March 2018

As result of the Medicare Outpatient Prospective Payment System rule, 85% of 340B hospitals will see net payment increases in 2018, with rural hospitals reaping the largest benefits, according to an analysis conducted by Avalere Health that was commissioned by Community Oncology Alliance. This analysis compared 2017 Part B payments with 2018 payments and included 3814 hospitals.

Although immuno-oncology is increasingly gaining strength within the community setting, familiarity with ever-changing indications, and patient and nonspecialist education are persistent issues for community oncology providers. These are a few of the many barriers currently standing in the way, based on interviews, focus groups, and surveys from 2017.

In the sarcoma field, the potential benefit of immunotherapy is currently challenged not only by the heterogeneity of each patient, but also by the heterogeneity of each histologic subtype. William D. Tap, MD, discussed the role for immunotherapy in patients with soft tissue sarcomas and gastrointestinal stromal tumors (GISTs) during a presentation at the 2018 ESMO Sarcoma & GIST Symposium.

Following in the footsteps of pazopanib and olaratumab, many targeted therapies are being studied in patients with soft tissue sarcomas to capitalize on the benefits of targeted therapies in sarcomas. Although chemotherapy-driven approaches remain the standard for treatment of sarcomas, many sensitivities to chemotherapies have appeared in patients with sarcoma subtypes. These patients may benefit from targeted therapy approaches.

Since the identification of the role of the JAK kinase family&nbsp;in the late 1980s, awareness of this&nbsp;has grown significantly. These tyrosine<br /> kinases have been proven to transmit a variety of signals into the cells with many biological consequences, adding to the interest in the targetability of the JAK pathway. However,&nbsp;better understanding of the complexities of JAK signaling are being evaluated in clinical trials.

Responses to lisocabtagene maraleucel have been potent and durable in the&nbsp;treatment of patients with relapsed/refractory diffuse large B-cell lymphoma.&nbsp;Separate exploratory&nbsp;analyses of this population treated with liso-cel found that high tumor burden and a series of in ammatory biomarkers were associated with high chimeric antigen receptor T-cell expansion and higher rates of cytokine release syndrome and neurotoxicity.

Selective internal radiation therapy with yttrium-90 resin microspheres was better tolerated compared with sorafenib in patients with advanced unresectable hepatocellular carcinoma, However, findings from the phase III SARAH trial&nbsp;did not improve rates of overall survival or progression-free survival. A&nbsp;radiotherapy approach was compared with this targeted therapy in the SARAH trial.

Prithviraj Bose, MD, discussed the findings of 2 combination trials with ruxolitinib to optimize outcomes for patients with myelofibrosis.&nbsp;The JAK inhibitor ruxolitinib is the only FDA-approved therapy for the treatment of patients with myelofibrosis, but novel agents and combination regimens are in development to address some of the unmet needs in the field.

Tazemetostat showed efficacy in heavily treated patients with relapsed/refractory non-Hodgkin lymphoma in interim results from a phase II trial. Investigators hope that the analysis of a 62-gene panel biomarker performed on the same patient population will help to identify the patients who will have an even stronger response to the oral EZH2 inhibitor developed by Epizyme.

Newer combination regimens are about to make their way into the treatment paradigm in RCC, with promising data fueling excitement for these approaching regimens.&nbsp;Each of the combinations approaching addition to the treatment paradigm for patients with RCC incorporates immunotherapy, demonstrating the growing role of this modality.