News in brief: HCV cure doubles survival in HCC; COVID-19 boosts confidence in home-based care; Surprise response to aromatase inhibitor in rare uterine cancer

Tuesday, 23 Feb 2021


DAAs the gateway drug to better liver cancer survival 

Patients with HCV-related liver cancer who have achieved HCV cure before their cancer diagnosis have improved overall survival compared with patients who are viraemic at diagnosis.

An Australian study of 422 patients with HCV-related hepatocellular carcinoma (HCC) found five-year overall survival was 51% in those who had achieved HCV cure before their cancer diagnosis but only 22% in the viraemic patients.

The retrospective study found 24% of patients had a HCV cure – following either interferon-based or DAA treatment – before their cancer diagnosis.

“With widespread use of DAA therapy, it can be expected that higher proportions of patients diagnosed with HCC will have prior HCV cure in coming years,” the study said.

The study found patients with HCV cure before HCC diagnosis were more likely to be detected by surveillance and have earlier tumour stage. However the survival benefit of a HCV cure remained significant in an adjusted analysis.

“If we can encourage patients who present for HCV treatment to remain engaged with the healthcare system and continue HCC surveillance after HCV cure, we can expect further improvements in HCV-related HCC survival in coming years,” the researchers concluded.

Journal of Viral Hepatitis


Pandemic opens up alternative models of care

COVID-19 has increased the acceptance for home-based management of low‐risk febrile neutropenia in children with cancer.

A survey of health care workers in paediatric oncology, infectious diseases and emergency medicine and parents/carers of children found high levels of support for the home‐based FN care.

Most healthcare workers thought it was important to implement a low-risk FN program at any time, but extremely important during the pandemic.

For some, the experience of other changes at their hospital in response to the pandemic had made them feel more comfortable with the idea of home-based care.

The majority of parents (>80%) were also interested in home based care for their children.

Over half (63%) were more worried about attending hospital since the pandemic started and 28% indicated they would now wait longer than usual before coming to hospital if their children developed a fever.

Non-COVID reasons for home based care included a general preference for a home setting, improved quality of life, reduced impact on family, perceived safety and positive anecdotal experiences.

The study said the pandemic had provided a unique opportunity to reassess health care delivery.

 Journal of Pediatrics and Child Health


Prospective trials still vital even in rare cancers 

The phase 2 PARAGON trial of anastrozole in patients with hormone receptor positive, recurrent low-grade endometrial stromal sarcomas (LGESS) has shown a modest objective response rate of 26.7%.

However the response rate is significantly lower than that seen in retrospective cases studies, some of which have shown up to 80% response rates.

“These tumors are rare and the reasons for the discordance in response rates between our study and the reported literature is most likely related to bias in reporting individual case reports, where typically a patient who appears to have had a good response is described, accompanied by a literature review,” the study said.

“Retrospective case series are also prone to bias, as they include a heterogeneous group of patients treated over a long duration of time usually in a single centre.”

The ANZGOG-led study of 15 patients showed a safety profile similar to other aromatase inhibitors. Grade 1 hot flushes, arthralgia and fatigue were the most common side effects.

Gynecologic Oncology

 

New first line option for patients with ALK positive NSCLC

The TGA has approved brigatinib (Alunbrig) for the first line treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive locally advanced or metastatic non-small cell lung cancer (NSCLC).

The second-generation ALK inhibitor has been available on the PBS since May 2020.

https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2019-PI-01282-1&d=20211110172310101

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