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MGUS and Smoldering Myeloma: the Most Prevalent of Plasma Cell DyscrasiasMonoclonal gammopathy of undetermined significance (MGUS) is the most prevalent of the plasma cell dyscrasias and is characterized by a low level of production of serum monoclonal (M) protein (classically less than 3 g/dL).
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Supraclavicular Extraskeletal Myxoid Chondrosarcoma Presenting With a Sensorimotor Polyneuropathy Associated With Anti-Hu AntibodiesThis case shows the importance of searching for antineural antibodies in oncologic patients with new neurologic deficits, and of having a judicious workup for occult malignancies in patients with known antineural antibodies.
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Chemotherapy for Brain TumorsTraditionally, cytotoxic drugs have played a limited role in the treatment of brain tumors, but important advances in chemotherapy have occurred during the past decade. Certain central nervous system (CNS) malignancies are
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Commentary (Sachelarie et al): Optimizing Adjuvant Chemotherapy in Early-Stage Breast CancerDrs. Perez and Muss provide acomprehensive review of therole of adjuvant chemotherapyin the management of breast cancerpatients. The benefits of anthracyclinevs nonanthracycline regimens are discussed,the taxanes are reviewed indetail, and data regarding dose intensity,dose density, and optimal numberof chemotherapy cycles areexplored. Data on newer agents andbiologic agents also are presented.Debate continues regarding the subsetsof patients who will derive thegreatest benefit from chemotherapyand which regimen is most appropriate.While the review indicates theefficacy of several regimens as definedby randomized clinical trials, itdoes not emphasize patient-specificfactors in determining the optimaltherapy for a given patient.
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Primary Cutaneous and Systemic Anaplastic Large Cell LymphomaAnaplastic large cell lymphoma (ALCL) is a biologic and clinically heterogenous subtype of T-cell lymphoma. Clinically, ALCL may present as localized (primary) cutaneous disease or widespread systemic disease. These two forms of ALCL are distinct entities with different clinical and biologic features. Both types share similar histology, however, with cohesive sheets of large lymphoid cells expressing the Ki-1 (CD30) molecule. Primary cutaneous ALCL (C-ALCL) is part of the spectrum of CD30+ lymphoproliferative diseases of the skin including lymphomatoid papulosis. Using conservative measures, 5-year disease-free survival rates are>90%. The systemic ALCL type is an aggressive lymphoma that may secondarily involve the skin, in addition to other extranodal sites. Further, systemic ALCL may be divided based on the expression of anaplastic lymphoma kinase (ALK) protein, which is activated most frequently through the nonrandom t(2;5) chromosome translocation, causing the fusion of the nucleophosmin (NPM) gene located at 5q35 to 2p23 encoding the receptor tyrosine kinase ALK. Systemic ALK+ ALCLs have improved prognosis compared with ALK-negative ALCL, although both subtypes warrant treatment with polychemotherapy. Allogeneic and, to a lesser extent, autologous stem cell transplantation play a role in relapsed disease, while the benefit of upfront transplant is not clearly defined. Treatment options for relapsed patients include agents such as pralatrexate (Folotyn) and vinblastine. In addition, a multitude of novel therapeutics are being studied, including anti-CD30 antibodies, histone deacetylase inhibitors, immunomodulatory drugs, proteasome inhibitors, and inhibitors of ALK and its downstream signaling pathways. Continued clinical trial involvement by oncologists and patients is imperative to improve the outcomes for this malignancy.
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Current Status of Gastroenteropancreatic Tumor ManagementGastroenteropancreatic tumors, although relatively rare, present management problems that may last many years, in comparison with the usually more aggressive adenocarcinomas whose management may encompass a far briefer span of time. In general, 50% of such tumors are insulinomas, while gastrinomas comprise 25%, and nonfunctional tumors 20% VIPomas and glucagonomas are the predominant lesions of the remaining 5%. Clinical diagnosis is usually made on the presence of the classical symptom complex. In uncertain circumstances or covert presentations, the critical diagnostic biochemical test is plasma chromogranin A as well as measurement of the specific peptide.
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The Role of PC-SPES, Selenium, and Vitamin E in Prostate CancerProstate cancer patients commonly use complementary and alternative medications. There has been growing interest in recent years in the role of the herbal medication PC-SPES and the essential nutrients selenium and vitamin E in the prevention and treatment of prostate cancer. This article reviews the preclinical and clinical studies of these therapies.
