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Is Imatinib Still an Acceptable First-Line Treatment for CML in Chronic Phase?Is it reasonable to start all new CML patients on treatment with imatinib alone and continue the drug indefinitely in those who fare well, or should one start treatment with one of the newer agents or possibly with imatinib in combination with another anti-CML agent in order to secure the best possible outcome for an individual patient?
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Metastatic Prostate Cancer: Quality of Life and Cost ConsiderationsThe pharmacoeconomics of patient managementis important in the case of the critically ill. Pain palliationand improvements to quality of life are treatment goals for patientswith metastatic prostate cancer and can actually
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ACR Appropriateness Criteria® Management of Vaginal CancerThis article represents the consensus opinion of an expert panel and may be used to inform clinical recommendations in vaginal cancer management.
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Commentary (Danforth): Breast Cancer During PregnancyThe care of a pregnant breast cancer patient is a challenging clinical situation that historically has placed the welfare of the mother in conflict with that of the fetus. For the woman in this situation, the emotions usually
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Lymphedema Prevention and Early Intervention: A Worthy GoalThe etiology and risk factors of breast cancer–related lymphedema (BCRL) are multifactorial and not fully understood.
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Current Status of Sentinel Node Surgery in Breast CancerSentinel node surgery potentially increases the accuracy of identifyinglymph nodes that contain breast cancer and decreases morbiditycompared to conventional axillary lymph node resection. However, nolong-term comparisons of the two modalities have been carried out,and the survival benefit associated with one protocol vs the other remainsunknown. Although sentinel node surgery is not expected to increasethe cure rate of breast cancer patients, a significant reduction inthe incidence of permanent side effects associated with axillary noderesection will be a considerable advance. The completion of clinicaltrials establishing that no meaningful reduction in survival is associatedwith the decrease in side effects is important.
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Photodynamic Therapy in Lung CancerPhotodynamic therapy (PDT) involves the use of photosensitizing agents that are selectively retained within tumor cells. The agents remain inactive until exposed to light of the proper wavelength. When activated by light, these
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Oncogenic Drivers in Lung CancerFrom the 2014 ASCO Annual Meeting, this internationally renowned lung cancer expert discusses oncogenic driver mutations in lung cancer.
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Commentary (Kelsen): Adjuvant Therapy for Colorectal CancerColon cancer remains one of the most common human malignancies, with an annual global incidence of slightly less than 1 million patients per year.
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Cytoreductive Surgery Plus HIPEC for Metastatic Colon CancerDavid Ryan, MD, discusses his debate with Paul H. Sugarbaker, MD, from the ASCO session “Intraperitoneal Chemotherapy and Cytoreductive Surgery in Colon Cancer” and how in his view this type of treatment, as presented to the patient, creates a certain dynamic between the surgeon and medical oncologist, one of hope vs reality.
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High-Dose Therapy With Stem-Cell Transplantation in the Malignant LymphomasApproximately 35,000 stem (progenitor)-cell transplants are performed annually worldwide, with an estimated yearly growth rate of between 10% and 20%.[1] Non-Hodgkin’s lymphoma remains the second most common indication for stem-cell transplantation, and Hodgkin’s disease ranks approximately seventh overall.[1]
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Incremental Gains and a Long Road Ahead in MDSSince the topic of risk-stratified management of patients with myelodysplastic syndromes (MDS) was last reviewed in ONCOLOGY in 2007,[1] a few additional clinically relevant studies have emerged that can help inform decision-making in the consultation room.
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Understanding the Kinetics of Cancer: Implications from Prevention to PrognosticationThe choices that patients and clinicians make when dealing with cancer are dictated by time, whether they are arranging for screening mammography and colonoscopy, compiling treatment plans, or determining follow-up intervals and the age of freedom from follow-up.
