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Oral Complications of Cancer TherapyThe mouth is a frequent site of complications arising from drug or radiation cancer therapy, with mucositis, xerostomia, osteoradionecrosis, and local infections being the most common. From the standpoint of dose
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Breast Cancer Screening: The Evolving EvidenceIn this paper, the historic and recent evidence supporting the value of breast cancer screening will be described, along with the underpinnings of the current debate over the relative and absolute benefit of regular mammography screening.
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Current Role of Retroperitoneal Lymph Node Dissection in Testicular CancerThis paper is a very nice review of the history of the development of modern urologic surgical procedures for the treatment of testicular germ-cell tumors and their current indications. I agree with virtually everything the authors say. I will emphasize several points that they make and highlight a few small areas of disagreement.
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Toward a Breast Cancer Vaccine:Work in ProgressAs outlined in the review byDrs. Emens and Jaffee entitled“Toward a Breast CancerVaccine: Work in Progress,” the developmentof anticancer vaccines hasclosely paralleled advances in the fieldof immunology. Basic immunologyhas provided and will continue toprovide important insights intohuman immunity that directly relateto the design and study of immunotherapeutics.To date, the mostimportant scientific observations applicableto immunotherapy include thefollowing:
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A Shifting Paradigm for Patients with Head and Neck Cancer: Transoral Robotic Surgery (TORS)The evolution of surgical oncologic technology has moved toward reducing patient morbidity without compromising oncologic resection. In head and neck surgery, organ-preserving techniques have paved the way for the development of transoral techniques that remove tumors of the upper aerodigestive tract without external incisions and potentially spare the patient adjuvant treatment. The introduction of transoral robotic surgery (TORS) improves upon current transoral techniques to the oropharynx and supraglottis. This review will report on the evolution of robotic-assisted surgery: We will cover its applications in head and neck surgery by examining early oncologic and functional outcomes, training of surgeons, costs, and future directions.
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Commentary (Kleinberg et al): Primary Combined-Modality Therapy for Esophageal CancerBased on positive results from the Radiation Therapy Oncology Group (RTOG) 85-01 trial, the conventional nonsurgical treatment of esophageal carcinoma is combined-modality therapy. Dose intensification of the RTOG 85-01 regimen, examined in the Intergroup (INT)-0123/RTOG 94-05 trial, did not improve local control or survival. Areas of clinical investigation include the development of combined-modality therapy regimens with newer systemic agents, the use of 18F-fluorodeoxyglucose positron-emission tomography to assist in the development of innovative radiation treatment planning techniques, and the identification of prognostic molecular markers. The addition of surgery following primary combined-modality therapy apparently does not improve survival, but this finding is controversial.
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Integrins and CancerIntegrins play an important physiologic role in cell adhesion, and accumulating evidence suggests that they also regulate cell growth, proliferation, migration, and apoptosis. A number of congenital and acquired disease states have been associated with integrins, and small- molecule integrin inhibitors have been approved for treatment of benign hematologic diseases. In cancer, aberrant expression with normal functioning rather than dominant genetic variations of genes coding for integrins has generally been observed. This aberrant expression is mediated through "bidirectional" receptor signaling and interaction with corresponding signals from growth factor signaling pathways, leading to inhibition of apoptosis, induction of cell proliferation, extracellular matrix remodeling, migration, and angiogenesis. From a clinical perspective, a growing number of molecules targeting integrins have been developed for treatment and imaging purposes; clinical studies in melanoma, prostate cancer, and other malignancies are underway. This review summarizes the biology of integrins, the signal transduction pathways they regulate, and their role in different stages of carcinogenesis. Furthermore, it provides a synopsis on the clinical advancements in integrin targeting for therapeutic and imaging purposes in cancer.
