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Hepatocellular Carcinoma: Neoadjuvant Therapy ReconsideredHepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis. The incidence of hepatocellular carcinoma is increasing in the United States and worldwide. Orthotopic liver transplantation (OLT) is a viable and potentially curative option for selected patients with HCC. Locoregional therapy has been used to control HCC before transplantation because of the limited number of donor organs, to prevent tumor progression, and to decrease the incidence of dropouts from the transplant waiting list. Traditionally, multiple investigational locoregional modalities such as tumor resection, radiofrequency ablation, transarterial chemoembolization, and systemic chemotherapy have been used as "bridging" therapies. While the investigation of novel neoadjuvant treatments is justified in an effort to prevent tumor progression, the absence of randomized controlled trials leaves uncertainty about the utility of these maneuvers in improving outcome. This review summarizes the current data on the different modalities used worldwide in the neoadjuvant treatment of hepatocellular carcinoma, the rationale for these approaches, efficacy, potential complications, and future prospects.
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Ongoing Trials May Pave Way To Bring Later-Line Therapies Upfront in Newly Diagnosed Multiple MyelomaRavi Vij, MD, MBA, suggested that 4-drug regimens may be a new standard for frontline therapy in newly diagnosed multiple myeloma, as oncologists await trial readouts from ongoing clinical trials.
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Gestational Trophoblastic TumorsGestational trophoblastic tumors (GTTs) encompass a spectrum of neoplastic disorders that arise from placental trophoblastic tissue after abnormal fertilization. GTTs are classified histologically into four distinct groups: hydatidiform mole (complete and partial), chorioadenoma destruens (invasive mole), choriocarcinoma, and placental site tumor [1,2].
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Cancer and Male Sexual DysfunctionMany men with cancer develop erectile dysfunction during treatment of their malignancy. Erectile dysfunction in these patients often has multiple causes, both physiologic and psychological. Various treatment options, including
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Molecular Pathogenesis of Cholangiocarcinoma: Implications for Disease Classification and TherapyKhaled W. Kabbara, MD, and colleagues, research treatment options for cholangiocarcinoma.
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p53 Tumor Suppressor Gene Therapy for CancerGene therapy has the potential to provide cancer treatments based on novel mechanisms of action with potentially low toxicities. This therapy may provide more effective control of locoregional recurrence in diseases like non–small-cell lung cancer (NSCLC) as well as systemic control of micrometastases. Despite current limitations, retroviral and adenoviral vectors can, in certain circumstances, provide an effective means of delivering therapeutic genes to tumor cells. Although multiple genes are involved in carcinogenesis, mutations of the p53 gene are the most frequent abnormality identified in human tumors. Preclinical studies both in vitro and in vivo have shown that restoring p53 function can induce apoptosis in cancer cells. High levels of p53 expression and DNA-damaging agents like cisplatin (Platinol) and ionizing radiation work synergistically to induce apoptosis in cancer cells. Phase I clinical trials now show that p53 gene replacement therapy using both retroviral and adenoviral vectors is feasible and safe. In addition, p53 gene replacement therapy induces tumor regression in patients with advanced NSCLC and in those with recurrent head and neck cancer. This article describes various gene therapy strategies under investigation, reviews preclinical data that provide a rationale for the gene replacement approach, and discusses the clinical trial data available to date. [ ONCOLOGY 13(Suppl 5):148-154, 1999]
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Deferasirox for the Treatment of Chronic Iron Overload in Transfusional HemosiderosisThis report describes the Food and Drug Administration's review of data and analyses leading to the approval of the oral iron chelator, deferasirox for the treatment of chronic iron overload due to transfusional hemosiderosis.
