıve-fold in magnitude. Sadly there are relatively few support groups for other GI sites and none of the size and fınancial power of those for breast and prostate cancer. However, if there could be a coalition of GI-minded advocacy groups to make clinical trial accrual a priority, we might hope that a similar improvement in accrual might occur. Trials such as BATTLE, ISPY, and, hopefully, ASSIGN should be encouraged and supported. Novel design methodologies might make such trials easier to complete with fewer patients needed to achieve clinically relevant endpoints. The PANGEA trial 19 for gastroesophageal cancers is one such novel design that merits further attention. In GI malignancies, the only molecular tests that have been validated to affect patient outcomes would be RAS testing for metastatic colorectal cancer, HER2/neu for metastatic gastric cancer, and microsatellite-instability (MSI) for stage II colon cancer. All other molecular tests should be the subject of further study. The plethora of molecular testing for cancer approved under the Clinical Laboratory Improvement Amendments of 1988 regulations is not linked to any accountability. Patients and oncologists alike, in good faith, may order such tests to be told that a drug seems like a good match for the genetic alteration “y” in the patient’s tumor, but rarely are there data to support a clinical benefıt of receiving that drug in that particular setting. We should fınd a way to encourage/mandate that any physician who orders a molecular profıle (outside the confınes of the examples listed above) should also obtain consent from the patient to review and discuss the results of the profıle, and if a treatment is administered purely on the basis of the molecular testing, that the response to that therapy is registered anonymously in a database available to all researchers. The establishment of such a database could be a source of discovery and aid in the design of clinical trials to validate promising results. Currently, the patient may or may not respond, but that information is lost to a future generation of patients with cancer who might have benefıted from that knowledge. CONCLUSION As academic oncologists, we know how rigorous the scientifıc methodology must be to prove a treatment is benefıcial. As a community of providers, patients and families, we know all too well the emotional and physical toll a cancer diagnosis takes. The price of neglect is too high. Together we must fınd ways to increase access, improve design, and speed completion of clinical trials—for the good of all. Disclosures of Potential Conflicts of Interest Relationships are considered self-held and compensated unless otherwise noted. Relationships marked “L” indicate leadership positions. Relationships marked “I” are those held by an immediate family member; those marked “B” are held by the author and an immediate family member. Institutional relationships are marked “Inst.” Relationships marked “U” are uncompensated. Employment: None. Leadership Position: None. Stock or Other Ownership Interests: George Fisher, Seattle Genetics (I). Honoraria: Cathy Eng, Sanofi, Roche, Lilly. Consulting or Advisory Role: George Fisher, Genentech. Cathy Eng, Roche/Genentech, Bayer Schering Pharma. Nancy Roach, Genentech. Speakers’ Bureau: None. Research Funding: George Fisher, Celgene (Inst), Novartis Pharmaceutical Group (Inst), Tercica (Inst), Bristol-Meyers Squibb (Inst), Newlink Genetics (Inst), Medivation (Inst), Pharmaceutical Research Associates (Inst), Polaris Group (Inst), Eli Lilly (Inst), PRA International (Inst), XBiotech (Inst), Bristol-Meyers Squibb (Inst), Tercica (Inst), Novartis, Celgene. Cathy Eng, Keryx, ArQule. Patents, Royalties, or Other Intellectual 42 2015 ASCO EDUCATIONAL BOOK | asco.org/edbook
CLINICAL TRIALS AND GI MALIGNANCIES Property: None. Expert Testimony: None. Travel, Accommodations, Expenses: George Fisher, Genentech/Roche. Nancy Roach, Millenium, Genentech. Other Relationships: None. References 1. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA. 2004;291: 2720-2726. 2. Ries LAG, Harkins D, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975-2003. http://seer.cancer.gov/archive/csr/1975_2003/. Accessed March 1, 2015. 3. Al-Refaie WB, Vickers SM, Zhong W, et al. Cancer trials versus the real world in the United States. Ann Surg. 2011;254:438-442. 4. Lavarreda SA, Brown ER, Cabezas L, et al. Number of uninsured jumped to more than eight million from 2007 to 2009. Policy Brief UCLA Cent Health Policy Res. 2010;(PB2010-4):1-6. 5. Sinha G. United Kingdom becomes the cancer clinical trials recruitment capital of the world. J Natl Cancer Inst. 2007;99:420-422. 6. Cancer Research UK. Over 60,000 cancer patients enrolled on clinical trials in the UK last year. http://www.cancerresearchuk.org/content/ over-60000-cancer-patients-enrolled-on-clinical-trials-in-the-uk-lastyear. Accessed March 11, 2015. 