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Dose Reductions and Delays: Limitations of Myelosuppressive ChemotherapyThrombocytopenia occurs at various grades of severity in patients with nonmyeloid malignancies undergoing chemotherapy with myelosuppressive agents. Frequently, it is the major dose-limiting hematologic toxicity, especially in the treatment of potentially curable malignancies such as leukemia, lymphomas, and pediatric cancers.
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Soft-Tissue SarcomasThe soft-tissue sarcomas are a group of rare but anatomically and histologically diverse neoplasms. This is due to the ubiquitous location of the soft tissues and the nearly three dozen recognized histologic subtypes of soft-tissue sarcomas.
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Research on Thalidomide in Solid Tumors, Hematologic Malignancies, and Supportive CareInterest in thalidomide (Thalomid) has intensified in recent years as research has identified and elucidated its immunomodulatory, anti-inflammatory, and antiangiogenic properties. In this supplement, we present a selection of abstracts
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Oncocytic Neoplasm on Renal Mass Biopsy: A Diagnostic ConundrumA 56-year-old man presented with a 4.5-cm leftsided renal mass incidentally discovered on an ultrasound performed for workup of lupus nephritis. On dedicated contrast-enhanced magnetic resonance imaging (MRI), the tumor was found to be avidly enhancing.
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MRI for every APBI candidate: An open questionIn this retrospective study by Godinez et al, 30 (38%) of 79 patients had additional foci on MRI. The researchers suggested that MRI should be used prior to APBI to rule out the presence of multifocal or multicentric disease.
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ACR Appropriateness Criteria® Adjuvant Management of Early-Stage Endometrial CancerAfter a review of the published literature, the panel voted on three variants to establish best practices for the utilization of imaging, radiotherapy, and chemotherapy after primary surgery for early-stage endometrial cancer.
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Precision Medicine in Metastatic Colorectal Cancer: Relevant Carcinogenic Pathways and Targets-PART 1: Biologic Therapies Targeting the Epidermal Growth Factor Receptor and Vascular Endothelial Growth FactorHere we review drugs that target the EGFR and VEGF pathways, focusing on patient selection, drug toxicities, and how to choose agents for first-line therapy.
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Clinical Issues in the Surgical Management of Screen-Identified Lung CancersThis review outlines the diagnostic and therapeutic challenges associated with the increased number of screen-identified indeterminate lung nodules, highlighting currently recommended follow-up and management algorithms, as well as the various methods of nodule localization, tissue diagnosis, and definitive local therapeutic modalities.
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Rationale for Trials Studying Pegylated Liposomal Doxorubicin in Metastatic Breast CancerBreast cancer is second only to lung cancer as a leading cause of cancer mortality in women. In women with metastatic, hence, essentially incurable disease, we strive to find effective chemotherapeutic regimens that offer a
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How We Treat Tumor Lysis SyndromeWhen tumor cells are rapidly broken down and their contents released into the extracellular space, the released ions and compounds can cause metabolic disturbances too great to be neutralized by the body's normal mechanisms.
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Biologic Therapy: Hematopoietic Growth Factors, Retinoids, and Monoclonal AntibodiesBiologic therapies are an increasingly important part of cancer treatment. In this chapter, we review the current status of studies of colony-stimulating factors (CSFs), erythropoietin (Epogen, Procrit), thrombopoietin, the retinoids, and monoclonal antibodies (MoAbs). The interferons, interleukin-2 (IL-2, aldesleukin [Proleukin]), and adoptive cellular immunotherapy are discussed in a separate chapter.
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Role of Positron-Emission Tomography Scan in the Diagnosis and Management of Breast CancerIn 2008, more than 184,000 new patients were diagnosed with breast cancer, the most commonly diagnosed malignancy in women in the United States. Despite great advances over the past few years in screening, detection, and treatment, more than 40,000 women died from the disease in 2008.[1] Early breast cancer is considered a curable disease, but the curative potential of patients with locally advanced or metastatic disease is limited.
