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Pathogenesis of AIDS-Related Kaposi's SarcomaEmmanoulides, Miles, and Mitsuyasu have written an excellent review summarizing our current understanding of the pathogenesis of AIDS-related Kaposi's sarcoma (AIDS/KS). The authors cover what is currently well established and also provide their viewpoint on future developments in AIDS/KS. My commentary will highlight some of the major questions related to this complex disease.
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Attacking a Moving Target: Understanding Resistance and Managing Progression in EGFR-Positive Lung Cancer Patients Treated With Tyrosine Kinase InhibitorsIn this article, we review the available literature addressing the competing treatment strategies in EGFR-Positive Lung Cancer and attempt to clarify best treatment practices, including the emerging role of T790M-directed therapies.
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Differentiated Thyroid Carcinoma: Risk Group Assignment and Management ControversiesIn this review, we provide a framework for clinical decision-making in the treatment of differentiated thyroid cancer. The clinical discussion and treatment recommendations are relevant to an adult population (more than 16
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Meta-analysis: Methods, Strengths, and WeaknessesMeta-analysis is a systematic, quantitative approach to the combination of data from several clinical trials that address the same question. This analytic approach can help resolve questions that remain unclear from the results
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Splenic Marginal Zone Lymphoma: Current Knowledge and Future DirectionsIn this article, we review the current knowledge on the biological findings, clinical features, and therapeutic approaches for splenic marginal zone lymphoma.
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Combination Therapies for Lung CancerAs part of our coverage of the AACR Annual Meeting, we discuss combination therapies and new research in the treatment of lung cancer.
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Triple- vs Double-Agent Chemotherapy for Advanced Non–Small-Cell Lung CancerIn our previous phase I/II studies, both the cisplatin (Platinol), gemcitabine (Gemzar), and vinorelbine (Navelbine) (PGV), and cisplatin, gemcitabine, and paclitaxel (Taxol) (PGT) regimens produced a median survival of
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Cancer Treatment and Cognitive Function: Chemotherapy Is Not the Only CulpritWith the growing number of cancer survivors, there is increased interest in understanding and preventing post-treatment sequelae that may limit full recovery to prediagnosis health.
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Role of Iron in Optimizing Responses of Anemic Cancer Patients to ErythropoietinMany patients with widespread cancer develop a hypoproliferative anemia,[1-3] which is often worsened by systemic cytotoxic chemotherapy. Some chemotherapeutic agents directly depress the capacity of bone marrow cells to proliferate,
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Cancer Vaccines: A New Frontier in Prevention and TreatmentVaccines have been exceptionally effective against diseases such as smallpox, measles, chickenpox, and polio. They are among the safest and most cost-effective agents for disease prevention. In recent years, vaccination has been considered for other diseases, including AIDS and cancer. Cancer vaccines can be categorized as preventive or therapeutic. Preventive vaccines, which are commercially available for cervical cancer and liver cancer, block infection with the causative agents of human papillomavirus and hepatitis B virus, respectively. The benefit of cancer treatment vaccines lies in their ability to "boost" the immune system response to cancer cells, which is generally low. Using vaccines in the treatment of cancer is relatively new, however, and chiefly experimental. Therapeutic vaccines for breast, lung, colon, skin, renal, prostate, and other cancers are now being investigated in clinical trials. Oncology nurses may play a significant role in reducing barriers to uptake of preventive vaccines among the general public and in increasing patients' acceptance of therapeutic cancer vaccines.
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Neoadjuvant Therapy As a Platform for Drug Development: Current Controversies and Regulatory PerspectivesThis commentary addresses our perspectives from a regulatory standpoint, as well as some controversies related to the use of neoadjuvant therapy as a platform for drug development.
