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Chemoprevention of Colorectal Cancer: Dietary and Pharmacologic ApproachesColorectal cancer is a major cause of death in the United States, where it accounts for approximately 57,000 deaths per year. Thus, the prevention of this disease would have a significant impact on public health. Chemoprevention is defined as the use of natural or pharmacologic agents to disrupt the process of carcinogenesis. Substances explored as chemopreventive agents in colorectal cancer include: (1) the nonsteroidal anti-inflamma-tory drugs (NSAIDS), which may inhibit the evolution and formation of adenomas by their inhibition of cyclooxygenase and decrease of prostaglandin synthesis; (2) antioxidants, such as vitamin E or C, which may modulate carcinogenic substances; and (3) folate and calcium, which may interfere with tumor cell growth and replication. Dietary intervention can be accomplished by decreasing fat intake and increasing fiber consumption, both of which have been linked to a lower incidence of colon cancer in multiple epidemiologic studies. This field is continuing to evolve. Hopefully, ongoing research efforts will offer a better understanding of the role of these and other substances in chemoprevention. This article summarizes the available data regarding dietary and pharmacologic approaches to colorectal cancer chemoprevention. [ONCOLOGY 1(13):89-98, 1999]
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Cervical CancerThis management guide covers the screening, diagnosis, staging, and treatment of cervical cancers.
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A Pharmacoeconomic Comparison of UFT and 5-FU Chemotherapy for Colorectal Cancer in South AmericaThe escalating role played by managed care organizations in the health-care system is reflected in the increased demand for cost-effectiveness analyses (CEAs) to assess the balance between economic impact
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Gemcitabine/Paclitaxel as First-Line Treatment of Advanced Breast CancerGemcitabine (Gemzar) and paclitaxel exhibit good activity and goodsafety profiles when used alone and together in the treatment of advancedbreast cancer. In a phase II trial, 45 patients with metastaticbreast cancer received gemcitabine at 1,200 mg/m2 on days 1 and 8 andpaclitaxel at 175 mg/m2 on day 1 every 21 days. Twenty-seven patients(60.0%) had prior adjuvant therapy. Objective response was observedin 30 patients (objective response rate 66.7%, 95% confidence interval[CI] = 52%–71%), including complete response in 10 (22.2%) and partialresponse in 20 (44.4%). Median duration of response was 18 months(95% CI = 11–26.7 months), median time to tumor progression for theentire population was 11 months (95% CI = 7.1–18.7 months), medianoverall survival was 19 months (95% CI = 17.3–21.7 months), and the1-year survival rate was 69%. Treatment was well tolerated, with grade3/4 toxicities being infrequent. Grade 3/4 leukopenia, neutropenia, andthrombocytopenia were each observed in six patients (13.3%). No patientwas discontinued from the study due to hematologic ornonhematologic toxicity. Thus, the gemcitabine/paclitaxel combinationshows promising activity and tolerability when used as first-line treatmentin advanced disease. The combination recently has been shownto be superior to paclitaxel alone as first-line treatment in anthracyclinepretreatedadvanced disease according to interim results of a phase IIItrial and it should be further evaluated in comparative trials in breastcancer.
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Expanding Androgen- and Androgen Receptor Signaling–Directed Therapies for Castration-Resistant Prostate CancerThis article reviews the most recent advances in androgen receptor-directed therapies for castration-resistant prostate cancer, and new agents under development.
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Current Perspectives on Locally Advanced Pancreatic CancerThis year, approximately 40% of the 28,300 patients diagnosed with pancreatic carcinoma in the United States will present with locally advanced disease. Radiotherapeutic approaches are often employed, as these patients
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UFT Plus or Minus Calcium Folinate for Metastatic Colorectal Cancer in Older PatientsTwo studies were carried out to determine the activity and evaluate the toxicity of oral chemotherapy with uracil and tegafur in a 4:1 molar ratio (UFT) plus or minus calcium folinate in elderly patients with advanced colorectal
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The UFT/Leucovorin/Etoposide Regimen for the Treatment of Advanced Gastric CancerGastric cancer is the most chemosensitive adenocarcinoma among digestive neoplasms. A few years ago, we performed a phase II trial with the FLEP regimen, in which fluorouracil (5-FU) and leucovorin are combined
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A Phase II Study of Doxorubicin/Paclitaxel Plus G-CSF for Metastatic Breast CancerThis phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line
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Studies to Watch at SABCS 2014In this preview of the 2014 San Antonio Breast Cancer Symposium, we take a look at some of the studies to watch for at this year's event.
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Irinotecan, Epirubicin, and Capecitabine in Metastatic Adenocarcinomas: Preliminary Results of a Phase I StudyThe combination of irinotecan (Camptosar), epirubicin, andcapecitabine (Xeloda) has shown an acceptable toxicity profile. In thisopen-label phase I study, irinotecan was administered IV at a fixeddose of 250 mg/m2 on day 1 in combination with capecitabine at a fixeddose of 1,500 mg/m2 for days 2 to 7 and epirubicin starting at a dose of40 mg/m2 and escalating by 10 mg/m2 in cohorts of three patients forthose with metastatic adenocarcinomas. With the addition of granulocytecolony-stimulating factor (G-CSF [Neupogen]) to the regimen,patients received epirubicin at clinically relevant doses after dose-escalation.Results of the topoisomerase activity will be reported with thefinal results of this phase I study. The dose-limiting toxicity has not yetbeen reached. This combination regimen in patients with upper gastrointestinalmalignancies and breast cancer will be investigated as partof phase II studies, once the dose-limiting toxicity is determined. Theappropriate sequencing of the regimen to maximize clinical efficacywill also be determined.
