50 episodes

As the leading authoritative, peer-reviewed audio source of oncology clinical news for clinicians and healthcare professionals, the AJO Podcast regularly brings you exclusive interviews with the world's leading researchers and clinicians responsible for pushing out the boundaries of science and practice.

Medicine, screening, radiotherapy, surgery, clinical trials, cancer care, epidemiology and prevention are covered impartially to give busy cancer professionals access to conversational spoken comments on the clinical implications of cancer developments in the real-world context, as practiced by cancer doctors and clinicians around the globe.

The AJO Podcast originates from the Audio Journal of Oncology—staffed by ex-BBC professional journalists, and mentored by world-leading cancer practitioners from bodies including the American Society of Clinical Oncology, Cancer Research UK, Istituto Nazionale dei Tumori, and Action Radiotherapy.

Each podcast is produced to the highest standards of audio recording and journalism and is subject to editorial appraisal to maintain that content, balance and clinical relevance of news and comment are delivered in a manner that's easy and enjoyable for listening while travelling, taking exercise, working or just relaxing.

Please contact Audio Medica with your comments and make your contribution to supporting a vibrant community of clinical cancer communicators!

Audio Journal of Oncology Podcast Audio Medica News

    • Science

As the leading authoritative, peer-reviewed audio source of oncology clinical news for clinicians and healthcare professionals, the AJO Podcast regularly brings you exclusive interviews with the world's leading researchers and clinicians responsible for pushing out the boundaries of science and practice.

Medicine, screening, radiotherapy, surgery, clinical trials, cancer care, epidemiology and prevention are covered impartially to give busy cancer professionals access to conversational spoken comments on the clinical implications of cancer developments in the real-world context, as practiced by cancer doctors and clinicians around the globe.

The AJO Podcast originates from the Audio Journal of Oncology—staffed by ex-BBC professional journalists, and mentored by world-leading cancer practitioners from bodies including the American Society of Clinical Oncology, Cancer Research UK, Istituto Nazionale dei Tumori, and Action Radiotherapy.

Each podcast is produced to the highest standards of audio recording and journalism and is subject to editorial appraisal to maintain that content, balance and clinical relevance of news and comment are delivered in a manner that's easy and enjoyable for listening while travelling, taking exercise, working or just relaxing.

Please contact Audio Medica with your comments and make your contribution to supporting a vibrant community of clinical cancer communicators!

    Volume CT Lung Cancer Screening Cuts Cancer Deaths 24 Per Cent

    Volume CT Lung Cancer Screening Cuts Cancer Deaths 24 Per Cent

    Second Study Confirms Lung Cancer CT Screening Cuts Deaths
    NETHERLANDS—Erasmus University Medical Center, Rotterdam—Research published in the New England Journal of Medicine has confirmed the viability of computed tomographic (CT) screening for detecting cases of lung cancer early in high-risk individuals—namely those who smoke heavily and or have done so for decades.
    A big new randomized study has confirmed that many deaths from lung cancer could be prevented by continuing and augmenting the global roll-out of computed tomographic (CT) screening for long-term heavy smokers. This follows important findings from the USA in which CT scanning was compared with chest X-ray for lung cancer detection that also came to the conclusion that many deaths from lung cancer can be prevented. Now that the professional community has confirmation from a separate study in a different continent with an alternative method of assessing CT (volumetric) the case for using CT screening for lung cancer may be considered to be convincing.
    The Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) population-based randomized controlled trial published in the New England Journal of Medicine emphasises the pivotal importance of addressing the epidemic of lung cancer which even today accounts for nearly a fifth of all cancer deaths worldwide. https://www.nejm.org/doi/full/10.1056/NEJMoa1911793
    In the Audio Journal of Oncology podcast first author Harry de Koning, MD PhD, Professor of Public Health at Erasmus MC University Medical Centre in Rotterdam, the Netherlands, tells reporter Peter Goodwin how a 24 per cent reduction in lung cancer mortality was found among men (after 10 years follow up) in the screening arm as compared to the control arm. Women did even better.  Koning makes the case for global adoption of CT scanning as a key method of reducing cancer deaths, which he says can be done at an affordable cost.
     
     
    Harry J. de Koning MD PhD

    • 16 min
    New Front Line Standard for Older Patients with Chronic Lymphocytic Leukemia

    New Front Line Standard for Older Patients with Chronic Lymphocytic Leukemia

     
    Audio Journal of Oncology
     
    SAN DIEGO—The first-line treatment of choice for older patients with chronic lymphocytic leukemia (CLL) should now be single agent ibrutinib according to conclusions drawn from the Alliance North American Intergroup Study A041202 reported at the 2018 Annual Meeting of the American Society of Hematology (ASH).
    https://ashpublications.org/blood/article/132/Supplement%201/6/265980/Ibrutinib-Alone-or-in-Combination-with-Rituximab
    “Unless there is a good reason why patients should be on bendamustine plus rituximab (meaning that they are inappropriate for ibrutinib) ibrutinib is the most reasonable choice for front line therapy,” said lead study author Jennifer A. Woyach MD, an associate professor at the Ohio State University Comprehensive Cancer Center of Ohio State University in Columbus, OH.
     
