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An Alternative Algorithm for Dosing Transdermal Fentanyl for Cancer-Related PainMany cancer patients are undermedicated and inappropriately managed for pain, leading to a diminished quality of life. Patients with moderate to severe pain often require opioid analgesics. Recently published guidelines
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Clinical Trials and NCI Resources for Cancer in HIV-Positive PatientsThe association between HIV infection and the development of cancer was noted early in the acquired immunodeficiency syndrome (AIDS) epidemic. The AIDS-defining malignancies are Kaposi’s sarcoma, intermediate- or high-grade B-cell non-Hodgkin’s lymphoma (NHL), and cervical cancer. All of these cancers feature specific infectious agents in their etiology. These agents are human herpesvirus 8/Kaposi’s sarcoma-associated herpesvirus, or HHV-8/KSHV (implicated in Kaposi’s sarcoma), Epstein-Barr virus, or EBV (in primary central nervous system lymphoma and a subset of systemic B-cell NHL) and human papillomavirus, or HPV (in cervical cancer).[1]
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Physicians Must Comply With Fraud and Abuse StatutesThe second part of this three-part series discusses the various types of fraud and abuse laws, reviews the laws on false claims, and provides suggestions for limiting a physician's exposure to fraud and abuse claims. Part 1, which appeared in the January, 1995, issue of Oncology News International (page 18), discussed the Stark statute, which prohibits self-referrals for certain services covered by Medicare and Medicaid, while the final article will review the Medicare and Medicaid anti-kickback statute.
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Transplantation or Resection for Hepatocellular Carcinoma: Biology Determines OutcomeIn their article “Liver Transplantation for the Treatment of Hepatocellular Carcinoma," Drs. Hanish and Knechtle provide a cogent review of many of the issues surrounding the management of hepatocellular carcinoma (HCC) in patients with cirrhosis.
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Commentary (Scully): Extraovarian Primary Peritoneal CarcinomaThe distribution of abdominal serous carcinoma in the female ranges from ovarian carcinoma with no tumor involvement of the peritoneum to peritoneal carcinoma with no evidence of carcinoma in the ovary. For the purposes of investigation and patient care, it has been necessary to formulate criteria to distinguish tumors that are most probably primary ovarian carcinomas from those that are most likely primary peritoneal cancers.
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Hematopoietic Management in Oncology PracticeThe year 1991 was truly a watershed year in medical oncology,as three events resulted in aparadigm shift in the tolerability,safety, and symptom management ofchemotherapy delivery. The first twoevents moved chemotherapy administrationfrom a user-unfriendly hospitalinpatient environment to whatevolved into a highly efficient, sophisticated,outpatient system led by privatepractitioners of medical oncology.Ondansetron (Zofran), the first of the5HT3-receptor antagonists, providedreliable prophylaxis of immediatechemotherapy-induced nausea andvomiting in highly emetogenic regimens.[1] Recombinant human granulocytecolony-stimulating factor(rhG-CSF, filgrastim [Neupogen]),[2]if dosed appropriately, significantlyreduced the duration of severe neutropeniathrough its role as the primaryregulator of increased production andrelease of granulocytes from the bonemarrow.
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Potential Role of Tumor Vaccines in GI MalignanciesThe article by Laheru and Jaffee offers an excellent summary of immunotherapies for gastrointestinal malignancies. Thoughtful descriptions of the antibody, cytokine, and cel- lular components of the immune system provide useful background information that facilitates an understanding of specific passive and active cancer immunotherapies. Immunotherapies that have demonstrated efficacy in colon cancer clinical trials, including levamisole (Ergamisol), passive monoclonal antibody vaccines, and bacillus Calmette- Guérin (BCG)–autologous tumor vaccines, are appropriately reviewed. In addition, novel approaches at varying stages of clinical testing are clearly summarized; these include the use of an anti-idiotypic antibody, genetically modified tumor and dendritic cells, recombinant protein, and viral and DNA vaccines. Some additional approaches, studies, and perspectives are also worthy of mention as a supplement to this review.
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The Evolution of Medical Journals: Why “Oncology”?Had Charles Darwin lived in the late 20th century, he might have found amusement in contemplating the evolution of biomedical journals.