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Rationale for Trials Studying Pegylated Liposomal Doxorubicin in Metastatic Breast CancerBreast cancer is second only to lung cancer as a leading cause of cancer mortality in women. In women with metastatic, hence, essentially incurable disease, we strive to find effective chemotherapeutic regimens that offer a
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Conservative Management of Rectal Cancer With Local Excision and Adjuvant TherapyIn their article, Drs. Wagman and Minsky provide an excellent overview of the current status of local treatment strategies for early rectal cancer. They have rightly pointed out that while minimal surgery is an attractive option, it must be balanced against the highly curable outcomes of radical surgical resection. Expanded experience with stapling devices has extended the level at which safe and satisfactory anastomoses can be accomplished in the distal rectum. The promise of enhanced preservation of rectal, urinary, and sexual functions makes local treatment strategies an attractive option. The most important aspect of disease management using this approach remains the process of patient selection.
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Treating Chemotherapy-Induced Thrombocytopenia: Is It Time for Oncologists to Use Thrombopoietin Agonists?Clinical trials of the new thrombopoietin receptor agonists in the management of chemotherapy-induced thrombocytopenia are needed to address concerns about the safety and practical efficacy new agents before we accept them as standard therapies.
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Thrombocytopenia: Optimizing Approaches in Cancer PatientsChemotherapy-induced thrombocytopenia causes nearly two-thirds of cases of thrombocytopenia in the cancer setting. In patients receiving chemotherapy, thrombocytopenia leads to dose reductions in 15% of treatment cycles and chemotherapy delays in 6% of cycles.
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What’s New in Genetic Testing for Cancer Susceptibility?The dilemma for clinicians is how best to understand and manage this rapidly growing body of information to improve patient care. With millions of genetic variants of potential clinical significance and thousands of genes associated with rare but well-established genetic conditions, the complexities of genetic data management clearly will require improved computerized clinical decision support tools, as opposed to continued reliance on traditional rote, memory-based medicine.
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Recent Advances in the Management of Brain Metastases in Non-Small Cell Lung CancerLung cancer is one of the most common and deadly malignancies in the United States, with an estimated 213,380 new cases in 2007 and an estimated 160,390 deaths in 2007. Approximately 85% of these patients will be diagnosed with non-small cell lung cancer (NSCLC), and only 10%-20% will have potentially curable disease.
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Mathematical Modeling for Breast Cancer Risk AssessmentWomen at increased risk of breast cancer have important opportunities for early detection and prevention. There are, however, serious drawbacks to the available interventions. The magnitude of breast cancer risk is a crucial factor in the optimization of medical benefit when considering the efficacy of risk-reduction methods, the adverse effects of intervention, and economic and quality-of-life outcomes. Breast cancer risk assessment has become increasingly quantitative and is amenable to computerization. The assembly of risk factor information into practical, quantitative models for clinical and scientific use is relatively advanced for breast cancer, and represents a paradigm for broader risk management in medicine. Using a case-based approach, we will summarize the major breast cancer risk assessment models, compare and contrast their utility, and illustrate the role of genetic testing in risk management. Important considerations relevant to clinical oncology practice include the role of risk assessment in cancer prevention, the logistics of implementing risk assessment, the ramifications of conveying risk information with limited genetic counseling, and the mechanisms for genetics referral. Medical professionals can embrace new preventive medicine techniques more effectively by utilizing quantitative methods to assess their patients’ risks. [ONCOLOGY 16:1082-1099, 2002]
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Commentary (Spaulding): Speech and Swallowing Rehabilitation for Head and Neck Cancer PatientsLogemann and colleagues highlight an aspect of the treatment of patients with head and neck cancer that is frequently ignored; ie, the importance of rehabilitation efforts and evaluations of post-therapy quality of life. As oncologists, whether surgical, radiation, or medical, our studies and publications have traditionally focused on overall survival, disease-free survival, and, particularly in the management of head and neck cancer, local control of disease. More recently, investigators have begun to address quality of life when constructing studies for patients with all kinds of malignancies, and newer performance outcome instruments have been designed specifically for patients with head and neck cancer.[1]
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HER2-Positive Breast Cancer: Beyond TrastuzumabThis review explores the use of several such agents, including lapatinib (Tykerb), HSP90 inhibitors, T-DM1, and other tyrosine kinase inhibitors. Emerging data from trials of these agents indicate that the HER2 pathway remains a valid therapeutic target following disease progression on trastuzumab.
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Controversies in the Surgical Management of GIST in the Era of ImatinibIn the pre-imatinib era, surgery was the only effective treatment for gastrointestinal stromal tumor (GIST). However, this treatment modality was often either not possible or insufficient for cure due to the aggressive nature of this disease.