    Woyach told a press briefing that when they randomized patients “one to one to one” between three options for treatment: bendamustine  plus rituximab, ibrutinib given as a single agent daily until disease progression, or ibrutinib given in combination with rituximab, there was a clear superiority for the ibrutinib-containing regimens.
     
    “Progression-free survival was longer in the two ibrutinib-containing arms than in the bendamustine plus rituximab arm. And there was no difference in the progression-free survival between the two ibrutinib-containing arms.”
     
    Woyach said they had conducted the trial to try to define the most optimal therapy for older patients with CLL.  “We know that those patients are under-represented in many of our clinical trials,” she said. “So it’s hard to know whether much of our therapy can be extrapolated to this older patient group.”
     
    Since ibrutinib had already been compared in earlier studies to chlorambucil in the phase three setting (leading to its FDA approval) it had never been compared to a chemo-immuntherapy regimen used in the CLL, she said.  “So we tried to pick the most effective immunochemotherapy regimen for older patients—which is bendamustine plus rituximab—so that there would really be an effective comparator.”
     
    In Woyach’s data there was no difference in progression free survival between patients treated with ibrutinib alone and those who received ibrutinib plus rituximab. “So ibrutinib alone would be the standard,” she said.
     
    When she was asked about her choice of bendamustine plus rituximab as the comparator treatment she said there had been two reasons.  Of the two chemo-immunotherapy regimens used in older patients (bendamustine plus rituximab and chlorambucil plus obinutuzumab) at the time the study was designed only the bendamustine regimen had been FDA approved, she said. “[But] regardless of that bendamistine plus rituximab does have superior progression free survival when you look at comparing across studies,” said Woyach.
     
    Her interpretation of the study results? “For most patients this tells us that ibrutinib is the most effective drug for front-line CLL,” she said.
     
     
    Woyach AJO Prouction MASTER

    • 3 min
    Microbiome Diversity Key To Survival After Allogeneic Hematopoietic Cell Transplantation

    Microbiome Diversity Key To Survival After Allogeneic Hematopoietic Cell Transplantation

    Microbiome Diversity Key To Survival After Allogeneic Hematopoietic Cell Transplantation
    The Audio Journal of Oncology Podcast
    SAN DIEGO—Overall survival after allogeneic hematopoietic cell transplantation (allo-HCT) was found to be adversely influenced by a lack of diversity in the intestinal microbiota—before, during and after the transplant—in a study from four research centers in three countries reported at the 2018 annual meeting of the American Society of Hematology.
    https://ash.confex.com/ash/2018/webprogram/Paper116967.html
     
    https://www.ncbi.nlm.nih.gov/pubmed/31289031
     
    https://www.ncbi.nlm.nih.gov/pubmed/31262981
     
    https://www.ncbi.nlm.nih.gov/pubmed/31010813
     
    Microbiome injury
    The study found patterns of “microbiome injury” were strikingly comparable from country to country and from one transplant center to another—even when patients had different baseline microbiomes and the centers had different antibiotic practices, Jonathan Peled MD PhD, a bone marrow transplant physician at Memorial Sloan Kettering Cancer Center, New York told the Audio Journal of Oncology. “The implication is that associations observed in one center—or interventions that are observed to work in a trial at one center—are likely to be applicable broadly,” he said.
     
    “We hypothesize that the injury we observed during transplant is attributable to antibiotic exposures and to not eating much during the transplant—although the chemotherapy conditioning and other drugs could be playing a role too.”
     
    “We’ve known from animal studies that intestinal microbiota has a really important impact on how an individual who has received a bone marrow transplant does,” said Peled. And so the aim of the study had been to investigate this in humans: “And not just in a single-center observational fashion but in a multi-center large cohort so that we could really try to answer these questions definitively,” he said. The study had been designed to find out whether the pre-transplant microbiome diversity in the intestine could predict patient outcome.
     
    Bacterial diversity
    Peled explained that intestinal diversity was a measures “richness”—how many unique bacterial species were present in a sample, and also “even-ness”—how evenly each species was distributed in the sample.  Typically, healthy bacterial communities in the gut had very high diversities, he said. And one microbiome injury pattern—or dysbiosis—they had observed in transplant patients had been a severe loss of this diversity. “In transplant patients a loss of diversity is seen that’s more severe than in most so-called dysbiotic states in other clinical settings” he said.
     