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Osteoporosis in Breast and Prostate Cancer SurvivorsRecent advances in treatment modalities for breast and prostate cancerhave resulted in an increasing number of patients that are cured orthat, despite residual disease, live long enough to start experiencingcomplications from cancer treatment. Osteoporosis is one such problemthat has been increasingly identified in cancer patients. Hypogonadismand glucocorticoid use are the two major causes of bone loss inthese patients. Osteoporosis is characterized by low bone mass and abnormalbone microarchitecture, which results in an increased risk offractures. Vertebral body and hip fractures commonly result in a drasticchange of quality of life as they can result in disabling chronic pain,loss of mobility, and loss of independence in performing routine dailyactivities, as well as in increased mortality. In patients with prostatecarcinoma, androgen-deprivation therapy by either treatment with agonadotropin-releasing hormone (GnRH) or bilateral orchiectomy resultsin increased bone turnover, significant bone loss, and increasedrisk of fractures. Patients with breast cancer are at increased risk forestrogen deficiency due to age-related menopause, ovarian failure fromsystemic chemotherapy, or from the use of drugs such as aromataseinhibitors and GnRH analogs. Several studies have indicated that theprevalence of fractures is higher in breast and prostate cancer patientscompared to the general population. Therefore, patients at risk for boneloss should have an assessment of their bone mineral density so thatprevention or therapeutic interventions are instituted at an early enoughstage to prevent fractures. This article will address the characteristicsof bone loss observed in breast and prostate cancer patients and potentialtreatments.
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COUNTERPOINT: Is There Still a Role for Intraperitoneal Platinum Therapy in Ovarian Cancer?There will be no further randomized phase III trials of cytotoxic IP chemotherapy; IP therapy in ovarian cancer will soon be an historical footnote along with other failed approaches in cancer care.
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Comments Regarding Lung Metastasis Surgery for SarcomaIn this issue of ONCOLOGY, Kon and Martin review the difficult issue of lung metastasis from sarcoma and its management.
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Commentary (Downey/Ginsberg): Surgical Treatment of Metastatic Pulmonary Soft-Tissue SarcomaIn their article, Chao and Goldberg provide a concise overview of the literature on pulmonary metastasectomy for sarcoma, including a brief history of the procedure, guidelines for preoperative evaluation, conduct of the operation, and probable outcomes achieved. Several points that they review deserve further discussion.
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Pelvic MRI for Guiding Treatment Decisions in Rectal CancerThis article discusses features that predict local recurrence and distant metastasis in rectal cancer, and how to use MRI to guide treatment decisions.
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Economic Savings and Costs of Periodic Mammographic Screening in the Workplacehis article discusses the costs and benefits of mammographic screening in the workplace. The cost of mammography itself and of diagnostic work-up are two of the largest costs involved.
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Proton beam RT not exempt from evidence-based medicineIn May 2008, ONI reviewed an article by Herman Suit, MD, and colleagues in which they argued that randomized trials of proton beam therapy vs standard radiotherapy are not needed prior to a wider use of proton beam therapy. In an ONI reader poll, 81% disagreed with Dr. Suit, as does Dr. Robert Parker, of SUNY Stony Brook, in his letter below.
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Modulation of Dose Intensity in Aerodigestive Tract Cancers: Strategies to Reduce ToxicityDr. Rich and colleagues present a compelling argument for the manipulation of temporal and spatial treatment parameters in chemoradiation programs. In essence, the authors address the shielding of normal tissues from the effects of cytotoxic agents. With respect to radiotherapy, this can be achieved via physical shielding by computer-generated dose algorithms using elaborate new planning technology (eg, intensity-modulated radiation therapy [IMRT]), chemical shielding with radioprotectants (eg, amifostine [Ethyol]), or temporal shielding by altered-fractionation schemes that exploit the differential alpha/beta ratios between tumor and normal tissue (eg, hyperfractionation).
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Curing Pediatric Cancers: A Success Story ReconsideredOver the past 50 years, great strides have been made in diagnosis, treatment, and survival of childhood cancer. In the 1960s the probability of survival for a child with cancer was less than 25%, whereas today it may exceed 80%. This dramatic change has occurred through significant and steady progress in our understanding of tumor biology, creation of specialized multidisciplinary care teams, incremental improvements in therapy, establishment of specialized centers with research infrastructure to conduct pivotal clinical studies, and the evolution of a cooperative group mechanism for clinical research. Most children with cancer in the United States, Europe, and Japan receive appropriate diagnosis and treatment, although access is limited in developing countries. The price of success, however, is the growing population of survivors who require medical and psychosocial follow-up and treatment for the late effects of therapy. Here we review the progress made in pediatric oncology over the past 3 decades and consider the new challenges that face us today.
