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Patients with locally advanced cancers have a poor prognosis when treated with radiotherapy and/or surgery alone. The appearance of distant metastases shortly after removal of the primary tumor indicates that micrometastases are already present at the time of diagnosis. We observed a favorable outcome in patients with locally advanced breast cancer treated with a prolonged regimen of neoadjuvant chemotherapy plus granulocyte-macrophage colony-stimulating factor (GM-CSF [Leukine]) compared with patients receiving fewer chemotherapy cycles prior to surgery and radiotherapy. These results can partly be explained by the dose-intensive regimen used, but biologic and immunologic processes inherent to the prolonged presence of the primary tumor and its draining lymph nodes might also contribute to the beneficial outcome. The effects of the prolonged presence of the primary tumor during chemotherapy and GM-CSF administration on the antitumor immune response, and more specifically the functional properties of dendritic cells and T cells, are currently being investigated in a multicenter randomized clinical trial comparing prolonged neoadjuvant chemotherapy plus cytokines with a conventional treatment schedule. Aside from investigations concerning the immune system, other biologic processes, such as tumor angiogenesis, are being investigated at the same time. [ONCOLOGY 16(Suppl 1):32-39, 2002]

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A phase 1 trial assessed the use of PSCA-directed CAR T cells in patients with metastatic castration-resistant prostate cancer.

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This look ahead at hematologic malignancies in 2017 focuses on new agents being studied for the treatment of acute leukemias, myelodysplastic syndromes, and chronic lymphocytic leukemia.

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Cancer Network spoke with Taofeek Kunle Owonikoko, MD, PhD, of Emory University, about talazoparib for patients with HRRD-positive stage IV squamous cell lung cancer.

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Here, 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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In this video, Tari A. King, MD, of the Memorial Sloan-Kettering Cancer Center, discusses what to look for at this year’s ASCO Breast Cancer Symposium.

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Until recently, the standard treatment for newly diagnosed patientswith chronic myeloid leukemia (CML) in chronic phase who were noteligible for allogeneic stem cell transplant was interferon-alfa alone orin combination with low-dose cytarabine. Moreover, about 20% to 25%of patients who were relatively young and had suitable HLA-matcheddonors have in recent years been offered treatment by allogeneic stemcell transplantation, a procedure that can cure CML but is associatedwith an appreciable risk of morbidity and mortality. However, followingthe recognition in the 1980s that the p210 oncoprotein encoded bythe BCR-ABL fusion gene on the Philadelphia chromosome had greatlyenhanced tyrosine kinase activity and was probably the initiating eventin the chronic phase of CML, much effort was directed toward developmentof drugs that would selectively inhibit this kinase activity. In 1998these efforts culminated in the first clinical use of imatinib mesylate(Gleevec), which has since been shown to produce impressive results intreatment of patients with CML in chronic phase. In previously untreatedpatients, the incidence of complete cytogenetic responses exceeds80%, and the majority of responses appear thus far to be durable.Imatinib also proved active in patients with accelerated phase and blasticphase disease, but in most of these cases, the benefits have been relativelyshort-lived. The advent of imatinib has thus necessitated a fundamentalreappraisal of the approach to the initial management of CML.

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Despite the fact that elderly patients comprise over 50% of the non-small cell lung cancer (NSCLC) population, our knowledge regarding the efficacy and safety of chemotherapy in this group is suboptimal. The “elderly” (defined as individuals ≥70 years of age) experience physiologically normal aging of their bone marrow and kidneys, which inherently increases toxicity to therapy. Standard practice has often been to discourage the use of combination chemotherapy in these patients; however, general consensus guidelines emphasize that performance status should primarily guide the choice of treatment. Elderly patients with advanced NSCLC treated with platinum doublet therapy demonstrate similar efficacy (but increased toxicity) to their younger counterparts. Patients with metastatic disease in which a targeted and/or biological agent(s) was added to chemotherapy experienced benefits similar to those treated with standard platinum doublets, but with increased morbidity and mortality. In the future, effective testing of molecular targeted therapies will have to include elderly patients among research cohorts or risk excluding a large population of eligible patients. Overall, elderly patients with advanced NSCLC, while experiencing greater toxicity, demonstrate the same response rates and survival benefits as their younger peers.

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The article by Dr. William Small on the role of radiation therapy in the treatment of breast cancer is a comprehensive review of the current standards of care and highlights the controversies surrounding recent trends. Breast cancer treatment has come full circle in the last 20 years, with emphasis now being placed on technical advances and treatment techniques as new data substantiate the impact of radiation therapy on survival following local surgery and mastectomy.

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A trial was designed to examine the combination of UFT and mitomycin (Mutamycin) plus tamoxifen (Nolvadex) as postoperative adjuvant therapy in the treatment of patients with stage II, estrogen receptor (ER)-positive

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The use of high-intensity focused ultrasound (HIFU) as a method for ablation of a localized tumor growth is not new. Several attempts have been made to apply the principles of HIFU to the treatment of pelvic, brain, and gastrointestinal tumors. However, only in the past decade has our understanding of the basic principles of HIFU allowed us to further exploit its application as a radical and truly noninvasive, intent-to-treat, ablative method for treating organ-confined prostate cancer. Prostate cancer remains an elusive disease, with many questions surrounding its natural history and the selection of appropriate patients for treatment yet to be answered. HIFU may play a crucial role in our search for an efficacious and safe primary treatment for localized prostate cancer. Its noninvasive and unlimited repeatability potential is appealing and unique; however, long-term results from controlled studies are needed before we embrace this new technology. Furthermore, a better understanding of HIFU's clinical limitations is vital before this treatment modality can be recommended to patients who are not involved in well-designed clinical studies. This review summarizes current knowledge about the basic principles of HIFU and its reported efficacy and morbidity in clinical series published since 2000.

