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Live Viruses in Cancer TreatmentAlthough antitumor activity and a low toxicity profile have been demonstrated for several oncolytic viruses, the development of viral therapy in cancer treatment has been limited by a lack of definitive phase III trials. The use
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Does Radiotherapy in Unresectable Pancreatic Cancer Add Value?This video reviews the conflicting data and perspectives regarding the use of radiotherapy in unresectable pancreatic cancer.
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Key Takeaways: Optimal Use of JAK Inhibitors in MF and Future Directions in CarePanelists share key takeaways on management strategies in myelofibrosis and hope for future evolutions in the treatment paradigm.
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Cytoreductive Surgery for Advanced Ovarian Cancer: Quo Vadis?This article focuses on the recent debate regarding when-or whether-patients with ovarian cancer should undergo aggressive surgical resection.
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Radioactive Iodine Overused in Papillary Thyroid CancerDespite well-established guidelines from the American Thyroid Association, radioactive iodine continues to be overused for some forms of thyroid cancer.
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Mutation-Derived Tumor Antigens: Novel Targets in Cancer ImmunotherapyBecause of the abundance of promising preclinical and early-phase clinical data, mutation-derived tumor antigens an exciting new class of targets in cancer immunotherapy.
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Docetaxel and Vinorelbine Plus GM-CSF in Malignant MelanomaPatients having locoregional or metastatic melanoma have a poorprognosis, with 50% to 100% of patients dying from the disease within5 years. Current chemotherapy regimens offer limited benefits to thesepatients, and more effective and less toxic treatments are needed. Wetherefore piloted a study of docetaxel (Taxotere), vinorelbine(Navelbine), granulocyte-macrophage colony-stimulating factor(GM-CSF, sargramostim [Leukine]), or the DVS regimen, in patientswith stage IV melanoma. Eight patients were treated after previousbiochemotherapy and two patients were given the regimen as an initialtreatment. The DVS regimen consisted of docetaxel at 40 mg/m2 IVover 1 hour, vinorelbine at 30 mg/m2 IV over 6 to 10 minutes every 14days, and GM-CSF at 250 mg/m2 SC on days 2 to 12. No grade 3 or 4toxicities were encountered. Of the 10 patients evaluable for response, 5were partial responders (50% response rate). Time to progression for the10 cases ranged from 2 to 26+ months (median: 8 months). The DVSregimen was active against advanced melanoma in both previously treatedand untreated patients. A larger study to confirm the activity of the DVSregimen for stage IV melanoma is currently under way.
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The Role of Mitoxantrone in Non-Hodgkin’s LymphomaDr. Armitage presents a succinct and thorough review of the role of mitoxantrone (Novantrone) in patients with non-Hodgkin’s lymphoma (NHL). He begins by emphasizing the importance of accurate diagnosis as described in the World Health Organization classification which evolved from the Revised European American Lymphoma classification. Both of these present day classifications are based on the immunologic principles separating lymphomas into B- and T-cell disorders developed in the 1970s by Lennert, Lukes, and Collins.[1,2] His review addresses multiple issues in mitoxantrone therapy, including dose intensity, cardiotoxicity, combination therapy with nucleoside analogs in low-grade lymphomas, the impact of rituximab (Rituxan), therapy for acquired immunodeficiency syndrome (AIDS)-related lymphoma, and the role of high-dose mitoxantrone as part of a preparative regimen for autologous transplants.
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ACR Appropriateness Criteria® Borderline and Unresectable Pancreas CancerThese guidelines review the use of radiation, chemotherapy, and surgery in borderline and unresectable pancreas cancer. Radiation technique, dose, and targets were evaluated, as was the recommended chemotherapy, administered either alone or concurrently with radiation. This report will aid clinicians in determining guidelines for the optimal treatment of borderline and unresectable pancreatic cancer.
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Conservative Management of Rectal Cancer With Local Excision and Adjuvant TherapyThe article by Drs. Wagman and Minsky is an excellent overview of the history, indications, treatment considerations, and comparative results of local excision alone and local excision plus chemoradiotherapy for selected distal rectal cancers. Although the literature and experience with local excision have increased, use of the technique has probably diminished over the past decade, primarily due to the groundswell of publications that lionize total mesorectal excision with low colorectal or coloanal anastomosis for most rectal cancers, as well as our inability to stage and predict nodal involvement, even in T1 cancers.
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DLBCL Cell of Origin: What Role Should It Play in Care Today?In this article, we review the methods of determining cell of origin (COO); use of COO in clinical practice; clinical trials in DLBCL according to COO; and future directions of tailoring treatment, including alternate categorization of genetic subtypes or clusters in DLBCL.
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Sexual Health Issues in Men With CancerWhile the cancer patient may be affected by sexual dysfunction throughout the entire course of the disease, sexual health is largely underevaluated and undertreated. Sexual problems should be anticipated and patients should be actively screened as they are unlikely to initiate discussion on sexual issues.