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AIDS-Related Cancers in the Era of Highly Active Antiretroviral TherapyHighly active antiretroviral therapy (HAART) has shown great efficacy in reducing human immunodeficiency virus levels, increasing immunity, and prolonging the survival of persons with acquired immunodeficiency
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Commentary (Cerfolio): Endoscopic Ultrasound Fine-Needle Aspiration in the Staging of Non-Small-Cell Lung CancerPrecise mediastinal staging of non-small-cell lung cancer is extremely important, as mediastinal lymph node metastases generally indicate unresectable disease. Reliance on computed tomography (CT) and positron-emission tomography (PET) alone to stage and determine resectability is limited by false-positive results. Whenever possible, pathologic confirmation of metastases is desirable. Mediastinoscopy and transbronchial fine-needle aspiration are widely established but imperfect modalities. Endoscopic ultrasound fine-needle aspiration (EUS-FNA) has emerged as a diagnostic and staging tool because of its safety, accuracy, and patient convenience. We reviewed 13 prospective studies evaluating the comparative performance of EUS for staging lung cancer. We conclude that EUS is a valuable staging modality. Further studies of the role of EUS compared to other modalities such as integrated PET/CT and endobronchial ultrasound (EBUS) are forthcoming.
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Commentary (Downey/Ginsberg): Surgical Treatment of Metastatic Pulmonary Soft-Tissue SarcomaIn their article, Chao and Goldberg provide a concise overview of the literature on pulmonary metastasectomy for sarcoma, including a brief history of the procedure, guidelines for preoperative evaluation, conduct of the operation, and probable outcomes achieved. Several points that they review deserve further discussion.
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The ABCDs of moles and melanomasWhen you inspect moles, pay special attention to their sizes, shapes, edges, and color. A handy way to remember these features is to think of the A, B, C, and D of skin cancer-asymmetry, border, color, and diameter.
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Commentary (Ginsberg): Diffuse Malignant Mesothelioma of the Pleural Space and Its ManagementDrs. Zellos and Sugarbaker have provided a concise yet complete review of the current management of resectable diffuse malignant mesothelioma and have identified areas worthy of further investigation. Although, on occasion, surgical treatment can produce long-term cure, in general, diffuse malignant mesothelioma is a devastating disease. One only has to look at the survival curves provided by the Brigham group to understand that, of 183 patients, only 7 survived for 5 years.[1] However, neither the number eligible for evaluation at 5 years nor the disease-free survival figures were reported.
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Study Identifies Effective PD-L1 Tests for Lung CancerA new study looking at PD-L1 expression lung cancer tissue has found that the SP142 assay shows significantly lower levels of PD-L1 expression compared with other available tests.
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Ovarian Tumors of Low Malignant PotentialThe Trimbles have provided auseful overview of the majorclinical and pathobiologic issuesinvolving ovarian borderlinetumors (also termed atypical proliferativetumors or tumors of low malignantpotential). The borderline category ofovarian tumors comprises a heterogeneousgroup of neoplasms that, whensubdivided according to histologicappearance and the presence of peritoneallesions, form distinctive subgroups,each with characteristicpathologic features and a distinctiveclinical course. Thus, retrospectivereviews of thousands of reported caseshave shown that borderline tumors ofall types that are confined to the ovaries(ie, lack peritoneal “implants”)are associated with virtually 100%survival and an extremely low recurrencerate.[1]
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Book Review: Cancer SurgeryAlthough several recently published textbooks and handbooks have some variation of "Surgical Oncology" in the title, a new text, Cancer Surgery, edited by McKenna and Murphy, shifts the emphasis from oncology to surgery. This focus is explicitly
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Cancer Management Chapter 11: Pancreatic, neuroendocrine GI, and adrenal cancersPancreatic cancer is the fifth leading cause of cancer death in the United States. In the year 2009, an estimated 42,470 new cases are expected to be diagnosed, and 35,240 deaths are expected to occur.
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Reporting of Study Comparing Casodex, Eulexin Is QuestionedI would like to call your attention to a misleading statement that appeared in the Industry Watch section of the October, 1995, issue of Oncology News International under the title "Casodex Approved for Prostatic Cancer" (page 23).
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The Microbiome and Outcomes After Allogeneic TransplantIn this interview we discuss advances in the relationship between the microbiome and outcomes after allogeneic transplant, including graft-vs-host disease and relapse.
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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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The New Face of Head and Neck Cancer: The HPV EpidemicThis review discusses current paradigms in the diagnosis and management of HPV-OPSCC, and we emphasize pertinent research questions to investigate going forward, including whether to deintensify treatment in these patients.
