Authors
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Bladder Cancer: Time for a Rethink?In this issue of ONCOLOGY, Kamat and Mathew provide an excellent overview of the current status and future imperatives of bladder cancer treatment and research.
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Bulky Mediastinal Classical Hodgkin Lymphoma in Young WomenAlthough the cure rate remains high in women who present with bulky mediastinal stage I–II HL, the challenge remains to balance efficacy and minimize long-term toxicities.
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Chronic Myeloid LeukemiaChronic myeloid leukemia (CML) is a clonal myeloproliferative disorder resulting from the neoplastic transformation of the primitive hematopoietic stem cell.
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Breast Cancer During PregnancyThe care of a pregnant breast cancer patient is a challenging clinical situation that historically has placed the welfare of the mother in conflict with that of the fetus. For the woman in this situation, the emotions usually
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Non-Hodgkin LymphomaThis management guide covers the risk factors, screening, diagnosis, staging, and treatment of non-Hodgkin lymphoma.
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Concurrent RT With 5-FU/Epirubicin and Cisplatin or Irinotecan for Locally Advanced Upper GI AdenocarcinomaFrom the results of recent studies, it is likely that multimodality therapy with chemotherapy and radiation treatment may improve the overall outcome of locally advanced upper gastrointestinal (GI) malignancies, including esophageal, gastric, pancreatic, and biliary tract carcinomas. However, more effective, more optimal, and less toxic chemotherapy regimen(s) with concomitant radiotherapy are needed beyond the concurrent continuous-infusion fluorouracil (5-FU) with radiation that is commonly applied in general practice. Epirubicin (Ellence), cisplatin, and irinotecan (Camptosar) are all active cytotoxic chemotherapy agents in upper GI cancers. Two phase I studies were designed to test the tolerability of the combination of radiotherapy with infusional 5-FU, epirubicin, and cisplatin (ECF) or 5-FU, irinotecan, and epirubicin (EIF) in the treatment of locally advanced upper GI malignancies.
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Cancer Age: Can We Reliably Estimate and Apply This Knowledge?In their article, Patrone et al utilize a modified version of Collins’ law to estimate the age of breast, lung, and colorectal cancers. Collins’ law, which states that the period of risk for recurrence of a tumor is equal to the age of the patient at diagnosis plus 9 months, has been applied primarily to pediatric tumors, in particular embryonal tumors.[1,2] The results from the application of Collins’ law to these tumors have been reasonable, although exceptions have been reported and the law is not applicable to all cancers.[3,4] Its utilization in adults in the manner used in this paper is therefore unique.
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Use of High-Resolution CT Imaging Data in Lung Cancer Drug Development: Measuring ProgressLung cancer is the leading cause of cancer death throughout the United States.[1] Despite massive efforts, tobacco consumption continues to grow, with a large and predictable impact on premature mortality across the globe.[2]
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Addressing the Disparities in Prostate Cancer Care and OutcomesDr. Kittles discusses the race-based health disparities in prostate cancer, and one genetic-environmental crossover that is clinically significant.
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Active Surveillance in Small Renal MassesIn this interview we discuss a new study that looked at the outcomes of patients with small renal masses who were followed with active surveillance.
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Update on the Management of Primary CNS LymphomaPrimary central nervous system (CNS) lymphoma is a non-Hodgkin’s lymphoma restricted to the nervous system. The incidence of this lymphoma is rising in the immunocompetent population but may be decreasing in patients
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UFT Plus Cisplatin With Concurrent Radiotherapy for Locally Advanced Non–Small-Cell Lung CancerA phase II study of combined-modality treatment consisting of uracil and tegafur (in a molar ratio of 4:1 [UFT]) plus cisplatin (Platinol) and concurrent radiotherapy was conducted to evaluate the activity of this regimen in
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Langerhans Cell Histiocytosis: Emerging Insights and Clinical ImplicationsLangerhans cell histiocytosis is a disorder characterized by lesions that include CD207+ dendritic cells along with an inflammatory infiltrate. Langerhans cell histiocytosis has a highly variable clinical presentation, ranging from a single lesion to potentially fatal disseminated disease.
