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Managing the Peritoneal Surface Component of Gastrointestinal Cancer: Part 2Until recently, peritoneal carcinomatosis was a universally fatalmanifestation of gastrointestinal cancer. However, two innovations intreatment have improved outcome for these patients. The new surgicalinterventions are collectively referred to as peritonectomy procedures.During the peritonectomy, all visible cancer is removed in an attemptto leave the patient with only microscopic residual disease. Perioperativeintraperitoneal chemotherapy, the second innovation, is employed toeradicate small-volume residual disease. The intraperitoneal chemotherapyis administered intraoperatively with moderate hyperthermia.Part 1 of this two-part article, which appeared in the January issue,described the natural history of gastrointestinal cancer with carcinomatosis,the patterns of dissemination within the peritoneal cavity, andthe benefits and limitations of peritoneal chemotherapy. Peritonectomyprocedures were also defined and described. Part 2 discusses the mechanicsof delivering perioperative intraperitoneal chemotherapy andthe clinical assessments used to select patients who will benefit fromcombined treatment. The results of combined treatment as they vary inmucinous and nonmucinous tumors are also discussed.
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The Pathway Ahead in Melanoma TrialsReviewing treatment modalities for melanoma provides many sobering reminders that advances in our scientific understanding have not yet translated into meaningful clinical benefit. As clearly delineated by the authors, the “standard” treatment of dacarbazine chemotherapy has a poor response rate and lacks durability.
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Estrogens and Women With Breast CancerI was quite disappointed with Dr. Graham A. Colditz’s review of the literature concerning the use of estrogen replacement therapy in patients with breast cancer, which appeared in the November 1997 issue of ONCOLOGY (pp 1491-1497).
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Understanding the Pathobiology of Chemotherapy-Induced Nausea and VomitingImproved understanding of the physiologic and neuropharmacologicmechanisms underlying chemotherapy-induced nausea andvomiting (CINV) has driven significant progress in the treatment ofCINV over the past 2 decades. Recognition of the role of neurotransmittersand their receptors in the process of CINV has been central tothis progress. Initial attention focused on dopamine, then on serotonin,and most recently on substance P, which has yielded a usefulnew class of antiemetic medications known as selective neurokinin-1receptor antagonists. Preclinical studies of these neurokinin-1 receptorantagonists suggested that they would demonstrate broad antiemeticactivity in acute emesis, demonstrate activity against cisplatininduceddelayed emesis, be well tolerated, and contribute to enhancedefficacy when used in combination with other classes of antiemetics.These suggestions appear to have been largely borne out in clinicaltrials. Pharmacogenomics may offer a means to further extend andapply our understanding of CINV by enabling more selective targetingof antiemetic therapies. To date, the application of pharmacogenomicsto CINV has focused on variations in the metabolism of serotoninreceptor antagonists by CYP 450 genotype and variations in the5-HT3 receptor gene itself.
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Complete Guide to Colorectal CancerNearly 150,000 people will be diagnosed with colorectal cancer in the United States in 2006. The impact of this diagnosis will be felt by countless family members, coworkers, and friends. Although screening tests for colorectal cancer have been available and encouraged by medical associations such as the American Cancer Society (ACS) and others, public awareness and compliance has been dismal.
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Book Review: Textbook of Uncommon Cancer, Second EditionThe second edition of the Textbook of Uncommon Cancer is a useful resource for practicing oncologists who encounter unusual presentations of common tumors or esoteric subtypes of more common cancers. The text is laid out according to
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Radiation Therapy for Node-Positive Prostate Cancer: It’s Time for a Randomized TrialWe are in urgent need of a randomized trial comparing radiation plus ADT vs ADT alone for men with node-positive prostate cancer.
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Paul M. Barr, MD, Examines Head-to-Head Data on BTK Inhibitors in Previously Treated, High-Risk CLLCancerNetwork® sat down with Paul M. Barr, MD, at the 2021 ASCO Annual Meeting to talk about what data has the greatest potential to impact standard treatment of chronic lymphocytic leukemia.