    The study found that low diversity—either pre-transplant or post transplant—predicted for poor outcomes with shorter overall survival, increased transplant-related mortality, and—in some sub-sets of patients—more graft versus host disease, said Peled.  “The number one implication is that we need clinical trials to design or test strategies to remediate damage. And number two: It may well be that bacteria have a pathogenic role in the pathophysiology of graft versus host disease,” he said.
     
    Samples
    The researchers collected 1922 stool samples from 991 patients having allo-HCT—in the United States, Germany and Japan—at four transplant centers. Patients varied in their underlying diagnoses, donor-graft sources, conditioning intensities, and graft versus host disease (GVHD) prophylaxis. “This is the largest such cohort that’s been assembled to ask these kinds of questions to date. And a critical feature of the study is that although we collected samples from all over the world we analyzed them all in one laboratory to try to overcome some of the potential biases,” Peled said.
     
    Consistent dysbiosis
    On average patients from all four transplantatio

    • 10 min
    Genomic-led AML Clinical Decision Making Within Seven Days

    Genomic-led AML Clinical Decision Making Within Seven Days

    Audio Journal of Oncology
    Reporting from 2018 annual meeting of the American Society of Hematology
    SAN DIEGO—Individualized therapy decisions that are founded on “genomic fingerprint” data can now be made within seven days for most patients with suspected diagnoses of acute myeloid leukemia (AML) according to findings from the “Beat AML Umbrella Study for Previously Untreated AML” reported at the 2018 annual meeting of the American Society of Hematology (ASH). The research investigated the use of an algorithm combining data from clinical study evidence from trials with a range of targeted therapies. https://ashpublications.org/blood/article/132/Supplement%201/559/263190/Initial-Report-of-the-Beat-AML-Umbrella-Study-for
    “I think it will be a huge paradigm shift for how AML is treated. We’ve really pushed the technology to its edge,” said study author Amy Burd PhD, of the Leukemia and Lymphoma Society, White Plains NY, at an ASH press briefing.
    Real time
    Being able to make treatment decisions within the seven-day period of time was becoming closer to the desired “real time” ability to make these decisions, she told the Audio Journal of Oncology. “With the number of targeted therapies that have been approved it provides the opportunity for doctors to make better choices for their patients.”
    Algorithm
    The study demonstrated that the algorithm was reducing the time taken for decision making in a disease that required prompt treatment, said Burd. The algorithm had used data on 11 out of the 12 prominent sub-types of mutations characterizing different forms of AML—including such molecular features as TP53, FLT3, IDH1, IDH2, core binding factor and NPM1.
    She said the analysis achieved by the algorithm combined three different commercially available diagnostic assays. “We’ve been able to make assignments within the seven day period of time for over 95 per cent of the patients—achieving our primary endpoint of the study,” she said.
    The Chief Medical Officer for the Beat AML Trial, John C. Byrd MD, Chair of Leukemia Research and Senior Advisor for Cancer Experimental Therapeutics at Ohio State University Comprehensive Cancer Center, Columbus OH, said that for many years acute myeloid leukemia—the most common adult leukemia—had been treated as a single disease but that science had prompted their study.  “What all of the basic science has taught us is that AML is not a single disease but, likely, 15 or more diseases.”
    Byrd said that in adults AML was characterized by so-called “driver mutations”—molecules that lead the bone marrow to perform abnormally. “Patients with AML will often have several of these—but one that’s dominant, and several that come later,” he said. “The significance of our trial is that we are looking at the different types of AML and prospectively picking the best therapy for the individual patient in a timely fashion.”
    Dominant molecular driver
    When he was asked about the diagnostic algorithm they had used in the study he said it had been based on the principle of looking for the dominant driver of the AML. “Do we have a therapy that’s going to be impactful for the biology? And do the patients fall into a small subgroup of patients where what we were doing before—chemotherapy—is really beneficial to them? If the standard is going to help patients we go with that,” he said, noting that the targeted therapies now offered options for the others.
    Byrd likened targeting the dominant driver molecule as similar to cutting the trunk of a tree—all the branches die with the tree. “The benefits of the study are that patients are allowed to take advantage of all the technologies we have to pick the best therapy,” he said.
    In the seven-day diagnostic time period this individualized approach allowed patients to become accommodated with their disease and

    • 11 min
    Ibrutinib: New Frontline Standard for Chronic Lymphocytic Leukemia?

    Ibrutinib: New Frontline Standard for Chronic Lymphocytic Leukemia?

