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Treatment of Adult ALL: More Questions Than AnswersIt is clear that the management of adult patients with ALL is an area in which little progress has been made in the last 30 years. Given the disappointing outcomes, the field is one that lends itself to the study of the incorporation of novel agents, including monoclonal antibodies and tyrosine kinase and proteasome inhibitors, as well as to further study of allogeneic transplant.
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Outline of Oncology TherapeuticsOutline of Oncology Therapeutics is a well-written, concise, and up-to-date book providing detailed descriptions of a variety of medications and issues important to the overall care and treatment of patients with cancer. Oncology practice today
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Honing in on Subtypes to Guide More Individualized Treatment of Soft Tissue SarcomaDr. von Mehren discusses current considerations and challenges in the management of patients with soft tissue sarcoma, as well as recent clinical trial data.
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Biweekly Gemcitabine, Doxorubicin, and Paclitaxel as First-Line Treatment in Metastatic Breast CancerIn a single-center, open, phase II trial, we assessed the toxicity and activity of a triple combination therapy-doxorubicin at 30 mg/m2 (day 1), paclitaxel (Taxol) at 135 mg/m2 (day 2), and gemcitabine (Gemzar) at 2,500 mg/m2
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Pilots for AirLifeLine Donate Flights to Patients in NeedIt used to take Mike Natishak, Sr., his wife Mary Alice, and their 9-year-old son Mike Jr., 6 hours to make the weekly drive from their home in Apalachin, NY, to Boston Children's Hospital. They had to stay over at a hotel to be at the hospital the next morning. So in addition to travel expenses, the Natishaks each lost 2 days of work.
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Patients look for answers on Web but trust it lessGlut of e-health information has put public in a ‘data smog.’
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Irinotecan in Relapsed or Refractory Non-Hodgkin’s LymphomasBecause irinotecan (CPT-11, Camptosar) is a topoisomerase I inhibitor with a broad spectrum of antitumor clinical activity, we investigated its activity in relapsed or refractory non-Hodgkin’s lymphomas (NHLs). Irinotecan at 300 mg/m² IV was administered every 21 days with intensive loperamide management of diarrhea.
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Uracil/Tegafur Plus Oral Calcium Folinate in Advanced Breast CancerUracil and tegafur (in a molar ratio of 4:1 [UFT]) has proven activity against breast cancer and is delivered in an easy-to-administer oral formulation. Orzel, which combines UFT with the oral biomodulator, calcium folinate, may
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One for All or One for One?The authors review the main evidence from the literature on neoadjuvant approaches in locally advanced rectal cancer, starting with the use of radiotherapy only in the pre–total mesorectal excision (TME) era, through fluorouracil (5-FU)–based chemoradiation in the TME era, to the most modern administration of “targeted therapy” in association with radiotherapy and traditional chemotherapy.
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Bone-Modifying Agents as Adjuvant Therapy for Early-Stage Breast CancerIn this review we describe the current evidence for use of bisphosphonates as part of the adjuvant treatment of patients with early-stage breast cancer.
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Cisplatin/Paclitaxel vs Cisplatin/Teniposide for Advanced Non-Small-Cell Lung CancerA total of 332 patients with advanced non-small-cell lung cancer were randomized by the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative
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Management Considerations in Cancer Patients With Rheumatoid ArthritisPatients with cancer and concomitant rheumatoid arthritis pose special challenges. Many therapies for rheumatoid arthritis can increase the risk of adverse events during cancer therapy because they are immunosuppressive.
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Chemoprevention of Colorectal Cancer: Dietary and Pharmacologic ApproachesRemarkable progress has been made in recent years in our understanding of colorectal cancer etiology. The various hypotheses of causality continue to be tested in human observational and intervention studies, as well as experimental models. Drs. Garay and Engstrom provide a comprehensive review of the dietary and chemopreventive factors for colorectal cancer. While their conclusions are noteworthy, those related to dietary factors are debatable.
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Is Surgery Always Necessary in Rectal Cancer?In this article, we review risks and benefits of the standard treatment approach for rectal cancer and compare standard treatment with alternative methods aimed at rectal preservation.
