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Increased Efficacy Through Moderate Dose Escalation of Chemotherapy: Interim Report From the HD9 Randomized Trial for Advanced Hodgkin’s DiseaseThis report aims to assess the effect of increased drug dose on the efficacy and toxicity of the BEACOPP regimen with
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Surgery in the Older PatientSurgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients.
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Novel Approaches in the Treatment of Non-Small-Cell Lung CancerA wealth of data indicates that certain genetic abnormalities can target specific cytotoxic drugs and intervene at an early step as a mechanism of resistance in the treatment of non-small-cell lung cancer. Therefore prescribing
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Docetaxel vs Mitomycin Plus Vinblastine in Anthracycline-Resistant Metastatic Breast CancerThis nonblinded, multicenter, randomized phase III study compares the median time to progression (primary endpoint), response rate, and quality of life, safety, and survival of
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Anthracycline and Trastuzumab in Breast Cancer TreatmentThis study was designed to evaluate the cardiac safety of the combined treatment of HER2-positive metastaticbreast cancer patients with trastuzumab (Herceptin) plus epirubicin and cyclophosphamide (EC) incomparison with EC alone in HER2-negative metastatic breast cancer patients. Patients included those withmetastatic breast cancer without any prior anti-HER2 treatment, anthracycline therapy, or any other chemotherapyfor metastatic disease. This was a nonrandomized, prospective, dose-escalating, multicenter, openlabel,phase II study in Germany. A control group of 23 patients received EC 90/600 mg/m2 3-weekly for sixcycles (EC90 alone). A total of 26 HER2-positive patients were treated with trastuzumab, or H (2 mg/kg weeklyafter an initial loading dose of 4 mg/kg), and EC 60/600 mg/m2 3-weekly for six cycles (EC60+H); another 25HER2-positive patients received H and EC 90/600 mg/m2 3-weekly for six cycles. Asymptomatic reductions inleft ventricular ejection fraction (LVEF) of more than 10% points were detected in 12 patients (48%) treatedwith EC60 + H and in 14 patients (56%) treated with EC90 + H vs 6 patients (26%) in the EC90 alone cohort.LVEF decreases to < 50% occurred in one patient in the EC60+H cohort and in two patients in the EC90+Hcohort during the H monotherapy. No cardiac event occurred in the cohort with EC90 alone. The overallresponse rates for EC60+H and EC90+H were >60%, vs 26% for EC90 alone. The interim results of this studysuggest the cardiac safety of the combination of H with EC may be greater than that of H with AC (doxorubicin[Adriamycin]/cyclophosphamide); however, studies in larger numbers of patients are warranted. The combinationregimen revealed promising efficacy.
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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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Controversies in the Management of Intracranial GerminomasIntracranial germinomas are uncommon tumors. In the past, patients have traditionally been diagnosed with a trial of focal radiotherapy without biopsy. If the tumor was radiosensitive, it was presumed to be a germinoma.
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Anthracycline and Trastuzumab in Breast Cancer TreatmentThis study was designed to evaluate the cardiac safety of the combined treatment of HER2-positive metastaticbreast cancer patients with trastuzumab (Herceptin) plus epirubicin and cyclophosphamide (EC) incomparison with EC alone in HER2-negative metastatic breast cancer patients. Patients included those withmetastatic breast cancer without any prior anti-HER2 treatment, anthracycline therapy, or any other chemotherapyfor metastatic disease. This was a nonrandomized, prospective, dose-escalating, multicenter, openlabel,phase II study in Germany. A control group of 23 patients received EC 90/600 mg/m2 3-weekly for sixcycles (EC90 alone). A total of 26 HER2-positive patients were treated with trastuzumab, or H (2 mg/kg weeklyafter an initial loading dose of 4 mg/kg), and EC 60/600 mg/m2 3-weekly for six cycles (EC60+H); another 25HER2-positive patients received H and EC 90/600 mg/m2 3-weekly for six cycles. Asymptomatic reductions inleft ventricular ejection fraction (LVEF) of more than 10% points were detected in 12 patients (48%) treatedwith EC60 + H and in 14 patients (56%) treated with EC90 + H vs 6 patients (26%) in the EC90 alone cohort.LVEF decreases to < 50% occurred in one patient in the EC60+H cohort and in two patients in the EC90+Hcohort during the H monotherapy. No cardiac event occurred in the cohort with EC90 alone. The overallresponse rates for EC60+H and EC90+H were >60%, vs 26% for EC90 alone. The interim results of this studysuggest the cardiac safety of the combination of H with EC may be greater than that of H with AC (doxorubicin[Adriamycin]/cyclophosphamide); however, studies in larger numbers of patients are warranted. The combinationregimen revealed promising efficacy.