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ESPAC-4: Adjuvant Gemcitabine/Capecitabine in Resected Pancreatic CancerThe ESPAC-4 trial found that adding capecitabine to gemcitabine in patients with resected pancreatic cancer resulted in an improved estimated 5-year survival rate.
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The Evolving Role of Radiation Therapy in DLBCL: From Early-Stage to Refractory DiseaseGavin Jones, MD, and colleagues explore the landscape of radiation therapy in diffuse large B-cell lymphoma.
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Commentary (Quek et al): Management of Patients With Muscle-Invasive and Metastatic Bladder CancerDrs. Henry, MacVicar, and Hussainprovide a timely reviewof the current management ofmuscle-invasive and metastaticurothelial cancer. The emerging roleof neoadjuvant chemotherapy and thepromise of novel, less toxic targetedtherapies are of particular interest inthe treatment of a disease in whichoutcomes remain poor for locally advancedand metastatic involvementdespite an aggressive multimodalityapproach.[1] We wish to briefly commenton three issues raised by theauthors: (1) the role of surgery in themanagement of invasive disease,(2) the indiscriminate use of neoadjuvantchemotherapy for clinically localizeddisease, and (3) the currentstatus of bladder-sparing approaches.
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The Evolution of Liver-Directed Treatments for Hepatic Colorectal MetastasesThis article will review the current practice of hepatic resection for colorectal liver metastases, including the possibility of combined resection of hepatic metastases at the time of resection of the primary cancer.
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Current Status and Optimal Use of RadiosurgeryThe field of stereotactic radiosurgery is rapidly advancing as a result of both improvements in radiosurgical equipment and better physician understanding of the clinical applications of stereotactic radiosurgery. This
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Second-Line Treatment of Small-Cell Lung CancerSmall-cell lung cancer is an aggressive tumor associated with highrates of regional or distant metastases at diagnosis. Although highlychemosensitive to agents given in the first-line setting (eg, etoposideand cisplatin), most patients relapse and have a poor prognosis.Treatment options for relapsed patients include radiotherapy forlimited-stage disease and chemotherapy or combined modalities foradvanced-stage disease. In clinical practice, however, some oncologistsmaintain that chemotherapy provides an insufficient survivalbenefit to justify the sometimes debilitating toxicity associated with themore active regimens in particular. Other potential barriers to furthertreatment include patient comorbidities, performance status, site(s) ofprogression, progression-free interval, and previous treatments. However,numerous clinical trials demonstrate that some patients benefitfrom treatment, achieving prolonged survival, symptom palliation,improved quality of life, and the opportunity, albeit rare, for durableremission. Additionally, several novel chemotherapeutics are availablethat alone or in combination help patients lead an improvedquality of life. Finally, alternative routes and schedules-oral formulations,weekly administration, and prolonged treatment vacations-have been developed to deliver chemotherapy to patients with poorperformance status or multiple comorbidities. This article reviews theadvantages and disadvantages of treating recurrent small-cell lungcancer and summarizes the utility of several active agents.
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Erlotinib/Gemcitabine for First-Line Treatment of Locally Advanced or Metastatic Adenocarcinoma of the PancreasErlotinib (Tarceva) is a human epidermal growth factor receptor type 1/epidermal growth factor receptor (HER1/EGFR) tyrosine kinase inhibitor initially approved by the US Food and Drug Administration for the treatment of patients with locally advanced or metastatic non–small-cell lung cancer after failure of at least one prior chemotherapy regimen. In this report, we present the pivotal study that led to the approval of erlotinib in combination with gemcitabine (Gemzar) in patients with locally advanced/metastatic chemonaive pancreatic cancer patients. The combination demonstrated a statistically significant increase in overall survival accompanied by an increase in toxicity. Physicians and patients now have a new option for the treatment of locally advanced/metastatic adenocarcinoma of the pancreas.
