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Marta Batus on the New Direct-to-Consumer Advertising for Nivolumab, and Its Impact on Oncology PracticeIn this interview we discuss the direct-to-consumer advertising for nivolumab (Opdivo) for the treatment patients with advanced non-small-cell lung cancer.
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Screening for Ovarian Cancer: What We Know, What We Need to KnowThe majority of women with ovarian cancer present with advanced-stage disease. Women with early-stage ovarian cancer have a much better chance of achieving a cure than do women with late-stage disease. This
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Chemoprevention of Colorectal Cancer: Dietary and Pharmacologic ApproachesColorectal cancer is one of the most commonly occurring cancers in the United States. In an effort to prevent the occurrence of colorectal cancer, agents identified as reducing risk of the disease are being targeted as potential chemoprevention tools. However, complex associations exist among diet, lifestyle factors, and genetic susceptibility and the eventual development of colon cancer, sometimes making the transition from associations identified in epidemiologic studies to the clinical use of chemoprevention agents difficult. Environmental factors that may serve as chemoprevention agents are addressed in the article by Garay and Engstrom. Does our current knowledge allow us to embrace these agents as tools for chemoprevention?
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New Questions About Transplantation in Multiple Myeloma: Review 2Multiple myeloma is now the most common indication for autologous stem cell transplantation (ASCT) in North America, with over 5,000 transplants performed yearly (Center for International Blood and Marrow Transplant Research [CIBMTR] data). While the role of ASCT as initial therapy in multiple myeloma has been established by randomized studies, newer therapies are challenging the traditional paradigm. The availability of novel induction agents and newer risk stratification tools, and the increasing recognition of durability of remissions are changing the treatment paradigm. However, even with arduous therapy designed to produce more complete remissions—for example, tandem autologous transplants—we have seen no plateau in survival curves. A tandem autologous procedure followed by maintenance therapy may be performed in an attempt to sustain remission. Sequential autologous transplants followed by nonmyeloablative allotransplants are pursued with the hope of "curing" multiple myeloma. We examine how the key challenges of increasing the response rates and maintaining responses are being addressed using more effective induction and/or consolidation treatments and the need for maintenance therapies after ASCT. We argue that given the biologic heterogeneity of multiple myeloma, risk-adapted transplant approaches are warranted. While the role of curative-intent, dose-intense toxic therapy is still controversial, conventional myeloablative allogeneic transplants need to be reexamined as an option in high-risk aggressive myeloma, given improvements in supportive care and transplant-related mortality.
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Retroperitoneal Neuroblastoma Causing Urinary Obstruction in a 5-Month-Old BoyThe patient is a 5-month-old Caucasian boy with no developmental abnormalities who presented Christmas Eve 2004 to his pediatrician with increasing fussiness, emesis, and inability to tolerate oral intake. He had a temperature of 100.2°F but otherwise normal vital signs. Physical exam at that time revealed a distended abdomen. He was sent home with a diagnosis of viral gastroenteritis.
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Management of Metastatic HER2-Positive Breast Cancer: Where Are We and Where Do We Go From Here?This review will summarize the current standard of care; key issues that arise when treating patients with HER2-positive disease; and developments in novel therapeutics, including small-molecule inhibitors, nanoparticles, immunotherapy, and agents targeting resistance pathways.
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Clinical Oncology, Second EditionA comprehensive textbook on clinical oncology should have broad appeal to readers from various disciplines, including educators, clinicians, and scientists working with cancer patients. Students of the medical disciplines must also have a reference textbook to guide them in their educational exploration, whether they are in the field of medicine itself or in complementary areas. We look to comprehensive textbooks not only to provide us with the latest updates in different disease entities, but also to guide us by choosing the most relevant areas of study and investigation. The editors who compiled this textbook have met these challenges, while maintaining a readability that is suitable for various levels of expertise and comprehension
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Metastatic Malignant Melanoma From an Unknown Primary Presenting as a Large Axillary MassThe patient is an otherwise healthy male transferred from an outside hospital with a newly diagnosed melanoma from an unknown primary presenting as a large, left axillary mass.