    SAN DIEGO—Patients 70 years old and younger with previously untreated chronic lymphocytic leukemia (CLL) lived longer and had progression of their disease delayed when treated with ibrutinib (an irreversible inhibitor of Bruton’s tyrosine kinase [BTK]) combined with the anti-CD 20 agent rituximab than patients in a control arm receiving standard fludarabine, cyclophosphamide and rituximab (FCR) in a phase three study from the ECOG-ACRIN Cancer Research Group reported to the 2018 annual meeting of the American Society of Hematology (ASH).
    https://ash.confex.com/ash/2018/webprogram/Paper120779.html
     
    New standard
    The researchers concluded that the findings had immediate practice changing implications establishing ibrutinib-based therapy as the most effective first-line treatment for most patients with CLL. “Ibrutinib-based therapy is now the preferred initial treatment for the majority of CLL patients around the world independent of age,” said lead study author, Tait D Shanafelt MD, Professor of Hematology at Stanford University in Stanford CA, noting that a partner phase three study had also established its superiority in older patients. (Alliance North American Intergroup Study A041202: https://ash.confex.com/ash/2018/webprogram/Paper116653.html )
     
    The “gold standard” treatment for younger patients—aged 70 and below—with previously untreated CLL (who were fit enough to tolerate aggressive treatment) had been FCR chemotherapy, said Shanafelt. “This trial evaluated whether the combination of ibrutinib and rituximab was similar to—or superior than—FCR-based therapy for these younger fit patients,” he said.
     
    FCR toxic and not curative
    At an ASH press briefing to announce the new findings Shanafelt told Oncology Times that although FCR had been the single best initial treatment for CLL, it had still not been a curative therapy.  “And it’s also a fairly toxic treatment with extensive side effects,” he said. “It’s a regimen that can only be tolerated by CLL patients under 70—who tend to be more robust.  So although it’s a good therapy, there’s room for improved effectiveness and certainly also room for improved side effect profile,” he said.
     
    B-cell signaling
    Ibrutinib targets Bruton’s tyrosine kinase (the enzyme that helps mediate cell signaling through the B-cell receptor pathway)—known to be an important survival pathway in CLL B-cells, said Shanafelt.  “We know that it is very effective in relapsed patients—and can lead to very durable remissions,” he said. But it’s recent approval as an option for previously untreated patients had been based on a trial in elderly patients with CLL that compared ibrutinib to chlorambucil.  “The challenge is that chlorambucil is a pretty ineffective treatment by itself for patients with CLL,” he said. “And the fact that ibrutinib was superior to chlorambucil didn’t really help us understand how it stacked up to our gold-standard treatments for CLL patients such as FCR,” he said. 
     
    Study
    In the study the investigators enrolled 529 patients with previously untreated CLL who were aged 70 and younger.  “We excluded patients with deletion 17p because that subgroup of patients does not respond well to FCR.  So they were inappropriate to be randomized,” said Shanafelt.  Two out of every three patients were randomized to ibrutinib plus rituximab, the remaining one-third of study patients received standard FCR—six cycles at “traditional dosing”, he said (intravenous fludarabine (25 mg/m2 ) and cyclophosphamide (250 mg/m2) days 1-3 with rituximab (50 mg/m2 on day 1 of cycle 1; 325 mg/m2 on day 2 of cycle 1; 500 mg/m2 on day 1 of cycles 2-6) every 28-days).
     
    Results
    After 34 months of follow up the ibrutinab/rituximab combination had conferred a superior progression free survival (PFS) as well as a superior over

    • 10 min
    Head and Neck Cancer Therapy De-Escalation: A “Salutary Lesson”

    Head and Neck Cancer Therapy De-Escalation: A “Salutary Lesson”

    MUNICH—A “salutary lesson” was reported by researchers investigating therapy for oropharyngeal cancer at the 2018 annual congress of the European Society for Medical Oncology (ESMO). It came from results of the De-ESCALaTE HPVstudy that found patients with low-risk head and neck cancer who tested positive for human papilloma virus (HPV+) did better if they had been treated with standard platinum-based chemotherapy (added their radiotherapy) rather than the epidermal growth factor receptor (EGFR) inhibitor cetuximab.
    https://cslide.ctimeetingtech.com/esmo2018/attendee/confcal/session/calendar?q=+LBA9_PR
    Phase three trials needed
    “One of the big lessons is that you really need phase three trials—even when treatments are already approved—as in [the] case [of] head and neck cancer,” said Hisham Mehanna PhD BMed Sci FRCS, Chair of Head and Neck Surgery at the Institute for Head and Neck Studies Education in the University of Birmingham, UK. “You need phase three trials to compare new treatments to standards of care to really be able to take [them] into the clinic,” he told the Audio Journal of Oncology. “Clinical practice should not be changed without these phase three trials.”
    Detriment from cetuximab
    TheDe-ESCALaTE HPV study—reported at ESMO by Mehanna and his colleagues—found there had been “significant detriment from the use of cetuximab instead of cisplatin in terms of tumor control and no benefit in terms of reduced toxicity. They concluded that: “Cisplatin and radiotherapy remained the standard of care in this setting.”
    Hisham Mehanna discusses head and neck cancer de-escalation

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