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Optimizing Outcomes for Patients With Curable Bladder CancerThis video highlights emerging data on genomic markers of response to neoadjuvant chemotherapy for patients with bladder cancer.
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Decision-Making and Adjuvant Therapy for Breast CancerOne of the primary challenges in the treatment of patients with early-stage breast cancer is determining which patients will benefit from adjuvant chemotherapy. Traditionally, treatment decisions have been made based on a combination of tumor characteristics and patient and physician perspectives regarding risks and benefits. Recent technologic advances, including the development of gene-expression arrays, have led to the identification of molecular signatures that provide prognostic information in addition to the basic clinicopathologic features of individual tumors. While these new methods allow for more refined determination of prognosis for an individual patient, few data are available to support use of these new technologies in the clinic for treatment decision-making. At present, data from a single retrospective study are available to support the use of one assay, the 21-gene recurrence score, for decision-making regarding adjuvant chemotherapy. Large, multinational clinical trials are currently ongoing to evaluate the use of two of the multiparameter assays, although it will be many years before oncologists can apply the results of these trials in the clinic.
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What Are Safe Margins of Resection for Invasive and In Situ Breast Cancer?The safety and efficacy of breast-conserving therapy (BCT) for women with early-stage breast cancer are well established. BCT entails wide excision of the tumor and appropriate nodal evaluation, followed by radiation therapy to the breast.
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5-Minute Inservice Mucositis ManagementPatients who have experienced oral mucositis report it as the most bothersome side effect of cancer therapy. It can result in pain, infection, and nutritional defi cits, and can interfere with appropriate cancer treatment. Many patients with mucositis are opiate-naive, presenting clinical challenges.
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Current Treatment Options for Non–Small-Cell Lung CancerChemotherapy is now employed in earlier-stage disease in neoadjuvant, adjuvant, and combined-modality treatments. The aim of this article is to review the current systemic treatments for NSCLC.
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Evaluating the Role of Serine Protease Inhibition in the Management of Tumor MicrometastasesConservation of blood is apriority during surgery, owingto shortages of donor bloodand risks associated with transfusionof blood products.[9,10] However,blood transfusions have been linkedto a number of negative postoperativesequelae, including poorer prognosisafter cardiac and cancer surgery.[11-21] In this context, recognition thatallogeneic transfusion-associatedimmunomodulation can increasemorbidity in allogeneically transfusedpatients has become a major concernin transfusion medicine.[9,22,23]
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Biphasic Tumors of the Female Genital TractIn this installment of Second Opinion, we are presenting two cases of tumors of the female genital tract, specifically, the ovary and uterus, which contain both epithelial and mesenchymal components and therefore have unique diagnostic and therapeutic implications. The first has an unusually poor prognosis and the second is notoriously difficult to diagnose.
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Endometrial Cancer: Recent Developments in Evaluation and TreatmentWe commend Chen et al for their comprehensive review of the evaluation and treatment of endometrial cancer. As the authors state, endometrial cancer is the most common gynecologic malignancy in the United States. Fortunately, it is also one of the most curable. The majority of women with endometrial cancer are treated by surgery alone; primary radiation therapy is generally reserved for patients with unacceptable risks of surgical morbidity. In this commentary, we will address several areas of current controversy.
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The Challenge of Designing Clinical Trials for AIDS-Related Kaposi’s SarcomaKaposi’s sarcoma (KS) is a frequent cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. Several characteristics of KS pose challenges for the conduct of clinical trials. Kaposi’s
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Clinical Trials and NCI Resources for Cancer in HIV-Positive PatientsThe association between HIV infection and the development of cancer was noted early in the acquired immunodeficiency syndrome (AIDS) epidemic. The AIDS-defining malignancies are Kaposi’s sarcoma, intermediate- or high-grade B-cell non-Hodgkin’s lymphoma (NHL), and cervical cancer. All of these cancers feature specific infectious agents in their etiology. These agents are human herpesvirus 8/Kaposi’s sarcoma-associated herpesvirus, or HHV-8/KSHV (implicated in Kaposi’s sarcoma), Epstein-Barr virus, or EBV (in primary central nervous system lymphoma and a subset of systemic B-cell NHL) and human papillomavirus, or HPV (in cervical cancer).[1]
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Cancer Vaccines: A New Frontier in Prevention and TreatmentVaccines have been exceptionally effective against diseases such as smallpox, measles, chickenpox, and polio. They are among the safest and most cost-effective agents for disease prevention. In recent years, vaccination has been considered for other diseases, including AIDS and cancer. Cancer vaccines can be categorized as preventive or therapeutic. Preventive vaccines, which are commercially available for cervical cancer and liver cancer, block infection with the causative agents of human papillomavirus and hepatitis B virus, respectively. The benefit of cancer treatment vaccines lies in their ability to "boost" the immune system response to cancer cells, which is generally low. Using vaccines in the treatment of cancer is relatively new, however, and chiefly experimental. Therapeutic vaccines for breast, lung, colon, skin, renal, prostate, and other cancers are now being investigated in clinical trials. Oncology nurses may play a significant role in reducing barriers to uptake of preventive vaccines among the general public and in increasing patients' acceptance of therapeutic cancer vaccines.
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Management of Triple-Negative Breast Cancer in Older Patients: How Is It Different?In this review, we will discuss the role of geriatric assessment, alternative treatment modalities for older women with triple-negative breast cancer, and other special considerations for this patient population.
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Helping Patients to Cope With CIPNOwing to the success of today’s cancer treatments, many cancer survivors are now living through and beyond the cancer experience.
