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POINT: Can Chemotherapy Be Eliminated in the Treatment of Follicular Lymphoma?Balancing the goal of obtaining a durable remission and that of avoiding a negative impact on quality of life argues against the routine use of chemotherapy in follicular lymphoma.
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Hormone Replacement Therapy: Making Informed DecisionsThe controversies regarding the association between hormonal replacement therapy (HRT) and cancers, the questions about HRT use in women with a high risk of breast cancer, and the increasing number of women with breast cancer and menopausal symptoms make HRT a significant cancer issue.
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In-Transit Melanoma: An Individualized ApproachThe management of in-transit metastases is challenging, since the treatments and extent of disease vary greatly based on the number, depth, location, and distribution of lesions, and on their biological behavior.
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Sexual Function of the Gynecologic Cancer SurvivorCurrent advances in the field of medicine have aided in the early detection and treatment of cancer, leading to an increased rate of survivorship among cancer patients after an initial diagnosis.
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Nonepithelial Malignancies of the BreastDrs. Chugh and Baker's concisereview highlights diseaseentities we hear little of, andmay never see, but of which we mustbe cognizant. The article serves as avaluable reminder that not every breastmass that is palpated or detected byradiologic screening represents eithera carcinoma or benign entity such as afibroadenoma. Although rare, the nonepithelialmalignancies must beconsidered in a complete differentialdiagnosis.
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Evolving Classification and Management of Myelodysplastic SyndromeMost adult patients with hematopoietic failure due to myelodysplastic syndrome (MDS) are treated with supportive care measures, including hematopoietic growth factors (epoetin alfa, darbepoetin alfa, filgrastim, pegfilgrastim, sargramostim), red blood cell or platelet transfusions, and antimicrobial agents. Allogeneic stem cell transplantation can be curative, but only a small subset of patients are eligible for transplantation, and until recently there were few options other than supportive care for transplant-ineligible patients. Since 2004, the US Food and Drug Administration (FDA) has approved three new therapies specifically for the indication of MDS: two DNA methyltransferase inhibitors (azacitidine and decitabine) and an immunomodulatory agent (lenalidomide). Several other drugs are used by clinicians for treatment of patients with MDS, but are not specifically FDA-approved for this indication. With several therapeutic options available, yet none of them effective in the majority of cases, it can be challenging for clinicians to choose the most appropriate treatment for an individual patient. Here we discuss a risk-based management approach to MDS that incorporates recent data regarding these new therapies. While many questions remain about the optimal use of newer agents, the long-standing perception of MDS as a syndrome where therapeutic nihilism is the only realistic approach is slowly beginning to change.
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Accelerated Partial-Breast Irradiation: A Promising Technique Under InvestigationBreast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.
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Stages 0 and I Breast CancerThis management guide covers the diagnosis and treatment of early-stage breast cancers, including lobular carincoma in situ (LCIS), ductal carcinoma in situ (DCIS), and both noninvasive and invasive disease.
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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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Granulocytic Sarcoma in an Older Woman: Case Considerations When There Is No Standard TherapyGranulocytic sarcomas have been reported in nearly every part of the body, including the gastrointestinal (GI) and genitourinary (GU) tracts, central nervous system (CNS), and respiratory, lymphatic, and skeletal systems. A few case series have been reported through the years.
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Chemo Brain in Cancer Patients: What Is It and How Can It Be Managed?Many patients complain of "chemo brain," or a drop in cognitive function during or after receiving chemotherapy, but there are strategies to manage chemo brain, as well as research on how chemotherapy affects the brain long-term.
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Endometrial Cancer Patients Not Offered Genetic Counseling ReferralsAccording to a study recently presented at the 2017 American Society of Clinical Oncology Annual Meeting, held June 2–6 in Chicago, women diagnosed with endometrial cancer are oftentimes not provided with genetic counseling referrals.
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Managing Toxicities of High-Dose Interleukin-2Although high-dose interleukin-2 (IL-2, Proleukin), a highly toxic agent used in the treatment of renal cell carcinoma and melanoma, was initially associated with treatment-related mortality, it can, in the appropriate
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Ibrutinib Yields Response in Patients With Chronic GVHDThis video examines a phase I/II study of ibrutinib in patients with chronic GVHD who failed corticosteroids.
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UFT/Leucovorin Plus Weekly Paclitaxel in the Treatment of Solid TumorsThe palliation of symptoms and improvement of quality of life are important aspects of therapy in patients with incurable metastatic cancer. This article describes the preliminary results of a phase I study of uracil and tegafur, an orally available fluorouracil (5-FU) derivative combined with oral leucovorin plus weekly intravenous paclitaxel.
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Commentary (Seres/Harrison): Nutritional Support of Patients Undergoing Radiation Therapy for Head and Neck CancerDr. Colasanto and his associatesare to be commended forskillfully and comprehensivelyreviewing the issues concerning theprovision of nutritional support to patientsundergoing radiation therapy.Their recommendations are well supportedby review of scientific studies,and the article is written in such a wayas to be accessible to those not fullyversed in prescribing nutritional support.There remain a few points thatdeserve discussion.
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Improving Outcomes in Advanced DLBCL: Systemic Approaches and RadiotherapyIn this review, we will first briefly summarize prior attempts to improve outcomes in advanced DLBCL using systemic therapy approaches, and then we will highlight the potential role of RT in advanced DLBCL.
