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ACR Appropriateness Criteria® Borderline and Unresectable Pancreas CancerThese guidelines review the use of radiation, chemotherapy, and surgery in borderline and unresectable pancreas cancer. Radiation technique, dose, and targets were evaluated, as was the recommended chemotherapy, administered either alone or concurrently with radiation. This report will aid clinicians in determining guidelines for the optimal treatment of borderline and unresectable pancreatic cancer.
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Management of Locally Advanced Breast CancerMultimodality therapy-ie, surgical excision followed by appropriate systemic therapy and radiotherapy-has an established role in managing patients with locally
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Anthracycline-Induced Cardiotoxicity: Risk Assessment and ManagementIn the current issue of ONCOLOGY, Hershman and Shao provide a comprehensive review of anthracycline-induced cardiotoxicity (AIC). Risk factors for AIC include age (≤ 18 or ≥ 65 years) at time of treatment, increasing cumulative dose or dose intensity of anthracyclines, mediastinal radiation therapy (RT), and female gender.[1-4]
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A Patient With Metastatic Melanoma of the Small BowelMelanoma frequently metastasizes to the small bowel. In this installment of Clinical Quandaries, we describe the case of 74-year-old man who presented with this rare but well described manifestation of malignant melanoma
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The Evolving Role of Cytoreductive Surgery for Metastatic Renal Cell CarcinomaDrs. Uzair Chaudhary and GeraldHull provide a comprehensivereview of the role ofcytoreductive surgery in metastaticrenal cell carcinoma. This controversialtopic has been debated for manyyears. Metastatic renal cell carcinomacontinues to be a chemotherapyresistanttumor with a poor prognosis.About 30% of newly diagnosedpatients present with metastatic disease.In the metastatic setting, themost recognized treatment modalitiesinvolve the biologic agents interferon-alpha and interleukin-2 (IL-2,Proleukin). They produce an objectiveresponse rate of about 10% to15%, with approximately 5% of patientsachieving a durable completeresponse.
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Radiation Boost Reduces Local Recurrence in DCIS PatientsA study presented last month at ASTRO found that a boost of radiation therapy following lumpectomy in DCIS patients resulted in reduced rates of local recurrence.
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A Young Woman With a Small ER-Positive Breast Cancer, a Micrometastatic Axillary Lymph Node, and an Intermediate Oncotype DX Recurrence Scorepatient is a 39-year-old premenopausal woman who presents with a new diagnosis of breast cancer to our multidisciplinary second opinion clinic.
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Colorectal Cancer: How Emerging Molecular Understanding Affects Treatment DecisionsIn this review we discuss the current treatment options in metastatic colon cancer, with a special focus on biologic agents and how molecular understanding guides treatment decisions.
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Can Schools Play Role in Skin Cancer Prevention?In this interview we discuss the idea of using schools to increase knowledge about skin cancer and attitudes toward sun exposure.
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5-Minute Inservice Mucositis ManagementPatients who have experienced oral mucositis report it as the most bothersome side effect of cancer therapy. It can result in pain, infection, and nutritional defi cits, and can interfere with appropriate cancer treatment. Many patients with mucositis are opiate-naive, presenting clinical challenges.
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A 60-Year-Old Man With Progressive Anemia While Receiving Checkpoint Blockade Therapy for Relapsed MyelofibrosisA 60-year-old man with a history of coronary artery disease and JAK2 V617F–positive polycythemia vera presented to our bone marrow transplantation clinic with progressive fatigue, splenomegaly, and cytopenias.
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Optimal Post-Treatment Surveillance in Cancer Survivors: Is More Really Better?In this review, we discuss the established guidelines and current evidence regarding post-treatment surveillance, and we propose general management strategies in prostate, colorectal, and breast cancers.
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Clinical Pearls on Recent Advances and the Future of Treatment in RCCMehmet Asim Bilen, MD, summarizes recent advances in metastatic RCC and looks towards the future of the field.
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A New Horizon in Cancer Care: Liquid BiopsyMehmet Sitki Copur, MD, gives his perspective on liquid biopsies and how they can be utilized in gastrointestinal cancer.
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Commentary (Golshan/Iglehart): Surgical Management of Hepatic Breast Cancer MetastasesIn general, surgery has no role inthe curative treatment of metastaticbreast cancer. Metastatic breastcancer is considered incurable, associatedwith an average survival of 18 to24 months. Certain factors such as hormone-receptor negativity, HER2/neupositivedisease, and a short disease-freeinterval portend a poor prognosis. Theliver is not usually a site of initialfailure-less than 15% of patients fitthis pattern.[1] Even fewer are candidatesfor surgical resection due toextrahepatic disease. Eventually, overhalf of all patients with metastatic diseasewill have liver metastasis duringtheir clinical course.