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2 Cycles of ABVD Plus Radiotherapy Is More Effective Than Radiotherapy Alone in Early Stage HD-Interim Ahan Radiotherapy Alone in Early Stage HD-Interim Analysis of the HD7 Trial of the GHSG Clinic of Internal Medicine I University of Cologne/GermanyBACKGROUND: Extended-field radiotherapy is effective in patients with early-stage Hodgkin’s disease, and more than
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Activity of Rituximab in Extranodal Marginal Zone Lymphomas (MALT Type)This phase II study aimed to evaluate the tolerability and activity of the monoclonal anti-CD20 antibody rituximab (Rituxan) in patients with either untreated or relapsed biopsy-proven extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type, with measurable or evaluable disease.
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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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Iodine-131 Tositumomab for Patients With Low-Grade or Transformed Low-Grade Non-Hodgkin’s Lymphoma: Complete Response DataTositumomab/iodine-131 tositumomab (Bexxar) is a radioimmunotherapeutic agent in development for patients with low-grade or transformed non-Hodgkin’s lymphoma (NHL). This analysis focuses
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2 Cycles of ABVD Plus Radiotherapy Is More Effective Than Radiotherapy Alone in Early Stage HD-Interim Ahan Radiotherapy Alone in Early Stage HD-Interim Analysis of the HD7 Trial of the GHSG Clinic of Internal Medicine I University of Cologne/GermanyBACKGROUND: Extended-field radiotherapy is effective in patients with early-stage Hodgkin’s disease, and more than
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21st Century Challenge of Ovarian Cancer in the ElderlyGiven that in the 21st century many believe 70 years of age is the new 60 and 80 years of age is the new 70, any article on ovarian cancer in the elderly depends on one’s definition of elderly. To put this in a 21st century perspective, in a thoughtful article on aging in The New Yorker (“The Way We Age Now,” April 30, 2007), Atul Gawande points out, “for most of our hundred-thousand-year existence-all but the past couple of hundred years-the average life span of human beings has been 30 years or less (research suggests that subjects of the Roman Empire had an average life expectancy of 28 years).
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Current Application of Selective COX-2 Inhibitors in Cancer Prevention and TreatmentThe multistep process of carcinogenesis, which can take many years, provides many opportunities for intervention to inhibit disease progression. Effective chemoprevention agents may reduce the risk of cancer by inhibiting the initiation stage of carcinoma through induction of apoptosis or DNA repair in cells harboring mutations, or they may act to prevent promotion of tumor growth. Similarly, chemoprevention may entail blocking cancer progression to an invasive phenotype.
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Quality-of-Life Improvement in Patients Receiving Paclitaxel/Platinum RegimensThe combination regimen of paclitaxel (Taxol) and cisplatin (Platinol) for non–small-cell lung cancer has shown improved response rates in some phase II trials, and because of its safety profile, it could offer patients with this
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PET Scanning: Worth the Cost in Cancer? Not for All Cancers-It’s Not Reliable Enough YetIn order for a test to be reliable, it must be reproducible and minimize test-retest variability. Yet, as with many imaging tests, FDG-PET has variance in standard uptake value (SUV) calculations, and even if standardization could be achieved, there is the issue of treatment effects, which introduce additional complexities.
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Epidemic Kaposi’s SarcomaKaposi’s sarcoma (KS) is the most common malignancy associated with human immunodeficiency virus-1 (HIV-1) infection and can result in significant morbidity. The clinical course of KS is quite variable, although for the
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Thalidomide-Induced Cessation of Weight Loss and Improved Sleep in Advanced Cancer Patients With CachexiaThe cachexia of malignancy is considered mediated through excess production of tumor necrosis factor–alpha and other cytokines. Thalidomide (Thalomid), a sedative/hypnotic, has been shown to inhibit tumor necrosis factor–alpha production.