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Smoking Cessation: Recent Developments in Behavioral and Pharmacologic InterventionsSmoking kills more than 430,000 people each year in the United States and is currently estimated to be responsible for 30.5% of all cancer-related deaths in our society. The majority of these deaths could be prevented,
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Robotics in Head and Neck Cancer: Future OpportunitiesA series of promising new advances have emerged in H&N oncology in recent years. Among these are the advancement of highly conformal radiation delivery techniques (e.g. IMRT, protons); the successful introduction of molecular targeted therapies (e.g. cetuximab); the recognition of HPV as a powerful prognostic biomarker; and the development of minimally invasive surgical techniques. The application of transoral robotic surgery (TORS) in H&N cancer is reviewed by Bhayani et al in this issue of ONCOLOGY[1].
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The Hemostatic System as a Therapeutic Target in Urothelial CarcinomaBladder neoplasms are associated with a high frequency of painless hematuria; however, when compared with the bleeding tendencies of other solid tumors, it is arguable that this comparatively high bleeding frequency is in part the result of an ascertainment bias.
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Systemic Therapy for Older Women With Breast CancerCancer and aging seem to go hand in hand. Most cancers and most cancer deaths occur in individuals over age 65 years. Likewise, as we age, osteoarthritis, heart disease, diabetes, and memory lapses seem to become part of our daily burden. Drs. Kimmick and Muss have detailed a strategy for managing breast cancer in older women. However, as they point out, there are several problems with defining optimal therapy for the elderly.
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In Search of Value in Cancer Care: What Resources Are Available to Practicing Oncologists?One of the more difficult topics to discuss concerning the ethics of healthcare is distributive justice-the fair distribution of benefits, risks, and costs.
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Recurrent Pancreatic Adenocarcinoma After Pancreatic ResectionThe University of Colorado Denver School of Medicine faculty hold weekly second opinion conferences focusing on cancer cases that represent most major cancer sites. Patients seen for second opinions are evaluated by an oncologic specialist. Their history, pathology, and radiographs are reviewed during the multidisciplinary conference, and then specific recommendations are made. These cases are usually challenging, and these conferences provide an outstanding educational opportunity for staff, fellows, and residents in training.The second opinion conferences include actual cases from genitourinary, lung, melanoma, breast, neurosurgery, gastrointestinal, and medical oncology. On an occasional basis, ONCOLOGY will publish the more interesting case discussions and the resultant recommendations. We would appreciate your feedback; please contact us at second.opinion@uchsc.edu.
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Salvage Therapy for Ovarian CancerPatients with epithelial ovarian cancer must receive optimal surgical care and state-of-the-art chemotherapy in the primary treatment setting. The salvage treatment of women with recurrent or persistent ovarian cancer remains a
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The Role of PSA in the Radiotherapy of Prostate CancerDr. Roach initiates his discussion with the relevant statement that how we detect, stage, and treat carcinoma of the prostate, as well as subsequently evaluate treatment efficacy, has forever been dramatically altered by the availability of prostate specific antigen (PSA), which has been labeled "the most useful tumor marker available" [1]. However, as Dr. Roach also notes, new information and insights generate new questions and uncertainties about the best applications of this valuable tumor marker.
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A Woman With Primary Breast Cancer and a Solitary Sternal MetastasisThe patient presented to her primary care physician 3 months prior with an inverted left nipple and a palpable lump that was highly suggestive of neoplasm on mammogram. An ultrasound-guided core biopsy revealed an infiltrating solid-type ductal carcinoma in situ. The estimated size of the mass was approximately 1 cm. She had no symptoms suggestive of metastatic disease.
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Management of Pressure UlcersPressure ulcers are a common problem, with about 1.5 to 3 million individuals in the United Stated affected. Treatment may be costly, requiring lengthy periods of hospitalization. Central to the development of pressure
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Erlotinib/Gemcitabine for First-Line Treatment of Locally Advanced or Metastatic Adenocarcinoma of the PancreasErlotinib (Tarceva) is a human epidermal growth factor receptor type 1/epidermal growth factor receptor (HER1/EGFR) tyrosine kinase inhibitor initially approved by the US Food and Drug Administration for the treatment of patients with locally advanced or metastatic non–small-cell lung cancer after failure of at least one prior chemotherapy regimen. In this report, we present the pivotal study that led to the approval of erlotinib in combination with gemcitabine (Gemzar) in patients with locally advanced/metastatic chemonaive pancreatic cancer patients. The combination demonstrated a statistically significant increase in overall survival accompanied by an increase in toxicity. Physicians and patients now have a new option for the treatment of locally advanced/metastatic adenocarcinoma of the pancreas.
