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Peripheral Neuropathy and CancerPeople living with cancer may experience nerve pain often described as tingling, burning, or numbness. Problems with coordination also may be present. These symptoms may be associated with a peripheral neuropathy. In this condition, nerves outside the brain and spinal cord have been damaged, often by the cancer treatments themselves.
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Epidermal Growth Factor Receptor Inhibitors for the Treatment of Colorectal Cancer: A Promise Fulfilled?The epidermal growth factor receptor (EGFR) is commonly expressedin colorectal cancers but not in most normal tissues, raising the possibilitythat this receptor could serve as a target for highly selective therapy.Based on preclinical studies demonstrating that antagonists of EGFRresulted in the inhibition of tumor growth, the development of clinicalreagents has been aggressively pursued. Early clinical studies demonstratedantitumor activity of EGFR inhibitors in patients with advancedcolorectal cancer, with acceptable toxicity. This early success fueledrapid clinical development. In this article, we will review the currentstatus of EGFR inhibitors in the treatment of patients with colorectalcancer, in an effort to describe both how far we have come as well aswhere we need to go in optimizing this promising therapeutic approach.
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New Drugs for Small-Cell Lung CancerBetter efficacy of chemotherapy for small-cell lung cancer (SCLC) has not been convincingly demonstrated despite many investigations examining increased drug
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Lymphatic Mapping in the Treatment of Breast CancerDeveloped initially for the treatment of malignant melanoma, lymphatic mapping and sentinel lymph node biopsy have recently been introduced into the treatment of early breast cancer. In breast cancer patients, harvested
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Paclitaxel and Carboplatin as First-Line Chemotherapy for Advanced Breast CancerIn a phase II study, 66 patients with advanced breast cancer (median age 56 years; range, 28 to 75 years) were treated with paclitaxel (Taxol), 175 mg/m² infused over 3 hours, and carboplatin (Paraplatin), dosed to attain an
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Some Elements of Prognosis in Terminal CancerPredicting the survival of terminal cancer patients is a difficult task. To better understand this difficulty, we divide prognostication into two distinct elements: foreseeing and foretelling. Foreseeing is a physician’s silent cognitive
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Favorable vs Unfavorable Intermediate-Risk Prostate Cancer: A Review of the New Classification System and Its Impact on Treatment RecommendationsThe population of patients with intermediate-risk prostate cancer are a large and heterogeneous group with highly variable prognoses, which present a challenge to efforts to develop standardized treatment recommendations.
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Ovarian Cancer in Elderly WomenThe incidence of ovarian carcinoma increases with advancing age,peaking during the 7th decade of life and remaining elevated until age80 years. Despite the high prevalence of ovarian cancer in the elderly,the management of these patients is often less aggressive than that oftheir younger counterparts. As a result, many elderly cancer patientsreceive inadequate treatment. However, data do not support the conceptthat age, per se, is a negative prognostic factor. In fact, the majority ofelderly patients are able to tolerate the standard of care for ovariancancer including initial surgical cytoreduction followed by platinumand taxane chemotherapy. Because functional status has not demonstrateda reliable correlation with either tumor stage or comorbidity,each patient’s comorbidities should be assessed independently. Forelderly patients with significant medical comorbidity, the extent ofsurgery and aggressiveness of chemotherapy should be tailored to theextent of disease, symptoms, overall health, and life goals. In addition,enhanced cooperation between geriatricians and oncologists may assistthe pretreatment assessment of elderly patients and improve treatmentguidelines in this population.
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Adding Palbociclib Delays Progression in HR-Positive Breast CancerIn this video we discuss the results of the PALOMA3 trial, which tested fulvestrant and palbociclib in metastatic, hormone receptor–positive HER2-negative breast cancer.
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Bladder Cancer: Time for a Rethink?In this issue of ONCOLOGY, Kamat and Mathew provide an excellent overview of the current status and future imperatives of bladder cancer treatment and research.