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BOOK REVIEW: LeukemiaThis text, originally published as Dameshek and Gunz's textbook Leukemia (1958), is now edited by an international team consisting of Dr. Henderson, Dr. Lister, and Dr. Greaves. This continues to be an outstanding text in its field, covering virtually all aspects of the acute and chronic leukemias.
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CCOP Brings Clinical Trials to the CommunityBETHESDA, Md--Cancer patients may be more likely to enter treatment trials if the medical centers are near their own homes. With this in mind, the National Cancer Institute and the Division of Cancer Prevention and Control developed the Community Clinical Oncology Program (CCOP).
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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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Monitoring Changes in the Microenvironment During Targeted TherapiesThis review covers progress to date in the identification of molecular targets on blood vessels in cancers, as well as agents that act on those targets, with emphasis on those currently in clinical trials. Current vascular-targeting therapies comprise two general types—antiangiogenic therapy and antivascular therapy. Advances in antiangiogenic therapies, particularly inhibitors of vascular endothelial growth factors and their receptors, have clarified the capacity of these inhibitors to change tumor-associated vessel structure to a more normal state, thereby improving the ability of chemotherapeutics to access the tumors. The responses of other antiangiogenesis target molecules in humans are more complicated; for example, αvβ3 integrins are known to stimulate as well as inhibit angiogenesis, and cleavage of various extracellular proteins/proteoglycans by matrix metalloproteinases produces potent regulators of the angiogenic process. Antivascular therapies disrupt established blood vessels in solid tumors and often involve the use of ligand-based or small-molecule agents. Ligand-based agents, irrespective of the antiangiogenic capacity of the ligand, target antivascular effectors to molecules expressed specifically on blood vessels, such as aminopeptidase N, fibronectin extra-domain B, and prostate-specific membrane antigen. Small-molecule antivascular agents, which are not targeted to molecules on blood vessels, rely on physical differences between the vasculatures in tumors and those in normal tissues.
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Prophylactic Cranial Irradiation for Patients With Locally Advanced Non–Small-Cell Lung CancerProphylactic cranial irradiation(PCI) in patients with locallyadvanced non–small-cell lungcancer (NSCLC) remains an area ofcontroversy. Dr. Gore has provided areview of the literature, including randomizedand nonrandomized studiesand, in particular, the ongoing RadiationTherapy Oncology Group trial(RTOG 0214), which is randomizingNSCLC patients to PCI or observation.
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Non-Secretory Myeloma: One, Two, or More Entities?To define the differences between the subtypes of myeloma patients, not only prospective collection of clinical and laboratory data are needed, but also cytogenetics and molecular profiling.
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Can We Know What to Do When DCIS Is Diagnosed?It is ironic that while huge strides have been made in the treatment of invasive breast carcinoma, resulting in breast conservation for many women, the most appropriate treatment of noninvasive breast carcinoma remains a topic of hot debate.
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Irinotecan in the Management of Patients With Pancreatic CancerSynergy with no overlapping toxicities has been demonstrated for the combination of irinotecan ( Camptosar, CPT-11) and gemcitabine (Gemzar) in vitro. Results of a single-institution phase I study in which patients with
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Advances in the Systemic Treatment of Metastatic MelanomaWithin the relatively short time that ipilimumab and vemurafenib have been commercially available, phase II data for the investigational agents nivolumab and MK-3475, for the combination of dabrafenib and trametinib, and for adoptive cell therapy strongly suggest even further improvements in treatment outcomes.
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Neoadjuvant Therapy for Early-Stage Breast Cancer: Current Practice, Controversies, and Future DirectionsIn this review, we will discuss multidisciplinary considerations in treating patients with neoadjuvant therapy and highlight areas of controversy and ongoing research.
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Hereditary Breast and Ovarian Cancer: High-Risk ManagementThe patient, DB, is a 51-year-old white, married female with a strong family history of breast cancer. She presented for high-risk assessment and genetic testing following the discovery of a deleterious mutation in a family member.
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Osteoporosis, Fractures, and Risk of FallsOsteoporosis in elderly cancer patients is an increasing problem, yet it remains under-recognized and under-managed. We commend Dr. Balducci for writing a comprehensive review of the bone complications associated with cancer and its treatment in the elderly.
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Melissa L. Johnson, MD, on the Approval of Tremelimumab Plus Durvalumab/Chemo in NSCLCMelissa L. Johnson, MD, spoke about the design of the phase 3 POSEIDON trial how its data led to the recent approval of tremelimumab plus durvalumab and chemotherapy in patients with advanced non–small cell lung cancer.
