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Systemic Therapy of Metastatic Melanoma: On the Road to CureIn this article, we summarize the systemic therapies now available for melanoma, with a focus on the recently approved agents for cutaneous melanoma; discuss important considerations in selecting a treatment from the available options; and highlight some of the promising investigational approaches for this disease.
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Head and Neck TumorsThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of head and neck cancers (including tumors of the oral cavity, oropharynx, hypopharynx, larynx, supraglottis, glottis, subglottis, and nasopharynx) using radiation, surgery, and medical treatment.
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Successful Treatment of Melanoma Metastatic to the Left Atrium Using External Beam Radiation TherapyThe successful treatment of a patient with primary nasal melanoma metastatic to the lung, pulmonary vein, and left atrium using radiation therapy is described. The patient was effectively treated with a conventional external beam radiation fractionation scheme (rather than a more commonly used hypofractioned regimen) that was utilized to minimize risk of arterial embolus of the tumor or rupture of a vessel wall. A post-treatment CT demonstrated a significant decrease in the caliber of the right pulmonary vein and tumor thrombus. The patient never developed cardiac valvular dysfunction or acute life-threatening massive embolism of tumor from the atrium. Unfortunately, the patient experienced clinical decline secondary to the massive progression of intra-abdominal disease and subsequently died from multiple liver metastases and liver failure. Numerous studies and this case report demonstrate that radiation therapy can be very effective in the treatment of malignant melanoma, especially when only small volumes of disease need to be treated and adequate total doses are used. Therefore, radiation therapy appears to play an important yet underutilized role in the treatment of metastatic melanomas.
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Multidisciplinary Evaluation and Treatment: Evolution to Standard Clinical PracticeCombined-modality therapy integrating chemotherapy with radiotherapy and/or surgery is playing an increasing role in the day-to-day management of a wide variety of solid tumors. No longer is this approach solely a clinical research tool. In fact, in
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High-Risk Prostate Cancer: The Rationale for BrachytherapyIn the realm of general oncology, patients who present with aggressive, poorly differentiated malignancies are usually at high risk for disseminated disease, and systemic therapy often supersedes local therapy in importance. It is not surprising, then, that a similar systemic approach to therapy is often considered for patients who present with high-risk prostate cancer. This recommendation is often supported by much of the surgical literature that cites discouraging outcomes in these patients when treated by radical prostatectomy alone.
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Chronic Lymphocytic Leukemia With del(17p13.1): A Distinct Clinical Subtype Requiring Novel Treatment ApproachesThis review will discuss the pathophysiology associated with the del(17p13.1) interphase cytogenetic abnormality, the current generally poor outcomes in affected patients, currently approved therapeutic agents, and new agents now undergoing investigation.
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Commentary (Kirkwood et al): Radiotherapy for Cutaneous Malignant Melanoma: Rationale and IndicationsThe rigorous assessment of thebenefits of radiotherapy formelanoma has been confoundedby superstition on one hand, andreligious fervor on the other. In thisissue, Ballo and Ang have reviewedthe use of radiotherapy for melanoma,focusing primarily on the controversialtopic of adjuvant postoperativeradiotherapy to the primary tumor bedand regional lymphatics.
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Most oncologists believe their career choice was a good one, survey findsOncologists remain largely satisfied with their career choice, with 85% expressing satisfaction and 82% of that group saying they would recommend their specialty to a medical student, according to a survey conducted by Epocrates, a provider of online clinical decision support tools for mobile and desktop devices.
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Survivin(g) Adult T-cell Leukemia/LymphomaIn this issue of ONCOLOGY, Tobinai reviews the management of human T-cell lymphotropic virus type 1 (HTLV-1)–associated adult T-cell leukemia/lymphoma (ATL). Although rare in the United States, an estimated 10 to 20 million people are infected with HTLV-1 worldwide and 2% to 5% will develop ATL.[1]
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Apoptosis Mechanisms: Implications for Cancer Drug DiscoveryDefects in the regulation of apoptosis (programmed cell death) makeimportant contributions to the pathogenesis and progression of mostcancers and leukemias. Apoptosis defects also figure prominently inresistance to chemotherapy, radiotherapy, hormonal therapy, andimmune-based treatments. Apoptosis is caused by activation ofintracellular proteases, known as caspases, that are responsible directlyor indirectly for the morphologic and biochemical events thatcharacterize the apoptotic cell. Numerous proteins that regulate thesecell death proteases have been discovered, including proteins belongingto the Bcl-2, inhibitor of apoptosis, caspase-associated recruitmentdomain, death domain, and death effector domain families. Thesecaspase-regulating proteins provide mechanisms for linkingenvironmental stimuli to cell death responses or to maintenance of cellsurvival. Alterations in the expression and function of several apoptosisregulatinggenes have been demonstrated in cancer, suggesting targetsfor drug discovery. Knowledge of the molecular details of apoptosisregulation and the three-dimensional structures of apoptosis proteinshas revealed new strategies for identifying small-molecule drugs thatmay yield more effective treatments for malignancies. Apoptosisregulatinggenes are also beginning to find utility as targets for antisenseoligonucleotides.
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Interesting Times in the Diagnosis and Treatment of CLLOne of the greatest challenges facing the physician caring for patients with chronic lymphocytic leukemia (CLL) is the heterogeneity of this disease. Over the past decade, there have been major advances in understanding the pathophysiology of CLL, and in the identification of biomarkers that are helpful to predict the clinical course for individual patients. Over the same period, the available therapeutic options have developed dramatically, exemplified by the introduction of combination therapy with purine analogs and monoclonal antibodies, resulting in significant opportunities to induce complete remission (CR) in CLL patients.
