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Esophageal CancerThis comprehensive guide for oncologists covers the diagnosis, staging, treatment, and management of esophageal cancer.
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Clinical Management of EGFRI Dermatologic Toxicities: US PerspectiveManagement of dermatologic toxicities from epidermal growth-factor receptor inhibitors (EGFRIs) is best tailored to the type of skin lesions present, extent of body surface involvement, and anatomic location affected. Although few randomized trials have been undertaken to address treatment of skin, hair, or nail side effects to this class of drugs, some basic principles of therapy based on experience of referral centers can help mitigate these toxicities and ensure consistent EGFRI administration and maintenance of patient quality of life. Patient education as to the expected EGFRI side effects and early physician intervention when these side effects appear can improve outcomes. Two dermatologists who treat high numbers of patients affected by these EGFRI-induced cutaneous side effects submit their recommendations for management.
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Cancer Management in Patients With End-Stage Renal DiseaseSignificant improvements in the management of patients with endstagerenal disease (ESRD) who are on chronic renal replacementtherapy (CRRT), has led to an increased prevalence of this populationamong older Americans. Since cancer is also common in the elderly,oncologists are likely to be faced with patients who suffer from bothcancer and ESRD. There is a paucity of information regarding issuessurrounding the optimal management of such patients, especially thoseneeding chemotherapy. This review surveys the relevant problemsoncologists may encounter in such patients and summarizes the availableliterature on chemotherapeutic management of common cancers.The reader is strongly urged to consult the original references for detailsof chemotherapy administration prior to use in an individualpatient.
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Treating Locally Advanced Penile CancerThis video examines the treatment of locally advanced penile cancer and whether an organ-sparing chemoradiotherapy approach might be an option instead of surgery.
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Putting Lung Cancer Clinical Trials Into PerspectiveGanti and colleagues have provided a comprehensive overview on recent presentations involving lung cancer.
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Central Nervous System Germ Cell Tumors: Controversies in Diagnosis and TreatmentThe variability and complexity of central nervous system germ cell tumors have led to controversy in both diagnosis and management. If a germ cell tumor is suspected, the measurement of cerebrospinal fluid and serum alpha-fetoprotein and beta–human chorionic gonadotropin is essential. A histologic specimen is not necessary if the patient has elevated levels; however, if the tumor markers are negative, a biopsy is needed to confirm the diagnosis of a germinoma. Germinomas are extremelyradiosensitive, enabling 5-year survival rates that exceed 90%. Treatment has traditionally included focal and craniospinal axis irradiation; however, multiple ongoing studies are being conducted to examinethe efficacy of reduction or elimination of radiation therapy with the addition of chemotherapy. Nongerminomatous germ cell tumors, on the other hand, are relatively radioresistant with a poorer outcome. The combination of chemotherapy and irradiation is associated with overall survival rates of up to 60%. This article provides a review of the controversies in diagnosis and treatment of central nervous system germ cell tumors.
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Pathologic Evaluation of Prostatic Carcinoma: Critical Information for the OncologistDuring the last few years, pathologists have assumed several important roles in the assessment of adenocarcinomas of the prostate. The establishment of postoperative serum prostate-specific antigen (PSA)
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Chemotherapy-Induced Cardiomyopathy: Clinical Scenarios and ChallengesWe will discuss the deleterious cardiovascular effects of anthracyclines and HER2-targeted agents in a case-based format, as well as specific approaches to prevention and treatment of associated cardiotoxicity.
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Adjuvant Therapy for Rectal Cancer: Results and ControversiesIn this excellent article, Dr. Minsky examines the current state of knowledge about adjuvant therapy for resectable rectal cancer, as well as ongoing research in this area. Reasonable recommendations for the management of patients with rectal cancer are made based on data obtained from clinical trials.