7. American Society of Clinical Onoclogy. Insurance Coverage for Clinical Trial Participants. http://www.asco.org/insurance-coverage-clinicaltrial-participants. Accessed March 2015. 8. Tepper JE. Gastrointestinal Cancers and the Cooperative Groups - 2011. Gastrointest Cancer Res. 2012;5(3 suppl 1):S1-S3. 9. Doroshow JH, Friedman S. National Cancer Institute. Clinical Trial Activation Timelines: Update on Implementation of the Operational Effıciency Working Group Recommendations. http://deainfo.nci.nih.gov/ advisory/ctac/1210/presentations/OEWG.pdf. Accessed March 8, 2015. 10. National Institutes of Health. Fact sheet: Impact of Sequestration on the National Institutes of Health. http://www.nih.gov/news/health/ jun2013/nih-03.htm. Accessed March 2015. 11. Glickman SW, McHutchinson JG, Peterson ED, et al. Ethical and scientifıc implications of the globalization of clinical research. N Engl J Med. 2009;360:816-823. 12. Institute of Medicine (US) Forum of Drug Discovery, Development, and Translation. Transforming Clinical Research in the United States: Challenges and Opportunities: Workshop Summary. http://www.ncbi.nlm.nih.gov/books/NBK50888/. Accessed March 2015. 13. VF News. Deadly Medicine. http://www.vanityfair.com/news/2011/01/ deadly-medicine-201101. Accessed March 2015. 14. Dimond EP, St Germain D, Nacpil LM, et al. Creating a “culture of research” in a community hospital: strategies and tools from the National Cancer Institute Community Cancer Centers Program. Clin Trials. Epub 2015 Feb 17. 15. Chiu JW, Serra S, Kamel-Reid S, et al. Next-generation sequencing: profıling gallbladder cancer (GBC). J Clin Oncol. 2015; 33:3s (suppl; abstr 286). 16. Fireman BH, Fehrenbacher L, Gruskin EP, et al. Cost of care for patients in cancer clinical trials. J Natl Cancer Inst. 2000;92:136-142. 17. Thompson MA. Social media in clinical trials. Am Soc Clin Oncol Educ Book. 2014;34:e101-105. 18. Leiter A, Sablinski T, Diefenbach M, et al. Use of crowdsourcing for cancer clinical trial development. J Natl Cancer Inst. 2014;106:dju258. 19. Catenacci DV. Next-generation clinical trials: novel strategies to address the challenge of tumor molecular heterogeneity. Mol Oncol. Epub 2014 Oct 18. asco.org/edbook | 2015 ASCO EDUCATIONAL BOOK 43
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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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NOWAKOWSKI AND CZUCZMAN sociated wi
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DAVID W. SCOTT Cell-of-Origin in Di
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DAVID W. SCOTT 10. Shaffer AL 3rd,
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CHEAH, OKI, AND FANALE Novel Treatm
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CHEAH, OKI, AND FANALE a similar me
Page 660 and 661:
CHEAH, OKI, AND FANALE TABLE 3. Sel
Page 662 and 663:
CHEAH, OKI, AND FANALE eral T cell
Page 664 and 665:
CHEAH, OKI, AND FANALE 77. Cairns R
Page 666 and 667:
STEPHEN ANSELL associated with pati
Page 668 and 669:
STEPHEN ANSELL Disclosures of Poten
Page 670 and 671:
MATEOS AND SAN MIGUEL Smoldering Mu
Page 672 and 673:
MATEOS AND SAN MIGUEL years. This f
Page 674 and 675:
MATEOS AND SAN MIGUEL previously me
Page 676 and 677:
MATEOS AND SAN MIGUEL TABLE 2. Risk
Page 678 and 679:
MATEOS AND SAN MIGUEL 30. Rajkumar
Page 680 and 681:
BHUTANI, LANDGREN, AND USMANI of th
Page 682 and 683:
BHUTANI, LANDGREN, AND USMANI bette
Page 684 and 685:
BHUTANI, LANDGREN, AND USMANI fıne
Page 686 and 687:
BHUTANI, LANDGREN, AND USMANI FIGUR
Page 688 and 689:
BHUTANI, LANDGREN, AND USMANI 15. K
Page 690 and 691:
MOREAU AND TOUZEAU Multiple Myeloma
Page 692 and 693:
MOREAU AND TOUZEAU other effıcacy
Page 694 and 695:
MOREAU AND TOUZEAU was able to indu
Page 696 and 697:
MOREAU AND TOUZEAU Group consensus
Page 698 and 699:
LYMPHOMA AND PLASMA CELL DISORDERS
Page 700 and 701:
MANAGEMENT OF CLL Up-Front Manageme
Page 702 and 703:
MANAGEMENT OF CLL than 17p-/TP53mut
Page 704 and 705:
MANAGEMENT OF CLL could be associat
Page 706 and 707:
MANAGEMENT OF CLL tion by nonmalign
Page 708 and 709:
MANAGEMENT OF CLL fludarabine and c
Page 710 and 711:
MANAGEMENT OF CLL lymphocytic leuke
Page 712 and 713:
PROGNOSTIC FACTORS AND ADJUVANT RAD
Page 714 and 715:
Page 716 and 717:
Page 718 and 719:
MERKEL CELL CARCINOMA Merkel Cell C
Page 720 and 721:
MERKEL CELL CARCINOMA tions in PIK3
Page 722 and 723:
MERKEL CELL CARCINOMA treating MCC
Page 724 and 725:
MERKEL CELL CARCINOMA 32. Leonard J
Page 726 and 727:
MELANOMA/SKIN CANCERS Locoregional
Page 728 and 729:
PERFUSION AND INFUSION IN THE ERA O
Page 730 and 731:
Page 732 and 733:
Page 734 and 735:
NEOADJUVANT THERAPY OF MELANOMA Neo
Page 736 and 737:
NEOADJUVANT THERAPY OF MELANOMA TAB
Page 738 and 739:
NEOADJUVANT THERAPY OF MELANOMA ity
Page 740 and 741:
NEOADJUVANT THERAPY OF MELANOMA 4.