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Central Nervous System Germ Cell Tumors: Controversies in Diagnosis and TreatmentThe variability and complexity of central nervous system germ cell tumors have led to controversy in both diagnosis and management. If a germ cell tumor is suspected, the measurement of cerebrospinal fluid and serum alpha-fetoprotein and beta–human chorionic gonadotropin is essential. A histologic specimen is not necessary if the patient has elevated levels; however, if the tumor markers are negative, a biopsy is needed to confirm the diagnosis of a germinoma. Germinomas are extremelyradiosensitive, enabling 5-year survival rates that exceed 90%. Treatment has traditionally included focal and craniospinal axis irradiation; however, multiple ongoing studies are being conducted to examinethe efficacy of reduction or elimination of radiation therapy with the addition of chemotherapy. Nongerminomatous germ cell tumors, on the other hand, are relatively radioresistant with a poorer outcome. The combination of chemotherapy and irradiation is associated with overall survival rates of up to 60%. This article provides a review of the controversies in diagnosis and treatment of central nervous system germ cell tumors.
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Dr. Rimas Lukas on Controlled Interleukin-12 Combined With a PD-1 Inhibitor in Recurrent GlioblastomaCancer Network spoke with Rimas V. Lukas, MD, of Northwestern University Feinberg School of Medicine, about the combination of controlled interleukin-12 with a PD-1 inhibitor in recurrent glioblastoma.
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Consider Thrombotic Microangiopathy in Pediatric and Hematopoietic Stem Cell Transplant PatientsThe article by Dr. George is of great use to the practicing clinician, not only in the hematology-oncology setting but also in general practice or emergency medicine.
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Infection in a Leukemia PatientMs. C is a 41-year-old Hispanic woman that came to our facility regarding her leukemia. She presented in January 2005 with migratory myalgias, headaches, and gingival bleeding. Complete blood count (CBC) revealed a white blood cell count (WBC) of 18.0/µL with 53% blasts, hemoglobin at 8.1 g/dL, and a platelet count of 12/µL. Bone marrow biopsy confirmed a diagnosis of acute lymphocytic leukemia.
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Survival Advantage Seen for HNPCC Colorectal CancerHereditary nonpolyposis colorectal cancer (HNPCC) is a dominantly inherited syndrome that is estimated to be responsible for between 0.5% to 5% of all colorectal cancers.[1] The syndrome is caused by germline mutations in any of at least four mismatch repair genes.
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The New Generation of Targeted Therapies for Breast CancerThe article by Drs. Syed andRowinsky is well written andcomprehensive. They introduceseveral biologic pathways that are importantin breast cancer and focus onnew pharmaceutical agents designedto disrupt these pathways. Patients andphysicians hope that agents that targetthe tyrosine kinase signal transductionpathways, block tumor angiogenesis,modulate apoptosis, and inhibithistone deacetylation will be effective,nontoxic therapies for breastcancer. These molecularly targeted approacheshold promise, but deliveringon this promise requires that we movebeyond histologic characterization ofthe disease and rethink the design ofclinical trials.
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Vesicant Extravasation From an Implanted Venous Access PortThe patient, “JB,” is a 68-year-old woman who underwent a right lumpectomy and axillary node dissection for stage II breast cancer. Her oncologist suggested adjuvant chemotherapy (four cycles of cyclophosphamide [Cytoxan] at 600 mg/m2 plus doxorubicin [Adriamycin] at 60 mg/m2) followed by local radiation therapy.
