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Management Considerations in Cancer Patients With Rheumatoid ArthritisPatients with cancer and concomitant rheumatoid arthritis pose special challenges. Many therapies for rheumatoid arthritis can increase the risk of adverse events during cancer therapy because they are immunosuppressive.
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BMT for Severe Autoimmune Diseases: An Idea Whose Time Has ComeMost patients with autoimmune diseases are thought to have a a normal life expectancy, and thus are treated conservatively. However, these diseases have a diverse clinical course. A small subset of patients have "severe autoimmune diseases," or SADS, which are rapidly progressive and are associated with early mortality. If patients with SADS can be identified before they develop irreversible organ damage, aggressive intervention would be indicated. Consequently, patients with SADS are now being enrolled in experimental protocols of immune ablation and hematopoietic stem-cell rescue (ie, bone marrow transplantation [BMT]) at several US institutions. For various reasons, including the high cost of BMT, it will probably be years before the benefits, if any, of this procedure are known. [ONCOLOGY 11(7):1001-1017, 1997]
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Commentary (Valicenti): Integrating Hormonal Therapy With External-Beam Radiation and Brachytherapy for Prostate CancerIcommend the authors for their excellent review and discussion regarding the integration of hormonal therapy with permanent prostate implants. They address several important issues relating to the sequence and duration of hormonal therapy in combination with externalbeam radiation therapy (EBRT) and its underlying relationships with permanent prostate implants.
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The Prostate Cancer Intervention Versus Observation Trial (PIVOT)The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is a randomized trial designed to determine whether radical prostatectomy or expectant management provides superior length and quality of life for men with clinically localized prostate cancer. Conducted at Department of Veterans Affairs and National Cancer Institute medical centers, PIVOT will enroll over 1,000 individuals less than 75 years of age. The primary study end point is all-cause mortality. Secondary outcomes include prostate cancer- and treatment-specific morbidity and mortality, health status, predictors of disease-specific outcomes, and cost-effectiveness. Within the first 3 years of enrollment, over 400 men have been randomized. Early analysis of participants' baseline characteristics indicate that enrollees are representative of men diagnosed with clinically localized prostate cancer throughout the United States. Therefore, results of PIVOT will be generalizable. These results are necessary in order to determine the preferred therapy for clinically localized prostate cancer. [ONCOLOGY 11(8):1133-1143, 1997]
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Richard Kim, MD, on Future Research Efforts With Immunotherapy Combos in Metastatic CRCRichard Kim, MD, highlights future research efforts examining immunotherapy/chemotherapy combinations for patients with metastatic colorectal cancer.
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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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Current Management of Unusual Genitourinary Cancers: Part IIOften overshadowed by more common genitourinary cancers, such as prostate, testicular, and kidney cancers, penile and urethral cancers nonetheless represent difficult treatment challenges for the clinician. The management of these cancers is slowly evolving. In the past, surgery, often extensive, was the treatment of choice. Recently, however, radiation and chemotherapy have begun to play larger roles as initial therapies, with surgery being reserved for salvage. With these modalities in their treatment armamentarium, oncologists may now be able to spare patients some of the physical and psychological sequelae that often follow surgical intervention without compromising local control and survival. Part 1 of this two-part article, published in last month’s issue, dealt with cancer of the penis. This second part focuses on cancer of the urethra in both females and males. [ONCOLOGY 13(11):1511-1520, 1999]
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Cutaneous T-Cell Lymphoma: Pathogenesis and TreatmentCutaneous T-cell lymphoma (CTCL) is a malignancy of a distinctive subset of T-helper cells designated “cutaneous T cells” because of their central role in the normal functioning of the skin immune system. Guided by
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CancerLinQ: ASCO Dives Into Big DataIn this interview we discuss the American Society of Clinical Oncology’s (ASCO) health information and patient record initiative called CancerLinQ.
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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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Commentary (Wahl): Diagnostic Use of Radiolabeled Antibodies for CancerSince 1995 represents the 20th anniversary of Kohler and Milstein's description of the hybridoma/monoclonal antibody technology, it is an appropriate time to take stock of progress in this area. The article by Harrison and Tempero provides a useful review and update of the field of monoclonal antibody imaging in this anniversary year.
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High-Dose Interleukin-2: Is It Still Indicated for Melanoma and RCC in an Era of Targeted Therapies?In this review, we examine the currently approved options available for these disease processes, including the newer agents and selected combinatorial approaches under investigation, and we attempt to identify the role of high-dose IL-2 in the context of current clinical practice.
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Management of Lymph Node–Positive Prostate Cancer: The Role of Surgery and Radiation TherapyCurrent evidence for the management of lymph node–positive prostate cancer suggests both a disease-control and survival benefit to systemic ADT plus surgery and radiation.
