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Social Challenges Can Be SignificantIn their informative article, Richard O’Hara and Diane Blum touch on several key challenges of cancer survivorship. Looking at cancer through the lens of social concerns and developmental issues, they have brought important psychosocial aspects of survivorship to the forefront of our attention, with a particular focus on the domain of social well-being within the parameters of interpersonal relationships, and financial, employment, insurance, and legal issues.
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Management of the Frail Elderly With Breast CancerBy the year 2030 most patients with breast cancer will be aged 65 years or more and many will be frail. Frailty implies diminished physiologic reserve; contributors include diminished organ function, comorbidities, impaired physical function, and geriatric syndromes. Time-efficient tools for assessing frailty are being developed and, once validated, can be used to identify frail cancer patients and help direct therapy. Screening mammography in frail patients is questionable, and a clinical breast exam is likely to identify breast cancers that warrant intervention. Hormonal therapy may be a reasonable primary therapy in older frail women with hormone receptor–positive lesions. For estrogen receptor– and progesterone receptor–negative lesions, excision of the primary tumor may be adequate. Adjuvant hormonal therapy may be appropriate in frail elders with high-risk hormone receptor–positive breast cancer; chemotherapy is rarely indicated regardless of tumor status. The majority of frail elders with metastases will have hormone receptor–positive breast cancers, and endocrine therapy should be considered; those with receptor-negative tumors may be treated with single-agent chemotherapy or supportive care measures. Oncologists need to acquire the skills to appropriately identify frail elders so they select appropriate therapies that will minimize toxicity and maintain quality of life.
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Management of Metastatic Cutaneous MelanomaDr. Buzaid’s article, “Managementof Metastatic CutaneousMelanoma,” is a review ofavailable treatment options with a historicalperspective. The conclusion includesa recommendation for the useof aggressive combination therapy inpatients who are young and otherwisehealthy enough to tolerate the toxicitiesof these aggressive forms of therapy,and consideration of single-agenttherapy for those who cannot tolerateaggressive combination regimens.While this review article includes thepublished reports as of the time of itssubmission, there are additional agentsand regimens that warrant mentiondue to their likelihood of improvingthe treatment landscape for future patientswith this devastating disease.Furthermore, some of the promisingregimens mentioned in this reviewshould be more closely scrutinized.The following commentary will coverthe topics included in Dr. Buzaid’sreport as well as updates on the currentstatus and future of selected investigationalagents.
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Managing CRPC: Improving Symptoms, Survival, or Both?In addition to endeavors to develop new therapeutics, we should anticipate and prioritize studies that will address questions regarding the efficacy of combination therapy, timing and sequencing strategies, and the development of predictive markers to individualize and optimize therapy.
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Intracystic Papillary Carcinoma of the Breast: Differential Diagnosis and ManagementWe present a case of intracystic papillary carcinoma of the breast associated with low-grade ductal carcinoma in situ in a young woman. This is a distinct subtype of intraductal carcinoma that typically presents in postmenopausal women with a favorable prognosis.
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Assessing Quality of Life in Research and Clinical PracticeThere is a growing recognition in oncology of the importance of maintaining or improving patients’ quality of life (QOL) throughout the disease course. With this goal in mind, many clinical trials in oncology now seek to evaluate QOL end points.
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Predicting Endocrine Responsiveness: Novel Biomarkers on the HorizonHistorically, breast tumor classification and therapeutic decisions have relied on immunohistochemical (IHC) techniques for characterizing biomarkers such as estrogen receptor (ER), progesterone receptor (PR), and the epidermal growth factor receptor 2 (HER2), as described in the review by Ma and colleagues. However, these markers have been found to be inadequate for fully predicting a patient’s response to a given breast cancer treatment such as endocrine therapy.
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Current Clinical Trials With STI571STI571 (Gleevec) is a member of the 2-phenylaminopyrimidine family of adenosine triphosphate (ATP) binding site inhibitors of protein tyrosine kinase. It potently inhibits the tyrosine kinase activity of Abl and Bcr-Abl,[1-3] platelet-derived growth factor receptor (PDGF-R), and Kit (stem cell factor receptor).[4-6]
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Heterogeneity and CancerCancer heterogeneity, long recognized as an important clinical determinant of patient outcomes, was poorly understood at a molecular level. Genomic studies have significantly improved our understanding of heterogeneity, and have pointed to ways in which heterogeneity might be understood and defeated for therapeutic effect.
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New Data on DCIS Recurrence Good News for Patients Electing Breast-Conserving SurgeryOur study shows a declining rate of recurrence over the decades, suggesting that for a woman treated today, the expected recurrence rate should be lower than that seen in the randomized trials.
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How Can We Optimize Treatment of HER2-Positive Metastatic Breast Cancer?Third, how much do we really know about de novo and acquired resistance to trastuzumab and lapatinib? There are several possible clinical relevant mechanisms of trastuzumab resistance, including crosstalk with other receptors, amplification of the PI3K/AKT pathway, alteration of the trastuzumab binding domain, and loss of HER2 expression.