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A Brief Review of Antifungal Therapy for Deep Fungal InfectionWith the continuing increase in clinically important fungal disease, especially seen in the neutropenic patient, the need for new and improved systemic antifungal agents marches on. A pharmacy and therapeutics committee may select an antifungal agent based on these criteria: spectrum of action, pharmacokinetic profile, toxicity, potential for resistance, and cost. A number of agents are now available for treating deep fungal infections, including amphotericin B in conventional and liposomal formulations, and the triazoles itraconazole (Sporanox) and fluconazole (Diflucan). It is important to note that there is lack of agreement in practice over what constitutes ideal therapy. The lipid formulations of amphotericin B and the improved oral solution and new intravenous formulation of itraconazole are recent additions to therapeutic options that are already having a significant influence on drug selection and treatment practices. [ONCOLOGY 15(Suppl 9):21-25, 2001]
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Who Knows How to Treat Systemic Light Chain Amyloidosis?A rarely noted aspect of the era of novel agents and explosive new knowledge in the clonal plasma cell diseases is how short the half-life of relevant information has become, and how this churning has challenged clinical thinking.
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Role of Angiogenesis Inhibitors in Cancer TreatmentAngiogenesis is essential for the growth of both primary andmetastatic tumors. This process, more complex than was previously thought,
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Commentary(McDermott/Hudes)-Testicular Cancer: Maintaining the High Cure RateDr. Raghavan is to be commendedfor a concise andcomprehensive overview ofthe management of germ cell tumors.As he suggests, given the demographicsof this relatively uncommon diseaseand the high cure rate that canbe achieved with proper treatmentand follow-up, it behooves us to maintainthese excellent results, even whilestriving to reduce the toxicity of treatment.We will highlight a few additionalpoints to complement thissuperb review.
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Brain Metastases and the Need for a Multispecialist ApproachMetastatic lesions to the brain occur commonly in oncology patients and portend a very poor outcome, as they often occur in the setting of progressive systemic metastatic disease and can result in neurologic deterioration that may preclude therapy. Therapy of patients with brain metastases requires a combination of measures to achieve local control at the site of metastasis (eg, with surgical resection or radiosurgery) and to reduce the subsequent risk of recurrences elsewhere in the brain (eg, with whole-brain radiation). Successful therapy of extracranial systemic metastases is required for optimal outcomes. Clinical trials are currently underway to define the optimal role of whole-brain radiation and radiosurgery in different subsets of patients. Novel therapies to enhance radiation responsiveness are also under investigation. In the current review, we discuss recent developments in the management of patients with brain metastases.
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Improving Outcomes in Resectable Gastric Cancer: A Review of Current and Future StrategiesHere we review the evidence supporting current approaches to resectable gastric cancer, including discussion of the optimal extent of surgery and lymphadenectomy, adjuvant chemotherapy, postoperative chemotherapy with chemoradiation, and perioperative chemotherapy.
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An 84-Year-Old Woman With an Indolent B-Cell LymphomaAn 84-year-old woman with a history of Graves disease, hyperlipidemia, and hypertension presented to her physician with progressive fatigue and palpable bilateral axillary lymphadenopathy.
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Targeted Therapy in Squamous Cell Cancers of the Head and NeckThe 5-year survival of patients with locally advanced squamous cell cancers of the head and neck is still less than 30%. Treatment of these cancers involves significant functional impairment, diminished quality of life, and considerable time and expense. Local recurrence and distant metastases are still fairly common, and the development of second primary cancers has a significant impact on survival in patients with initial early-stage disease. Despite the success of combination chemoradiation in locally advanced head and neck cancers, these facts stress the need for improved treatment of this disease.
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Clinical Manual for the Oncology Advanced Practice NurseThis book is intended to serve as a quick reference for advanced practice nurses (APNs) caring for oncology patients, from diagnosis through treatment and rehabilitation. With the advances made over the past several years in prevention, early
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Health Literacy: Improving Patient UnderstandingThe review of health literacy and its impact on older adults by Amalraj and colleagues in this issue of ONCOLOGY brings much-needed attention to this very critical issue. The impact of limited health literacy is made even more critical given the increasing number of older adults in the United States, estimated to be 20% of the US population by the year 2030, and the fact that limited health literacy disproportionately affects them.
