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The Long Road-and the High Road-to Successful Implementation of OncoEMRWhat distinguishes those practices that are successful in their use of the EMR is their commitment to the product and their recognition that it is the central element in the treatment of their patients.
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Current Strategies for the Immunotherapy of Multiple MyelomaHere we outline the most promising novel cellular immune strategies for patients with multiple myeloma. In addition, we highlight combinatorial approaches that, it is hoped, will further optimize cellular immunotherapies for myeloma and lead to deep and durable responses and, possibly, even cures.
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UFT/Leucovorin Plus Irinotecan in Advanced or Metastatic Colorectal CancerUFT (with leucovorin) and irinotecan both have single-agent activity in colorectal cancer, with non–cross-resistant mechanisms of action. Combining these drugs would be anticipated to increase response rates while maintaining the advantages of a regimen based on an orally administered fluoropyrimidine.
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Unrelated Donor StemCell Transplantation: The Role of the National Marrow Donor ProgramApproximately 70% of patientswith life-threatening diseasestreatable with allogeneic bloodstem cell transplantation do not havematched related donors. The NationalMarrow Donor Program (NMDP) wasestablished in 1986 to provide humanleukocyte antigen (HLA)-matched,volunteer unrelated donors for thesepatients. The NMDP performs thistask by maintaining a registry of morethan 4.9 million volunteer donors ofmarrow and peripheral blood stemcells (PBSC) and 12 cord blood bankscontaining more than 25,000 units ofumbilical cord blood.
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Current Combined Treatment of High-Grade OsteosarcomasThe evaluation and treatment of osteosarcoma have evolved considerably over the past 2 decades, with corresponding dramatic improvements in prognosis. In large part, the improved outlook is attributable to
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Managing Colorectal Cancer Liver MetastasesThe combined-modality care of the patient with colon or rectal cancer metastatic to the liver demands a team approach. It is little wonder that there is much confusion about this topic, given the number of unique treatment options that are delivered in a sequential and reiterative process. The concept of multidisciplinary approaches to complex cancer challenges has been adopted for a variety of tumor types and situations.
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Do Oncogenic Drivers Exist in Squamous Cell Carcinoma of the Lung?The Cancer Genome Atlas provides us with our first thorough insight into the genetic heterogeneity of squamous cell carcinoma of the lung; whether these findings will translate into personalized squamous cell lung cancer therapy is yet to be determined.
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Thalidomide in Solid Tumors: The London ExperienceInvestigators at the Royal Marsden Hospital and University College in London have studied thalidomide (Thalomid) as both low-dose (100 mg orally, every night) and high-dose (600 mg, given as 300 mg twice per day)
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Pathologic Evaluation of Prostatic Carcinoma: Critical Information for the OncologistDr. Epstein provides a comprehensive review of the pathology of prostatic carcinoma and its importance in guiding the clinical management of treatment for our patients with abnormal prostates and prostate cancer. Prostate cancer, its evaluation, screening, and treatment, remain in many aspects the most controversial for the urologic oncologist. Clearly, our decisions on how we treat patients with elevated PSA's, abnormal prostate exams, and a diagnosis of prostate cancer is influenced greatly by the interpretation of the pathologist of biopsies and radical prostatectomy specimens. In short, the oncologist and urologist are unable to make intelligent and accurate recommendations without accurate pathologic review.
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Small Steps Forward in the Land of Small TumorsMetastatic well or moderately differentiated neuroendocrine tumors of the gastrointestinal tract and lung (NETs) are a fascinating and markedly heterogeneous group of generally indolent, but relentless cancers.
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Commentary (Kinsella): Current Status of Radiation Sensitization by FluoropyrimidinesDrs. Pu, Robertson, and Lawrence provide a concise update of recent laboratory and clinical studies of fluoropyrimidine radiosensitization. From a clinical perspective, one can conclude that this drug-radiation interaction appears to be greater than additive and clearly has resulted in significant therapeutic gains, particularly for gastrointestinal cancers, as summarized in Tables 2 and 3 of their article. From a laboratory perspective, the focus has now shifted to trying to better understand the mechanisms of the interaction as related to molecular events at the G1/S interphase and in early S phase.
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Timothy Moynihan, MD, on ‘Death Cafés’ and the Importance of Discussing End-of-Life Issues With Your PatientsThis interview discusses the importance of discussing end-of-life issues with patients.
