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Commentary (Hochberg/Cher): Current Management of Primary Central Nervous System LymphomaDr. DeAngelis provides a succinct analysis of primary central nervous system lymphoma and its management. This malignancy remains a puzzle because of its unusual behavior, being widely disseminated within the CNS, and yet rarely involving the systemic compartment. Patients who develop primary central nervous system lymphoma need to be divided into two groups: Those who are immunocompetent and those who are immunocompromised, including patients with HIV infection and transplantation recipients.
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AIDS Malignancies in the Era of Highly Active Antiretroviral TherapyThe introduction of highly active antiretroviral therapy (HAART) has had a dramatic impact on the morbidity and mortality of individuals living with human immunodeficiency virus (HIV). In addition to contributing to dramatic
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Liver, Gallbladder, and Biliary Tract CancersThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of liver, gallbladder, and biliary tract cancers using radiation, surgery, and medical treatment.
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Immunotherapy Prior to Stem Cell Transplant in Multiple MyelomaIn a 12-patient multiple myeloma pilot study, researchers demonstrated that anti-CD3 and anti-CD20 bispecific antibody (CD20Bi) activated both cellular and humoral anti-myeloma immunity that was detectable after patients received an autologous stem cell transplant.
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Current Advances in Novel Proteasome Inhibitor–Based Approaches to the Treatment of Relapsed/Refractory Multiple MyelomaThe introduction of new therapies has led to improved survival of patients with multiple myeloma (MM), even those with relapsed and/or refractory (R/R) disease.
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The Current Clinical Value of the DCIS ScoreThe DCIS Score provides clinically relevant information about personal risk that can guide patient discussions and facilitate shared decision making.
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Commentary (Kleinberg et al): Primary Combined-Modality Therapy for Esophageal CancerBased on positive results from the Radiation Therapy Oncology Group (RTOG) 85-01 trial, the conventional nonsurgical treatment of esophageal carcinoma is combined-modality therapy. Dose intensification of the RTOG 85-01 regimen, examined in the Intergroup (INT)-0123/RTOG 94-05 trial, did not improve local control or survival. Areas of clinical investigation include the development of combined-modality therapy regimens with newer systemic agents, the use of 18F-fluorodeoxyglucose positron-emission tomography to assist in the development of innovative radiation treatment planning techniques, and the identification of prognostic molecular markers. The addition of surgery following primary combined-modality therapy apparently does not improve survival, but this finding is controversial.
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Update on Hepatic Intra-Arterial ChemotherapyTheoretically, effective regional cancer chemotherapy should afford the opportunity to deliver a significantly higher concentration of a cytotoxic agent than is possible with systemic administration of the same agent. Furthermore, regional chemotherapy should cause its greatest stress on the site of administration, producing a lesser burden of toxicity on the whole body.
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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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Will We Be Able To Care For Cancer Patients In The Future?The number of cancer patients and cancer survivors continues to increase rapidly amid predictions of a shortfall in physicians to care for them. In addition, newer cancer therapies have become increasingly complex and resource-intensive, compounding the impending workforce shortage. Simultaneously, the growing understanding of the biologic heterogeneity of cancer and the development of pharmacogenomics have opened up the possibility of personalized approaches to cancer diagnosis and treatment. Such personalization has been promulgated as a means of decreasing the cost of drug development, improving the efficacy of treatments, and reducing treatment toxicity. Although there have been notable successes, the fulfillment of these promises has been inconsistent. Providing care for future cancer patients will require the development of innovative delivery models. Moreover, new approaches to clinical research design, to the assessment of therapeutic value, and to the approval of and reimbursement for diagnostics and treatments are needed.
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Principles of Radiation TherapyThis chapter provides a brief overview of the principles of radiation therapy. The topics to be discussed include the physical aspects of how radiation works (ionization, radiation interactions) and how it is delivered (treatment machines, treatment planning, and brachytherapy). Recent relevant techniques of radiation oncology, such as conformal and stereotactic radiation therapy, also will be presented. These topics are not covered in great technical detail. It is hoped that a basic understanding of radiation treatment will benefit those practicing in other disciplines of cancer management. This chapter does not address the principles of radiobiology, which guide radiation oncologists in determining issues of treatment time, dose, and fractionation or in combining radiation with sensitizers, protectors, and chemotherapy or hormones.
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Addressing the Challenge of Managing Radiation Use in Medical Imaging: Paradigm Shifts and Strategic PrioritiesThe rise in utilization of medical imaging-especially computed tomography and nuclear medicine-and the issues of perceived, potential, theoretical, and known risks associated with ionizing radiation exposure from imaging have come to the forefront of public and professional awareness, raising concerns and controversies.
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Issues in the Management of Cancer-Related ThrombocytopeniaThrombocytopenia remains a significant clinical problem for patients with cancer. Management approaches include watchful waiting, platelet transfusions, and the use of pharmacologic agents. Although platelet
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Management of Young Breast Cancer Patients With de Novo Genetic MutationsA 24-year-old woman presents to her primary care provider with a mass in her left breast. Examination confirms a 2.2-cm mass in the upper outer quadrant, with a single mobile axillary node that is firm to palpation.
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Influenza Vaccination in Patients With Cancer: an OverviewInfluenza infection is a potential cause of additional morbidity and mortality in patients who are immunocompromised because of cancer or its treatment. Of particular note, influenza infection may delay or interrupt chemotherapy and necessitate hospitalization. Successful immunization depends on an intact immune system that can produce antibodies in response to antigen exposure. Patients with cancer often have a suppressed immune system, resulting from their disease and/or immunosuppressive therapies, and as a consequence they may have a suboptimal serologic response to influenza vaccination. Since vaccination is the only proven method for preventing influenza infection, the Advisory Committee on Immunization Practices recommends seasonal influenza vaccination for adults without contraindications who have disease- or medication-related immunosuppression. Patients with cancer should be given the trivalent inactivated vaccine. Preliminary data suggest that administering the vaccine between cycles of chemotherapy may yield the best results.