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Watch Where You Sit!A recent study examined the influence of social interactions between cancer patients during chemotherapy sessions, finding that patients who spent time with other patients who died within 5 years had an increased risk of dying within 5 years themselves. Pardon me for being underwhelmed.
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Hurricane-Hit Practice Offers Lessons in Disaster PlanningIn a recent conversation with the ONCOLOGY Nurse Edition, Ms. Donohue discussed the short- and long-term effects of these disasters on patient care, and offered recommendations for emergency preparation in any setting.
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Interdisciplinary Breast Cancer Care: Declaring and Improving the StandardThe Susan G. Komen BreastCancer Foundation joins authorDr. Barbara Rabinowitz in underscoringthe importance and valueof interdisciplinary/multidisciplinarybreast care. We agree, as well, thatthe multimodal approach that Dr.Rabinowitz carefully outlines in herarticle should be adopted more consistentlyand recognized as this nation’sstandard of breast care. Herarticle provides the perspective neededto understand why this is so.
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Improving Outcomes in Resectable Gastric Cancer: A Review of Current and Future StrategiesHere we review the evidence supporting current approaches to resectable gastric cancer, including discussion of the optimal extent of surgery and lymphadenectomy, adjuvant chemotherapy, postoperative chemotherapy with chemoradiation, and perioperative chemotherapy.
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Oslerian Genomics for Prostate Cancer OncologyThe great strength of the PCWG3 is the recognition that second- , third- , and fourth-line treatments offer new possibilities for extending overall survival.
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The Role, Timing, and Clinical Use of ADT in Prostate CancerThe role, timing, and clinical use of androgen deprivation therapy (ADT) in prostate cancer remain a controversial topic for clinicians. Drs. Fang, Merrick, and Wallner provide a compelling review of the clinical benefits and side effects of ADT in high-risk prostate cancer. The number of patients presenting with advanced disease remains significant despite the stage migration of prostate cancer during the PSA (prostate-specific antigen) era.
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Practical Management of Adverse Events Associated With AfatinibIn this video from the 2015 ONS meeting, Dr. Sipples talks about effective management of side effects for patients taking afatinib, an oral, targeted agent for lung cancer.
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Coalition Urges U.S. Panel to Approve CT Colonography for Routine ScreeningA growing body of evidence supports the use of CT colonography for colon cancer screening, and a U.S. panel should reverse its decision to not endorse the procedure, according to the CT Colonography Coalition.
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A 35-Year-Old Woman With a Change in HER2 Expression Following Neoadjuvant Chemotherapy for Invasive Breast CancerA 35-year-old woman noticed a mass in her right breast and underwent a diagnostic workup, including a mammogram that revealed a 2.4-cm mass and ultrasound that showed two adjacent masses, as well as enlarged axillary lymph nodes.
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Radiologic Diagnosis of Extrathoracic Metastases to the LungBecause many types of cancers metastasize to the lungs, early detection may affect both tumor staging and treatment planning. On the other hand, it is also important to refrain from subjecting patients to procedures that
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Adenocarcinoma of the Esophagus: Risk Factors and PreventionEsophageal cancer poses an interesting challenge for oncologists. Esophageal squamous cell cancer has the most varied geographical incidence of any cancer, suggesting the existence of critically important environmental and molecular epidemiologic factors. These factors remain largely unrecognized.
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UFT/Leucovorin Plus Vinorelbine Combination for Advanced Breast CancerThis phase I study was undertaken to define the maximum tolerated dose, the dose-limiting toxicity, and the recommended dose of UFT plus leucovorin and vinorelbine in combination treatment of patients with metastatic breast cancer previously treated with one chemotherapy regimen. The pharmacokinetics of UFT and vinorelbine were also evaluated.
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UFT Plus Oral Calcium Folinate/Vinorelbine for Advanced Breast CancerThis phase I study was undertaken to define the maximum tolerated dose, dose-limiting toxicity, and recommended dosage of UFT (uracil and tegafur) plus oral calcium folinate (Orzel) and vinorelbine (Navelbine) in
