News in brief: Neoadjuvant therapy adds value in pancreatic cancer; TGA approves dual immunotherapy for mesothelioma; Clinical nutrition guidance for cancer patients

13 May 2021

Improved prognosis follows response to neoadjuvant therapy

Pancreatic cancer patients who respond to neoadjuvant therapy likely have a favourable disease biology and will progress well following resection.

An Australian review of outcomes in 60 patients, with either borderline resectable or locally advanced pancreatic cancer treated with neoadjuvant therapy (NAT) then curative resection, found mean recurrence-free survival was 30 months and OS 35 months.

“On multivariable analysis, inferior OS was predicted by enlarged loco-regional lymph nodes on initial computed tomography (p = 0.032), larger tumour size post-NAT (p = 0.006) and Common Terminology Criteria for Adverse Events post-NAT toxicity greater than grade 2 (p = 0.015),” the study said.

The study concluded that patients who respond to NAT should be selected for more aggressive upfront management, and those with resistant disease should be spared from high-risk surgery.

European Journal of Surgical Oncology

TGA approve improved treatment option for mesothelioma

Nivolumab (Opdivo) plus ipilimumab (Yervoy) has been TGA approved for first-line treatment of unresectable malignant pleural mesothelioma.

The combination’s registration is based on recent results from the CheckMate -743 trial, which found nivolumab plus ipilimumab improved overall survival compared to standard of care chemotherapy.

The international study, published earlier this year, found 2-year overall survival rates of 41% in the nivolumab plus ipilimumab group compared to 27% in the chemotherapy group.

The safety profile for nivolumab plus ipilimumab in first-line mesothelioma was manageable and consistent with previous studies of the combination in other tumour types.

The approval was granted under the TGA Priority Review process for treatments in areas of high unmet clinical need where substantial benefit has been demonstrated.

Practical nutrition guidelines for cancer patients

Despite the consumer frenzy around cannabinoids, new clinical guidelines do not recommend them to improve taste disorders or anorexia in cancer patients.

In one of 43 recommendations, the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on nutrition in cancer patients said there is simply not sufficient evidence for cannabinoids.

Also ruled out are glutamine supplementation to manage symptoms during chemotherapy or targeted therapy, and probiotics to reduce radiation-induced diarrhoea.

The guideline recommendations span general screening and assessment of nutritional status through to interventions for specific patient categories including patients undergoing different cancer treatments, palliative patients, and cancer survivors.

Nutritional interventions include oral, enteral or parenteral nutrition with exercise also featuring to support muscle mass, physical function, and metabolic pattern.

Clinical Nutrition

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