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Early Impressions of High-Intensity Focused Ultrasound for Prostate CancerThe use of high-intensity focused ultrasound (HIFU) as a method for ablation of a localized tumor growth is not new. Several attempts have been made to apply the principles of HIFU to the treatment of pelvic, brain, and gastrointestinal tumors. However, only in the past decade has our understanding of the basic principles of HIFU allowed us to further exploit its application as a radical and truly noninvasive, intent-to-treat, ablative method for treating organ-confined prostate cancer. Prostate cancer remains an elusive disease, with many questions surrounding its natural history and the selection of appropriate patients for treatment yet to be answered. HIFU may play a crucial role in our search for an efficacious and safe primary treatment for localized prostate cancer. Its noninvasive and unlimited repeatability potential is appealing and unique; however, long-term results from controlled studies are needed before we embrace this new technology. Furthermore, a better understanding of HIFU's clinical limitations is vital before this treatment modality can be recommended to patients who are not involved in well-designed clinical studies. This review summarizes current knowledge about the basic principles of HIFU and its reported efficacy and morbidity in clinical series published since 2000.
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The Allegheny General Modification of the Harvard Breast Cosmesis Scale for the Retreated BreastRepeat lumpectomy and retreatment radiotherapy following ipsilateral breast tumor recurrence (IBTR) by either external-beam irradiation or brachytherapy in lieu of salvage mastectomy is an area of significant recent clinical interest. Multiple authors have reported their results, with encouraging numbers of patients avoiding mastectomy.[1‑4]
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'Unresectable' Pancreatic Cancer: Conceptual ChallengesInoperable pancreatic adenocarcinoma is a dilemma that oncologists frequently encounter. Only 15% to 20% of patients are diagnosed when cancer of the pancreas is still surgically resectable. However, pancreaticoduodenectomy is the only curative option for this disease and should be offered to all patients who meet resection criteria and do not have significant comorbidities. For inoperable pancreatic cancer, the goals of treatment are to palliate symptoms and prolong life. Improved survival in locally advanced disease has been demonstrated with chemoradiation plus fluorouracil or with gemcitabine (Gemzar) alone. In metastatic disease, single-agent gemcitabine has been associated with improvement in symptoms and survival. Trials combining various chemotherapeutic agents with gemcitabine have not had a significant impact on overall survival, although meta-analyses suggest a small benefit. The targeted agent erlotinib (Tarceva) has shown a modest improvement in overall survival in combination with gemcitabine. This combination is another option for first-line therapy in patients with locally advanced or metastatic disease. Despite these recent advances, survival for patients with inoperable pancreatic cancer continues to be poor. Future investigations need to focus on understanding the molecular nature of this malignancy, with the goal of developing interventions based on this knowledge.
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Forging Ahead in a Time of CrisisONCOLOGY® recently sat down with David R. Gandara, MD, director of the thoracic oncology program and senior advisor to the director of the University of California (UC) Davis Comprehensive Cancer Center, to discuss the impact of the pandemic on the current management and treatment of patients with lung cancer, as well as the future of education and patient care in a post–COVID-19 world.
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Commentary (Spigel/Winer): Myalgias and Arthralgias Associated With PaclitaxelNeurotoxicity is a well-describedside-effect of paclitaxeltherapy, often characterizedas a peripheral sensory neuropathy.Neuropathy is a dose-dependenteffect, occurring with cumulative cyclesand higher doses. Occasionally,this may be dose-limiting for patientswho are benefiting from treatment, aswell as problematic for subsequenttherapies. Another well-recognizedthough less-described neurotoxic effectof paclitaxel is myopathy. Myopathy,consisting of myalgias andarthralgias, can be at least as commonwith standard paclitaxel regimens andequally troubling for patients. In thisissue of ONCOLOGY, Garrison andcolleagues review paclitaxel-associatedmyopathy and offer suggestionsfor patient management.
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ASTRO 2017: Updates in HPV-Positive Head and Neck CancerThis video highlights studies on HPV-positive head and neck cancer presented at the 2017 ASTRO Annual Meeting.
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Geriatric Syndromes and Assessment in Older Cancer PatientsOlder individuals are at risk for adverse events in all settings where cancer is treated. Common geriatric syndromes can complicate cancer therapy, and thus, increase patient morbidity and the costs of care. Furthermore,
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Adjuvant Treatment of Stage IB Lung Cancer: Untangling the ControversyThe article by Calhoun and colleagues, published in this issue of ONCOLOGY, is a timely review of one of the more controversial questions in thoracic oncology: whether or not patients with stage IB non–small-cell lung cancer (NSCLC) should receive adjuvant chemotherapy.