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Commentary (Crispens/Rothenberg): Epidermal Growth Factor Receptor Inhibitors for the Treatment of Epithelial Ovarian CancerOvarian cancer is the deadliestof the gynecologic malignancies.Approximately threequartersof patients present with advanced-stage disease. With aggressivecytoreductive surgery followed byplatinum-based chemotherapy, mostpatients will achieve remission. Despitethis initially good response totreatment, most patients experiencerecurrence and ultimately die of theirdisease. Novel treatment strategies areneeded. Molecularly targeted therapiesoffer the promise of improvedefficacy with decreased toxicity. Inthis article, Drs. Stephanie Blank, RichardChang, and Franco Muggiapresent an excellent summary of thecurrent status of epidermal growth factorreceptor (EGFR) inhibitors in thetreatment of ovarian cancer. They describethe promise of these drugs aswell as some of the questions regardingthe best way to integrate theminto therapy for ovarian cancer.
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Management of Leptomeningeal Disease From Solid TumorsMetastasis of solid tumors to the cerebrospinal fluid is a serious complication of cancer. Although it can occur with any type of cancer, tumors with a high propensity for CNS involvement (brain metastases) are the most likely to spread to the cerebrospinal fluid.
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ASCO GU: Early Treatment and Active Surveillance of Prostate Cancer PatientsAhead of the ASCO GU meeting, we spoke with two symposium committee members, Dr. Mack Roach, of the University of California, San Francisco, and Dr. Hans T. Chung, of the University of Toronto, about early treatment and surveillance of prostate cancer patients.
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Radium-223 vs EBRT for Multiple Painful Bone Metastases: Is Less More?There is no question that radiopharmaceuticals have a role in the management of patients with metastatic bone disease. There is also no question that fractionated external beam radiotherapy (EBRT) is highly effective and generally well tolerated when delivered with large open or focal fields.
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Weekly Irinotecan and Concurrent Radiation Therapy for Stage III Unresectable NSCLCIn preclinical studies, the topoisomerase I inhibitor irinotecan (Camptosar, CPT-11) has demonstrated activity as a radiosensitizer, probably due to its ability to inhibit potentially lethal radiation damage repair. We conducted a
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Cutaneous T-Cell Lymphoma: Current and Emerging TherapiesJulia Dai, MD, and Madeleine Duvic, MD, present a comprehensive review of the current state of research and treatment in cutaneous T-cell lymphoma.
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AIDS-Related Cancers in the Era of Highly Active Antiretroviral TherapyThe National Cancer Institute’s Dr. Robert Biggar has probably studied the impact of the acquired immunodeficiency syndrome (AIDS) epidemic on cancer trends at least as thoroughly as anyone in the field. His long-term experience is reflected in this comprehensive and well-written overview, which summarizes the evidence concerning highly active antiretroviral therapy (HAART). Indeed, patients are developing fewer opportunistic infections and living significantly longer than they did before the advent of these potent anti-human immunodeficiency virus (HIV) drugs. However, the question remains as to what extent this treatment might also change the incidence of cancers?
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Treatment of Metastatic Pancreatic Adenocarcinoma: New Options and Promising StrategiesAll improvements in outcomes for patients with metastatic pancreatic adenocarcinoma have occurred with the use of cytotoxic agents, which will probably remain the mainstay of treatment for advanced pancreatic adenocarcinoma.
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Managing Acute Myeloid Leukemia in the ElderlyAcute myeloid leukemia (AML) is a disease of the elderly, with the majority of patients diagnosed in their 6th and 7th decade of life. Older patients with AML are less likely to achieve complete remission after induction chemotherapy, and they suffer from higher rates of leukemia relapse compared to younger cohorts. Suboptimal outcomes are the result of adverse biologic characteristics of leukemia in the elderly, as well as the presence of medical comorbidities and patient or physician preferences as to initiating treatment. In addition, there is a distinct lack of randomized, prospective data to guide management decisions for the treatment of AML in the elderly. Patients who are over age 75, with poor performance status, multiple comorbidities, or poor prognostic features, should be considered for a clinical trial or palliative therapy. Elderly patients who are candidates for standard induction chemotherapy and achieve complete remission are unlikely to benefit from intensive postremission therapy and should be referred to a clinical trial when possible. Further prospective trials are needed to identify a tolerable, effective treatment regimen for older patients with AML.
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Finding Ways to Break the Mold in GU OncologyLeaders in genitourinary oncology spoke about key research advances as well as personal experiences in navigating the field.
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The Evolving Landscape of Prostate Cancer ManagementMaha Hussain, MD, FACP, FASCO, spoke about BRCA testing and ctDNA as diagnostic tools and PSMA-imaging and -targeted approaches in prostate cancer.