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Urothelial and Kidney CancersThis management guide covers the treatment of urothelial cancers (carcinomas of the bladder, ureters, and renal pelvis) and kidney cancers (renal tumors).
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Beyond Neutrophil Recovery: Manipulation of the Tumor Microenvironment by GM-CSF to Control CancerCancer researchers can almost feel the ground rumble beneath their feet as they walk through their clinics and laboratories. A veritable explosion of information has radically altered the way we think about cancer, and has introduced new concepts
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COUNTERPOINT: Early Salvage vs Adjuvant Radiotherapy for High-Risk Prostate CancerThe data for adjuvant radiotherapy remain strong.
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Commentary (Kavoussi)-Testicular Cancer: What’s New in Staging, Prognosis, and TherapyExperienced authors Richard Foster and Craig Nichols providea thoughtful, state-of-the-art discussion of current controversies in the management of testicular cancer. Present cure rates illustrate that significant diagnostic, chemotherapeutic, and surgical advances made over the past century have transformed testicular cancer from a once uniformly fatal disease into a tremendous oncologic success story.
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ACR Appropriateness Criteria® Recurrent Hodgkin LymphomaBy combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the complex decision-making associated with the management of recurrent Hodgkin lymphoma.
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The "Epidemic" of Breast Cancer in the U.S.--Determining the FactorsDrs. King and Schottenfeld have provided an interesting review of the literature in their attempts to relate changes in breast cancer incidence over time to secular changes in postulated risk factors.
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Primary Metastatic Small Intestinal Carcinoid Tumor Without Carcinoid SyndromeSmall intestinal “carcinoid” or well-differentiated grade 1 neuroendocrine tumors can have an insidious onset or be diagnosed serendipitously at the time of surgery, during the workup for another disorder, or during a screening test.
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Improving Cancer Clinical TrialsIn this interview we discuss outcomes in clinical trials and how to improve trials by redefining clinically meaningful outcomes.
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Role of Calcium/Magnesium Infusion in Oxaliplatin-Based Chemotherapy for Colorectal Cancer PatientsThe combination of oxaliplatin plus fluorouracil/leucovorin is known as the FOLFOX regimen, and it has become a standard regimen for colorectal cancer (CRC), both as adjuvant therapy and as treatment for metastatic disease. Unfortunately, platinum-based chemotherapies also produce neurotoxicity as a side effect. Neurotoxicity is the most common dose-limiting toxicity of oxaliplatin, and it is one of the major causes for patients to stop receiving chemotherapy. It can manifest as either of two distinct syndromes: a transient, acute syndrome that can appear during or shortly after the infusion (~1%–2% of patients), and a dose-limiting, cumulative sensory neuropathy. Calcium/magnesium (Ca/Mg) infusions have been used to decrease the incidence of oxaliplatin-induced neuropathy. The actual utility of Ca/Mg infusions in this setting has been an interesting and controversial topic. They may reduce the severity of neurotoxicity, but some investigators have questioned whether they also will alter the efficacy of these chemotherapy regimens. In this paper, we review the clinical data concerning the usefulness of Ca/Mg infusions in reducing the incidence of oxaliplatin-induced neuropathy as well as their effect on responsiveness to chemotherapy.
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New Research on HER2-Positive Breast CancerDr. Gianni has been involved with new drug therapies in medical oncology for some time, and in this interview he discusses the changing use of breast cancer treatments, neoadjuvant regimens, and research and developments on HER2-positive breast cancer.
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Endometrial Carcinoma and Precursors: Diagnosis and TreatmentThis clinically oriented text focuses on the diagnosis and management of endometrial adenocarcinoma and endometrial hyperplasia. Due to its clinical orientation, the book does not include information on the molecular basis of endometrial cancer.
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Perspectives on Salvage Therapy for Non–Small-Cell Lung CancerPlatinum-based chemotherapy offers a modest survival advantage overbest supportive care in chemotherapy-naive patients with a good performancestatus and advanced/metastatic non–small-cell lung cancer(NSCLC). Despite the survival benefit associated with first-line chemotherapy,the majority of patients will experience relapse or disease progression.In clinical practice, an increasing number of patients maintaina good performance status after first-line treatment and are eligible forfurther treatments. Docetaxel (Taxotere) at 75 mg/m2 given once every3 weeks has been the standard of care for second-line chemotherapy sincethe year 2000. Pemetrexed (Alimta) is a novel multitargeted antifolateagent with single-agent activity in first- and second-line treatment ofNSCLC. A large phase III study comparing docetaxel to pemetrexed insecond-line therapy demonstrated that pemetrexed is equally active andless toxic than docetaxel. Based on these results, pemetrexed is a reasonablesecond-line chemotherapy option for patients with recurrent, advancedNSCLC. Progress made in the field of molecular biology has led to theidentification of drugs active against specific cellular targets. Gefitinib(Iressa) and erlotinib (Tarceva) are both orally active tyrosine kinase inhibitorsof the epidermal growth factor receptor. Phase II and III trialshave demonstrated that these agents are active particularly in a subgroupof patients with specific biologic characteristics. Both drugs have beenapproved for the treatment of pretreated NSCLC. Other drugs, such ascetuximab (Erbitux) and bevacizumab (Avastin) have shown promisingactivity in NSCLC and are currently being tested in clinical trials.
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A Phase II Study of Doxorubicin/Paclitaxel Plus G-CSF for Metastatic Breast CancerThis phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line