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Large Bladder Mass and Renal Failure in a 14-Year-Old BoyA 14-year-old, otherwise healthy adolescent male originally presented to his primary care physician with abdominal pain and distention. Ultrasound revealed a complex mass with cystic components along the superior pole of the bladder and bilateral hydroureteronephrosis down to the level of the bladder.
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The Role of Genomic Techniques in Predicting Response to Radiation TherapyThe understanding of the relationship between genetic variation and an individual patient’s response to radiation therapy has gained significant ground over the past several years. Genetic markers have been identified that could ultimately serve as the foundation for predictive models in clinical practice, and that hold the potential to revolutionize the delivery of precision medicine in oncology.
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It’s Going to Be in the GenesDeveloping a scoring system for staging patients with hepatic colorectal metastases is important for prognosis and for identifying those who will benefit from additional systemic therapy.
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Commentary (Petrelli): Managing the Peritoneal Surface Component of Gastrointestinal CancerDr. Paul H. Sugarbaker hasspent most of his surgical oncologycareer researching andtreating patients with peritoneal surfacemalignancies. His participationin the treatment of 385 patients withappendiceal malignancy over a 15-year period is probably the largestsuch experience ever reported.[1] Dr. Sugarbaker has demonstrated that inpatients with peritoneal carcinomatosisfrom gastrointestinal malignancies,the best treatment results are associatedwith mucinous epithelial malignancyof the appendix.
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Breast Cancer in MenThe review by Dr. Buzdar emphasizesa variety of clinicalfeatures observed in male breastcancer. Although this is an uncommondiagnosis even in a busy oncologypractice (representing less than 1%of all breast cancers), it is occasionallyseen.
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The Role of Surgery in the Management of Barrett's EsophagusBarrett's esophagus represents replacement of normal distal esophageal squamous epithelium with specialized columnar epithelium containing goblet cells. Typically arising in the setting of chronic gastroesophageal reflux disease, the presence of Barrett's esophagus carries a 50- to 100-fold increased risk of developing esophageal cancer. Risk factors include male sex, smoking history, obesity, Caucasian ethnicity, age > 50 and > 5-year history of reflux symptoms. Aggressive medical or surgical antireflux therapy may ameliorate symptoms, but have not yet been proven to affect the risk of developing esophageal adenocarcinoma in randomized trials. Although dysplasia is an imperfect biomarker for the development of subsequent malignancy, random sampling of esophageal tissue for dysplasia remains the clinical standard. There have been no studies to establish that endoscopic screening/surveillance programs decrease the rates of death from cancer. Fit patients with Barrett's esophagus and high-grade dysplasia should undergo esophagectomy to prevent the risk of developing esophageal adenocarcinoma. For non–operative candidates, endoscopic ablative approaches may represent a reasonable therapeutic alternative.
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Upfront Chemotherapy in Prostate CancerIn this interview we discuss recent trials that looked at the use of upfront chemotherapy combined with androgen deprivation therapy in men with metastatic prostate cancer and how they have changed clinical practice.
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STAMPEDE: Front-Line Docetaxel Prolongs Survival in Metastatic Prostate CancerIn this video, Dr. Nicholas David James discusses the results of the STAMPEDE trial, which tested front-line docetaxel combined with hormonal therapy in patients with advanced, hormone-naive prostate cancer.
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Gleason 6 Prostate Cancer: Serious Malignancy or Toothless Lion?There is strong evidence from longitudinal cohort studies of men with both treated and untreated Gleason 6 prostate cancer to suggest that Gleason 6 disease, when not associated with higher-grade cancer, virtually never demonstrates the ability to metastasize and thus represents an indolent entity that does not require treatment.
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Neoadjuvant Chemotherapy and Surgical Management of the Axilla in Breast Cancer: A Review of Current DataThis review will discuss the current status of surgical management of the axilla for patients treated with neoadjuvant chemotherapy.