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Medicare Rule Raises Dilemma in Recurrent Ovarian CancerEpithelial ovarian cancer is the leading cause of death from gynecologic malignancies. In 1996, an estimated 26,000 new cases were diagnosed, and approximately 14,000 women died of this disease in the United States alone.[1] Between 75% and 80% of ovarian cancer patients present with advanced disease at diagnosis, and these patients have a 5-year survival rate of 21%.[2,3]
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Docetaxel/Doxorubicin/Cyclophosphamide in the Treatment of Metastatic Breast CancerPreliminary results from phase I trials suggest that the use of docetaxel (Taxotere) and doxorubicin (Adriamycin) is a well tolerated and highly active combination regimen for
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Camptothecin and Taxane Regimens for Small-Cell Lung CancerFor more than 2 decades, combination chemotherapy has been the standard treatment for patients with small-cell lung cancer. Despite high initial response rates in both extensive- and limited-stage disease, long-term survival
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Antifungal Resistance: The Clinical FrontThe emergence of resistance and changes in the spectrum ofCandida infections have led to an increased interest in susceptibilitytesting of antifungal drugs. Such testing may be particularly useful inpatients with invasive candidiasis who have been previously treated withazole antifungals, those whose infections are not responding to treatment,and those with infections caused by non-albicans species of Candida.The choice of a specific antifungal depends on the clinical statusof the patient, the relative toxicity and efficacy of the drug in the givenpatient population, the infecting species and antifungal susceptibilityof the isolate, and the patient’s prior exposure to antifungal agents.Infectious Diseases Society of America recommendations for the initialmanagement of candidemia and acute disseminated candidiasisinclude an azole, caspofungin, amphotericin B (AmB), or a combinationof fluconazole plus AmB. Caspofungin and voriconazole show goodactivity against most Candida species and may be good alternatives forpatients with Candida glabrata and Candida krusei infections and forthose with relapsing infections.
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Weekly Irinotecan and Concurrent Radiation Therapy for Stage III Unresectable NSCLCIn preclinical studies, the topoisomerase I inhibitor irinotecan (Camptosar, CPT-11) has demonstrated activity as a radiosensitizer, probably due to its ability to inhibit potentially lethal radiation damage repair. We conducted a
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Commentary (Bishop/Wingard)-Patient-Physician Communication in Oncology: What Does the Evidence Show?As noted by Back,[1] the primarygoals of effective patient-physician communicationare to enhance patient understandingof the illness, to improvedecision-making, and to facilitate patientadjustment. These three goalsare sensible and important concernsof the communication dyad. A numberof studies have examined variousaspects of the communication processand the factors that influence communicationoutcomes, and a few evenhave tested interventions to improvephysician communication skills. However,there remains a dearth of studiesthat examine communication effectson the three major goals articulatedabove and that evaluate the effectivenessof communication skill interventionsin influencing patient outcomes.
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Through the Looking Glass: The Evolution of Erythropoiesis-Stimulating Agent UseThe perception and reality of the clinical value of erythropoiesis-stimulating agents (ESAs) in cancer supportive care have undergone a dramatic transformation since their initial use in 1990. The perception of ESA value in patients has evolved from panacea to miscreant over a 2-decade period of laboratory research, clinical trial data, and postmarketing experience. Meanwhile, the real clinical benefits of ESAs have changed very little from those described in the joint American Society of Clinical Oncology/American Society of Hematology guidelines originally published in 2002.[1] Even then, the value of initiation of ESAs was clear only in patients with hemoglobin values < 10 g/dL; quality-of-life measures produced inconsistent and, therefore, clinically inapplicable, results; and ESA use was shown to reduce the proportion of patients requiring red blood cell (RBC) transfusions by approximately 20%. The reality of ESA use that came to light following approval was increased mortality rates in certain populations, higher tumor progression and cancer recurrence rates, and more frequent and severe serious adverse effects including thromboembolism, stroke, and cardiovascular events.
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Book Review:Pediatric Hematology, Second EditionThe second edition of Pediatric Hematolgy, edited by the text's original editors, John S. Lilleyman and Ian M. Hann, as well as a new editor, Victor S. Blanchette, completely updates and expands upon the first edition (published in 1992). The new edition grew from 15 to 40 chapters, with contributions by many of the most well-known investigators and clinicians in pediatric hematology in the world. The textbook will especially be of value to practicing clinicians, house staff, and students.
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Gastric Cancer: Are There New Therapeutic Options?The majority of patients who undergo resection for gastric cancer experience relapse and ultimately die of their disease. Therefore, considerable attention has been paid to neoadjuvant and adjuvant strategies to improve surgical outcomes. Two different approaches have been tested in major clinical trials conducted in the past several years: Postoperative chemoradiotherapy was assessed in a US Southwest Oncology Group/Intergroup study (SWOG 9008/INT 0116), and perioperative chemotherapy was studied in a UK Medical Research Council (MRC) randomized trial (the MRC Adjuvant Gastric Infusional Chemotherapy [MAGIC] trial). These trials demonstrated statistically significant survival benefits in patients with resectable gastric cancer. This review will consider these trials and their implications for clinical practice.
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Gal9/TIM-3 Expression Levels Affects Chemotherapy in Leukemia PatientsA new report suggests targeting the Gal9/TIM3-axis could help boost chances of complete remission in patients with acute myeloid leukemia.
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Preoperative UFT/Leucovorin and Radiation Therapy in Rectal CancerThe use of combined modality regimens has been well established in the treatment of stages II and III rectal cancer. The most common chemotherapy regimens used include continuous-infusion 5-FU delivered with the help of a central venous catheter and the use of portable pumps.
