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By replacing CA 125 with a multivariate index assay (OVA1 blood test, Vermillion Inc), researchers showed the potential of a modified version of the American College of Obstetricians and Gynecologists guidelines to identify more ovarian malignancies before surgery. The modified guidelines detected almost 80% of all missed malignancies and more than 90% of missed epithelial ovarian cancers. The new guidelines, however, decreased specificity and positive predictive value.

In a multicenter, randomized, phase 2/3 trial, the 4-drug combination oxaliplatin/irinotecan/fluorouracil/leucovorin (FOLFIRINOX) prolonged median overall and progression-free survival and increased the overall response rate compared with gemcitabine, the reference standard, for patients with metastatic pancreatic adenocarcinoma and good performance status (0-1). However, the combination regimen was associated with more adverse events, especially febrile neutropenia, and a decrease in quality of life.

For women with stage II to III estrogen receptor–rich, HER2-negative breast cancer, neoadjuvant aromatase inhibitor (AI) therapy can increase the likelihood of successful breast-conservation surgery. According to phase 2 results of American College of Surgeons Oncology Group Z1031, exemestane, letrozole, and anastrozole are biologically equivalent and therefore likely to achieve similar adjuvant activities. The researchers concluded that because this is a low-toxicity approach, neoadjuvant AI therapy is a reasonable standard of care for selected members of this population.

A clinicopathologic staging system for diffuse malignant peritoneal mesothelioma (DMPM) stratifies survival through tumor-node-metastasis (TNM) criteria. Using prospectively collected data from 8 institutions, the developers identified 3 prognostic factors independently associated with survival: peritoneal cancer index, lymph node status, and extra-abdominal metastasis. The developers based the TNM system on these 3 factors, which they identified as influenced by disease progression from a set of 7 factors associated with improved survival in their univariate analysis of the data.

Objective response rates, median progression-free survival, and overall survival increased in patients with metastatic renal cell carcinoma (RCC) and sunitinib-induced hypertension, according to results of a retrospective analysis of more than 500 RCC patients treated with sunitinib. The rate of adverse events did not increase in hypertensive patients, except for renal adverse events (5% vs 3%). Because of the ease of clinical monitoring, the researchers concluded that, if prospectively validated, sunitinib-induced hypertension will make a desirable biomarker in these patients.

The US Food and Drug Administration (FDA) has approved everolimus (Afinitor, Novartis) for progressive neuroendocrine tumors of pancreatic origin (PNET) in patients with unresectable, locally advanced, metastatic disease.

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Using the recommended dose of 1.3 mg/m²administered as a 3- to 5-second bolus intravenous (IV) injection on days 1, 4, 8, and 11 of 21-day cycles, patients with relapsed multiple myeloma (MM) after 1 to 3 previous lines of therapy achieved noninferior efficacy with subcutaneous versus IV delivery of the drug when receiving up to eight 21-day cycles. In addition, those in the SQ arm experienced improvement in their systemic safety profile.

By sequencing, then comparing the whole genomes of tumors with those of the patient’s healthy cells in 50 women with breast cancer, researchers found more than 1700 mutations, most of which were unique to the individual. They identified 8 significantly mutated genes: PIK3CA, TP53, ATR, RUNX1, MYST3, PRSS8, ZNHIT2, and MAP3K1. Of these, PIK3CA (43%), TP53 (15.2%), and MAP3K1 (9.3%) were found to have the highest rates of incidence.