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Commentary (Asgharzadeh/Finlay): Recent Advances in the Treatment of Pediatric Brain TumorsThe review by Gururangan andFriedman takes an interestingand informative approach to pediatricbrain tumors in emphasizingthe possible biologic bases for chemotherapyfailure in these neoplasmsin general, and focusing on newer, asyet largely unproven, strategies employing“biologic” therapies to circumventsuch mechanisms of tumor resistance.Many of these newer treatment strategiesare drawn from the work of theauthors and others in the field of adultmalignant gliomas. To date, minimalprogress has been achieved in improvingoutcome for children with malignantsupratentorial gliomas andbrainstem tumors. Hopefully, these newstrategies will have significant benefitin pediatric as well as adult patients.
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Unmet Needs and the Future of Multiple MyelomaExperts muse on the unmet needs of multiple myeloma, and exciting investigational therapies on the horizon.
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PARP Inhibitors and the Challenges of Developing Ovarian Cancer TherapeuticsCancer Network interviews two prominent ovarian cancer researchers from both sides of the Atlantic on the role of PARP inhibitors and the challenges of developing ovarian cancer therapies.
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Therapeutic Implications of Molecular Subtyping for Pancreatic CancerIn this article, we review seminal articles that have evaluated the molecular architecture of pancreatic cancer. We compare the methods used and the molecular subtypes defined, and assess the predominant subgroups in order to better understand which therapies may improve patient outcomes.
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Provenge wild ride blazes trail for immunotherapyAmidst controversy, the FDA finally approved the controversial prostate cancer therapy. Hopes are high that Provenge represents the first in a long line of effective immunotherapeutics.
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Commentary (Bryan/Berek): Ovarian Cancer in Elderly WomenAs the population ages over thenext 50 years, the number ofcancer patients is expected todouble from the current 1.3 million to2.6 million, and the majority of thosepatients will be at least 75 years old.[1]Projected increases in life expectancyaccount for this change. For womenliving in industrialized countries, it isestimated that the average life span infuture decades will reach 90 years.[2]Most cancers increase in incidenceand mortality as a population ages,although the causal link between oncogenesisand senescence remainscomplex and elusive. Within the contextof an upsurge in cancer incidence,an analysis of the inequitable treatmentof older patients afflicted withcancer takes on an urgent need.
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Jonathan S. Zager, MD, on Results of Phase 3 FOCUS Trial Examining Percutaneous Hepatic Perfusion in Ocular Melanoma With Hepatic MetastasesJonathan S. Zager, MD, discussed the use of percutaneous hepatic perfusion vs best alternative care for patients with hepatic-dominant ocular melanoma analyzed in the phase 3 FOCUS trial.
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Chemotherapy in Advanced Nasopharyngeal CancerChemotherapy is an integral part of treatment for patients with nasopharyngeal carcinoma. Chemotherapy can achieve long-term survival rates of up to 15% to 20%, even in patients with recurrent or metastatic disease. In
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Treatment of Midgut Neuroendocrine TumorsThis video examines current options for the treatment of midgut neuroendocrine tumors and highlights results of the NETTER-1 trial.
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Breast Cancer: New Radiation Treatment OptionsSix published randomized trials[1-6] and one meta-analysis[7] of published and unpublishedtrials have demonstrated thatbreast-conserving therapy (breast-conservingsurgery plus breast irradiation)is equivalent to mastectomy interms of survival. As a result, breastconservingtherapy is the option preferredby many women for thetreatment of early-stage breast cancer.[8] Breast irradiation followingbreast-conserving surgery is an integralpart of breast-conserving therapy.There are seven other publishedrandomized trials demonstrating thatbreast irradiation substantially reducesthe rate of local recurrence andprevents the need for subsequent mastectomy.[9-15] A recent meta-analysisalso supports the conclusion that breastcancer patients who receive breast irradiationhave improved survival.[16]
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Management of Marginal Zone LymphomaMZL comprises three different entities that require integration of clinical and pathologic features to make a diagnosis. Treatment is chosen and initiated on the basis of presentation, symptoms, and underlying subtype.
