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Osimertinib Plus Savolitinib Shows Activity in EGFR-Mutant, MET-Amplified NSCLCCancer Network spoke with Lecia V. Sequist, MD, MPH, about the TATTON study, which tested the combination of osimertinib and savolitinib in previously treated non–small-cell lung cancer patients.
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Cervical CancerThis management guide covers the screening, diagnosis, staging, and treatment of cervical cancers.
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Melanoma’s Radioresistant Reputation ChallengedConventional wisdom would have one believe that melanoma is a highly radioresistant tumor, perhaps even “radiation proof.” This reputation developed as a result of a combination of factors. First, early in vitro studies of melanoma radio-biology suggested that melanoma cells displayed enhanced postradiation survival vs comparison cells.[1] Second, clinical use of radiation therapy for melanoma did not seem to work very well.[2] This combination, a clinical observation supported by laboratory work, seems to have led radiation therapy to be avoided for melanoma treatment.
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Commentary (Ellis): The Horizon of Antiangiogenic Therapy for Colorectal CancerIn this issue of ONCOLOGY, Olszewski,Grossbard, and Kozuchprovide an excellent overview ofthe role of antiangiogenic therapy inthe treatment of patients with metastaticcolorectal cancer. The authorshave brought several important issuesto the forefront that warrant furtherdiscussion, and these issues will beaddressed in this commentary.
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Irinotecan in Lymphoma, Leukemia, and Breast, Pancreatic, Ovarian, and Small-Cell Lung CancersIrinotecan (CPT-11 [Camptosar]) has a broad range of antitumor activity. Extensive preclinical and early clinical work has demonstrated its activity against many tumor types--head and neck, esophagus, stomach, pancreas,
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Recent Advances in Preventing Chemotherapy-Induced Nausea and VomitingThis article will address changes in CINV guidelines over the past 5 years and provide updates on recently approved agents and agents that are expected to be approved, based on published phase III trials. It will also explore other factors affecting optimal CINV control, including the role of patient-related risk factors and the role of physician adherence to antiemetic guidelines in reducing the residual risk of CINV.
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Exercise in Regulation of Inflammation-Immune Axis Function in Cancer Initiation and ProgressionThis article provides an overview of the current state of knowledge pertaining to exercise modulation of the inflammation-immune axis in cancer. The current evidence suggests that exercise may be a promising adjunctive strategy that can favorably alter numerous components of the immune system, which, in turn, may modulate tumorigenesis.
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Endometrial Cancer: Recent Developments in Evaluation and TreatmentEndometrial carcinoma is the most common gynecologic malignancy in the United States. Most cases are diagnosed at an early stage. However, the outcome for women diagnosed with advanced-stage disease remains poor. The etiology of most endometrial carcinomas stems from the effects of excess estrogen, whether this comes from exogenous or endogenous sources. Differences in epidemiology and presentation suggest the existence of two forms of endometrial cancer: those related to and those unrelated to hormonal stimulation. Most women with endometrial cancer present with abnormal uterine bleeding; endometrial sampling is essential to exclude endometrial carcinoma in such patients. Endometrial cancer is surgically staged, and staging usually includes a hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy also should be performed in selective cases to better assess disease spread and to evaluate the need for adjuvant therapy. Adjuvant treatment may include the use of radiation, progestins, or cytotoxic chemotherapeutic agents. Several clinical trials are underway to compare these treatment modalities, as well as to determine the optimal combination of active chemotherapeutic agents, such as doxorubicin, platinum agents, and paclitaxel (Taxol). [ONCOLOGY 13(12):1665-1675, 1999]
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Use of Transcription Factors as Agents and Targets for Drug DevelopmentCells respond to external signals by either activating or inhibiting key regulatory proteins of gene expression called transcription factors (TFs). Abnormal expression of these factors plays a critical role in many human
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Dr. Emens Discusses Overall Survival in HER2+ Breast CancerDr. Leisha Emens of the University of Pittsburgh Medical Center's Hillman Cancer Center discusses the overall survival in the KATE2 study.
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COUNTERPOINT: The Role of Stem Cell Transplantation in Mantle Cell LymphomaManagement strategies for patients with mantle cell lymphoma continue to demonstrate pendulum-like swings between those appropriate for low-grade lymphoma, and those appropriate for very aggressive lymphoma.