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MCL Treatment Advances and Future DirectionsMartin Dreyling, MD, spoke about the potential use of CAR T-cell therapy in earlier treatment stages for certain patient groups with mantle cell lymphoma.
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Emerging Efficacy Endpoints for Targeted Therapies in Advanced Renal Cell CarcinomaSeveral novel targeted agents are being tested for the treatment of advanced renal cell carcinoma (RCC), and results of phase I and II trials have been encouraging. A recently completed phase III, placebo-controlled study showed that median progression-free survival doubled from 12 weeks to 24 weeks in patients treated with the multi-kinase inhibitor sorafenib (Nexavar) (hazard ratio [HR], 0.44; P < .00001), and approximately three-quarters of patients had some degree of tumor regression. Furthermore, interim analysis showed an estimated 39% improvement in overall survival in sorafenib-treated patients (HR, 0.72; P = .018) and an investigator-assessed response rate of 10%, indicating that many more patients had clinical benefit than had tumor regression qualifying as response by traditional criteria. These data and others have added to the evidence of lack of correlation between response rate and clinical benefit in RCC patients (as well as in other tumor types) treated with targeted therapies. Issues surrounding study endpoints and biologic efficacy markers for molecular targeted agents in RCC are discussed in this article, with a focus on results of the Treatment Approaches in Renal Cancer Global Evaluation Trial (TARGETs).
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Flaws In Medicare Coding InterpretationsI work with medical oncologists/hematologists across the country in both the private practice and hospital settings. Based on my company’s experience, I would like to point out a couple of key flaws in the current Medicare code interpretations.
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Lung Cancer in the Elderly: Factors to ConsiderThe issue of cancer in the elderly is of growing concern given the aging population. It is a particular issue in lung cancer, where the median age of patients is over 60.
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Stereotactic Body Radiation TherapyThe article by Song, Kavanagh,Benedict, and Schefter is an insightfuland interesting summaryof this new technologic approachto the treatment of extracranial tumors.The work summarizes thesalient aspects of the emerging stereotacticbody radiation therapy (SBRT)paradigm, and characterizes the rationale,methodologies, and perceivedpotential for this promising new approachto treatment. The authorspresent interesting perspectives on thechallenges facing early adopters ofthe approach and, as early adopters,we find that our own experience supportsmany of the conclusions drawnby the authors.
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Further Perspectives on Treating Localized Prostate CancerStandard treatment options for prostate cancer patients include surveillance, surgery, external-beam radiotherapy, brachytherapy, the combination of external-beam and brachytherapy, and the combination of radiotheraputic modalities with hormonal therapy, for appropriately chosen patients.
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Paclitaxel as First-Line Treatment for Metastatic Breast CancerWhen administered as a single agent in pretreated patients with advanced breast cancer, paclitaxel (Taxol) exhibits remarkable antitumor activity. This trial was undertaken to compare paclitaxel with standard
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Oral UFT Plus Leucovorin in Patients With Relapsed or Refractory Colorectal CancerTherapeutic options for patients with advanced colorectal cancer who have failed treatment with fluorouracil (5-FU) are limited. Responses have been reported in this setting with a protracted venous infusion of 5-FU. Daily oral therapy with tegafur and uracil (UFT) plus leucovorin (LV) has the potential to mimic the pharmacology of continuous infusion 5-FU. Therefore, we undertook a phase II study of a 28-day schedule of a combination chemotherapy regimen containing oral UFT/leucovorin in patients with measurable metastatic colorectal cancer who had failed treatment with bolus 5-FU. In addition, we sought to determine whether coadministration of UFT and leucovorin alters the bioavailability of these agents. In a pretreatment phase, each patient underwent sequential pharmacokinetic sampling following a single dose of UFT alone, leucovorin alone, and the combination of UFT plus leucovorin. The preliminary results of this trial suggest that tegafur pharmacokinetics are not affected by coadministration of leucovorin and that folate pharmacokinetics are not affected by UFT. [ONCOLOGY 11(Suppl 10):22-25, 1997]
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Gemcitabine in Combination With New Platinum Compounds: An UpdateCombinations of gemcitabine (Gemzar) with cisplatin (Platinol) are among the most active new chemotherapy regimens developed for advanced non-small-cell lung cancer. Carboplatin (Paraplatin) is a platinum analog
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ABT-414 Shows Promise Against EGFR-Amplified GlioblastomaIn this interview we discuss findings from M12-356, an open-label, phase I, escalation cohort study of the investigational anti-EGFR antibody-drug conjugate ABT-414 for patients with EGFR-amplified recurrent glioblastoma.
