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ALARA: In Radiation Oncology and Diagnostic Imaging AlikeIn this issue of ONCOLOGY, Dr. Goske and colleagues present an excellent review of efforts to reduce radiation exposure from diagnostic medical imaging.[1]
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Adverse Prognostic Features in Chronic Lymphocytic LeukemiaOur ability to stratify patients with CLL into high-risk and low-risk categories has advanced dramatically over the past two decades. However, which test or tests are most reliable remains to be seen.
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ASCO 2014 Plenary Session: Results From the CHAARTED TrialThe results of the CHAARTED trial, which looked at whether the addition of upfront chemotherapy to hormonal therapy improved overall survival in patients with hormone-sensitive metastatic prostate cancer, were presented at the ASCO Annual Meeting.
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Tumors of the Uterine CorpusCarcinoma of the endometrium is the most common female pelvic malignancy and the fourth most common cancer in females, after breast, bowel, and lung carcinomas. In 1995, an estimated 32,800 new cases of endometrial carcinoma and 5,900 related deaths will occur in the United States [1]. The relatively low mortality for this cancer is probably due to the fact that in 80% of cases, the disease is diagnosed when it is confined to the uterus.
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PET Scanning: Worth the Cost in Cancer? Not for All Cancers-It’s Not Reliable Enough YetIn order for a test to be reliable, it must be reproducible and minimize test-retest variability. Yet, as with many imaging tests, FDG-PET has variance in standard uptake value (SUV) calculations, and even if standardization could be achieved, there is the issue of treatment effects, which introduce additional complexities.
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Management of Metastatic HER2-Positive Breast Cancer: Where Are We and Where Do We Go From Here?This review will summarize the current standard of care; key issues that arise when treating patients with HER2-positive disease; and developments in novel therapeutics, including small-molecule inhibitors, nanoparticles, immunotherapy, and agents targeting resistance pathways.
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Every-2-Week Darbepoetin Alfa Is Comparable to rHuEPO in Treating Chemotherapy-Induced AnemiaThe safety and efficacy of darbepoetin alfa (Aranesp) at 3.0 µg/kg administered every 2 weeks and recombinant human erythropoietin (rHuEPO) given as 40,000 U weekly or 150 U/kg three times weekly were evaluated by
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Targeted Therapy: Its Status and Promise in Selected Solid Tumors Part IIThis second article in our two-part series on targeted therapies in solid tumors covers the emergence of targeted therapies for the treatment of two common malignancies: lung cancer and breast cancer.
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Adjuvant Hormonal Therapy in Early Breast CancerFor many years, tamoxifen has been the gold standard adjuvanthormonal therapy with the greatest impact in early breast cancer forboth pre- and postmenopausal women. Tamoxifen-based adjuvant endocrinetherapy and chemotherapy have together contributed substantiallyto the reduction in breast cancer mortality that has occurred inrecent years. Over the past few years, the role of aromatase inhibitorshas grown in prominence and they are now on the threshold of supplantingtamoxifen as the new gold standard adjuvant therapy for postmenopausalwomen with estrogen-receptor–positive disease. With extendeduse of oral antihormones such as tamoxifen, the role of ovariansuppression on the other hand has become less clear in the adjuvantsetting. This article reviews the most important data regarding the variousadjuvant hormonal treatments in the management of early breastcancer and will also give a brief overview of the role of these agents inthe neoadjuvant setting.
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Is Diagnosing Cancer With a Smartphone in Our Future?The proposition that a consumer smartphone could somehow become part of the diagnostic toolkit of an oncologist may seem ridiculous. There are, however, many researchers and start-ups that would disagree.
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The Heartaches of Cancer Therapy: Acute and Late Cardiotoxicity in Cancer SurvivorsHere, we discuss the etiologies, prevention, and management of cardiac toxicities in cancer survivors, considering cancer-related, treatment-related, and patient-related risks and effects. Programs in place to address cardiovascular risk factors in cancer survivors are highlighted.
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Tailoring Treatment in Elderly PatientsAs noted in part 1 of this two-part article, non-Hodgkin's lymphoma is one of a few malignancies that have been increasing in incidence over the past several decades. Likewise, these disorders are more common in elderly patients, with a median age of occurrence of 65 years. Therapy in elderly patients may be affected by multiple factors, especially attendent comorbidities. The approaches to management of these patients, with either indolent or aggressive disease processes, have been based on prospective clinical trial results, many of which have included a younger patient population. Fortunately over the past decade, results of treatment trials that have targeted an older patient population have emerged. The disease incidence and treatment approaches for both follicular (part 1) and diffuse aggressive (part 2) histologies in elderly patients are reviewed, as well as the impact of aging on the care of these patients.
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Commentary (Remick): Management of Anal Cancer in the HIV-Positive PopulationThe article by Kauh and colleaguesprovides a timely reviewof the therapeutic approachto invasive carcinoma of theanus in human immunodeficiency virus(HIV)-infected patients, which isan emerging clinical problem. Importantlimitations of the published experience,however, need to be pointedout; given the present pursuit of moretargeted anticancer therapy, new avenuesare being explored, even in themanagement of HIV-associated analcancer.
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Unexpected N2 Lymph Node Involvement Found During Surgery for Early-Stage NSCLCDuring investigation of an episode of self-limiting abdominal pain, a 63-year-old Caucasian female never-smoker was found to have an asymptomatic right lower lobe pulmonary mass. A positron-emission tomography/computed tomography (PET/CT) scan revealed the right lower lobe mass to be 25 × 32 mm with a standardized uptake value (SUV) of 10.2, without evidence of hilar or mediastinal lymphadenopathy or of distant metastases.