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Advances in the Treatment of Gynecologic MalignanciesHistorically, two-thirds of patients with endometrial carcinoma had disease confined to the uterus, and the cornerstone of treatment was total abdominal hysterectomy and bilateral salpingo-oophorectomy. Since the introduction of surgical staging in 1988, however, more patients are found to have disease outside the uterine cavity. Unfortunately, the current rules for staging are not followed by every practitioner, and the required specimens for pathologic examination are not always obtained. Therefore, recommendations for postoperative adjuvant therapy are usually based on the surgico-pathologic information available for each patient.
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Intraperitoneal Drug Delivery for Ovarian Cancer: Why, How, Who, What, and When?Epithelial ovarian cancer (EOC) spreads prominently within the peritoneal cavity. In fact, we now know that high-grade serous cancers are often of tubal origin, and their presentation as tubo-ovarian masses renders it likely that intraperitoneal spread occurs as an early event in their clinical evolution.
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The Variegated Morphology of HPV-Related Neoplasms of the PenisOur commentary aims to expand on the evolution and present state of the art in the pathology of HPV in penile cancer and precancerous lesions.
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Cancer Metabolism as a Therapeutic Target: Finding the Right Target(s) in the Context of Tumor Heterogeneity, Evolution, and Metabolic PlasticitySince Otto Warburg first formulated his theory on the importance of metabolism in cancer, our knowledge of this process and of its complexity has expanded, as has our ability to target many metabolic pathways that are undoubtedly necessary for cancer proliferation.
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The UFT/Leucovorin/Etoposide Regimen for the Treatment of Advanced Gastric CancerGastric cancer is the most chemosensitive adenocarcinoma among digestive neoplasms. A few years ago, we performed a phase II trial with the FLEP regimen, in which fluorouracil (5-FU) and leucovorin are combined
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The Role of Surgery in Stage III Non-Small-Cell Lung CancerIn this edition of Clinical Quandaries, Ramalingam et al present a 67-year-old man who seeks care for a new, asymptomatic left upper lobe lung mass, which was found incidentally on a routine chest x-ray as part of a preoperative work-up for an elective surgery. Further staging studies included a computed tomography (CT) scan of the chest and a positron-emission tomography (PET) scan followed by a magnetic resonance imaging (MRI) scan of the liver. Pathology from a fine-needle aspiration biopsy of the left lingular lesion was consistent with poorly differentiated adenocarcinoma and immunohistochemical stains consistent with a lung primary. The left lingular lesion and the prevascular lymph node were felt to be the only sites of involvement, making this stage IIIA (T1, N2, M0) lung cancer.
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Cancer Stem CellsTreatments that target cancer stem cells have been proposed as alternatives to current cancer therapies. However, the clonal evolution model suggests that multiple tumor cell populations may need to be targeted for these treatments to be successful.
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Precision Medicine in Phase I Cancer TrialsIn this video we discuss the use of biomarker-guided treatment in phase I trials, which can yield high response rates.
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Hereditary Renal Tumor Syndromes and the Use of mTOR InhibitorsA 47-year-old woman with a history of drug-resistant epilepsy during childhood presented to the emergency department with sudden dyspnea and chest pain. Upon admission, her oxygen saturation was 88%.
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Hematopoietic Stem Cell Transplantation in the ElderlyHematopoietic stem cell (HSC) transplantation may improve outcomes of patients with hematologic malignancies not curable with conventional therapies. In some clinical settings, transplantation represents the only curative option. The feasibility and efficacy of this approach in older patients are undefined, since this population has been excluded from nearly all clinical trials. Advances in supportive care, HSC harvesting, and safer conditioning regimens have made this therapy available to patients well into their 6th and 7th decades of life. Recent evidence suggests that elderly patients with good performance status and no comorbidities could, in fact, not only survive the transplant with reasonable risk, but also benefit in the same measure as younger patients.
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ASTRO 2017: Highlights in Advanced Lung CancerThis video highlights studies on advanced lung cancer with practice-changing potential presented at the 2017 ASTRO Annual Meeting.
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Splenic Marginal Zone Lymphoma: Current Knowledge and Future DirectionsIn this article, we review the current knowledge on the biological findings, clinical features, and therapeutic approaches for splenic marginal zone lymphoma.