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Prostate Cancer and African-American MenMortality from prostate cancer is two to three times greater among African-American men between the ages of 50 and 70 than among American Caucasian men of similar ages. Also, African-Americans tend to present with more advanced tumors than their American Caucasian counterparts. This article explores differences between the two races that may account for the disproportionately high mortality among African-Americans and their more advanced disease stage at presentation. These include epidemiologic and histologic features of prostate cancer; clinical, biologic, and environmental factors; and barriers to health care. Various important issues that warrant further investigation are also highlighted. [ONCOLOGY 11(5):599-605, 1997]
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Phase I Study of Irinotecan and Concurrent Radiation Therapy for Upper GI TumorsIrinotecan (Camptosar) is an active chemotherapeutic agent for lung, gastric, esophageal, and colorectal cancers and a potent radiosensitizer. This phase I study was designed to assess the maximum tolerated dose of weekly
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Everyone's Guide to Cancer Supportive CareAs an oncologist, I am always on the lookout for good patient education material. This book, which is based on the experience of the Stanford Integrative Medicine Clinic Cancer Supportive Care Program, is a good choice for a highly literate, print-oriented patient or family member. The book is divided into five parts: (1) Cancer: Diagnosis, Information, and Treatment, (2) The Role of the Mind, (3) The Care of the Body, (4) Supportive and Social Services for Life and Death Issues, (5) Planning for the Future, and (6) Resources. These five parts are divided into 50 individual chapters covering specific topics, and the chapters are focused, concise, and practical.
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Irinotecan Plus Cisplatin in Patients With Advanced Non- Small-Cell Lung CancerDuring the 1980s, platinum-based regimens were yielding response rates typically less than 25%, median survival durations of about 25 weeks, and 1-year survival rates less than 25% in patients with advanced non-small-cell lung
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Stages III and IV Breast CancerThis chapter addresses the diagnosis and management of locally advanced, locally recurrent, and metastatic breast cancer, that is, stages III and IV disease.
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Small-Cell Lung CancerSmall-cell lung carcinoma (SCLC) accounts for 20% to 25% of all new cases of lung cancer in the United States. It is estimated that approximately 42,000 new cases will occur in the United States in 1995 [1,2]. Of the various histologic types of lung cancer, small-cell is the most sensitive to chemotherapy and radiotherapy, yet overall outcome is poor, with only 5% to 10% of patients surviving 5 years from diagnosis.
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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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Latest Immunotherapy Approaches in Multiple MyelomaThis video highlights novel approaches using immunotherapies and vaccines for advancing treatment in multiple myeloma.
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A Phase I Study of Paclitaxel, UFT, and LeucovorinThis phase I study examines the dose escalation of UFT given in combination with fixed doses of oral leucovorin and weekly doses of paclitaxel in patients with metastatic solid tumor malignancies (excluding colorectal cancer). There are two main objectives for this study.
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Improving Radiotherapy After Breast-Conserving SurgeryIn assessing the value of innovations in breast cancer radiotherapy, it is important to consider not only the basis of their impact on mortality, local recurrence, and cosmesis; emphasis should also be placed on factors such as treatment tolerance, convenience, and delayed morbidities.
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Role of Iron in Optimizing Responses of Anemic Cancer Patients to ErythropoietinApproximately 50% of cancer patients develop anemia. In the past, the only available treatment option for these patients was transfusion. Since the late 1980s, recombinant human erythropoietin (rHuEPO, epoetin alfa
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Rare PTCLs: Treatment Lagging Behind Pathobiologic AdvancesPeripheral T-cell lymphomas, or PTCLs, represent an uncommon and biologically heterogeneous group of hematologic malignancies, accounting for less than 10% of all non-Hodgkin lymphomas worldwide, with marked geographic differences. Due to their low prevalence, variable clinical presentation and phenotypic heterogeneity, these lymphomas have historically been difficult to diagnose and categorize. Since the introduction of immunophenotyping and molecular genetic methods, as well as the development of comprehensive classification systems, there have been significant advances in diagnostic accuracy, classification, and our understanding of the biologic behavior of different PTCL subtypes. However, the molecular pathogenesis of most subtypes of PTCL remains incompletely understood, and treatment outcomes with conventional anthracycline-based chemotherapy regimens are generally significantly inferior to those in aggressive B-cell lymphomas.
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Iodine-131 Tositumomab for Patients With Low-Grade or Transformed Low-Grade Non-Hodgkin’s Lymphoma: Complete Response DataTositumomab/iodine-131 tositumomab (Bexxar) is a radioimmunotherapeutic agent in development for patients with low-grade or transformed non-Hodgkin’s lymphoma (NHL). This analysis focuses
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Initial Control of Chemotherapy-Induced Nausea and Vomiting in Patient Quality of LifeThe side effects commonly experienced by patients receiving chemotherapy for the treatment of cancer can challenge many aspects of daily life. Nausea and vomiting, the most common side effects reported by patients, affect the ability to continue with usual life activities and, thus have a pronounced impact on quality of life.