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Gynecologic Manifestations of Hereditary Nonpolyposis Colorectal CancerHereditary nonpolyposis colorectal cancer (HNPCC) is an autosomaldominant cancer susceptibility syndrome associated with inheriteddefects in the DNA mismatch repair system. HNPCC family membersare at high risk for developing colorectal, endometrial, and ovariancancers. Studies of HNPCC families have helped define the importantrole that mismatch repair genes play in the molecular pathogenesis ofendometrial and ovarian cancers. This review will describe some of theimportant clinical and molecular features of HNPCC-related endometrialand ovarian cancer and describe how genetic susceptibility can beidentified in patients with sporadic endometrial and ovarian cancers. Itis important to identify patients with HNPCC, as families of mutationcarriers may benefit from genetic counseling, testing, and intensifiedcancer surveillance.
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New Testing for Lung Cancer ScreeningIn this review, the authors discuss past attempts at lung cancer screening, the results of the National Lung Cancer Screening Trial, and innovative tests for lung cancer screening currently being evaluated.
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Guiding Post-Treatment Decisions in Rectal Cancer: mrTRG Is a Practical Place to StartThe authors propose that current policies regarding the use of chemoradiotherapy or short-course preoperative radiotherapy have resulted in an approach to rectal cancer management that often represents overtreatment, with significant loss of quality of life for patients.
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Commentary (Spirtos/Eisenkop): Laparoscopy in Gynecologic MalignanciesMinimally invasive surgery is simply the use of small incisions with specialized equipment to accomplish surgical objectives that would otherwise be completed through larger incisions with conventional equipment. A priority of gyne-cologic oncologists
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The Role of Prognostic Factors and Oncogenes in the Detection and Management of Non-Small-Cell Lung CancerLike other epithelial tumors, non-small-cell lung cancer (NSCLC) is a result of a series of genetic and epigenetic changes that eventually progress to invasive cancer. The order and timing of these changes, involving specific
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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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Primary and Metastatic Brain TumorsIntracranial neoplasms can arise from any of the structures or cell types present in the cranial vault, including the brain, meninges, pituitary gland, skull, and even residual embryonic tissue.
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Reassessments of ESAs for Cancer Treatment in the US and EuropeAnemia is a widely prevalent complication among cancer patients. At the time of diagnosis, 30% to 40% of patients with non-Hodgkin lymphoma or Hodgkin lymphoma and up to 70% of patients with multiple myeloma are anemic; rates are higher among persons with myelodysplastic syndromes. Among patients with solid cancers or lymphomas, up to half develop anemia following chemotherapy. For almost 2 decades, erythropoiesis-stimulating agents (ESAs) were the primary treatment for cancer-related anemia. However, reassessments of benefits and risks of ESAs for cancer-associated anemia have occurred internationally. We reviewed guidelines and notifications from regulatory agencies and manufacturers, reimbursement policies, and utilization for ESAs in the cancer and chronic kidney disease settings within the United States, Europe, and Canada. In 2008 the US Food and Drug Administration (FDA) restricted ESAs from cancer patients seeking cure. Reimbursement is limited to hemoglobin levels < 10 g/dL. In the United States, ESA usage increased 340% between 2001 and 2006, and decreased 60% since 2007. The European Medicines Agency (EMEA) recommended that ESA benefits do not outweigh risks. In Europe between 2001 and 2006, ESA use increased 51%; since 2006, use decreased by 10%. In 2009, Canadian manufacturers recommended usage based on patient preferences. In Canada in 2007, approximately 20% of anemic cancer patients received ESAs, a 20% increase since 2004. In contrast to Europe, where ESA use has increased over time, reassessments of ESA-associated safety concerns in the United States have resulted in marked decrements in ESA use among cancer patients.
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POINT: Should Radiation Therapy After Surgery for Ductal Carcinoma In Situ Be Standard Practice?At this time RT following BCS remains the standard of care for most patients. Current tools, including prognostic scores and tumor genetics, have failed to identify a cohort for whom RT confers no benefit with respect to invasive recurrences.
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Update on Adjuvant Chemotherapy for Early Breast CancerAdjuvant chemotherapy represents a significant advance in the management of early-stage breast cancer and, as such, has saved many lives. Worldwide, adjuvant chemotherapy has benefitted all groups tested, including