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Current Challenges in the Management of Patients with Relapsed/Refractory Multiple MyelomaFor patients with multiple myeloma (MM) who experience relapse, important advances in medical therapies in the past decade have doubled the duration of survival, mainly because of the effectiveness of novel agents such as thalidomide (Thalomid), bortezomib (Velcade), and lenalidomide (Revlimid).[1]
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The Role of Irinotecan and Oxaliplatin in the Treatment of Advanced Colorectal CancerColorectal carcinoma is one of the most common malignancies in the western world, and although fluorouracil (5-FU) has been used in its treatment for almost 40 years, new agents with significant activity have been introduced recently. Irinotecan (CPT-11, Camptosar), a topoisomerase I inhibitor, administered at 300 to 350 mg/m2 every 3 weeks is significantly more active than continuous-infusion 5-FU in patients who have experienced disease progression after conventional therapy with 5-FU. In comparison to best supportive care, irinotecan improves survival and preserves quality of life despite treatment-related toxicity. Moreover, the combination of irinotecan and 5-FU has been explored in a number of different schedules. In previously untreated patients, overall response rates are high. Irinotecan can also be combined with mitomycin (mitomycin-C [Mutamycin]), oxaliplatin, or raltitrexed (Tomudex). Oxaliplatin is a new-generation platinum compound that has demonstrated activity against colorectal carcinoma in preclinical trials. It has been evaluated as a single agent against advanced colorectal carcinoma in the salvage setting and also in combination with 5-FU as initial therapy for metastatic disease (where it shows significant activity). The toxicity profile of oxaliplatin (chiefly characterized by neurotoxicity) differs from that of irinotecan (primarily producing diarrhea) and the potential, therefore, exists for combining these agents or for exploiting their possible synergy with 5-FU. The introduction of these two new active agents of different pharmacologic classes promises to enable significant improvements in the treatment of patients with colorectal carcinoma. [ONCOLOGY 15(4):415-434, 2001]
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Selecting Adjuvant Endocrine Therapy for Breast CancerThis year alone, more than 215,000 women in the United States will bediagnosed with, and over 40,000 will die from, invasive breast cancer.Recently, mortality from female breast cancer has declined despite anincrease in its incidence. This decline corresponds with improved screeningfor prompt tumor detection, and advances in the treatment of earlydisease. Of these, endocrine therapy has played a prominent role. Forwomen with estrogen receptor (ER)-positive and/or progesterone receptor(PR)-positive breast cancers, endocrine therapy has proven to be amajor component of adjuvant therapy, but it is not effective in womenwhose breast cancers lack ERs and PRs. The selective estrogen-receptormodulator (SERM) tamoxifen has been well established as safe and effectivein the adjuvant care of both pre- and postmenopausal women withhormone-receptor–positive early breast cancer. For premenopausalwomen, ovarian suppression is an important option to be considered.Additionally, the aromatase inhibitors have recently demonstrated utilityin postmenopausal women. The ideal sequencing of treatment withtamoxifen and/or an aromatase inhibitor is the subject of several ongoingstudies. Factors involved in selecting an appropriate endocrine regimenhave grown considerably over the past decade. It is becoming more importantfor those caring for women with breast cancer to fully understandthe available endocrine treatment options and the prognostic and predictivefactors available to help select the most appropriate treatment. Thegoal of this article is to assist clinicians in making decisions regardingadjuvant hormonal therapy and to provide information regarding availableclinical trials. To achieve this, the therapeutic options for hormonaltherapy will be reviewed, as will prognostic and predictive factors used inmaking decisions. Finally, four cases illustrating these difficult decisionswill be discussed, with recommendations for treatment.
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Fertility-Preserving Options for Cervical CancerChildbearing is one of the most important life goals for many women, and fertility preservation is a very important factor in the overall quality of life of cancer survivors. Cervical cancer frequently affects young women; because some women tend to delay childbearing, fertility preservation must be considered when treatment options are discussed. Over the past decade, the radical trachelectomy procedure has become a well established fertility-preserving option for young women with early-stage cancer; this procedure is associated with low morbidity, good oncologic outcome, and a high proportion of pregnancies that reach the third trimester and babies that are delivered at term. This article will review available literature on the vaginal radical trachelectomy procedure and data from other surgical approaches, such as the abdominal radical trachelectomy. In addition, the potential future application of neoadjuvant chemotherapy followed by fertility-preserving surgery in patients with locally advanced cervical cancer will be examined. Finally, ultraconservative surgical approaches (eg, conization alone with or without laparoscopic lymphadenectomy) in very early-stage disease will be discussed.