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A total of 332 patients with advanced non-small-cell lung cancer were randomized by the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative

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As a variety of new hormonal agents are increasing survival times for men with metastatic disease, it is becoming increasingly important to consider cardiovascular, renal, and other potentially more serious risks associated with long-term ADT, especially in an aging population.

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Authors von Gunten, Lutz, and Ferris have provided oncologists, and all physicians with patients who have cancer, an excellent and pithy review of how those with very advanced cancer are currently cared for as they approach the end-of-life

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Drs. Konner and O’Reilly have provided a thorough review of current perspectives on pancreatic cancer. The disease is lethal, difficult to diagnose in its early stages, and resistant to standard chemotherapy regimens. Surgery can be curative if performed when the tumor is small (< 2 cm), but only a minority of patients have small tumors.

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The second edition of Pediatric Hematolgy, edited by the text's original editors, John S. Lilleyman and Ian M. Hann, as well as a new editor, Victor S. Blanchette, completely updates and expands upon the first edition (published in 1992). The new edition grew from 15 to 40 chapters, with contributions by many of the most well-known investigators and clinicians in pediatric hematology in the world. The textbook will especially be of value to practicing clinicians, house staff, and students.

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Lung cancer remains the leading cause of cancer death in the United States, with only 16% of patients living 5 years or more after they are diagnosed.

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Although no overall differences in survival have been observed betweenthe many chemotherapy combinations in non–small-cell lungcancer, the clinical application of mRNA expression levels of amplifiedgenes may disclose many genetic influences on cytotoxic drug sensitivityand enable clinicians to tailor chemotherapy according to eachindividual’s gene profile. Specifically, the assessment of ribonucleotidereductase subunit M1 and thymidylate synthase mRNA expression levelsmight select patients who benefit from gemcitabine (Gemzar) orpemetrexed (Alimta) combinations. Until recently, clinical prognosticfactors such as performance status, weight loss, and lactate dehydrogenasewere the only parameters used to predict chemotherapy responseand survival. However, accumulated data indicate that overexpressionof genes involved in cancer glycolysis pathways plays an important role,and might be an independent mechanism of chemoresistance. Thedysregulation of glycolytic genes is affected by growth signals involvingthe PI3K/Akt pathway and downstream genes such as hypoxiainduciblefactor-1-alpha. One can thus envision that substantial improvementsin therapeutic outcome could benefit from the integrationof tailored ribonucleotide reductase-dependent chemotherapy, ribonucleotidereductase antisense therapy, and targeted therapy.

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Pain is one of the most feared consequences of cancer. Pain is a major symptom in 75% of hospitalized cancer patients. Poorly relieved pain contributes to the suffering of the patient and family, which may motivate them to seek additional complementary and alternative therapies. Evidence-based complementary therapies are being used for symptom control and to improve quality of life. There is recent research on several complementary therapies&#151;acupuncture, mind-body therapies, massage, reflexology, and Reiki&#151;that provides evidence for pain management. These therapies are not well utilized due to a lack of information on benefits, risks, and resources. There is a call for education to alert patients, families, nurses, and physicians to the benefits of evidence-based complementary therapies and to the dangers of "unproven" cancer therapies. Oncology nurses are ideally positioned to assess patients' pain, to educate patients, to determine with the patient and physician the most appropriate and safe complementary therapy for pain, to refer patients to appropriate resources, and in some cases to provide the therapy itself. This article will discuss specific complementary therapies for pain control and will arm nurses with the confidence to intervene with knowledge, referrals, and ideas for hands-on ­implementation.

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Epithelial ovarian cancer is the leading cause of death from gynecologic malignancies. In 1996, an estimated 26,000 new cases were diagnosed, and approximately 14,000 women died of this disease in the United States alone.[1] Between 75% and 80% of ovarian cancer patients present with advanced disease at diagnosis, and these patients have a 5-year survival rate of 21%.[2,3]

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Interest in complementary and alternative medicine (CAM) has grown dramatically over the past several years. Cancer patients are always looking for new hope, and many have turned to nontraditional means. This study was

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In the early 1980s, we first began to see cases of Kaposi's sarcoma (KS) in patients with the lymphadenopathy now known to be associated with infection by the human immunodeficiency virus (HIV). During that period, we

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Nearly 150,000 people will be diagnosed with colorectal cancer in the United States in 2006. The impact of this diagnosis will be felt by countless family members, coworkers, and friends. Although screening tests for colorectal cancer have been available and encouraged by medical associations such as the American Cancer Society (ACS) and others, public awareness and compliance has been dismal.

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The staging of lung cancer defines the extent of disease. Accurate staging is important to define operability, select treatment regimens, and predict survival. Nonsurgical and surgical techniques are used to stage patients. The

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Healthcare professionals must do more to address an issue that impacts a patient’s daily life.

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Bortezomib (PS-341, Velcade) is a novel, first-in-class proteasomeinhibitor with antitumor activity against a number of hematologic andnonhematologic malignancies.

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The American Cancer Society has estimated that 23,300 women will develop ovarian cancer in 2002, and 13,900 women will die from the disease.[1] The 5-year survival rate is about 80% for women with stage I disease, 50% for women with stage II disease, 25% for women with stage III disease, and 15% for women with stage IV disease. Among women with advanced-stage disease, optimal debulking surgery, as well as platinum/taxane-based adjuvant therapy prolongs disease-free and median survival.[2,3] Population-based data suggest that guidelines for therapy are not uniformly followed in community practice.[4] In addition, older patients appear to receive less aggressive treatment than younger patients.