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Circulating Tumor DNA as a Liquid Biopsy: Current Clinical Applications and Future DirectionsHere we review the clinical data supporting these different plasma genotyping methodologies, and present a practical approach to the interpretation of the results of these tests.
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Tailoring Treatment for Multiple Myeloma Patients With Relapsed and Refractory DiseaseResponses to treatment of relapsed and refractory multiple myeloma are characteristically short, and median survival is as brief as 6 months. Although prognostic factors in the context of relapsed and refractory disease require further characterization, high-risk patients include those with certain cytogenetic abnormalities, high β2-microglobulin, and low serum albumin.
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Quality of Life in Low-Grade Non-Hodgkin’s LymphomaLow-grade non-Hodgkin’s lymphoma (NHL) is an indolent form of the disease with a generally slow course of progression. Although still usually incurable, low-grade disease has shown responsiveness to some of the newer
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A Rare Case of Metastatic Renal Epithelioid AngiomyolipomaThe patient is a 43-year-old man who was initially evaluated at an outside institution for unexplained anemia and who was found to have a large right kidney mass. He underwent a radical nephrectomy for a 19-cm large-cell, poorly differentiated neoplasm, consistent with pleomorphic, epithelioid angiomyolipoma (EAML) with extensive necrosis and cytologic atypia.
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SUNSHINE: High-Dose Vitamin D Improved PFS in Colorectal CancerThis video highlights results of the SUNSHINE study, which found that high-dose vitamin D added to standard treatment slowed disease progression in newly diagnosed metastatic colorectal cancer.
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Implementing Survivorship Care Plans Within an Electronic Health RecordSurvivorship care is “a distinct phase of care for cancer survivors that includes four components: (1) prevention and detection of new cancer or recurrent cancer; (2) surveillance for cancer spread, recurrence, or second cancers; (3) intervention for consequences of cancer and its treatment; and (4) coordination between specialists and primary care providers to ensure that all of the survivor’s health needs are met.”
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The Breast: Comprehensive Management of Benign and Malignant Diseases, Second EditionThis second edition of the text edited by Bland and Copeland represents a comprehensive reference that reviews the history, pathobiology, and current clinical management of diseases of the breast. Much more than a book about breast
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Breast Cancer Stem Cells: A New Target for TherapyThe cancer stem cell (CSC) theory was first proposed to explain the fact that only a small proportion of leukemia or solid tumor cells have the capacity to induce growing tumors in immunodeficient mice.[1,2]
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Chemotherapy for Resectable and Advanced Pancreatic CancerThis article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single
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Are Cancer Patients Subject to Employment Discrimination?We sought to determine whether patients undergoing treatment for cancer had experienced discrimination in employment and, if so, how that discrimination was manifested. We also sought to determine what variables affected the rate of discrimination, including age, gender, occupation, and employer size.
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Infusional 5-FU, Folinic Acid, Paclitaxel, and Cisplatin for MetastaticOur phase II study results demonstrating high efficacy and low toxicity for a weekly schedule of high-dose, 24-hour infusional 5-fluorouracil(5-FU)/folinic acid (HD5-FU/FA) in intensively pretreated patients with metastatic
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Eovist Injection and Resovist Injection: Two New Liver-Specific Contrast Agents for MRIIn this short review, we describe two new liver-specific contrast agents for MRI that are in clinical development. The main differences among the liver-specific contrast agents available at present are also discussed briefly.
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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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UFT and Its Metabolites Inhibit Cancer-Induced Angiogenesis via a VEGF - Related PathwayTreatment with UFT for spontaneous lung metastasis of murine renal carcinoma (RENCA) after resection of the primary tumor has resulted in significant prolongation of the life span of tumor-bearing animals. UFT inhibited the growth of metastatic nodules in the lung, apparently via decreased density of microvessels in the metastatic foci. Subsequent experiments used dorsal air sac assay to directly trace newly forming microvessels.
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Tumor Heterogeneity: The Lernaean Hydra of Oncology?Intratumor heterogeneity is one of the biggest challenges in cancer diagnosis and treatment. Despite morphologic and clinical recognition of tumor heterogeneity, an understanding of it at a molecular level has only begun to emerge in recent years.
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UFT Plus Cisplatin in Advanced Non-Small-Cell Lung Cancer: Interim Analysis of 67 PatientsA single-institution phase II study indicated that combination chemotherapy using UFT (tegafur and uracil) plus cisplatin (Platinol) in patients with non-small-cell lung cancer was active with less host toxicity than other cisplatin-
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The Different Faces of Disseminated Intravascular Coagulation in Solid Tumors: How to Identify and Manage“Treat the underlying cause” has been the classic mantra for the treatment of disseminated intravascular coagulation. Whenever feasible in disseminated intravascular coagulation associated with solid tumors, this principle appears to hold good.
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Neoadjuvant Treatment for Surgically Resectable Metastatic Colorectal Cancer: Is There an Optimal Succession?It remains difficult to decipher which patients are appropriate candidates for conversion therapy vs upfront surgery. Therefore, in predicting potential outcomes, several factors should be considered. Here, we will attempt to address such factors and provide insights.