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An Overview Cost-Utility Analysis of Prostate Cancer ScreeningThe value of prostate cancer screening remains controversial because of the high prevalence of the disease and the fact that many tumors detected through screening are not destined to lead to morbidity or mortality, rendering
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'Economies of Scale' Yield Multiple Benefits for a Private, Physician-Run Oncology PracticeThe community oncology practice is the nation’s headquarters in the war on cancer. Eighty-five percent of all cancer patients receive their treatment in local community oncology practices.
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Current Clinical Trials in Small-Cell Lung CancerLung cancer is the number one cause of cancer death for both men and women in the United States. In the year 2001, it is
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Palliative RT Research in Prostate Cancer: Understanding the Past, Anticipating the FutureMoving forward, perhaps no recent development in the use of RT in metastatic prostate cancer has captured greater attention than the use of radium-223 in metastatic castration-resistant prostate cancer (mCRPC).
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Vaccinations Against Infectious Diseases in Hematopoietic Stem Cell Transplant RecipientsBlood and marrow transplantation, a curative treatment for avariety of serious diseases, induces a period of sustained immunosuppressionpredisposing recipients to opportunistic infections. Both forthe protection of the individual transplant recipient and as a matter ofpublic health policy, the US Centers for Disease Control and Prevention(CDC) has developed guidelines for the use of vaccination in theprevention of infectious disease following transplantation. This reviewexamines the primary clinical research supporting vaccinationpolicies in this target population. Widely accepted recommendationsfor transplant recipients based on scientific data are sparse, as fewlarge studies have been conducted in this population. Anecdotalreports, expert advice, summaries, and limited series involving lessthan 50 patients using surrogate end points form the basis of thescientific literature, with the result being a wide variation in practice.Although based largely on inadequate scientific data, the CDC recommendationsoffer a pragmatic approach to the prevention of opportunisticdisease in hematopoietic transplant recipients and serve as auseful starting point for standardization of practice while defining thedirection of future studies in transplant recipients and other immunocompromisedhosts.
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Evaluating the Role of Serine Protease Inhibition in the Management of Tumor MicrometastasesConservation of blood is apriority during surgery, owingto shortages of donor bloodand risks associated with transfusionof blood products.[9,10] However,blood transfusions have been linkedto a number of negative postoperativesequelae, including poorer prognosisafter cardiac and cancer surgery.[11-21] In this context, recognition thatallogeneic transfusion-associatedimmunomodulation can increasemorbidity in allogeneically transfusedpatients has become a major concernin transfusion medicine.[9,22,23]
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Active Surveillance for Low-Risk Localized Prostate CancerIn this review, we summarize contemporary data pertaining to active surveillance, a safe and appropriate strategy for select patients with low-risk cancer characteristics who undergo monitoring at regular intervals.
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Pancreatic Cancer: Recognizing an Hereditary PredispositionAlthough candidate genes for hereditary pancreatic cancer have been identified (Figure 1), namely p16 and BRCA2, pancreatic cancer patients having an inherited predisposition will not be easy to recognize on clinical grounds.
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Development of PARP Inhibitors: An Unfinished StoryIn this issue of ONCOLOGY, Comen and Robson provide a timely overview of poly(ADP-ribose) polymerase (PARP) inhibitors and their potential for the treatment of breast cancer. The authors highlight the recent demonstration of synthetic lethality between PARP inhibition and loss of either of the breast cancer susceptibility genes, BRCA1 and BRCA2, as well as the development of PARP inhibitors that are suitable for clinical therapy. However, many questions pertaining to both the basic biology of PARP inhibition and the potential clinical implications of PARP inhibitors still need to be addressed. In the following commentary, we highlight some of these remaining challenges.
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Propelling Immunotherapy Combinations Into the ClinicThis review summarizes promising new targets and immunotherapy combination strategies currently under clinical development.
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Face-Off: Award Presentations and Event ConclusionJudy concludes the event and presents the awards.
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Minimal Residual Disease–Directed Adjuvant Therapy for Patients With Early-Stage Colon Cancer: CIRCULATE-USIbrahim Halil Sahin, MD, and colleagues, explore, the CIRCULATE-US (NRG-GI008; NCT05174169) investigating postoperative ctDNA dynamics in early-stage colon cancer for treatment selection.
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The Role of Amifostine as a RadioprotectorEffective radiotherapy for patients with cancer should include maximal tumor cell killing with minimal injury to normal tissue. Radiation doses that can be delivered, without causing severe damage to surrounding normal
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Combined Radiation and Chemotherapy for Carcinoma of the Anal CanalSphincter-preserving treatment with combined radiation and chemotherapy has replaced abdominoperineal resection as the standard of care for patients with carcinoma of the anal canal. Randomized studies have shown
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Salivary Gland Cancers: The Challenges of Progress in Rare TumorsThe diversity and complexity, combined with the rarity of salivary gland malignancies, lead to definite and distinct challenges in their study, and consequently in advancing treatment options for affected patients.
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Prostate Cancer in a Man With Multiple Previous Cancerspatient is a 67-year-old male with mild obstructive symptoms and an American Urology Association symptom score of 8.[1] He was noted to have a prostate-specific antigen (PSA) level of 3.2 ng/mL. Because this represented a significant increase in his PSA velocity (rate of change over time), he proceeded to have a biopsy, which was positive for prostate cancer. He has no other complaints and visits us for an opinion on the treatment of his prostate cancer.