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Breast Cancer: New Radiation Treatment OptionsConventional radiotherapeutic treatment for early and advancedbreast cancer has been based on broad-field radiation treatment principlesthat date back several decades. Although these strategies havebeen successful, newer techniques now offer the ability to incorporateimproved target imaging, dosimetric planning, and treatment deliveryinto the treatment design. These newer techniques include acceleratedpartial-breast irradiation and hypofractionated whole-breast irradiationfor early-stage breast cancer, and intensity-modulated radiotherapy(IMRT) for both early and advanced breast cancer. Accelerated partial-breast irradiation and hypofractionated whole-breast radiotherapyare treatment approaches that promise both reduced overall treatmenttimes and the potential for increased use of breast-conservation therapy.IMRT offers unparalleled dose homogeneity and conformality thatenables dose reduction to normal structures with the potential to reducetreatment toxicity and improve cosmesis. Based on the publishedliterature, an increasing number of treatment facilities are offering treatmentwith these techniques. However, further clinical study remainsimportant to thoroughly define the appropriate clinical setting, patientselection criteria, and limitations for each of these innovative treatmentapproaches.
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Man With Recurring Chordoma and Progressive Disease Despite Radiotherapy and Radical ResectionA 60-year-old man presented with lower limb claudication and a painful mass on his left buttock. Physical examination revealed a firm round mass, fixed to deep planes. A biopsy was performed and revealed a chordoma.
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Management of the Clinically Node-Negative Axilla: What Have We Learned From the Clinical Trials?Here we review the evolution of sentinel lymph node biopsy for the management of clinically node-negative breast cancer, and we address the current controversies and management issues.
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Risk Models for Neutropenia in Patients With Breast CancerBreast cancer is the most common noncutaneous malignancy inwomen in industrialized countries. Chemotherapy prolongs survival inpatients with early-stage breast cancer, and maintaining the chemotherapydose intensity is crucial for increasing overall survival. Manypatients are, however, treated with less than the standard dose intensitybecause of neutropenia and its complications. Prophylactic colonystimulatingfactor (CSF) reduces the incidence and duration of neutropenia,facilitating the delivery of the planned chemotherapy doses.Targeting CSF to only at-risk patients is cost-effective, and predictivemodels are being investigated and developed to make it possible forclinicians to identify patients who are at highest risk for neutropeniccomplications. Both conditional risk factors (eg, the depth of the firstcycleabsolute neutrophil count nadir) and unconditional risk factors(eg, patient age, treatment regimen, and pretreatment blood cell counts)are predictors of neutropenic complications in early-stage breast cancer.Colony-stimulating factor targeted toward high-risk patients startingin the first cycle of chemotherapy may make it possible for fulldoses of chemotherapy to be administered, thereby maximizing patientbenefit. Recent studies of dose-dense chemotherapy regimens with CSFsupport in early-stage breast cancer have shown improvements in disease-free and overall survival, with less hematologic toxicity than withconventional therapy. These findings could lead to changes in how earlystagebreast cancer is managed.
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Patient With Abdominal Inflammatory Myofibroblastic TumorA 37-year-old Lebanese male with no significant past medical history initially presented with an increase in abdominal girth over a few weeks with worsening shortness of breath, nausea, and intermittent vomiting.
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The Changing Field of Locoregional Treatment for Breast CancerSince 1990, death rates from breast cancer have decreased, mainly in women younger than 50 years of age (3.3% per year) vs women aged 50 years or older (2% per year), reflecting the benefit of widespread use of systemic treatment added to early detection.[1]
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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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Cardiovascular Risk Associated With Androgen Deprivation TherapyProstate cancer is the second leading cause of cancer-related death among men in the United States.[1] Androgen deprivation therapy (ADT) is a common treatment for prostate cancer. ADT includes gonadotropin-releasing hormone (GnRH) agonists (leuprolide, goserelin, triptorelin), bilateral orchiectomy, and anti-androgen receptor blockers such as flutamide and bicalutamide. Several studies have now shown conflicting evidence that anti-androgen therapy may lead to increased cardiovascular morbidity and mortality.[2-5] None of these studies has provided conclusive evidence for causality or a direct link to cardiovascular disease, but they have proposed that therapy side-effects increase parameters that are similar to those of the metabolic syndrome.
