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Hypersensitivity Reactions to Oxaliplatin: Incidence and ManagementOxaliplatin (Eloxatin) is a novel platinum compound that has activityin a wide variety of tumors. Several hypersensitivity reactions distinctfrom laryngopharyngeal dysesthesia have been described. We retrospectivelyanalyzed 169 consecutive patients who received oxaliplatinfor esophageal or colorectal cancer between 1/1/00 and 7/31/02 andreviewed any significant adverse reactions labeled as hypersensitivityreactions. Thirty-two patients (19%) reportedly experienced hypersensitivity.Skin rash was the most common event (22 patients), occurringafter a median of three infusions. Fever was seen in five patients aftera median of two infusions. Five patients experienced respiratory symptomsat median infusion number 6. Ocular symptoms of lacrimationand blurring of vision were seen in two patients. Five patients experiencedmore than one type of reaction. Treatments prescribed forhypersensitivity were antihistamines, steroids, and topical emollients.One patient developed grade 4 hypersensitivity during cycle 6, characterizedby laryngeal edema, tongue swelling, and labored breathing.This patient underwent a desensitization procedure, adapted from guidelinesfor carboplatin (Paraplatin) allergy. Subsequently, three cycleswere administered over 6 hours and were well tolerated. However,during the fourth infusion postdesensitization, the patient developedrecurrent signs of hypersensitivity. In conclusion, hypersensitivity isfrequently seen with oxaliplatin, but most reactions are mild.
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Gynecologic Malignancies in Older WomenThe aging of the population is a social phenomenon that will present a challenge to clinical practice in the 21st century. Women constitute a majority of the elderly population as they outlive males by 5 to 7 years. Ovarian,
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How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management.
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Gemcitabine and Paclitaxel in Metastatic Breast Cancer: A ReviewGemcitabine (Gemzar) and paclitaxel are active drugs in the treatmentof metastatic breast cancer. Phase I clinical trials data have suggestedthat the gemcitabine plus paclitaxel combination is safe in breastcancer patients. Two doses/administration schedules have been preferredin subsequent phase II and III trials: gemcitabine on days 1 and8 plus a taxane on day 1, every 3 weeks; or gemcitabine plus a taxaneon days 1 and 14, every 4 weeks. In phase II trials, 114 of 221 patients(52%) responded to gemcitabine/paclitaxel therapy. Response rates werelower among patients who received previous chemotherapy for metastaticdisease (response rates: 45%, second line and 70%, first line).Toxicity of gemcitabine/paclitaxel regimens has generally been low, withfew cases of neutropenia or nonhematologic toxicity. Results of therandomized phase III registration trial show a clear advantage forgemcitabine plus paclitaxel over paclitaxel alone in time to disease progression,objective response, and overall survival. Triplet combinations,in which an anthracycline is added to gemcitabine/paclitaxel, are beingexplored in the metastatic and neoadjuvant settings.
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Genomic Testing in Colorectal Cancer: How Much Is Enough?The identification and characterization of gene signatures, driver events, and pharmacogenomics in molecularly homogeneous subsets of patients is likely to advance effective drug development strategies in colorectal cancer.
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Biphasic Tumors of the Female Genital TractIn this installment of Second Opinion, we are presenting two cases of tumors of the female genital tract, specifically, the ovary and uterus, which contain both epithelial and mesenchymal components and therefore have unique diagnostic and therapeutic implications. The first has an unusually poor prognosis and the second is notoriously difficult to diagnose.
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Dendreon vs CMS: Why the Provenge Coverage Controversy Is Bigger Than Just One ProductIt appeared that the controversy surrounding the prostate cancer immunotherapy Provenge ended with FDA approval in April. But now Medicare is questioning whether the government should pay for the new therapy. The CMS decision is just as important to the biopharmaceutical industry as it is to Dendreon.
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The Surgical Management of Peritoneal Carcinomatosis of Colorectal OriginIn the United States, approximately 20% of patients with colorectal cancer present with distant metastasis at diagnosis. In 25% of cases, the peritoneal cavity is the only site of metastatic disease, which is not indicative of a generalized systemic disease, as is the case with lung or liver metastases.