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2010: Selected Colorectal Sessions FromEvery year in the United States, approximately 160,000 cases of colorectal cancer (CRC) are diagnosed, and about 57,000 patients die of the disease, making it the second leading cause of death from cancer among adults.
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Chemotherapy-Induced Cardiomyopathy: Clinical Scenarios and ChallengesWe will discuss the deleterious cardiovascular effects of anthracyclines and HER2-targeted agents in a case-based format, as well as specific approaches to prevention and treatment of associated cardiotoxicity.
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Endocrine Therapy in 2009: Consideration of the Tumor and the HostBreast cancer is the most common female malignancy in the Western world. Two-thirds of all breast cancers are estrogen receptor (ER)-positive, a phenotypic characteristic that is prognostic of disease-free survival and predictive of response to endocrine therapy.
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Review of "Physical Late Effects in Adult Cancer Survivors"The authors of this article accomplished their goal to provide an overview of physical long-term / late effects. Similar to most available literature published since the Institute of Medicine report in November 2005, it provided a descriptive summary of the epidemiologic data. While vital to increasing the knowledge base of nurses on the frontlines, it provides little guidance as to how to change or improve practice.
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Cognitive Function After Systemic Therapy for Breast CancerDr. Julie Olin has highlighted an important issue for patients and providers contemplating systemic therapy for breast cancer: how the brain works after such treatment. Her excellent article summarizes four important studies, identifies the research design problems and questions raised by these and other studies, and proposes a model for how chemohormonal therapy might affect cognitive functioning and quality of life (see Figure 1 of her article). Finally, she identifies how actual, as well as potential, cognitive impairment might influence patient decisions and care (the author’s Table 1).
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The Oncologist as Primary Palliative Care ProviderThere has been much progress in our “war on cancer,” launched with President Nixon’s signing of the National Cancer Act in 1971. In 2011, however, it is estimated that more than 571,000 people will die from cancer.
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Advances in the Treatment of Gynecologic MalignanciesThe article by Kim et al is a comprehensive summary of several decades of research in the management of cervical and vulvar cancer. It describes the current status of treatment and possible future trials.
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Adjuvant Hormonal Therapy in Premenopausal Women With Operable Breast Cancer: Not-So-Peripheral PerspectivesWhile optimal adjuvant hormonal therapies for premenopausal women with operable breast cancer have yet to be defined, discussions and reviews of the state of the art and “areas of confusion” often fail to consider developments that are germane to keeping evidence-based clinical practice truly up-to-date.
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Who's Coding Whom?My practice has been concerned that we physicians were not maximizing our “coding potential”; that is, we were not receiving as much remuneration for each cancer patient visit as Medicare permits under its guidelines. Therefore, the practice hired a company that specializes in teaching physicians how to get more. This company is part of a newly minted industry that does nothing else.
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Second-Line Regorafenib Extends Survival in Sorafenib-Tolerant HCC PatientsThis video examines an exploratory analysis of the RESORCE trial, which tested regorafenib vs placebo in hepatocellular carcinoma patients following radiographic progression on sorafenib.
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An Approach to the Management of Rare TumorsThis case report presents the management of a very rare tumor. Confronting a rare tumor can be frustrating to both physician and patient.
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Persistence of Lymphedema Reduction After Noninvasive Complex Lymphedema TherapySecondary lymphedema is quite prevalent in cancer patients who require lymph node dissection for staging and/or treatment of their disease. Chronic lymphedema may arise shortly after surgical intervention or months to years afterward. The tendency of chronic lymphedema is to worsen over time.
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Treatment of Estrogen Deficiency Symptoms in Women Surviving Breast Cancer, Part 6Problem: Several million women worldwide have survived breast cancer but are currently advised against the use of estrogen for the management of menopausal symptoms and for the prevention of early cardiovascular death and osteoporosis.
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Silicone Breast Implants: An Oncologic PerspectiveIn 1992, the FDA decided that silicone gel-filled breast implants would be available only through controlled clinical studies, despite the fact that they had been used for mammoplasty in millions of women around the world
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Role of Interferon-Alfa in NHL: Still Controversial?Recombinant interferon-alfa (Intron A, Roferon-A) has been under investigation as a therapeutic agent for non-Hodgkin’s lymphoma (NHL) for 25 years. It has antitumor efficacy in a number of histologic subtypes but has not
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Midostaurin in FLT3-Mutated AML: Results of the RATIFY TrialIn this interview we discuss results of the CALGB 10603 RATIFY trial of midostaurin for acute myeloid leukemia presented earlier this month at ASH.