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Reassessment of Anti-CD20 Therapy in Lymphoid Malignancies: Impact, Limitations, and New DirectionsThis review will highlight the survival impact that rituximab therapy has had on major lymphoid malignancies, such as diffuse large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, and mantle cell lymphoma. We will also discuss alternative anti-CD20 monoclonal antibodies.
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Oslerian Genomics for Prostate Cancer OncologyThe great strength of the PCWG3 is the recognition that second- , third- , and fourth-line treatments offer new possibilities for extending overall survival.
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Defining the Role of Hepatic Arterial Infusion Chemotherapy in Metastatic Colorectal CancerThe use of hepatic arterial infusion (HAI) chemotherapy in patientswith liver-only colorectal metastases is based on the pharmacologicprinciple that the regional administration of some drugs can lead tohigher drug concentrations at the site of the metastases and avoid systemictoxicity. Early randomized trials resulted in high response ratesbut did not lead to a survival advantage with HAI. More recent trialshave utilized improved surgical techniques and strict guidelines regardingdose reduction or cessation of HAI chemotherapy, resulting in asignificant reduction in toxicity. In patients with unresectable liver metastases,two recent European trials using HAI fluorouracil (5-FU)again failed to demonstrate an improvement in survival, but both wereplagued by a high complication rate with an associated high proportionof patients failing to receive the assigned treatment. In contrast,the preliminary results of a recent Cancer and Leukemia Group B trialdid demonstrate a survival advantage with HAI floxuridine when comparedto systemically administered 5-FU. Trials investigating the useof HAI chemotherapy in the adjuvant setting have yielded mixed results.Moreover, in light of improved response rates and overall survivalwith newer more active chemotherapeutic and novel agents, theabsolute role of HAI chemotherapy remains undefined.
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Oslerian Genomics for Prostate Cancer OncologyThe great strength of the PCWG3 is the recognition that second- , third- , and fourth-line treatments offer new possibilities for extending overall survival.
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The Role of the Comprehensive Geriatric Assessment in the Evaluation of the Older Cancer PatientGeriatric assessments have now been recommended as part of the standard evaluation of an older adult considering cancer therapy.
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Chemotherapy in Prostate Cancer Beyond Metastatic CRPCAlthough great therapeutic advances have been made in metastatic castration-resistant prostate cancer, the role of systemic approaches in the management of patients outside of metastatic castration-resistant prostate cancer remains largely undefined.
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Oral UFT and Leucovorin in Patients With Advanced Gastric CarcinomaThirty-nine patients with locally advanced or metastatic gastric carcinoma received oral UFT (tegafur and uracil) plus leucovorin. Treatment consisted of UFT 360 mg/m2/day plus leucovorin 25 mg/m2/day, given orally in divided
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Treatment of Metastatic Pancreatic Adenocarcinoma: A ReviewGemcitabine monotherapy has been the standard of care for patients with metastatic pancreatic cancer for several decades. Despite recent advances in various chemotherapeutic regimens and in the development of targeted therapies, metastatic pancreatic cancer remains highly resistant to chemotherapy.
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Commentary (Hankins)-Integrated PET-CT: Evidence-Based Review of Oncology IndicationsRecent technical advances leadingto the development of integratedpositron-emissiontomography (PET)–computed tomography(CT) have been a boon for oncologicimaging. Combining these twoimaging modalities into the same imagingunit has greatly simplified visualfusion of function (PET) andanatomic (CT) data. The popularityof this modality has resulted in over60% of all PET sales currently beingPET-CT units.
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Quality of life deficits offset benefits of preoperative rectal radiation therapyAlthough preoperative radiotherapy has been shown to improve recurrence and mortality rates in patients with rectal cancer, a quality-of-life analysis by the same researchers suggests that male sexual dysfunction and fecal incontinence may be the trade-offs for those improved outcomes
