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Olverembatinib Combos May Be ‘Promising’ in Ph+ Acute Lymphoblastic LeukemiaCombining olverembatinib with blinatumomab appears to produce high complete molecular remission rates in patients with newly diagnosed, Philadelphia chromosome–positive acute lymphoblastic leukemia, says Elias Jabbour, MD.
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Radium-223 in Bone-Metastatic Prostate Cancer: Current Data and Future ProspectsThis article will describe the historic background of Ra-223; outline the clinical studies which led to phase III trials of this agent; highlight key results of these phase III studies; and explore possible future directions for use of Ra-223 and other alpha particles-both in prostate cancer and for management of other diseases.
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Management of Acute Promyelocytic Leukemia: Implications for Treatment of Other CancersThe article by Drs. Stein and Tallman is an excellent summary indicating that several different approaches may lead to the cure of acute promyelocytic leukemia (APL).
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The Sentinel Node in Colorectal CarcinomaThe role of sentinel lymph node identification has been investigated over the past decade in a variety of malignancies. It has become part of standard care for melanoma. Its role in breast cancer is evolving, but with the completion of two large randomized clinical trials, it will probably be added to the surgical armamentarium for the management of most breast cancers. Studies have been proposed or are under way to evaluate sentinel node mapping in head and neck cancer, penile and vulvar cancer, and gastrointestinal cancers.
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Biological Basis of Radiation SensitivityRecent studies have elucidated some of the molecular and cellular mechanisms that determine the sensitivity or resistance to ionizing radiation. These findings ultimately may be useful in devising new strategies to improve the
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Management of Heavy Chain Diseases: The Challenges of Biologic HeterogeneityIn the absence of a clear understanding of the underlying biologic heterogeneity, the etiology of the different heavy chain diseases (HCDs) should be taken into consideration when treatment decisions are made. Extrapolation from related conditions, such as aggressive lymphomas (in γ-HCD) and CLL (in μ-HCD), suggests that novel and targeted therapies may be effective in the management of these rare diseases.
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Whole-Body PET Imaging of Breast Cancer Characteristics to Improve Precision TreatmentHowever, it is becoming ever clearer that tumor characteristics can change during the course of disease. Given this change over time, other supporting techniques for guiding therapy would be of value. Molecular radionuclide imaging with positron emission tomography (PET) can potentially fulfill this need.
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Outline of Oncology TherapeuticsOutline of Oncology Therapeutics is a well-written, concise, and up-to-date book providing detailed descriptions of a variety of medications and issues important to the overall care and treatment of patients with cancer. Oncology practice today
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Persistence of Lymphedema Reduction After Noninvasive Complex Lymphedema TherapySecondary lymphedema is quite prevalent in cancer patients who require lymph node dissection for staging and/or treatment of their disease. Chronic lymphedema may arise shortly after surgical intervention or months to years afterward. The tendency of chronic lymphedema is to worsen over time.
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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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PARP Inhibitors: The Cornerstone of DNA Repair–Targeted TherapiesPARP inhibitors are an active, novel, and exciting class of anticancer agents. They have shown clear patient benefit in gBRCA, HR-deficient, and other ovarian cancers.
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$25 Million Patient Navigation Program Aims to Reduce Cancer Health Disparities in Targeted CommunitiesOn June 29, 2005, President Bush signed into law the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005 (H.R. 1812). This legislation authorized the National Cancer Institute (NCI) to oversee the distribution of $25 million in competitive 5-year grants to help underserved communities access health care services.
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Inhibition of Poly(ADP)-Ribose Polymerase as a Therapeutic Strategy for Breast CancerAs knowledge increases about the processes underlying cancer, it is becoming feasible to design “targeted therapies” directed toward specific pathways that are critical to the genesis or maintenance of the malignant phenotype. Poly(ADP-ribose) polymerase (PARP) inhibitors are an example of this new framework. DNA damage repair is a complex and multifaceted process that is critical to cell survival. Members of the PARP family are central to specific DNA damage repair pathways, particularly the base excision repair (BER) pathway. PARP inhibition, with subsequent impairment of the BER mechanism, may enhance the cytotoxicity of agents that generate single-strand breaks in DNA, such as radiation and certain chemotherapy drugs. In addition, PARP inhibitors may induce death through “synthetic lethality” if the DNA repair mechanisms that rescue BER-deficient cells are themselves impaired. This mechanism is thought to underlie the impressive results of PARP inhibition in BRCA-associated breast and ovarian cancer, and may also account for the reported benefit of this approach in “triple-negative” breast cancer. This review will examine the current understanding of PARP inhibition as a treatment for breast cancer, ongoing clinical trials, and future directions for this new approach.
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Locoregional Treatment of Breast Cancer: Where to Next?Personalized cancer care is generally thought of as using molecular information from tumors in order to identify which therapeutic agents will be most effective in a given patient.
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Exploring Current Research on Immunotherapy for Breast CancerDuring the 2018 Miami Breast Cancer Conference, Dr. Elizabeth A. Mittendorf discussed immunotherapy concepts and strategies related to breast cancer.
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Imaging Vigilance for Patients at High Risk for Breast CancerWe spoke with breast imaging radiologist Dr. Elizabeth Morris on imaging vigilance for women at high risk of developing breast cancer.
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Oncologic drug safety: Separating fact from fictionAnnually, adverse drug reactions (ADRs) result in costs of $3.6 billion and 140,000 deaths.1 Yet in 2005, only 15,107 reports of fatalities linked to potential drug toxicity were reported to the US Food and Drug Administration.2 This low number suggests that, despite significant morbidity and morality, ADRs remain underappreciated by clinicians. This is particularly troublesome when it comes to ADRs associated with oncology drugs.