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High-Dose Chemotherapy With Autologous Stem Cell Rescue in the Outpatient SettingOutpatient bone marrow transplant (BMT) strategies, as reviewed by Dix and Geller, have evolved for various reasons—from social to medical. If high-dose approaches are to become a viable treatment for common cancers, such as breast cancer, the refinement of transplants to a “kinder and gentler” approach is essential.
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Commentary (Parker)-Stereotactic Breast Biopsy: Indications and ResultsA decade has passed since the first stereotactic-guided histologic breast biopsy was performed. Initially, the large-scale implementation of this technique met with a great deal of resistance from most surgeons, and more surprisingly, from many breast radiologists in academia.
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ASCO: Controversies in Phase I Clinical TrialsSteve Joffe, MD discusses the ethical challenges and controversies in phase I clinical cancer trials.
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Lymphoma science meets patient careAs a young candy striper at a Los Angeles hospital, lymphoma researcher Alexandra M. Levine, MD, MACP, experienced a portentous moment, although she didn’t necessarily realize it at the time. An older patient, feeling alone and lonely, waved the teenager to his bedside for a chat and she obliged. “He thanked me profusely for having helped him,” she said. “I didn’t understand what I had done, but it was one of those moments that was huge.”
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Management of Asymptomatic Rising PSA After Prostatectomy or Radiation TherapyControversy exists over the optimal management of patients with an asymptomatic rising prostate-specific antigen (PSA) following definitive therapy for clinically localized prostate adenocarcinoma.
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Surgical Management of Pancreatic CancerPancreatic cancer is the fifth leading cause of cancer death in the United States, with an overall survival rate of 3%. Unfortunately, only a minority of patients present with localized disease amenable to surgical resection.
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Cognitive Function After Systemic Therapy for Breast CancerAnecdotal reports of cognitive compromise among patients treated with chemotherapy are relatively common among breast cancer survivors and may play an important role in adversely affecting functioning in multiple domains. As noted by Dr. Olin,
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Hepatic Colorectal Metastasis: Current Status of Surgical TherapyMetastatic colorectal cancer to the liver develops in over 50,000 US patients each year and is rapidly fatal if untreated. Even the most active chemotherapeutic agents rarely prolong survival for more than 3 years. Liver
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Use of Hematopoietic Hormones for Bone Marrow Defects in AIDSAnemia is a common complication of HIV infection. Erythropoietin (Procrit, Epogen) can correct anemia. When given to patients with HIV infection, erythropoietin ameliorates anemia and improves quality of life. Given these three facts, one wonders why an effective drug such as erythropoietin is not used appropriately in patients with HIV infections.
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Management of Metastatic Cutaneous MelanomaAlthough chemotherapy regimenscan produce objectiveresponses in patients withmetastatic melanoma, curative responsesare extremely rare. It is thereforeof significant interest that themajority of complete responses to immunotherapywith high-dose interleukin(IL)-2 (Proleukin) alone aredurable and probably curative.[1]
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Adjuvant Chemotherapy for Colon Cancer in the Elderly: Moving From Evidence to PracticeStates population will be over 65 years old, with 2% of the population over 84. The corresponding projections for 2050 are 21% and 5%, respectively.[1] These projections underscore the aging of the population, with most recent estimates of life expectancy hitting a record high of 78.1 years.[2] With Americans living longer than ever before, physicians are already seeing larger numbers of elderly patients with cancers whose incidence increases with age, including colon cancer.
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A Pharmacoeconomic Comparison of UFT and 5-FU Chemotherapy for Colorectal Cancer in South AmericaThe escalating role played by managed care organizations in the health-care system is reflected in the increased demand for cost-effectiveness analyses (CEAs) to assess the balance between economic impact
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Paclitaxel and UFT Plus Oral Calcium Folinate in Pretreated Metastatic Breast CancerThis phase I study was designed to determine the maximum tolerated dose (MTD) and dose-limiting side effects of combination treatment with paclitaxel (Taxol) and UFT (uracil and tegafur in a 4:1 molar ratio) plus oral
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Malignant Angiomyolipoma: a Rare Entity With Unusual BiologyThe authors present an interesting case of a very rare renal neoplasm, malignant epithelioid angiomyolipoma (AML), which belongs to a family of mesenchymal tumors known as perivascular epithelioid tumors (PEComas).