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Treatment of Metastatic Pancreatic Adenocarcinoma: A ReviewGemcitabine monotherapy has been the standard of care for patients with metastatic pancreatic cancer for several decades. Despite recent advances in various chemotherapeutic regimens and in the development of targeted therapies, metastatic pancreatic cancer remains highly resistant to chemotherapy.
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Liposomal Doxorubicin in Combination With Bortezomib for Relapsed or Refractory Multiple MyelomaLiposomal doxorubicin received FDA approval for use in combination with bortezomib in patients with multiple myeloma who have not previously received bortezomib and have received at least one prior therapy.
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Patient-Centered Care in Prostate CancerFocusing on patient-centered care, Rana R. McKay, MD, and the Oncology Brothers discuss the role of PSA and PSMA PET scans in guiding treatment for patients with prostate cancer.
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Proton Therapy for Prostate CancerThis review discusses the rationale, history, and current status of proton therapy for prostate cancer-and controversies regarding it.
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Commentary (Corry et al): The Role of Neck Dissection Following Definitive ChemoradiationIn this issue of ONCOLOGY, Kutleret al eloquently address the concept,application, and controversiesof a planned neck dissection inpatients with head and neck carcinomaand nodal metastasis who receivenonsurgical therapy to the primary tumor.As stated lucidly in the article,planned neck dissection arose in thehistorical context of low rates of completeresponse in patients with N2/3neck disease treated with conventionallyfractionated radiotherapy, coupledwith low surgical salvage ratesamong patients who failed in the neck.Hence, the concept evolved that allpatients with N2/3 neck disease shouldundergo a planned neck dissection regardlessof response to radiotherapy.
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Commentary (Brand et al): Pancreatic Cancer in the Older PatientPancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local
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Docetaxel in the Management of Advanced or Metastatic Urothelial Tract CancerPhase II studies of single-agent docetaxel (Taxotere) yielded promising results in advanced or metastatic transitional cell carcinoma (TCC) of the urothelium. Antitumor responses have been demonstrated in previously treated and chemotherapy-naive TCC patients, as well as in a subgroup of patients with renal impairment unable to receive traditional cisplatin-based regimens.
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Commentary (Burt): Genetics of Colorectal CancerApproximately 6% of colorectal cancers can be attributed to recognizable heritable germline mutations. Familial adenomatous polyposis is an autosomal dominant syndrome classically presenting with hundreds to thousands of adenomatous colorectal polyps that are caused by mutations in the APC gene.
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DNA Microarrays in Lymphoid MalignanciesIn this issue of ONCOLOGY,Rosenwald describes in detail thecurrent state of gene expressionprofiling and its role in the classificationand prediction of outcome in lymphoidmalignancies. Since the firstpublication describing the use of geneexpression signatures to predict outcomein diffuse large B-cell lymphoma(DLBCL), a few subsequent papershave appeared, detailing comprehensivefindings in other lymphoma subtypes.[1-4] Together these works bringclarity to the molecular taxonomyof the non-Hodgkin's lymphomas(NHL). Insights gleaned from thesestudies not only provide an improvedunderstanding of the biology of thesetumors, but have also led to a significantimprovement in our ability to assignrisk for individual patients withlymphoma.[2]
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Rationale and Dose-Finding Studies of the Combination of Irinotecan and a Taxane on a Weekly ScheduleCisplatin (Platinol)-based chemotherapy has been the standard systemic therapy for both non-small-cell and small-cell lung cancer for the past 2 decades, though the efficacy and benefit remain modest. Recently, several novel
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Head and Neck TumorsThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of head and neck cancers (including tumors of the oral cavity, oropharynx, hypopharynx, larynx, supraglottis, glottis, subglottis, and nasopharynx) using radiation, surgery, and medical treatment.
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Irinotecan/Thalidomide in Metastatic Colorectal CancerThe prognosis for patients with metastatic colorectal cancer is poor. Use of irinotecan (CPT-11, Camptosar) results in modest response rates of approximately 20% in refractory patients diagnosed with this advanced stage of disease and offers a side-effect profile that improves on that of previous standard treatments.