Page 742 and 743:
MELANOMA/SKIN CANCERS Targeted Mole
Page 744 and 745:
SULLIVAN ET AL FIGURE 1. Relevant S
Page 746 and 747:
SULLIVAN ET AL Resistance to BRAF i
Page 748 and 749:
SULLIVAN ET AL TABLE 1. Clinical Tr
Page 750 and 751:
SULLIVAN ET AL 17. Halait H, Demart
Page 752 and 753:
SULLIVAN ET AL NRAS-mutant melanoma
Page 754 and 755:
KLEPIN, RODIN, AND HURRIA Treating
Page 756 and 757:
KLEPIN, RODIN, AND HURRIA plication
Page 758 and 759:
KLEPIN, RODIN, AND HURRIA plan was
Page 760 and 761:
KLEPIN, RODIN, AND HURRIA patient-s
Page 762 and 763:
KLEPIN, RODIN, AND HURRIA 62. Blanc
Page 764 and 765:
PERIPHERAL NEUROTOXICITY IN CANCER
Page 766 and 767:
Page 768 and 769:
Page 770 and 771:
Page 772 and 773:
PARTRIDGE, JACOBSEN, AND ANDERSEN C
Page 774 and 775:
PARTRIDGE, JACOBSEN, AND ANDERSEN c
Page 776 and 777:
PARTRIDGE, JACOBSEN, AND ANDERSEN w
Page 778 and 779:
PARTRIDGE, JACOBSEN, AND ANDERSEN v
Page 780 and 781:
LESLIE R. SCHOVER Sexual Healing in
Page 782 and 783:
LESLIE R. SCHOVER tinuous ADT in pr
Page 784 and 785:
LESLIE R. SCHOVER 12. Potosky AL, H
Page 786 and 787:
CATHERINE H. VAN POZNAK TABLE 1. Wo
Page 788 and 789:
CATHERINE H. VAN POZNAK (tamoxifen,
Page 790 and 791:
CATHERINE H. VAN POZNAK TABLE 3. FD
Page 792 and 793:
CATHERINE H. VAN POZNAK premenopaus
Page 794 and 795:
SHARI GOLDFARB KEY POINTS Brea
Page 796 and 797:
SHARI GOLDFARB and friction with va
Page 798 and 799:
SHARI GOLDFARB importance both duri
Page 800 and 801:
PATIENT AND SURVIVOR CARE Moving Su
Page 802 and 803:
MAYER ET AL TABLE 1. Quality Metric
Page 804 and 805:
MAYER ET AL to enhance the quality
Page 806 and 807:
MAYER ET AL FIGURE 2. (A) Infertili
Page 808 and 809:
MAYER ET AL efıcial suggests that
Page 810 and 811:
PATIENT AND SURVIVOR CARE The Chall
Page 812 and 813:
BRUERA AND PAICE Choice of Opioid a
Page 814 and 815:
BRUERA AND PAICE toxicity and proce
Page 816 and 817:
BRUERA AND PAICE effective. Basic s
Page 818 and 819:
PEDIATRIC ONCOLOGY Real-Time Molecu
Page 820 and 821:
CARROLL, RAETZ, AND MEYER KEY POINT
Page 822 and 823:
CARROLL, RAETZ, AND MEYER most are
Page 824 and 825:
CARROLL, RAETZ, AND MEYER markers a
Page 826 and 827:
PEDIATRIC ONCOLOGY Translating Surv
Page 828 and 829:
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
Page 854 and 855:
PATIENT-REPORTED OUTCOMES IN ONCOLO
Page 856 and 857:
PROFESSIONAL DEVELOPMENT Trends, An
Page 858 and 859:
CLINICAL ONCOLOGY PRACTICE 2015 FIG
Page 860 and 861:
CLINICAL ONCOLOGY PRACTICE 2015 (6.
Page 862 and 863:
CLINICAL ONCOLOGY PRACTICE 2015 Pro
Page 864 and 865:
ADJUVANT/NEOADJUVANT MEDICAL THERAP
Page 866 and 867:
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
Page 880 and 881:
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
Page 900 and 901:
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
Page 912 and 913:
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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