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New Combinations With Epirubicin in Advanced Breast CancerSeveral trials have shown that anthracyclines and taxanes can be combined to achieve response rates ranging from 70% to 90%, with complete responses ranging from 19% to 41%. In an attempt to increase the activity while
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New Antifolates in Clinical DevelopmentNumerous new antifolate drugs have been developed in an attempt to overcome the potential mechanisms of tumor cell resistance to methotrexate, which can include decreased drug transport into cells; decreased
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Oncologic Emergencies and Paraneoplastic SyndromesThis management guide covers the oncologic emergencies such as superior vena cava syndrome, deep venous thrombosis, pulmonary embolism, and other paraneoplastic syndromes.
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Paraneoplastic Leukocytosis: An Unusual Manifestation of Squamous Cell Carcinoma of the Urinary BladderA 76-year-old woman with a history of dementia, hypertension, type 2 diabetes mellitus, and newly diagnosed squamous cell carcinoma of the urinary bladder was referred to Indiana University Medical Center after 3 to 4 weeks of hospitalization at two other hospitals.
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Irinotecan and Gemcitabine in Patients With Solid Tumors: Phase I TrialUsing a day 1 and 8, every-3-week schedule, our purpose was to determine the maximum tolerated dose of irinotecan (CPT-11, Camptosar) that can be administered immediately after gemcitabine (Gemzar) at a dose of 1,000 mg/m² IV. In this phase I trial, the maximum tolerated dose was defined as the dose level immediately below the level in which two of the first three patients in any cohort, or at least two of six patients in any expanded cohort, experienced dose-limiting toxicity. Dose-limiting toxicity pertained only to toxicity during the first cycle of treatment. Escalation of irinotecan was planned in groups of three patients, with three additional patients added at the first indication of dose-limiting toxicity. A total of 19 patients have been enrolled.
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Follow-up Care for Cancer: Making the Benefits Equal the CostThe premise that early diagnosis of certain types of malignancies improves outcome and survival is a cornerstone of modern medicine. Routine use of the Pap smear has been associated with reduced mortality from cervical cancer. Randomized trials
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Docetaxel Plus Cisplatin: An Active Combination Regimen in Non-Small-Cell Lung CancerDocetaxel (Taxotere) isa semisynthetic taxoid that possesses significant activity as a single
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Improving Outcomes in Resectable Gastric Cancer: A Review of Current and Future StrategiesHere we review the evidence supporting current approaches to resectable gastric cancer, including discussion of the optimal extent of surgery and lymphadenectomy, adjuvant chemotherapy, postoperative chemotherapy with chemoradiation, and perioperative chemotherapy.
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Neuroblastoma: Biology and TherapyNeuroblastoma is the most common solid extracranial tumor in children. Although the outcome of patients with localized disease has improved substantially, the prognosis for those with advanced disease is still poor, despite multimodality therapeutic efforts of increasing intensity over the last 20 years. Dr. Matthay provides an excellent overview review of the biology and treatment of this devastating but fascinating childhood malignancy.
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Patient Quality of Life Endpoints in Oncology Trials, Part IIThis interview covers symptom management and quality-of-life outcomes in cancer clinical trials, which are being incorporated more readily as secondary and sometimes primary trial endpoints.
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Problems in Lymphoma Management: Special Sites of PresentationDr. Connors has written an excellent review of the management of five unusual sites of lymphomatous involvement. Several basic principles are illustrated in his discussion of rare entities:
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Current Issues in the Treatment of Resistant Bloodstream InfectionsBloodstream infections cause significant morbidity and mortality for patients with hematologic malignancy. Antimicrobial drugs are the most reliable currently available treatment for infection, but several issues must be
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Implications of the New Face of Head and Neck CancerAlthough screening methods for HPV-OPSCC have not yet been developed, population-based prevention may be achievable through HPV vaccination, but only if concerted efforts are made to increase vaccine uptake in the United States.
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Unexpected Benefit Links Hypertension to Better Ovarian Cancer OutcomesNew research suggests that hypertension and diabetes and the use of medications to treat these conditions may influence the survival of ovarian cancer patients.
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Strategies for Identification and Clinical Evaluation of Promising Chemopreventive AgentsStrategies for chemopreventative drug development are based on the use of well-characterized agents, intermediate biomarkers correlating to cancer incidence, and suitable cohorts for efficacy studies. Since
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High-Dose Chemotherapy With Autologous Stem Cell Rescue in the Outpatient SettingOutpatient bone marrow transplant (BMT) strategies, as reviewed by Dix and Geller, have evolved for various reasons—from social to medical. If high-dose approaches are to become a viable treatment for common cancers, such as breast cancer, the refinement of transplants to a “kinder and gentler” approach is essential.
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FDA simplifies patient access to investigational drugsRules balance access to promising new therapies against the need to protect patient safety.
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Implementing Change: A View From the TrenchesWith perhaps 100 patients scheduled for chemotherapy each day and about the same number of consultations, the nurses, physicians, and staff in any medium-sized oncology clinic are fully booked. Changing their routines may be the last thing anyone wants to think about.
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3 Things You Should Know About Hemolytic AnemiasHemolytic anemias are a collection of rare but severe diseases including paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome.