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Recurrent Epithelial Ovarian Cancer: An Update on TreatmentEmerging therapies in the management of ovarian cancer have resulted in a shift in paradigm, including in the appropriate time to institute therapy, and in the selection of therapy. This review focuses on chemotherapy and emerging biologic agents that present a therapeutic option for patients with recurrent ovarian cancer.
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Commentary (Palesty et al)-Imatinib Mesylate: A Molecularly Targeted Therapy for Gastrointestinal Stromal TumorsDr. Eisenberg has produced anexcellent, concise, yet comprehensivereview of the evolutionof the KIT inhibitor imatinibmesylate (Gleevec) and the preoperativeand postoperative treatmentdilemmas surrounding mesenchymalgastrointestinal stromal tumors(GISTs), particularly in the face ofadvanced disease and recurrences. Thefocus of the article is on the naturalhistory of GISTs, from a molecularand pathobiologic perspective, toclarify the rationale for the use ofimatinib.
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Changing Perspectives on Palliative CareIn the United States, hospice and palliative care are two distinct expressions of the hospice interdisciplinary team approach to end-of-life care, which originated in Great Britain in the 1960s. The hospice movement developed largely as a home-care program and alternative to conventional care.
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Pharmacology of Antineoplastic Agents in Older Cancer PatientsThe fastest growing segment of the US population is the group over the age of 65 years. In the next 30 years, this group will comprise over 20% of the population. Because 60% of all cancers occur in this age group, there will be an expected rise in the total cancer burden.
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In Vivo Purging With Rituximab Prior to Stem Cell Collection Is Associated With Persistent Molecular Evidence of t(14;18) That Often Disappears Post-Transplant in Patients With Follicular LymphomaWe previously reported that “in vivo purging” with rituximab (Rituxan) during stem-cell collection is safe and does not adversely affect engraftment. We now report on our transplant experience with rituximab. From June 1998 to December
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Limited-Field and Whole-Breast Hypofractionated RadiotherapyWith the publication of mature experiences using accelarated partial breast irradiation (APBI) and accelerated whole breast irradiation (AWBI), the use of shortened courses of radiotherapy has become increasingly popular.
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Complications of Androgen Deprivation Therapy: Prevention and TreatmentAndrogen deprivation, as a form of treatment for prostate cancer,has been used for decades. Within the last decade, however, its use hasincreased significantly. Therefore, it is incumbent upon the physicianto be familiar with the side effects associated with this treatment. Someof these side effects (eg, osteoporosis, changes in lipid profiles, andanemia) may be associated with significant morbidity, whereas others(eg, impotence, decreased libido, fatigue, and hot flashes) primarilyaffect the patient’s quality of life. Prevention strategies and treatmentsexist for many of these side effects. In addition, alternative forms ofantiandrogen therapy such as intermittent hormone ablation andantiandrogen monotherapy may be effective, with the added benefit ofminimizing side effects. This review focuses on the wide range of sideeffects associated with androgen ablation as well as preventive and treatmentstrategies.
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Improving Palliative and Supportive Care in Cancer PatientsTwenty years of research in controlling symptoms such as pain andnausea have shown persistent suboptimal performance by the US oncologysystem. The data suggest that some of the tools of palliative careprograms can improve physical symptoms of seriously ill patients at acost society can afford. To fix these problems will require recognitionof the symptoms or concerns, a system such as an algorithm or careplan for addressing each, measurement of the change, and accountabilityfor the change. Symptom assessment scales such as the EdmontonSymptom Assessment Scale or Rotterdam Symptom Check List work tomake symptoms manifest. Listing symptoms on a problem list is a necessarystep in addressing them. Physical symptoms such as pain can beimproved by use of computer prompts, algorithms, dedicated staff time,team management, or combinations of these strategies. Less concreteproblems such as medically appropriate goal-setting, integrating palliativecare into anticancer care sooner, and informing patients aboutthe benefits and risks of chemotherapy near the end of life require morecomplex solutions. We review what is known about symptom control inoncology, how and why some programs do better, and make suggestionsfor practice. Finally, we suggest a practical plan for using symptomassessment scales, listing the problems, and managing them accordingto algorithms or other predetermined plans.
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Cost-Effectiveness of Rituximab in Treatment of Diffuse Large B-Cell LymphomaRituximab (Rituxan), when combined with CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone) chemotherapy (R-CHOP) in the treatment of patients with CD20-positive diffuse large B-cell lymphoma (DLCL), significantly prolongs event-free and overall survival (GELA [Groupe d’Etude des Lymphomes de l’Adulte] LNH 98-5 study). Our objective was to estimate the cost-effectiveness of R-CHOP based on the evidence currently available.