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Early Detection and Treatment of Spinal Cord CompressionSeveral key areas must be considered in the diagnosis and managementof spinal cord compression. Because the outcome can be devastating,a diagnosis must be made early and treatment initiated promptly.Although any malignancy can metastasize to the spine, clinicians shouldbe aware that this occurs more commonly in certain diseases, ie, lungcancer, breast cancer, prostate cancer, and myeloma. The current algorithmfor early diagnosis of spinal cord compression involves neurologicassessment and magnetic resonance imaging of the entire spine.Treatment generally consists of intravenous dexamethasone followedby oral dosing. Depending on the extent of the metastases, symptomsmay also be managed with nonnarcotic pain medicines, anti-inflammatorymedications, and/or bisphosphonates, with local radiation administeredas needed. Surgery has often led to destabilization of the spine.
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Invasive Staging and Aggressive Surgical Resection: Essential to Management of Central NSCLCIn summary, central lung cancers, when appropriately staged, are optimally treated by surgical resection. Initial evaluation is best done by a multidisciplinary team, involving a trained thoracic surgeon.
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Maximizing Radiation Benefit in Breast CancerWe read with interest the article and reviews of "Current Status of Radiation in the Treatment of Breast Cancer," which appeared in the April 2001 issue of ONCOLOGY.[1] These papers suggest that one of the most controversial areas in this
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Carcinoma of an Unknown Primary SiteCarcinoma of an unknown primary site is a common clinical syndrome, accounting for approximately 3% of all oncologic diagnoses. Patients in this group are heterogeneous, having a wide variety of clinical presentations and pathologic findings.
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Cancer- and Treatment-Related Cognitive Changes: What Can We Do Now? What Lies Ahead?Much of the existing research into the phenomenon commonly referred to as “chemobrain” has been descriptive, and we know enough now to identify some patients at risk for cognitive changes after a diagnosis of cancer.
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Recurrent Urothelial Carcinoma With Pulmonary MetastasisA 56-year-old woman was referred to our institution for a left nephroureterectomy after the diagnoses of a nonfunctioning left kidney and noninvasive papillary urothelial carcinoma of the distal left ureter (Ta grade 1). Following the procedure, surveillance cystoscopy and computed tomography (CT) scan of the abdomen and pelvis demonstrated a large bladder tumor with pan-urothelial extension.
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Strategies for Identification and Clinical Evaluation of Promising Chemopreventive Agentselloff and colleagues have been key players in the recent development of chemoprevention strategies--as initiators of their own studies and minders of others. The succinct summary of their approach is of particular value to oncologists, both because it provides a great deal of data on the current state of chemoprevention research itself and because it draws some useful distinctions between chemoprevention and chemotherapy.
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Primary and Metastatic Brain TumorsIntracranial neoplasms can arise from any of the structures or cell types present in the cranial vault, including the brain, meninges, pituitary gland, skull, and even residual embryonic tissue.
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Cancers of the Gallbladder and Biliary DuctsNeoplasms of the biliary tract tree are uncommon and have a poor overall prognosis. Although numerous risk factors have been identified, little is known about the pathogenesis of these tumors, and no effective screening
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Survivin(g) Adult T-cell Leukemia/LymphomaIn this issue of ONCOLOGY, Tobinai reviews the management of human T-cell lymphotropic virus type 1 (HTLV-1)–associated adult T-cell leukemia/lymphoma (ATL). Although rare in the United States, an estimated 10 to 20 million people are infected with HTLV-1 worldwide and 2% to 5% will develop ATL.[1]
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Commentary (Niederhuber): Pancreatic Cancer in the Older PatientPancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local
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Color Atlas of Clinical Hematology, Third EditionThe third edition of the Color Atlas of Clinical Hematology, authored by Drs. A. Victor Hoffbrand and John E. Pettit, contains 19 chapters covering the entire spectrum of hematology, including normal hematopoiesis, benign and malignant
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Indolent B-Cell Non-Hodgkin’s LymphomasThe indolent B-cell non-Hodgkin’s lymphomas are a diverse group of disorders that differ markedly with respect to presenting features and natural history. This article reviews entities that have generally been encompassed
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Commentary (Sylvester): Integrating Hormonal Therapy With External-Beam Radiation and Brachytherapy for Prostate CancerDrs. Andrews and Roach present an excellent review and discussion of the existing literature regarding the role of androgen ablation therapy in patients being treated with external-beam radiation therapy (EBRT) and prostate brachytherapy. However, the indications for, and optimal timing of androgen ablation with radiation therapy remain controversial, particularly in regard to brachytherapy.
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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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Commentary (Ensley): Nutritional Support of Patients Undergoing Radiation Therapy for Head and Neck CancerPerhaps no other group of malignanciesis more severely affectedby the problems patients havewith establishing or maintaining goodnutrition than those of the upper aerodigestivetract. Nutrition, or malnutrition,is a critical considerationduring all phases of the diagnosis, treatment,and long-term management ofpatients with head and neck malignancies, even following curative therapy.
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Perspectives on COVID-19 Prophylaxis and VaccinationTo close the discussion, panelists reflect on their practices’ guidance on long-acting antibody prophylaxis and vaccination against COVID-19 for patients with graft-versus-host-disease (GVHD).
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Adult Medulloblastoma, From Spongioblastoma Cerebelli to the Present Day: A Review of Treatment and the Integration of Molecular MarkersHere we present the history, staging system, and treatment of medulloblastoma, reviewing the prognostic value and clinical application of molecular subtyping while highlighting the differences between adult and pediatric disease.
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Current Therapy in Cancer, Second EditionIn their new book entitled Current Therapy in Cancer, Drs. Foley, Vose, and Armitage endeavor to provide a short and concise presentation of various cancers. Their purpose is to aid clinicians in presenting a succinct overview of individual