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Current Status and Optimal Use of RadiosurgeryThe field of stereotactic radiosurgery is rapidly advancing as a result of both improvements in radiosurgical equipment and better physician understanding of the clinical applications of stereotactic radiosurgery. This
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Myelodysplastic Syndromes: Where Do We Go From Here?The review by Dr. Akhtari outlines the diagnosis, prognosis, and treatment options for patients with myelodysplastic syndromes (MDS), and touches on the current challenges in treating patients suffering from MDS.
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Adjuvant/Neoadjuvant Chemoradiation for Gastric and Pancreatic CancerBoth gastric and pancreatic cancer remain leading causes of cancer death in the United States and worldwide. While surgical resection continues to be required for long-term cure of both these neoplasms, 5-year survival
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Substance Abuse Issues in Cancer Patients:The relationship between the therapeutic use of potentially abusable drugs for symptom control and the multifaceted nature of abuse and addiction is extremely complex. Research is only beginning to elucidate the
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Clinical Status of Laparoscopic Bowel Surgery for GI MalignancyLaparoscopic colorectal surgery is being utilized increasingly for benign diseases. Recent published series have proven that morbidity and mortality from laparoscopic procedures are superior to those seen after traditional open
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Current Status of Retinoid Chemoprevention of Lung CancerClinical trials have suggested that retinoid chemoprevention prevents the development of second primary tumors following head and neck or non-small-cell lung cancer. The findings of these initial studies are now being
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Head and neck tumorsIn 2009, approximately 35,720 men and women (25,240 men and 10,480 women) in the United States will be diagnosed with cancer of the oral cavity and pharynx, and 7,600 will succumb to these diseases. Further, an estimated 12,290 men and women (9,920 men and 2,370 women) in the United States will be diagnosed with laryngeal cancer, and 3,660 will die from this malignancy. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).
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Improving the Toxicity of Irinotecan/5-FU/ Leucovorin: A 21-Day ScheduleIrinotecan (CPT-11, Camptosar) is one of the new generation ofchemotherapeutic agents that has activity in advanced colorectal cancer.It has antitumor efficacy as a single agent, and also has beencombined with fluorouracil (5-FU) and leucovorin (IFL) to treat thesepatients. Randomized studies have confirmed the superiority of IFL to5-FU and leucovorin alone with regard to patient survival, time toprogression, and tumor response rate. The optimal schedule for combiningthese agents remains uncertain, but in the United States, theschedule of IFL weekly for 4 consecutive weeks repeated every 6 weeks,according to the schedule reported by Saltz et al, has been widely used,although with some toxicity (especially myelosuppression and diarrhea).In an attempt to improve the tolerability of IFL, some haveadvocated modifying the schedule of IFL to weekly for 2 weeks, withrepeated cycles every 21 days. Twenty-three patients with advancedcolorectal cancer have been treated on this schedule at a single institution.Therapy was well tolerated, with 35% of patients experiencinggrade 3/4 neutropenia, two of whom had episodes of febrile neutropenia,and 9% with grade 3/4 diarrhea. The median relative dose intensityof irinotecan administered in the first 18 patients treated with thisregimen was 94%. These data support the hypothesis that modifying theschedule of administration of IFL improves the tolerability and abilityto deliver the regimen, but must be confirmed by randomized prospectivestudies, which may also attempt to evaluate the role of bolus 5-FUin the treatment of advanced colorectal cancer.
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Should IMRT Be the New Standard in Esophageal Cancer?This video discusses the use of intensity-modulated radiation therapy and whether it should be the new standard for treating patients with esophageal cancer.
