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Management of Small-Cell Lung Cancer: Time to Move ForwardSmall-cell lung cancer (SCLC) is a pathologically distinct malignancy of the lung, characterized by rapid growth, propensity for early metastatic spread, and responsiveness to chemotherapy and radiation. Despite its generally good initial response, the relapse and subsequent mortality rate remain very high. Only 3% to 8% of all patients survive 5 years, and median survival for extensive stage disease is 8 to 13 months.[1,2]
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Using Immune Checkpoint Inhibitors in Lung CancerImmune checkpoint inhibitors have changed the treatment paradigm for patients with lung cancer, bringing about the most promising outcomes we have seen in a long time.
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Breast Cancer Outlook for 2017: Keeping the Accelerator to the FloorExpansion of precision medicine approaches will play a key role in optimizing care and improving outcomes for breast cancer patients in 2017. Here we highlight some of the studies and FDA approvals we are most anxious to see in the coming year.
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Treatment of Low-Lying Early Rectal CancerThis video examines the treatment of patients with low-lying rectal cancer and explores options such as neoadjuvant chemoradiotherapy, which could improve the efficacy of surgery.
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UFT Plus or Minus Calcium Folinate for Metastatic Colorectal Cancer in Older PatientsTwo studies were carried out to determine the activity and evaluate the toxicity of oral chemotherapy with uracil and tegafur in a 4:1 molar ratio (UFT) plus or minus calcium folinate in elderly patients with advanced colorectal
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Plastic Surgery: A Component in the Comprehensive Care of Cancer PatientsPlastic surgery represents a small but critical component of the comprehensive care of cancer patients. Its primary role in the treatment of cancer patients is to extend the ability of other surgeons and specialists to more
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Epirubicin, Cisplatin, Oral UFT, and Calcium Folinate in Advanced Gastric CarcinomaUFT (uracil and tegafur in a 4:1 molar ratio) plus calcium folinate treatment has favorable activity and tolerable toxicity in patients with advanced gastric carcinoma. High response rates have been reported in patients with
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Mathematical Modeling for Breast Cancer Risk AssessmentWomen at increased risk of breast cancer have important opportunities for early detection and prevention. There are, however, serious drawbacks to the available interventions. The magnitude of breast cancer risk is a crucial factor in the optimization of medical benefit when considering the efficacy of risk-reduction methods, the adverse effects of intervention, and economic and quality-of-life outcomes. Breast cancer risk assessment has become increasingly quantitative and is amenable to computerization. The assembly of risk factor information into practical, quantitative models for clinical and scientific use is relatively advanced for breast cancer, and represents a paradigm for broader risk management in medicine. Using a case-based approach, we will summarize the major breast cancer risk assessment models, compare and contrast their utility, and illustrate the role of genetic testing in risk management. Important considerations relevant to clinical oncology practice include the role of risk assessment in cancer prevention, the logistics of implementing risk assessment, the ramifications of conveying risk information with limited genetic counseling, and the mechanisms for genetics referral. Medical professionals can embrace new preventive medicine techniques more effectively by utilizing quantitative methods to assess their patients’ risks. [ONCOLOGY 16:1082-1099, 2002]
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Commentary (Corry et al): The Role of Neck Dissection Following Definitive ChemoradiationIn this issue of ONCOLOGY, Kutleret al eloquently address the concept,application, and controversiesof a planned neck dissection inpatients with head and neck carcinomaand nodal metastasis who receivenonsurgical therapy to the primary tumor.As stated lucidly in the article,planned neck dissection arose in thehistorical context of low rates of completeresponse in patients with N2/3neck disease treated with conventionallyfractionated radiotherapy, coupledwith low surgical salvage ratesamong patients who failed in the neck.Hence, the concept evolved that allpatients with N2/3 neck disease shouldundergo a planned neck dissection regardlessof response to radiotherapy.
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Healing Pain-The Innovative Breakthrough Plan to Overcome Your Physical Pain & Emotional SufferingDr. Ann Berger does an excellent job of writing to the chronic pain sufferer in her book Healing Pain. Health-care providers and family caregivers will also find it an excellent resource and can benefit greatly from reading this work. Throughout the book the author maintains a true sense of hope for the individual experiencing significant pain. Her ability to communicate this sense of hope will be rather contagious for the health-care provider who may have become less than enamored with our ability to accomplish pain management in individuals with complex pain syndromes.
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Plans Must Show Quality of Care to Remain CompetitiveToday, the US health-care system is being driven by a desire to contain escalating health-care expenditures. Oncology has not been spared, and the cancer burden on this country is great in terms of monetary costs as well as human morbidity and mortality.
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Reassessments of ESAs for Cancer Treatment in the US and EuropeAnemia is a widely prevalent complication among cancer patients. At the time of diagnosis, 30% to 40% of patients with non-Hodgkin lymphoma or Hodgkin lymphoma and up to 70% of patients with multiple myeloma are anemic; rates are higher among persons with myelodysplastic syndromes. Among patients with solid cancers or lymphomas, up to half develop anemia following chemotherapy. For almost 2 decades, erythropoiesis-stimulating agents (ESAs) were the primary treatment for cancer-related anemia. However, reassessments of benefits and risks of ESAs for cancer-associated anemia have occurred internationally. We reviewed guidelines and notifications from regulatory agencies and manufacturers, reimbursement policies, and utilization for ESAs in the cancer and chronic kidney disease settings within the United States, Europe, and Canada. In 2008 the US Food and Drug Administration (FDA) restricted ESAs from cancer patients seeking cure. Reimbursement is limited to hemoglobin levels < 10 g/dL. In the United States, ESA usage increased 340% between 2001 and 2006, and decreased 60% since 2007. The European Medicines Agency (EMEA) recommended that ESA benefits do not outweigh risks. In Europe between 2001 and 2006, ESA use increased 51%; since 2006, use decreased by 10%. In 2009, Canadian manufacturers recommended usage based on patient preferences. In Canada in 2007, approximately 20% of anemic cancer patients received ESAs, a 20% increase since 2004. In contrast to Europe, where ESA use has increased over time, reassessments of ESA-associated safety concerns in the United States have resulted in marked decrements in ESA use among cancer patients.