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Evaluating the Role of Serine Protease Inhibition in the Management of Tumor MicrometastasesManagement of patients with neoplastic disease has shifted from searchand-destroy approaches employing radical surgery, chemotherapy,and radiotherapy to novel strategies that target specific molecular orgenetic characteristics or modify growth factors, angiogenesis, and cell-cell interactions.Attention has also been focused on modifying the production and function ofcertain enzymes pivotal to the genesis of disseminated disease.
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The Role of Intraperitoneal Therapy in Advanced Ovarian CancerIntraperitoneal (IP) chemotherapy is a preferred treatment option that should be offered to all women for front-line treatment of stage III optimally debulked ovarian cancer. Patients should be provided with information on the survival and toxicity for both IP and intravenous (IV) therapies, as well as practical information about the administration of each regimen, so that they may play an active role in the decision-making process. When making a decision between IP and IV therapeutic options, the experience and preference of the oncologist are critical factors in determining appropriate therapy for each woman.
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Systemic Treatment Options for Brain Metastases from Non–Small-Cell Lung CancerIn this review, we discuss recent clinical investigations that highlight the effects of novel compounds targeting EGFR, ALK, and other receptor oncogenes, as well as the promise of immunotherapy in lung cancer CNS disease.
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Managing the Patient With Borderline Resectable Lung CancerDespite recent therapeutic advances, lung cancer continues to be one of the leading causes of cancer-related mortality. Of the various histologic subtypes, non–small-cell lung cancer (NSCLC) is the most common-accounting for approximately 85% of all lung cancers-and will be the focus of this article. In general, the treatment of lung cancer may include surgery, radiation therapy, systemic therapy (eg, chemotherapy with or without targeted therapy), or a combination of the above. Surgery continues to offer the best chance of long-term cure. The initial treatment of stage I and II NSCLC usually entails surgical resection, whereas stage IV disease is primarily treated with systemic agents, in light of the lack of curative potential with surgery and/or radiation therapy alone. It is locally advanced NSCLC, including stage IIIA and IIIB disease, that continues to pose a therapeutic dilemma, given its heterogeneous nature.
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Lung Cancer Screening: Has Its Time Come?The simple answer, according to some, is that lung cancer screening’s time has come. However, in my opinion, the answer is not that simple.
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Use of Molecular Biomarkers to Inform Adjuvant Therapy for Colon CancerIn this review, we will discuss adjuvant chemotherapy in non-metastatic colon cancer, the existing prognostic and predictive molecular biomarkers in the field, and how to integrate these molecular biomarkers into the decision about whether to administer adjuvant therapy.
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Indolent B-Cell Non-Hodgkin’s LymphomasB-cell non-Hodgkin’s lymphomas (NHL) are an increasingly common cause of cancer morbidity and mortality. In 1996, approximately 52,700 new cases of NHL were diagnosed, representing a marked increase in incidence. Indeed, the incidence rose from 8.5 per 100,000 population in 1973 to 15.1 per 100,000 in 1992.[1] About 20% to 30% of these are NHLs of the indolent varieties.
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Commentary (Seres/Harrison): Nutritional Support of Patients Undergoing Radiation Therapy for Head and Neck CancerDr. Colasanto and his associatesare to be commended forskillfully and comprehensivelyreviewing the issues concerning theprovision of nutritional support to patientsundergoing radiation therapy.Their recommendations are well supportedby review of scientific studies,and the article is written in such a wayas to be accessible to those not fullyversed in prescribing nutritional support.There remain a few points thatdeserve discussion.
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Leveraging “Exciting” CAR T-Cell Therapy Advancements in Multiple MyelomaWhether CAR T-cell therapy or T-cell engagers should dominate the multiple myeloma landscape may be hard to determine, says David S. Siegel, MD.