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Irinotecan/Cisplatin Followed by 5-FU/ Paclitaxel/Radiotherapy and Surgery in Esophageal CancerLocal-regional carcinoma of the esophagus is often diagnosed inadvanced stages because the diagnosis is established when symptomsare severe. The prognosis of patients with local-regional carcinoma ofthe esophagus continues to be grim. While preoperative chemoradiotherapyincreases the fraction of patients who achieve pathologiccomplete response, that percentage is approximately 25%. In an attemptto increase the number of patients with either no cancer in the surgicalspecimen or only microscopic cancer, we adopted a three-step strategy.The current study utilized up to two 6-week cycles of induction chemotherapywith irinotecan (CPT-11, Camptosar) and cisplatin as step 1.This was followed by concurrent radiotherapy and chemotherapy withcontinuous infusion fluorouracil (5-FU) and paclitaxel as step 2. Oncethe patients recovered from chemoradiotherapy, a preoperative evaluationwas performed and surgery was attempted. All patients signed aninformed consent prior to their participation on the study. A total of 43patients were enrolled. The baseline endoscopic ultrasonography revealedthat 36 patients had a T3 tumor, five patients had a T2 tumor, andtwo had a T1 tumor. Twenty-seven patients had node-positive cancer(N1). Thirty-nine (91%) of the 43 patients underwent surgery; all hadan R0 (curative) resection. A pathologic complete response was noted in12 of the 39 patients. In addition, 17 patients had only microscopic(< 10%) viable cancer in the specimen. Therefore, a significant pathologicresponse was seen in 29 (74%) of 39 taken to surgery or 29 (67%)of all 43 patients enrolled on the study. With a median follow up beyond25 months, 20 patients remain alive and 12 patients remain free ofcancer. Our preliminary data suggest that the proportion of patientswith significant pathologic response can be increased by using thethree-step strategy.
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Irinotecan and Radiation in Combined-Modality Therapy for Solid TumorsIrinotecan (CPT-11, Camptosar) is a camptothecin derivative thatis thought to exert its cytotoxic effects by targeting topoisomerase
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Evolving Treatment Landscape of RCC: Future Directions in CareClosing out their program on renal cell carcinoma management, key opinion leaders share closing thoughts on emerging therapies and how the field is evolving.
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Small-Cell Lung Cancer, Mesothelioma, and ThymomaThis management guide covers the symptoms, screening, diagnosis, and treatment of small-cell lung cancer (SCLC), mesothelioma, and thymoma from a surgical, medical, and radiation oncology approach.
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Plasma Glutamine as a Prognostic Biomarker in Localized Prostate Cancer: Comparison of Conventional Variables in Risk StratificationThis study investigated the biomarker potential of glutamine among known prognostic variables in localized prostate cancer.
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Unusual Myelomas: A Review of IgD and IgE VariantsAlthough survival of patients with IgD or IgE multiple myeloma is shorter in comparison to those with IgG or IgA multiple myeloma, the outcome for patients with IgD and IgE subtypes is improving with the use of novel agents and autologous transplantation.
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Gemcitabine Plus Cisplatin in Breast CancerIn recent years, the clinical application of paclitaxel (Taxol), docetaxel (Taxotere), vinorelbine (Navelbine), and trastuzumab (Herceptin) has improved the management of advanced breast cancer. With the introduction of
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Breast Cancer Screening Benefits More Consistent Than Previously ThoughtMajor studies looking at breast cancer screening with mammography may have more consistent findings than previously thought.
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The War on Pancreatic Cancer: We Are Not There YetAfter 2 decades of disappointing phase III trials and years of single-agent gemcitabine therapy, the pancreatic cancer community is relieved to expand the front-line armamentarium in patients with mPAC. Here we evaluate the current landscape and ask some provocative questions about response rate, dosing, and predictive markers.
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Infusional Chemoradiation for Operable Rectal Cancer: Post-, Pre-, or Nonoperative Management?Dr. Rich presents a comprehensive overview of adjuvant therapy for advanced operable rectal cancer. He emphasizes the roles of infusional chemoradiation in both the adjuvant setting and as sole therapy. Unless otherwise specified, the following comments pertain to clinically resectable B2-C (T3, N0-N1) adenocarcinoma of the rectum.