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Book Review: Textbook of Uncommon Cancer, Second EditionThe second edition of the Textbook of Uncommon Cancer is a useful resource for practicing oncologists who encounter unusual presentations of common tumors or esoteric subtypes of more common cancers. The text is laid out according to
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The Costs of Cancer Care in the United States: Implications for ActionThe total annual cost of cancer care in the United States (including direct and indirect costs) has been estimated at more than $96 billion. Although third-party payers have led the effort to reduce these costs, such high
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Mind-body medicine in cancer care: Making patients wholeA cancer diagnosis carries with it a unique set of challenges for patients, their family, and healthcar e professionals. Patients newly diagnosed with cancer and their support people are frequently in shock, fearful, and emotionally regressed.
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Recurrent Pancreatic Adenocarcinoma After Pancreatic ResectionThe University of Colorado Denver School of Medicine faculty hold weekly second opinion conferences focusing on cancer cases that represent most major cancer sites. Patients seen for second opinions are evaluated by an oncologic specialist. Their history, pathology, and radiographs are reviewed during the multidisciplinary conference, and then specific recommendations are made. These cases are usually challenging, and these conferences provide an outstanding educational opportunity for staff, fellows, and residents in training.The second opinion conferences include actual cases from genitourinary, lung, melanoma, breast, neurosurgery, gastrointestinal, and medical oncology. On an occasional basis, ONCOLOGY will publish the more interesting case discussions and the resultant recommendations. We would appreciate your feedback; please contact us at second.opinion@uchsc.edu.
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Don't Undercode: Bill Level Five for Payment of Cognitive ServicesA large part of delivering high-value cancer care is devoted to cognitive services, which are very difficult to quantify within the current coding system. Achieving appropriate payment for cognitive services delivered is an ongoing dilemma within the oncology community.
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Colorectal Cancer Patients With Oligometastatic Liver Disease: What Is the Optimal Approach?In a good percentage of patients who have oligometastatic disease confined to a single organ-usually the liver-complete metastasectomy can result in cure. However, once the decision to pursue surgery is made, there remain a number of issues that must be addressed in order to ensure the best possible outcome.
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Cancer, Unproven Therapies, and MagicCommonly used by cancer patients, unproven therapies are treatments that the practitioner claims can alter the disease process although there is no proof to support the claim. The reasons for the popularity of uproven
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Provocative Pearls in Diagnosing and Treating Acute Promyelocytic LeukemiaThe treatment of APL in the modern era is a success of modern hematology. In this review we have attempted to plant the seeds of understanding regarding how diagnosis and treatment of APL will be pursued over the next decade.
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Modulation of Dose Intensity in Aerodigestive Tract Cancers: Strategies to Reduce ToxicityAdvances in diagnostic and therapeutic radiology and a better understanding of cell biology are being applied in practical ways to modulate treatment morbidity. Conformal radiotherapy targets the cancer precisely and can be combined with new systemically administered radiosensitizers.
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Patterns of Chemotherapy Administration in Patients With Intermediate-Grade Non-Hodgkin’s LymphomaRecords from 653 patients treated between 1991 and 1998 in the Oncology Practice Patterns Study (OPPS) were analyzed to determine contemporary chemotherapy delivery patterns in patients with intermediate-grade non-
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Paclitaxel in the Treatment of Small-Cell Lung CancerNew treatment strategies for small-cell lung cancer patients are required, as there have been few developments in the past 20 years. Paclitaxel (Taxol) has been shown to be effective in non–small-cell lung cancer when given in