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Communicating With Oncology Patients About Palliative CarePalliative care differs from other oncology care settings because it involves end-of-life discussions. This article is intended to help oncology nurses who deliver news that involves palliative care by describing components of breaking bad news, providing an example for how to break bad news, and suggesting methods for evaluating a nurse-patient interaction. One possible scenario for achieving a positive outcome after delivering unwelcome information will also be described. Applying the methods described in this article can help to promote a positive outcome when a nurse delivers bad news to a patient.
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Impact of UFT on Tumoral TS and DPD Levels in Colorectal CancerThis was an open lable, pilot translational clinical pharmacology study of a brief (7 day) course of UFT, 300 mg/m²/day, in combination with leucovorin, 90 mg/day, in six patients with newly diagnosed advanced colorectal cancer.
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Mounting Evidence for Postmastectomy Locoregional Radiation TherapyPostmastectomy locoregional radiation therapy markedly reduces the risk of locoregional recurrence. Several randomized trials, including two recently updated studies with 10- to 15-year follow-up, demonstrate an
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Dr. Patricia Eifel on the Shifts in Cervical Cancer TreatmentCancer Network spoke with Patricia Eifel, MD, of the University of Texas MD Anderson Cancer Center, about the current shifts in the treatment of cervical cancer.
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Patient Communication and Strategies for Managing FatigueFatigue is common in patients with cancer. Fatigue is very distressing to patients, who often view it as an indication that their disease is progressing or that treatment is ineffective.
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Toward Evidence-Based Management of the Dermatologic Effects of EGFR InhibitorsRecent results from prospective, controlled trials, specifically evaluating strategies for preventing or reducing the severity of the dermatologic effects of EGFR inhibitors, represent the first step toward an evidence-based approach to the prevention and management of these important effects.
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Oxaliplatin in Tumors Other Than Colorectal CancerOxaliplatin (Eloxatin) has demonstrated significant activity in a variety of tumor types in addition to colorectal cancer. Several studies have reported on the effectiveness of oxaliplatin as single-agent treatment or in
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Commentary (Baile/Parker)-Patient-Physician Communication in Oncology: What Does the Evidence Show?We are delighted to reviewthe article by Dr. TonyBack on communicationwith cancer patients. We applaud hiseffort to provide recommendations forenhanced communication with patientsand families based on findings fromthe literature. We agree that using thecancer trajectory to identify key communicationtasks provides a useful heuristicmodel because, by matchingcommunication tasks to "high-stakes"clinical encounters, this approach intuitivelyappeals to practicing clinicians.As clearly described by Dr. Back, thevast majority of recommendations forcommunication among oncologist, patient,and family are not derived fromevidence-based research. This underscoresthe importance of conductingadditional research to use as a basis forguiding clinicians in how to handlethese challenging communication tasks.
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Current Issues in the Treatment of Resistant Bloodstream InfectionsBloodstream infections cause significant morbidity and mortality for patients with hematologic malignancy. Antimicrobial drugs are the most reliable currently available treatment for infection, but several issues must be
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Metastatic Papillary Adenocarcinoma in a 22-Year-Old: Is Her History of Mayer-Rokitansky-Küster-Hauser Syndrome Causative or Incidental?A 22-year-old college student with primary amenorrhea due to Müllerian agenesis presented with a headache, dysarthria, nausea, vomiting, and left upper extremity weakness. MRI of the brain showed numerous intracranial lesions.
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Blood-Tumor Barrier’s Role in Brain MetsIn this video, Dr. Patricia Steeg discusses the role of the blood-tumor barrier in both development and treatment of brain metastases.
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Treatment for Advanced Melanoma: New Drugs, New Opportunities, New ChallengesRemarkably, within 2 years of the introduction of ipilimumab and vemurafenib into the clinic, major new advances have been reported in both the immune checkpoint blockade and small-molecule kinase inhibition arenas.