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Evaluating the Role of Serine Protease Inhibition in the Management of Tumor MicrometastasesConservation of blood is apriority during surgery, owingto shortages of donor bloodand risks associated with transfusionof blood products.[9,10] However,blood transfusions have been linkedto a number of negative postoperativesequelae, including poorer prognosisafter cardiac and cancer surgery.[11-21] In this context, recognition thatallogeneic transfusion-associatedimmunomodulation can increasemorbidity in allogeneically transfusedpatients has become a major concernin transfusion medicine.[9,22,23]
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Hematopoietic Stem Cell Transplantation for Non-Hodgkin’s LymphomaHigh-dose myeloablative therapy with autologous or allogeneicstem cell rescue is an effective treatment strategy for non-Hodgkin’slymphoma (NHL), but NHL is much less likely to stay in remission afteran autologous transplant than after an allogeneic transplant. Thebenefit of undergoing an autologous transplant earlier in the course ofthe disease, especially for patients who present with intermediate orhigh scores on the International Prognostic Index of risk factors, is stillunclear. The addition of immunotherapy, biologic modifiers, andantibody therapy such as rituximab (Rituxan) or radiolabeled antibodyto the autologous transplant are approaches undergoing evaluation.Historically, there has been a high regimen-related mortality rateassociated with myeloablative allogeneic transplant that has made thisapproach a less appealing option for therapy. The use of nonmyeloablativeallogeneic transplants as treatment for NHL is less well studiedand remains to be defined.
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The Challenge of Selecting Adjuvant Breast Cancer Chemotherapy for Older PatientsDr. Hy Muss is a well recognized expert in the treatment of elderly women with breast cancer, and his article “Adjuvant Chemotherapy of Breast Cancer in the Older Woman” is an extremely important addition to the limited existing literature on this topic. As he points out, nearly half of all breast cancer diagnoses occur in women over 65 years of age. As the total number of women in that demographic increases with the aging of our population, medical oncologists will be faced with a growing number of elderly breast cancer patients, for whom evidence-based recommendations on treatment are needed. As any medical oncologist who sits face-to-face with these older women knows, it is not acceptable to simply tell the patient that there are inadequate data to guide recommendations for adjuvant chemotherapy in her age group, though this is what the EBCTCG (Early Breast Cancer Trialists Collaborative Group) overview has concluded.
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Management of Metastatic Colorectal CancerThe management of colorectal cancer is a complex endeavor that requires treatment individualization founded on molecular characterization of the tumor, an in-depth understanding of the patient, and an appreciation of the interaction between the two.
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Optimization of Genetic Testing for mCRPCJason M. Hafron, MD, CMO, and Oliver Sartor, MD, share their approach for the optimal management of mCRPC through genetic testing.
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Accelerated Partial-Breast Irradiation: The Current State of Our KnowledgeAccelerated partial-breast irradiation is a shorter, alternative radiation technique for select patients with favorable early-stage breast cancer. We review here the different modalities of delivery and discuss the possible benefits and harms associated with these treatments.
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Multidisciplinary Management of Pediatric Soft-Tissue SarcomaThe management of pediatric soft-tissue sarcomas has improved drastically through the use of multimodal therapy. These tumors include rhabdomyosarcomas and nonrhabdomyosarcomas. Both are staged using
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Castration-Refractory Prostate Cancer: New Therapies, New QuestionsResistance to androgen deprivation is an ominous milestone in the natural history of metastatic prostate cancer:this disease state, now referred to as castration-refractory prostate cancer (CRPC), is historically associated with a median survival of less than two years. Until recently, only docetaxel (in combination with prednisone or estramustine) demonstrated a benefit in overall survival vs comparator therapy with mitoxantrone plus prednisone.[1,2] However, in the past year, compelling data in support of several promising new treatments for CRPC have been reported. The new data offer evidence-based treatment options, but also raise many questions for patient management and future clinical research.