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Adjuvant 5-FU/Folinic Acid and Gemcitabine Equally Effective in Pancreatic CancerIn a large study of resected pancreatic cancer, overall survival did not differ whether patients received gemcitabine or 5-FU/folinic acid.
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Six Points of Miscommunication Between Oncologists and PathologistsRegardless of where you practice, good communication between you and your pathologist is the best way to ensure that correct testing is done. Here are six common points of miscommunication to watch out for.
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Challenges and Opportunities for Immunotherapies in Gynecologic CancersThe advent of immunotherapy presents us with new treatment approaches in gynecologic cancers, with preliminarily promising outcomes. Multiple clinical trials are currently being conducted to better define the role of immunotherapy. Further investigation is warranted to develop and identify predictive biomarkers.
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UFT and Mitomycin Plus Tamoxifen for Stage II, ER-Positive Breast CancerA trial was designed to examine the combination of UFT and mitomycin (Mutamycin) plus tamoxifen (Nolvadex) as postoperative adjuvant therapy in the treatment of patients with stage II, estrogen receptor (ER)-positive
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Prostate-Specific Antigen: What’s New in 1997When used alone, prostate-specific antigen (PSA) is not sufficiently sensitive or specific to consider it an ideal tool for the early detection or staging of prostate cancer. To optimize the use of PSA, the concepts of PSA velocity,
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Proton Radiotherapy for Prostate Cancer: How Did We Get Here, and Where Do We Go From Here?Despite the promise of proton therapy, comparative evidence has yet to definitively demonstrate its clinical benefit over other forms of contemporary radiation for prostate cancer.
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A Psychological War Against SmokingWhen I heard about the FDA’s dramatic new step in the anti-smoking fight, I couldn’t help but wonder if it would really make a difference. The new measure requires tobacco companies to add gruesome images to cigarette packages; the images include a corpse, a person’s chest stitched together following heart surgery and even a man with smoke drifting through a hole in this throat.
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Exercise After Cancer Diagnosis: Time to Get MovingExercise and physical activity are beneficial along the spectrum of care in cancer patients. However, much more research is needed to better understand this association and guide recommendations for patients.
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Continuous Low-Dose GM-CSF as Salvage Therapy in Refractory Recurrent Breast or Female Genital Tract CarcinomaGranulocyte-macrophage colony-stimulating factor (GM-CSF,sargramostim [Leukine]) is a powerful cytokine that is able to stimulatethe generation of dendritic cells. Adjuvant treatment with continuous lowdoseGM-CSF has been shown to prolong survival of stage III/IV melanomapatients. Data on continuous low-dose GM-CSF therapy in tumorsother than prostate cancer are still lacking.
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POINT: Is Lymphadenectomy Required in Endometrial Cancer for Adequate Surgical Staging?The diagnostic benefits of SLN evaluation include an ability to identify the extent of tumor dissemination and the utility of SLN mapping in guiding targeted adjuvant treatment in high-risk patients.
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Herb-Drug Interactions in Cancer CareIn this article, we describe the mechanisms via which interactions between herbs and prescription drugs may occur, and highlight four popular herbs and a medicinal mushroom commonly used by cancer patients, along with reports of their interactions with standard drugs.
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Face-Off: Award Presentation CeremonyFollowing a spirited debate, Joshua K. Sabari, MD, presents the winning team with the coveted title of victors of this CancerNetwork® Face-Off event.
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Encouraging Improvement in Cytopenias of Patients With Myelodysplastic Syndromes With ThalidomideMyelodysplastic syndrome patients present with variable cytopenias even though their bone marrows are generally hypercellular. Excessive cytokine-induced apoptosis of hematopoietic cells in the marrows has been proposed as a possible
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Efficiency of In Vivo Purging With Rituximab Followed by High-Dose Therapy With Autologous Peripheral Blood Stem Cell Transplantation in B-Cell Non-Hodgkin’s Lymphomas: A Single-Institution StudyHigh-dose therapy (HDT) with peripheral blood stem cell transplantation is a treatment option for patients with advanced follicular, marginal, and mantle cell lymphoma. In this setting, frequent contamination of peripheral blood stem cell harvests by
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PCR Analysis for the t(14;18) Translocation in Patients With Recurrent Follicular Lymphoma Following Immunotherapy With Rituximab (IDEC-C2B8)The chimeric monoclonal anti-CD20 antibody rituximab (Rituxan) has been shown to have clinical activity in patients with
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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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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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Commentary (Pierson): Detection of Nodal Micrometastases in Head and Neck Cancer by Serial Sectioning and ImmunostainingDrs. Ambrosch and Brinck appropriately emphasize the problems and limitations encountered when using routine pathologic procedures to examine lymph nodes from head and neck cancer specimens. Extraordinary processing techniques have repeatedly yielded a larger number of small nodes and, on occasion, have demonstrated the presence of micrometastases. The majority of these observations come from examination of breast specimens and their axillary dissections. Labor-intensive clearing techniques have varied to some extent, but generally involve progressive removal of opaque fat with alcoholic solvents of increasing percentages culminating in absolute alcohol (100%). Final visualization involves submerging the defatted specimen in cedarwood oil, followed by careful examination and dissection of the backlighted specimen.