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Dermatologic Challenges in Cancer Patients and SurvivorsThe increased approval of anticancer agents has led to unprecedented results, with improved quality of life and longer survival times, resulting in millions of individuals living with a diagnosis of cancer. Whereas these novel medical, surgical, and radiation regimens, or combinations thereof, are largely responsible for these remarkable achievements, a new, unexpected constellation of side effects has emerged. Most notably, cutaneous toxicities have gained considerable attention, due to their high frequency and visibility, the relative effectiveness of anti–skin toxicity interventions, and the otherwise decreasing incidence of systemic or hematopoietic adverse events. Optimal care dictates that dermatologic toxicities must be addressed in a timely and effective fashion, in order to minimize associated physical and psychosocial discomfort, and to ensure consistent antineoplastic therapy. Notwithstanding the critical importance of treatment-related toxicities, dermatologic conditions may also precede, coincide, or follow the diagnosis of cancer. This review provides a basis for the understanding of dermatologic events in the oncology setting, in order to promote attentive care to cutaneous health in cancer patients and survivors.
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Current Frontline Treatment of Diffuse Large B-Cell LymphomaThis review article discusses which frontline treatment are best for diffuse large B-cell lymphoma.
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Nonionizing Electromagnetic Fields and Cancer: A ReviewThe paper by Salvatore et al discusses a very broad, complex subject, which, in some aspects, is quite controversial. The review touches on many different topics but not always in enough detail to provide clarity. Pertaining to the debated link between 50 to 60 Hz power line field exposure and cancer, the authors characterize their article as "... a review of the basic science that points to this possible association [with cancer]." However, the "basic science" that "points to" occupies much of their presentation, while some major types of evidence and reasoning that "points away" is not mentioned.
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Extended Surgery for Retroperitoneal Sarcoma: Too Much Surgery for Some and Not Enough for Others?Recently controversy has emerged regarding the extent of resection that constitutes optimal surgical management of retroperitoneal soft-tissue sarcoma.
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Pertuzumab: Increasing the OptionsAt this point, there is expectation that pertuzumab given in the neoadjuvant setting will improve long-term efficacy. We welcome the opportunity to include pertuzumab in the neoadjuvant regimen of patients with HER2-positive breast cancer.
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Conservative Management of Rectal Cancer With Local Excision and Adjuvant TherapyThe standard surgical treatment of distal, resectable, invasive rectal cancers is an abdominoperineal resection or a low anterior resection. Given the morbidity associated with these standard treatments and the frequent need
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Nonepithelial Malignancies of the BreastPrimary nonepithelial malignancies of the breast comprise an importantminority of breast neoplasms, including primary breast sarcomas,therapy-related breast sarcomas, the phyllodes tumors, and primarybreast lymphomas. With widespread mammographic detection ofbreast lesions, these tumors represent critical elements of the differentialdiagnosis of even benign-appearing lesions. Each has a distinctclinical profile, including presentation, available therapeutic options,and prognosis, further underscoring the importance of timely recognition.The increasing incidence of breast carcinomas and the subsequenttherapy thereof may be contributing to an increase in the numberof therapy-related breast tumors. This review discusses various featuresof these uncommon malignancies and their treatment, with thegoal of increasing understanding of their clinical behavior andmanagement.
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Bone Biology and the Role of the RANK Ligand PathwayBone renewal is essential for bone strength. During childhood and early adulthood, bone formation prevails over bone resorption, as bones increase in size and strength. Peak bone mass is achieved during the third decade in life, with a higher peak bone mass being protective against osteoporosis later in life.[1] Bone loss is most prominent in women at menopause due to the effects of a natural decline in estrogen levels. However, bone mass begins to decrease with age, and bone loss is most prominent in women at menopause due to the effects of a natural decline in estrogen levels.[2]
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Current Imaging Techniques for Head and Neck TumorsModern head and neck imaging has led to advances in both the diagnosis and treatment of head and neck cancers. Both computed tomography (CT) and magnetic resonance imaging (MRI) studies provide important information
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Innovation in the Management of Brain MetastasesTherapy of patients with brain metastases requires a combination of measures to achieve local control at the site of metastasis and to reduce the subsequent risk of recurrences elsewhere in the brain. In the current review, we discuss recent developments in the management of patients with brain metastases.