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Changing paradigms for tumor response spark debate at ECR special focus sessionVIENNA-Yes, size does matter, but it is certainly not the only way to monitor the effi cacy of cancer treatment. Th e way in which lesions are measured is extremely important as well, according to a special focus session on the assessment of tumor response at the 2009 European Congress of Radiology.
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Monoclonal Antibodies and Side-Effect ManagementMonoclonal antibodies are increasingly becoming a standard part of clinical cancer treatment. Eight monoclonal antibodies are approved by the Food and Drug Administration for the treatment of cancer in the United States. Oncology nurses are expected to be familiar with these agents, their indications, and their adverse effects, to provide appropriate care and symptom management to patients receiving these agents, and to adequately educate patients and families about these treatments and their specific and overlapping side effects. Monoclonal antibody mechanisms of action and indications, infusion guidelines, and symptom management are outlined in this article.
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Surgery in the Older PatientSurgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients.
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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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Measure for measure: How to make practice benchmarks meaningfulMINNEAPOLIS-When it comes to taking stock of an oncology practice’s productivity, less is more. It benefits a practice to develop a few meaningful benchmarks rather than multiple overlapping, overwhelming, and meaningless measurements.
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A Phase II Study of Doxorubicin/Paclitaxel Plus G-CSF for Metastatic Breast CancerThis phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line
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Using Genomic Sequencing to Improve Management in MelanomaHere we summarize the available genomic and genetic tests for melanoma, and the level of evidence supporting each of these. We also discuss the current impact of genomic sequencing on the management of melanoma, as well as roles it may play in the near future.
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Management of Fatigue in the Cancer PatientFatigue is one of the most common symptoms experienced by patients with cancer and other progressive diseases. Although reported to be a major obstacle to maintaining normal daily activities and quality of life, remarkably few studies of this syndrome have been conducted.
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Pemetrexed in Pancreatic CancerSingle-agent gemcitabine (Gemzar) is the standard of chemotherapyfor advanced pancreatic cancer, with no phase III trials to date havingshown significantly improved survival with gemcitabine-based combinationsvs single-agent treatment. The multitargeted antifolate agentpemetrexed (Alimta) shows synergistic effects in vitro in combinationwith gemcitabine, and activity and good tolerability when used as singleagenttreatment in advanced pancreatic cancer. In a phase II trial inpatients with advanced pancreatic cancer, the combination ofgemcitabine at 1,250 mg/m2 on days 1 and 8 plus pemetrexed at 500mg/m2 on day 8 after gemcitabine every 21 days resulted in a mediansurvival of 6.5 months and a 1-year survival rate of 29%. Neutropeniawas the primary toxicity, with grade 4 toxicity in 51% of patients. Thepromising results of this trial prompted the initiation of a phase IIItrial comparing gemcitabine at 1,000 mg/m2 on days 1, 8, and 15 every28 days vs the 21-day gemcitabine/pemetrexed regimen given with vitaminsupplementation in patients with pancreatic cancer. The primaryoutcome measure was overall survival, with secondary measures includingresponse rate, progression-free survival, and quality of life.While an increase in response and time to progression was reported forthe gemcitabine/pemetrexed combination, there were no significantdifferences in survival between treatment arms.
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Is Surgery Always Necessary in Rectal Cancer?In this article, we review risks and benefits of the standard treatment approach for rectal cancer and compare standard treatment with alternative methods aimed at rectal preservation.
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Stereotactic Body Radiotherapy in the Management of Painful Bone MetastasesBone metastases are a common feature of many solid cancers, especially those originating from the prostate, breast, lung, kidney, melanoma, and other sites. Up to 80% of patients with these cancers will develop painful bony disease during the course of their disease.