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Honing Therapy for Rectal CancerEpidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) are often overexpressed in colorectal cancer and are associated with inferior outcomes. Based on successful randomized phase III trials, anti-EGFR and anti-VEGF therapeutics have entered clinical practice. Cetuximab (Erbitux), an EGFR-specific antibody, is currently approved in the United States in combination with irinotecan (Camptosar) for patients with metastatic colorectal cancer refractory to irinotecan or as a single agent for patients unable to tolerate irinotecan-based therapy. In retrospective analyses, patients with EGFR-expressing rectal cancer undergoing neoadjuvant radiation therapy had a significantly inferior disease-free survival and lower rates of achieving pathologic complete response. Based on the positive data in metastatic colorectal cancer and synergy with radiation therapy seen in preclinical models, there is a strong rationale to combine cetuximab with neoadjuvant radiation therapy and chemotherapy in rectal cancer. Bevacizumab (Avastin), a VEGF-specific antibody, was the first antiangiogenic agent to be approved in the United States for use in combination with standard chemotherapy in the first- and second-line of treatment in metastatic colorectal cancer. VEGF-targeted therapy may lead to indirect killing of cancer cells by damaging tumor blood vessels, and may increase the radiosensitivity of tumor-associated endothelial cells. VEGF blockade can also "normalize" tumor vasculature, thereby leading to greater tumor oxygenation and drug penetration. This review will address completed and ongoing trials that have established and continue to clarify the effects of these agents in rectal cancer.
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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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Current Management of Depression in Cancer PatientsDepression is a common but treatable condition among cancer patients. Screening for depression can be done simply and effectively, and a variety of practical treatment strategies are available. Numerous factors should be
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Commentary (Carr/Goudas): An Alternative Algorithm for Dosing Transdermal Fentanyl for Cancer-Related PainTo assist in converting patients from one opioid agent to another in their daily practice, many oncologists carry pocket dosage conversion guides based on package inserts approved by the US Food and Drug Administration (FDA). One such guide issued by the manufacturer of transdermal fentanyl (Duragesic), reproduced in Table 3 of the expert consensus article written by Breitbart et al, presents the equivalent of 25 µg/h of transdermal fentanyl as 45 to 134 mg/d of oral morphine. In another guide, distributed by one of the manufacturers of controlled-release morphine, the 25 µg/h strength of transdermal fentanyl is said to be equianalgesic to 15 mg of controlled-release morphine administered every 12 hours (and both are deemed equivalent to 10 mg of controlled-release oxycodone every 12 hours). Faced with such a wide range of conversion factors, it is of little surprise-as Breitbart et al point out-that clinicians often fail to achieve equianalgesia when converting patients from one opioid to another.
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DNA Ploidy and Cell Cycle Analysis in Cancer Diagnosis and Prognosispplication of the techniques of flow cytometry and image analysis to quantitation of DNA and estimation of events in the cell cycle in human tumors has achieved considerable popularity as a laboratory procedure but so far has failed to be of practical clinical value. As brilliantly summarized by Dr. Ross, retrospective studies have repeatedly shown abnormal DNA values to be of prognostic significance in several organ systems, among them, tumors of the urothelium [1] and prostate [2] and, perhaps to a lesser extent, mammary carcinomas [3].
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Immune Checkpoint Inhibition in Lung Cancer: The Good, the Bad, and the UglyImmune checkpoint inhibitors are a reality for the treatment of patients with NSCLC, and if approved for SCLC, would be a treatment breakthrough we have not seen for decades.
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Strategies for Communicating Treatment Risks and Uncertainty of OutcomesIn this video, Professor Dame Lesley Fallowfield explains why oncologists need to be aware of their own tolerance of uncertainty before discussing possible treatment risks and outcomes with patients.
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Anastrozole: A New Selective Nonsteroidal Aromatase InhibitorAromatase (estrogen synthetase) is the enzyme complex responsible for the final step in estrogen synthesis-the conversion of androstenedione and testosterone to estrone and estradiol, respectively. Inhibitors of this enzyme
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Cytoreductive Surgery for Advanced Ovarian Cancer: Quo Vadis?This article focuses on the recent debate regarding when-or whether-patients with ovarian cancer should undergo aggressive surgical resection.
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Commentary (Kosecoff/Michelson): Current Status of Practice Guidelines in OncologyIt is somewhat bittersweet that an article about the need for cancer guidelines is being written in 1995. On the one hand, it is heartening that Dr. Winn has patiently organized a coherent framework for creating and implementing guidelines. On the other hand, it is quite bitter medicine to realize, as Dr. Winn points out, that even today, "follow-up studies.... have not been able to
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Hepatic Colorectal Metastasis: Current Status of Surgical TherapyMetastatic colorectal cancer to the liver develops in over 50,000 US patients each year and is rapidly fatal if untreated. Even the most active chemotherapeutic agents rarely prolong survival for more than 3 years. Liver
