Rationale: Per the YACPRIME Study published in Cancer, the QoL of AYAs requires urgent attention. Sleep, body image, and social support may be important modifiable targets for intervention to improve their QoL.

Rationale: There was a statistically significant decrease in the odds of disease progression for patients from the LIFT (exercise) group compared to those who did not attend LIFT. Patients from the LIFT group had a 66% (OR = 0.34, 95% CI 0.19 to 0.61) decrease in the odds of disease progression compared with the non-LIFT group. There was also a statistically significant decrease in the odds of death for patients from the LIFT group compared to the non-LIFT group. Patients from the LIFT group had a 76% (OR = 0.24, 95% CI 0.12 to 0.47) decrease in the odds of death compared with the non-LIFT group. The analysis showed that there was no statistically significant effect on the number of LIFT sessions on disease progression.

Rationale: The growing cancer survivor population, which is projected to reach 20 million Americans by 2025. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev. 2016;25:1029-1036.

Rationale: Sexual dysfunction (SD) is a common side effect of both radiation therapy (RT) and androgen deprivation therapy (ADT). Both therapies cause high levels of erectile dysfunction (ED) with prevalence estimated to be 67%-85% after RT and up to 94% for ADT. More than 80% of prostate cancer survivors have described their overall sexual function as ‘poor/very poor’ at 18 to 42 months after diagnosis. Other sexual side effects linked to ADT include loss of libido, delay or inability to reach orgasm, penis and testicle shrinkage, reduction in ejaculate and infertility. There may also be indirect effects on sexual lives caused by breast enlargement, weight gain, hot flashes and fatigue. RT can cause dry ejaculation, penile shrinkage, dyspareunia and infertility. In men treated with RT, it was found that 26% of men who also received ADT regained their baseline EF after 2 years compared with 42% of men who received RT alone.

Rationale: BTK inhibitors have largely replaced the use of chemotherapy, selecting the optimal treatment for patients is ultimately less challenging. There is still potentially some importance of 17p deletions and TP53 mutations, mostly because the data are not as mature for [agents] such as venetoclax [Venclexta] and obinutuzumab [Gazyva]. The only exception to that now is the one population that still could be considered for chemotherapy: young patients with very good risk features who are highly motivated for short-duration therapy and are OK with the effects of chemotherapy. Those patients could certainly be considered for chemotherapy, even in today’s world.

Rationale: Per the YACPRIME Study published in Cancer, relationship status was inversely related to mental health, such that those not in a relationship (ie, single) reported better mental health.

Rationale: Persistent opioid users after treatment were more likely than nonpersistent users to have lung, esophagus, or rectal cancer and were less likely to have prostate cancer. Persistent opioid users were slightly more likely to have higher T4 disease, have higher N-stage disease, undergo chemotherapy, or undergo surgery. Persistent opioid users were more likely to be female and slightly more likely to be African American, be unmarried, reside in a rural location, or reside in a region with higher rates of poverty. Additionally, patients who became persistent opioid users had a higher burden of comorbidity, including a prior diagnosis of depression.

Rationale:Although completion lymphadenectomy is no longer recommended for patients with melanoma and tumor-positive SNLs, therapeutic lymph node dissection is still recommended for patients with melanoma and lymph node recurrences. Therapeutic lymph node dissection lacks therapeutic benefit for patients with lymph node recurrences in melanoma, according to results from a study presented at the 2020 annual meeting of the Society of Surgical Oncology. Approximately 10% to 15% of patients with melanoma who have negative sentinel lymph node (SLN) biopsies at their index operation will experience a locoregional recurrence, and 4% to 10% of patients will develop an isolated lymph node recurrence in the same basin, depending partly on the experience of the surgeon, said Ana Wilson, MS, DO, a second-year fellow at John Wayne Cancer Institute, in Santa Monica, Calif., who presented the data. “The majority of these recurrences happen in the first two years after surgery and are more common in patients with thicker, ulcerated primary lesions; lesions on the trunk, head or neck; and in patients who are male,” Dr. Wilson said. https://www.clinicaloncology.com/Melanoma/Article/01-21/What-Is-Value-of-Therapeutic-Lymph-Node-Dissection-in-Melanoma-/62299

