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Paclitaxel and Carboplatin as First-Line Chemotherapy for Advanced Breast CancerIn a phase II study, 66 patients with advanced breast cancer (median age 56 years; range, 28 to 75 years) were treated with paclitaxel (Taxol), 175 mg/m² infused over 3 hours, and carboplatin (Paraplatin), dosed to attain an
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Bovine Infectious Agents and Cooking-Induced Carcinogens Contribute to Certain CancersIn this interview we discuss a bovine infectious agent, which may interact with carcinogens that arise during cooking or curing, and play a causative role in certain cancer.
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Optimizing the Delivery of Antineoplastic Therapies to the Central Nervous SystemThis review describes the anatomy of the blood-brain barrier and currently available methods to quantify the entry of therapeutic compounds into the brain. It also summarizes data from a variety of approaches designed to improve drug delivery to the central nervous system.
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The Use of Serum hCG as a Marker of Tumor Progression and of the Response of Metastatic Urothelial Cancer to Systemic ChemotherapyA 55-year-old woman with a history of metastatic melanoma in remission for 8 years presented to the emergency department with gross hematuria. A CT scan, ordered because the patient was in menopause, demonstrated a bladder tumor.
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Use of Saline-Filled Tissue Expanders to Protect the Small Bowel from RadiationThe article by Hoffman, Sigurdson, and Eisenberg updates their experience in the use of temporary saline-filled tissue expanders (TEs) for small bowel exclusion. In their initial prospective study of 34 patients with a median time of patient surveillance after TE placement of 18 months, the authors demonstrated that small bowel was displaced from more than 95% of the radiation therapy treatment volume in 70% of 27 evaluable patients and from more than 75% of the treatment volume in 89% of patients.[1]
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ACR Appropriateness Criteria® Resectable Stomach CancerFor resectable gastric cancer, perioperative chemotherapy or adjuvant chemoradiation with chemotherapy are standards of care. The decision making for adjuvant therapeutic management can depend on the stage of the cancer, lymph node positivity, and extent of surgical resection.
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Gemcitabine/Irinotecan/Celecoxib in Pancreatic CancerUnresectable pancreatic cancer has few therapeutic options and adismal prognosis. Cyclooxygenase-2 (COX-2) expression is increasedat the RNA and protein levels in most human pancreatic cancers. Thepurpose of this trial was to determine whether the addition of a COX-2inhibitor to chemotherapy was beneficial. To date, 11 patients with inoperablepancreatic cancer have been treated with the combination ofgemcitabine (Gemzar), irinotecan (Camptosar), and celecoxib(Celebrex) at 400 mg orally twice daily. Encouraging pain relief, improvementin performance status, and decreases in CA 19-9 andcarcinoembryonic antigen levels have been observed.
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Surgical Approach to Organ Preservation in the Treatment of Cancer of the LarynxThe article by Dr. Weinstein is a discussion of the newer surgical options available for the treatment of patients with laryngeal cancer. Several aspects of the article deserve mention.
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Improving Tolerance of AIs: Predicting Risk and Uncovering Mechanisms of Musculoskeletal ToxicityEndocrine therapy plays a critical role in the management of early-stage hormone receptor–positive breast cancer, providing a nearly 50% reduction in the risk of distant and local recurrence.
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Neoadjuvant Pertuzumab: the Exception That Proves the Rule?Contrary to some expectations, getting accelerated approval for neoadjuvant therapy does not look easy, and the pertuzumab story may be the exception that proves the rule.
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Commentary (Begossi/Wanebo): Surgery in the Older PatientWith this insightful manuscript, Drs. Termuhlen and Kemeny shed some light on the surgical management of older cancer patients. The authors highlight pitfalls in patient selection and offer proposals to improve the surgical oncologist’s approach to patient care. They review the role of curative surgical management of the most common forms of cancer in the elderly, while emphasizing the role of surgical palliation to improve the quality of life of older cancer patients.
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Commentary (Douglass): Managing the Peritoneal Surface Component of Gastrointestinal CancerNo American surgeon has thesame breadth of experiencewith extensive peritoneal resectionas Dr. Paul Sugarbaker. Moreover,only a few clinicians worldwidehave the same level of experiencewith intraperitoneal chemotherapy fora variety of intraperitoneal cancers,particularly after peritoneal resection.[1] The value of these therapiesis unquestionable in patients with lowgradetumors confined to the peritonealcavity. A number of patientstreated in this fashion show no evidenceof recurrent disease a decadeor more posttreatment.
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Lung Cancer Screening Guidelines UpdatedThe debate over screening for lung cancer continues. While there have been many advances in treatment for late-stage disease, screening and prevention are likely the most cost effective and best approaches to preventing lung cancer deaths.
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Advances in the Systemic Treatment of Metastatic MelanomaWithin the relatively short time that ipilimumab and vemurafenib have been commercially available, phase II data for the investigational agents nivolumab and MK-3475, for the combination of dabrafenib and trametinib, and for adoptive cell therapy strongly suggest even further improvements in treatment outcomes.