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The REMS Publication ParadoxThe introduction of mandatory risk evaluation and mitigation strategy (REMS) programs, in which patients must participate in order to receive a new therapy, provides an opportunity to examine an issue affecting ethical oversight and publication of scientific study results.
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Some Elements of Prognosis in Terminal CancerPredicting the survival of terminal cancer patients is a difficult task. To better understand this difficulty, we divide prognostication into two distinct elements: foreseeing and foretelling. Foreseeing is a physician’s silent cognitive
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Rationing Healthcare: Who's Responsible?To place responsibility for rationing chemotherapeutics on the oncologist not only increases his or her emotional burden, but it also strains the doctor-patient relationship. We should not allow oncologists to become bedside healthcare rationers simply because no one else wants to do the job.
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Lung Cancer Screening With Spiral CT: Toward a Working StrategyGiven that there is no validated test for early lung cancer detection,the current standard approach to lung cancer detection is to wait forsigns or symptoms to develop. In that setting, newly detected lung canceris generally rapidly fatal resulting in over 157,000 deaths annually.Sole dependence on tobacco control is an insufficient public healthresponse to lung cancer, since most newly diagnosed individuals areeither former smokers or never smokers. Finding a more effective wayto diagnose premetastatic lung cancer would be a crucial step towardan improved lung cancer-related mortality rate. Based on studies ofbreast cancer screening, we know that achieving optimal benefit fromearly cancer detection also involves defining the most effective, efficient,and safest approach to the clinical management of screen-identifiedlung cancer. In this review, we consider how to build on the successesof other cancer screening efforts to detect and manage earlylung cancer. This involves outlining the specific elements for lung cancerthat could make a screening program safe, affordable, and effective.We also explore the current standards of early lung cancer managementand target areas where potential pitfalls and opportunities forimprovement exist.
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Graft-Versus-Host Disease: A Complex Long-Term Side Effect of Hematopoietic Stem CellConsider the following case study, which illustrates the complex physical and psychosocial care required for the patient developing graft-versus-host disease (GVHD) following an allogeneic hematopoietic stem cell transplantation (HSCT): Mr. SR is a 38-year-old male with a diagnosis of anaplastic large cell non-Hodgkin’s lymphoma (NHL).
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Counseling Women at High Risk of Ovarian or Endometrial CancerPatient education and counseling are essential in women at increased risk for ovarian and endometrial cancer. Women must be educated regarding the signs, symptoms, and risks associated with these cancers.
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The Growing Need for Specific Care of Geriatric Cancer PatientsThroughout the geriatric sessions we were continually reminded of our aging population, the fact that cancer is a disease of the aging, and of the mismatch in this increasing number of patients and the number of geriatric providers entering the workforce. General oncologists will need to understand the nuances of caring for older patients with cancer.
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ACR Appropriateness Criteria® Adjuvant Management of Early-Stage Endometrial CancerAfter a review of the published literature, the panel voted on three variants to establish best practices for the utilization of imaging, radiotherapy, and chemotherapy after primary surgery for early-stage endometrial cancer.
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Celecoxib and Radiation Therapy in Non–Small-Cell Lung CancerOverexpression of cyclooxygenase-2 (COX-2) is frequently presentin lung cancer and may play a significant role in carcinogenesis, invasion,and metastasis. It has been associated with shortened survival inpatients with resected early-stage adenocarcinoma of the lung. COX-2inhibition decreases tumor cell proliferation in vivo and has been shownto enhance tumor radiosensitivity. Additionally, COX-2 inhibition mayprotect normal pulmonary tissue from radiation fibrosis. Clinical studiesare under way to assess the potential benefits and risks of COX-2inhibition in the treatment of lung cancer. The rationale for COX-2inhibitors in the treatment of lung cancer will be reviewed. The resultsof a phase II study assessing the acute toxicity of concurrent celecoxib(Celebrex) and thoracic irradiation in patients with non–small-cell lungcancer (NSCLC) are reported, and an ongoing Radiation TherapyOncology Group study using celecoxib and concurrent radiation therapyfor NSCLC in patients with intermediate prognostic factors is reviewed.
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Commentary (Laheru/Jaffee): Novel Vaccines for the Treatment of Gastrointestinal CancersThe identification of key signaltransduction pathways and, inparticular, specific proteins thatare involved in the regulation of cancercell growth has provided unprecedentedopportunities for researchersinterested in targeted cancer treatment.The identification of molecular target-specific therapy offers the potentialof maximal therapeutic benefitwhile minimizing toxicity to normalcells. The accomplishment that led tothe sequencing and analysis of theentire human genome in 2001 has providedresearchers with the basic criticaltools to begin to identify anddifferentiate cancer from normal tissueat the genetic level.[1,2] Whilethe implications of this landmarkachievement are still being realized,it has become evident that the identificationof critical genes and proteinsinvolved in cell division and growthare just the beginning. The complexrelationships between multiple signaltransduction pathways, the surroundingtumor microenvironment, andpathways involved in immune-systemregulation have gained new appreciation.The ability to manipulate thesemultiple interactive systems with targetedtherapies represents a new treatmentparadigm in oncology.
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Using Nuclear Medicine Imaging in Clinical Practice: Update on PET to Guide Treatment of Patients With Metastatic Breast CancerWe review how radiolabeled glucose and estrogen analogs can be used in breast cancer patients. We focus this review on the application of positron emission tomography imaging to ER-positive metastatic breast cancer as an example of how imaging can guide breast cancer treatment.
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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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Management of Metastatic Prostate Cancer in Frail/Elderly PatientsIn this article, we discuss the importance of assessing frail and elderly prostate cancer patients before starting treatment and making adjustments to the choice of therapy, or supportive services, in order to maximize benefit and minimize potential harms.