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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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Chemotherapy of Intermediate-Grade Non-Hodgkin's Lymphoma: Is "More" or "Less" Better?While it would seem obvious that dose intensity is an important determinant of treatment outcome in aggressive lymphomas, actually there are very few prospective data to support this hypothesis. Circumstantial evidence derived from retrospective analyses suggests that dose intensity is of clinical significance.
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Promoting Smoking Cessation Among Cancer Patients: A Behavioral ModelThe smoking cessation clinical practice guideline recently published by the Agency for Health Care Policy and Research (AHCPR) summarizes current knowledge on smoking cessation treatments. Among its
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The New Face of Head and Neck Cancer: The HPV EpidemicThis review discusses current paradigms in the diagnosis and management of HPV-OPSCC, and we emphasize pertinent research questions to investigate going forward, including whether to deintensify treatment in these patients.
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Chronic Myelogenous Leukemia: Update on Biology and TreatmentChronic myelogenous leukemia (CML) is an intriguing disease for reasons that point to important biological differences between this and other types of leukemia:
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A 38-Year-Old Man With Pancreatic CancerMichael H. Levy, MD: This 38-year-old white male first came to his physician in January of 1993 complaining of epigastric and low back pain. In March of 1993, he was diagnosed with pancreatic cancer that was metastatic to his
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A 15-Year-Old Boy With Primitive Neurectodermal TumorDr. Peter Staats presented the case of a 15-year-old, 40-kg boy with a primitive neurectodermal tumor located in
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Management of Sleep-Wake Disturbances Comorbid With CancerIn both primary care and oncology settings, screening patients for sleep-wake disturbances comorbid with cancer and their daytime consequences can reduce the economic burden of untreated sleep problems.
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Immunologic and Biologic Properties of the Primary Tumor During Prolonged Neoadjuvant ChemoimmunotherapyPatients with locally advanced cancers have a poor prognosis when treated with radiotherapy and/or surgery alone. The appearance of distant metastases shortly after removal of the primary tumor indicates that micrometastases are already present at the time of diagnosis. We observed a favorable outcome in patients with locally advanced breast cancer treated with a prolonged regimen of neoadjuvant chemotherapy plus granulocyte-macrophage colony-stimulating factor (GM-CSF [Leukine]) compared with patients receiving fewer chemotherapy cycles prior to surgery and radiotherapy. These results can partly be explained by the dose-intensive regimen used, but biologic and immunologic processes inherent to the prolonged presence of the primary tumor and its draining lymph nodes might also contribute to the beneficial outcome. The effects of the prolonged presence of the primary tumor during chemotherapy and GM-CSF administration on the antitumor immune response, and more specifically the functional properties of dendritic cells and T cells, are currently being investigated in a multicenter randomized clinical trial comparing prolonged neoadjuvant chemotherapy plus cytokines with a conventional treatment schedule. Aside from investigations concerning the immune system, other biologic processes, such as tumor angiogenesis, are being investigated at the same time. [ONCOLOGY 16(Suppl 1):32-39, 2002]
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Exposure to In Utero Chemotherapy Did Not Affect Children’s Development, BehaviorIn this video we discuss two poster presentations on childhood development and behavior after in utero exposure to chemotherapy for maternal cancer in pregnancy.
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Chemoradiation Therapy for Organ Preservation in Localized Male Urethral CarcinomaMore research is needed to define the optimal radiotherapy and chemotherapy regimen for male urethral carcinoma. However, modern chemoradiation is a feasible treatment option for motivated men with urethral carcinoma who want to preserve their organs.
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Clinical Management of Uveal and Conjunctival MelanomaIn this review, we discuss current management strategies, as well as future directions, for the management of uveal and conjunctival melanoma.
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The Management of Nongastric MALT LymphomasNo definite guidelines exist for the management of nongastric MALT lymphoma. Retrospective series have included patients treated with different modalities, and excellent cause-specific and overall survival have been demonstrated, independent of the type of treatment adopted.
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Biomarkers Could Predict Bladder Cancer ProgressionThis video examines a study that used liquid biopsies to monitor disease progression in patients with bladder cancer.
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CLL Therapy: The Increasing Importance of Predictive MarkersIt is easy to anticipate that as the complex biology of CLL continues to unfold, new prognostic and predictive biomarkers will be recognized. The discovery of genetic mutations that are key regulators of the development, growth, and proliferation of CLL leukemic cells augurs an alluring future.
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Principles of Oncologic PharmacotherapyThe effective use of cancer chemotherapy requires a thorough understanding of the principles of neoplastic cell growth kinetics, basic pharmacologic mechanisms of drug action, pharmacokinetic and pharmacodynamic variability, and mechanisms of drug resistance. Recent scientific advances in the field of molecular oncology have led to the identification of large numbers of potential targets for novel anticancer therapies. This has resulted in a tremendous expansion of the drug development pipeline, and in the present era, the diversity of clinically useful novel anticancer therapeutic agents is growing at an unprecedented rate. However, the great enthusiasm that surrounds these new agents must be tempered by the challenges they present in optimizing their clinical use and in rationally integrating them with existing anticancer therapies. This discussion focuses on the basic principles underlying the development of modern combination chemotherapy, and it is followed by a description of the major classes of chemotherapeutic drugs and their mechanisms of action.
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Nuclear Medicine Imaging in Breast Cancer: Current Strategies and Future DirectionsThe article “PET Scan in the Diagnosis and Management of Breast Cancer” by Jame Abraham and coworkers is a complete, updated review of the existing scientific literature about clinical indications for positron-emission tomography (PET) in this malignancy.