Rationale: Among VA patients who were not frail, overall survival was more similar to that reported in pivotal clinical trials. VA patients represent an older and a more comorbid cohort. They noted that although over 3,000 clinical trials have been conducted evaluating ICIs alone or combined with other modalities, as many as 70% of real-world cancer patients would not meet the criteria to participate in pivotal clinical trials. https://www.clinicaloncology.com/Community-Oncology/Article/11-20/Outcomes-Less-Than-Expected-in-Largest-Real-World-Study-of-ICIs-/61194

Rationale:The FDA approved relugolix (Orgovyx, Myovant Sciences), the first oral androgen deprivation therapy for adults with advanced prostate cancer. Relugolix blocks the pituitary gland from making luteinizing hormone and follicle-stimulating hormone, thereby reducing the amount of testosterone made by the testicles. Relugolix is an oral once daily therapy. The most common side effects of relugolix include hot flush, musculoskeletal pain, fatigue, constipation and diarrhea; increased levels of glucose, triglycerides and liver enzymes; and decreased levels of hemoglobin. Androgen deprivation therapies such as relugolix may affect the heart’s electrical properties or cause electrolyte abnormalities; therefore, health care providers should consider periodic monitoring of electrocardiograms and electrolytes. https://www.clinicaloncology.com/FDA-Watch/Article/01-21/FDA-Approves-Orgovyx-to-Treat-Prostate-Cancer/62170

Rationale: https://www.clinicaloncology.com/FDA-Watch/Article/12-20/New-Oncology-Drug-Approvals-in-2020/61464 Gilteritinib ( Xospata) is an inhibitor of AXL receptor tyrosine kinase, hence it is a tyrosine kinase inhibitor.It was developed by Astellas Pharma. In April 2018, Astellas filed a new drug application with the Food and Drug Administration for gilteritinib for the treatment of adult patients with FLT3 mutation–positive relapsed or refractory acute myeloid leukemia (AML). In November 2018, the FDA approved gilteritinib for treatment of adult patients with relapsed or refractory acute myeloid leukemia (AML) with a FLT3 mutation as detected by an FDA-approved test Avapritinib (Ayvakit, Blueprint Medicines), a once-daily tyrosine kinase inhibitor (TKI) indicated for gastrointestinal stromal tumor (GIST) harboring a platelet-derived growth factor receptor alpha exon 18 mutation. “Clinical trials showed ... almost 85% of patients experiencing tumor shrinkage with this targeted drug. Pemigatinib (Pemazyre, Incyte) is an oral fibroblast growth factor receptor 2 (FGFR2) indicated to treat cholangiocarcinoma that has spread and cannot be resected. Between 9% and 14% of the 8,000 cases diagnosed each year have FGFR2 mutations. “This is the first drug approved to treat this condition, which is typically treated with surgery and chemotherapy,” Tharaldson said. The FDA approval was based on data from a multicenter, open-label, single-arm study of 107 adults harboring FGFR2 fusions or rearrangements. Pemigatinib monotherapy resulted in an ORR of 36% and a DOR of 9.1 months. Capmatinib (Tabrecta, Novartis) is an oral TKI approved for adults with metastatic or inoperable non-small cell lung cancer (NSCLC) with a mesenchymal-epithelial transition (MET) exon 14 skipping mutation. Novartis estimated that up to 5,000 patients will be candidates annually for this treatment, which is the first drug to be approved for NSCLC caused by the MET mutation. The approval of capmatinib is based on results from the pivotal GEOMETRY study. In the MET exon 14 population (n=97), the confirmed ORR was 68% (95% CI, 48%-84%) and 41% (95% CI, 29%-53%) among treatment-naive (n=28) and previously treated patients (n=69), respectively. The study also demonstrated a median DOR of 12.6 months (95% CI, 5.5-25.3 months) in treatment-naive patients (19 responders) and 9.7 months (95% CI, 5.5-13 months) in previously treated patients (28 responders).

Rationale: https://onlinelibrary.wiley.com/doi/10.1002/cam4.3512 African Americans are underrepresented in white collar and professional occupations that have the best job retention after cancer, and are overrepresented in positions requiring physically demanding work that are associated with reduced employment after cancer. Decreased employment and financial hardship are more common among African Americans.