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Diagnosis and Treatment of Thrombocythemia in Myeloproliferative DisordersMyeloproliferative disorders originate in the clonal expansion of a transformed pluripotential hematopoietic progenitor cell. This results in a group of syndromes that include polycythemia vera, essential thrombocythemia,
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Commentary (Burke): Prostate Cancer Risk Assessment ProgramBruner and colleagues describe a comprehensive, long-term research program designed to understand, model, and modify prostate cancer risk. According to the investigators, the main problem with early prostate cancer risk screening is the
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Commentary (Van Gelder/Schouten)-Follicular Lymphoma: Expanding Therapeutic OptionsGanti et al present quite an extensive overview of follicular lymphoma, with most of their emphasis on clinical practice. Many of the issues they touch upon demonstrate that we cannot draw firm conclusions about the superiority of various treatments over others, due to a variety of study limitations. These challenges to interpretation include the indolent course of the disease in most patients (and thus the long follow-up needed to draw firm conclusions), the often small number of patients in this category, the retrospective nature of most studies, differences in risk factors, and the relative lack of randomized studies. As is also the case with efficacy, the most beneficial treatment strategy in follicular lymphoma remains to be established.
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Neoadjuvant Chemotherapy for Operable Breast CancerOver the past 2 decades, two major trends in the treatment of breast cancer-breast-conserving therapy and neoadjuvant (or preoperative) chemotherapy-have converged to stimulate interest in the use of neoadjuvant chemotherapy to facilitate breast conservation in women presenting with large tumors. After being established as the treatment of choice for locally advanced or inoperable breast cancer, theoretical considerations and the desire to extend breast-conserving therapy to more patients with large tumors have resulted in an increase in the use of neoadjuvant chemotherapy in operable patients. Drs. Green and Hortobagyi have provided us with a comprehensive review of the background and the current state of neoadjuvant chemotherapy for breast cancer.
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Brachytherapy in the Treatment of Head and Neck CancerBrachytherapy is a therapeutic modality that may provide a significant improvement in the therapeutic ratio when appropriately applied, and hence, is an appealing treatment strategy for the head and neck. For several
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Book Review: Physicians' Guide to the InternetThose of us who have been involved in medicine for a number of years can remember a time when physicians were the ones who informed their patients about the latest advances in diagnosis and treatment. In the new electronic age, however, medic
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The Epidemiologic Scope of Kaposi's SarcomaThe unique epidemiology of Kaposi's sarcoma among patients with the acquired immunodeficiency syndrome suggests a multifactorial cause. Although the human immunodeficiency virus (HIV) plays a major role in the
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COUNTERPOINT: Is Immediate Radical Cystectomy Justified When Non–Muscle-Invasive Bladder Cancer First Presents as High-Grade T1 Urothelial Carcinoma on Re-Resection?Patients with T1 bladder cancer on re-resection achieve the best possible survival benefit by IRC and thorough pelvic lymph node dissection.
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Combination Therapy for Advanced Breast Cancer: Cyclophosphamide, Doxorubicin, UFT, and TamoxifenWe evaluated combination therapy for advanced and recurrent breast cancer with cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), uracil and tegafur (UFT), and tamoxifen (Nolvadex) (CAUT), designed as
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Blood Substitutes: How Close to a Solution?The term "blood substitute" is commonly misused when "red cell substitute" is meant. The ideal red cell substitute should deliver oxygen (O2), require no compatibility testing, cause few side effects, have prolonged storage qualities, persist in the circulation, and be available at reasonable cost. While no drug with all of these qualities is on the near horizon, several early generation red cell substitutes are approaching submission for licensure, at least for limited indications.
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Future Perioperative Strategies in Non-Small Cell Lung CancerBefore closing out their discussion on non–small cell lung cancer, experts share excitement for possible improvements in the setting of perioperative therapy.
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Pharmacology of Antineoplastic Agents in Older Cancer PatientsPeople over the age of 65 are a fast-growing segment of the US population, and with the incidence of cancer increasing with age, the challenges of treating older cancer patients are also on the rise. Drs. Lichtman and Skirvin present a comprehensive review of the antineoplastic agents used in elderly cancer patients. They highlight the important factors of chemotherapy pharmacology in elderly cancer patients, with emphasis on the impact of physiologic changes-especially renal clearance-in dosing and toxicity. In addition, descriptions of significant toxicities are provided. The following additional issues should be considered.
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Doublets and Triplets: New Drug Combinations in the Palliative Care of NSCLCChemotherapy has been shown to prolong survival in patients with stage IV non-small-cell lung cancer (NSCLC). However, traditional cisplatin (Platinol)-containing regimens are associated with significant toxicity.
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Current Management of Depression in Cancer PatientsDepression is a common but treatable condition among cancer patients. Screening for depression can be done simply and effectively, and a variety of practical treatment strategies are available. Numerous factors should be
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Ground-Glass Opacity Lung Nodules in the Era of Lung Cancer CT Screening: Radiology, Pathology, and Clinical ManagementThis review focuses on the radiologic and pathologic features of ground-glass opacity nodules, along with the clinical management of these lesions.