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Neoadjuvant Chemotherapy for Ovarian CancerPrimary debulking surgery by a gynecologic oncologist remains thestandard of care in advanced ovarian cancer. Optimal debulking surgeryshould be defined as no residual tumor load. In retrospective analyses,neoadjuvant chemotherapy followed by interval debulking surgerydoes not seem to worsen prognosis compared to primary debulking surgeryfollowed by chemotherapy. However, we will have to wait for theresults of future randomized trials to know whether neoadjuvant chemotherapyfollowed by interval debulking surgery is as good as primarydebulking surgery in stage IIIC and IV patients. Interval debulking isdefined as an operation performed after a short course of induction chemotherapy.Based on the randomized European Organization for Researchand Treatment of Cancer–Gynecological Cancer Group (EORTC-GCG)trial, interval debulking by an experienced surgeon improves survival insome patients who did not undergo optimal primary debulking surgery.Based on Gynecologic Oncology Group (GOG) 152 data, intervaldebulking surgery does not seem to be indicated in patients who underwentprimarily a maximal surgical effort by a gynecologic oncologist.Open laparoscopy is probably the most valuable tool for evaluating theoperability primarily or at the time of interval debulking surgery.
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Improving Palliative and Supportive Care in Cancer PatientsTwenty years of research in controlling symptoms such as pain andnausea have shown persistent suboptimal performance by the US oncologysystem. The data suggest that some of the tools of palliative careprograms can improve physical symptoms of seriously ill patients at acost society can afford. To fix these problems will require recognitionof the symptoms or concerns, a system such as an algorithm or careplan for addressing each, measurement of the change, and accountabilityfor the change. Symptom assessment scales such as the EdmontonSymptom Assessment Scale or Rotterdam Symptom Check List work tomake symptoms manifest. Listing symptoms on a problem list is a necessarystep in addressing them. Physical symptoms such as pain can beimproved by use of computer prompts, algorithms, dedicated staff time,team management, or combinations of these strategies. Less concreteproblems such as medically appropriate goal-setting, integrating palliativecare into anticancer care sooner, and informing patients aboutthe benefits and risks of chemotherapy near the end of life require morecomplex solutions. We review what is known about symptom control inoncology, how and why some programs do better, and make suggestionsfor practice. Finally, we suggest a practical plan for using symptomassessment scales, listing the problems, and managing them accordingto algorithms or other predetermined plans.
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Anthracyclines Are a Critical Component of Adjuvant ChemotherapyThe anthracyclines doxorubicin (A) and epirubicin (E) are among the most active agents for breast cancer.
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When Cancer Pain Breaks Through, What Can You Do?Oncology nurses must play an integral role in improving the treatment of breakthrough pain-one patient, one in-service for colleagues, and one clinical research study at a time.
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Testicular CancerThis testicular cancer management guide covers the diagnosis, staging, and treatment of germ-cell tumors and seminoma.
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Blood and Marrow Transplantation in Relapsed or Refractory Non-Hodgkin’s LymphomaIt was not until 1995 that a phase III randomized trial demonstrated that autologous stem cell transplants (ASCT) improve the progression-free and overall survival of patients with relapsed refractory diffuse aggressive non-Hodgkin’s lymphoma. Investigators are now focusing on improving the clinical benefit of transplants. The relative contributions made by more intensive preparative regimens, purging, concomitant immunotherapy, and the timing of transplants are under study. Also, as transplant trials shift from relapsed disease to initial therapy, anticipated benefits must be balanced against both short-term and long-term toxicities.[ONCOLOGY 12(Suppl 8):56-62, 1998]
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Unanswered Questions About SBRT in Bone MetastasesThe goal of palliative radiotherapy is to treat symptoms as rapidly and efficiently as possible, with the fewest side effects.[1] For many years, pain medication, radiotherapy, and surgery were the only tools available for the treatment of bone metastases. This has changed significantly over the past 15 years. New systemic agents, including bisphosphonates such as zoledronic acid (Reclast, Zometa), are available to prevent the development of new lesions, strengthen the bone, and improve symptoms. In addition, targeted treatments directed at achieving tumor ablation now include radiofrequency ablation and stereotactic body radiation therapy (SBRT).