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What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?There is ample evidence suggesting that physical activity and exercise can be therapeutic tools for patients with prostate cancer. Patients diagnosed with localized disease should be advised to stay physically active; furthermore, patients who are undergoing radiation therapy and/or treatment with ADT appear to benefit from regular aerobic and resistance exercise to alleviate side effects.
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Subcutaneous Rituximab Maintained Efficacy, Was Safe in DLBCL, FLSwitching from intravenous to subcutaneous administration of rituximab for non-Hodgkin diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL) resulted in similar efficacy with no new safety issues.
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Management of Centrally Located Non-Small-Cell CarcinomaTreatment optimization for centrally located lung cancers requires special considerations for determining resectability and patient selection.
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Stereotactic Body Radiation TherapySong and colleagues deliver athorough and fair review of theinitial clinical investigations ofa new paradigm in radiotherapy mostrecently called stereotactic body radiationtherapy (SBRT).[1] Oncology observers may take exception withthe use of the designation “new paradigm.”After all, from a tumor controlpoint of view, skeptics might say,“radiotherapy is radiotherapy.” Recentadvances in radiotherapeutictechnology such as three-dimensionsal(3D) conformal therapy and intensity-modulated radiotherapy (IMRT)have made treatments less toxic, butnot particularly more effective in curingcancer.
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Osimertinib Plus Savolitinib Shows Activity in EGFR-Mutant, MET-Amplified NSCLCCancer Network spoke with Lecia V. Sequist, MD, MPH, about the TATTON study, which tested the combination of osimertinib and savolitinib in previously treated non–small-cell lung cancer patients.
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Cervical CancerThis management guide covers the screening, diagnosis, staging, and treatment of cervical cancers.
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Melanoma’s Radioresistant Reputation ChallengedConventional wisdom would have one believe that melanoma is a highly radioresistant tumor, perhaps even “radiation proof.” This reputation developed as a result of a combination of factors. First, early in vitro studies of melanoma radio-biology suggested that melanoma cells displayed enhanced postradiation survival vs comparison cells.[1] Second, clinical use of radiation therapy for melanoma did not seem to work very well.[2] This combination, a clinical observation supported by laboratory work, seems to have led radiation therapy to be avoided for melanoma treatment.
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Commentary (Ellis): The Horizon of Antiangiogenic Therapy for Colorectal CancerIn this issue of ONCOLOGY, Olszewski,Grossbard, and Kozuchprovide an excellent overview ofthe role of antiangiogenic therapy inthe treatment of patients with metastaticcolorectal cancer. The authorshave brought several important issuesto the forefront that warrant furtherdiscussion, and these issues will beaddressed in this commentary.
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Irinotecan in Lymphoma, Leukemia, and Breast, Pancreatic, Ovarian, and Small-Cell Lung CancersIrinotecan (CPT-11 [Camptosar]) has a broad range of antitumor activity. Extensive preclinical and early clinical work has demonstrated its activity against many tumor types--head and neck, esophagus, stomach, pancreas,
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Recent Advances in Preventing Chemotherapy-Induced Nausea and VomitingThis article will address changes in CINV guidelines over the past 5 years and provide updates on recently approved agents and agents that are expected to be approved, based on published phase III trials. It will also explore other factors affecting optimal CINV control, including the role of patient-related risk factors and the role of physician adherence to antiemetic guidelines in reducing the residual risk of CINV.
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Exercise in Regulation of Inflammation-Immune Axis Function in Cancer Initiation and ProgressionThis article provides an overview of the current state of knowledge pertaining to exercise modulation of the inflammation-immune axis in cancer. The current evidence suggests that exercise may be a promising adjunctive strategy that can favorably alter numerous components of the immune system, which, in turn, may modulate tumorigenesis.
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Endometrial Cancer: Recent Developments in Evaluation and TreatmentEndometrial carcinoma is the most common gynecologic malignancy in the United States. Most cases are diagnosed at an early stage. However, the outcome for women diagnosed with advanced-stage disease remains poor. The etiology of most endometrial carcinomas stems from the effects of excess estrogen, whether this comes from exogenous or endogenous sources. Differences in epidemiology and presentation suggest the existence of two forms of endometrial cancer: those related to and those unrelated to hormonal stimulation. Most women with endometrial cancer present with abnormal uterine bleeding; endometrial sampling is essential to exclude endometrial carcinoma in such patients. Endometrial cancer is surgically staged, and staging usually includes a hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy also should be performed in selective cases to better assess disease spread and to evaluate the need for adjuvant therapy. Adjuvant treatment may include the use of radiation, progestins, or cytotoxic chemotherapeutic agents. Several clinical trials are underway to compare these treatment modalities, as well as to determine the optimal combination of active chemotherapeutic agents, such as doxorubicin, platinum agents, and paclitaxel (Taxol). [ONCOLOGY 13(12):1665-1675, 1999]
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Use of Transcription Factors as Agents and Targets for Drug DevelopmentCells respond to external signals by either activating or inhibiting key regulatory proteins of gene expression called transcription factors (TFs). Abnormal expression of these factors plays a critical role in many human
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Dr. Emens Discusses Overall Survival in HER2+ Breast CancerDr. Leisha Emens of the University of Pittsburgh Medical Center's Hillman Cancer Center discusses the overall survival in the KATE2 study.