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Update on Adjuvant Chemotherapy for Early Breast CancerAdjuvant chemotherapy represents a significant advance in the management of early-stage breast cancer and, as such, has saved many lives. Worldwide, adjuvant chemotherapy has benefitted all groups tested, including
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PSA Testing in Prostate Cancer: Early Treatment vs ObservationIn this interview we discuss the role of early treatment, active surveillance, and watchful waiting in patients with PSA-detected early-stage prostate cancer.
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Cancer Chemotherapy in the Elderly PatientThe management of older patients with cancer is historically challenging because of a lack of prospective data regarding the appropriate management of this population. In this review, we address some of the issues and challenges surrounding the treatment of older cancer patients, including the withholding of medically appropriate treatment based on chronologic age, the historical omission of elderly from clinical trials, and the impact of geriatric assessment, and age-related changes in pharmacokinetics and pharmacodynamics. Finally, we conclude by discussing the existing evidence related to cancer treatment in the elderly, focusing primarily on the malignancies most commonly seen in older patients, and making general treatment recommendations where applicable.
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Primary Cutaneous CD30+ Lymphoproliferative Disorders: New Insights Into Biology and TherapyThe spectrum of CD30+ lymphoproliferative diseases of the skin includes CD30+ cutaneous anaplastic large cell lymphoma, lymphomatoid papulosis, as well as borderline cases. These entities constitute the second most common group of cutaneous lymphomas according to the newly revised World Health Organization and European Organisation for Research and Treatment of Cancer consensus classification. Recent progress in immune and molecular biology, and identification of therapeutic targets have increased our understanding of these diseases and have led to novel treatment approaches. This review will provide an update on recent findings of immunologic, molecular, cytogenetic features and treatment strategies for patients with CD30+ lympho-proliferative diseases.
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ACR Appropriateness Criteria® Borderline and Unresectable Pancreas CancerThese guidelines review the use of radiation, chemotherapy, and surgery in borderline and unresectable pancreas cancer. Radiation technique, dose, and targets were evaluated, as was the recommended chemotherapy, administered either alone or concurrently with radiation. This report will aid clinicians in determining guidelines for the optimal treatment of borderline and unresectable pancreatic cancer.
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Multidisciplinary Management of Breast Cancer Brain MetastasesThis review summarizes the most up-to-date approach to the multidisciplinary management of patients with breast cancer brain metastases.
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Yoga and cancer care: Guide your patients down the right pathDr. McCall is a board-certified internist and the medical editor of Yoga Journal. He is the author of Yoga as Medicine: The Yogic Prescription for Health and Healing (Bantam, 2007). He can be found on the Web at www.DrMcCall.com.
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The Prostate Cancer Intervention Versus Observation Trial (PIVOT)The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is a randomized trial designed to determine whether radical prostatectomy or expectant management provides superior length and quality of life for men with clinically localized prostate cancer. Conducted at Department of Veterans Affairs and National Cancer Institute medical centers, PIVOT will enroll over 1,000 individuals less than 75 years of age. The primary study end point is all-cause mortality. Secondary outcomes include prostate cancer- and treatment-specific morbidity and mortality, health status, predictors of disease-specific outcomes, and cost-effectiveness. Within the first 3 years of enrollment, over 400 men have been randomized. Early analysis of participants' baseline characteristics indicate that enrollees are representative of men diagnosed with clinically localized prostate cancer throughout the United States. Therefore, results of PIVOT will be generalizable. These results are necessary in order to determine the preferred therapy for clinically localized prostate cancer. [ONCOLOGY 11(8):1133-1143, 1997]
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ACR Appropriateness Criteria® Postradical Prostatectomy Irradiation in Prostate CancerThe purpose of this article is to present an updated set of American College of Radiology consensus guidelines formed from an expert panel on the appropriate use of radiation therapy in postprostatectomy prostate cancer.
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Brachytherapy Boost Techniques for Locally Advanced Prostate CancerDr. Vicini and colleagues provide an excellent review of the experience to date utilizing interstitial brachytherapy in the treatment of locally advanced prostate cancer. As the authors mention, ample evidence suggests the existence of a dose-
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Stereotactic Radiosurgery for Brain MetastasesWorldwide, approximately 100,000 patients have undergone stereotactic radiosurgery for a variety of intracranial lesions, of which brain metastases represent the most common treatment indication. This article summarizes the major issues surrounding the management of brain metastases, and also analyzes 21 independent reports of Gamma Knife– or linear accelerator–based radiosurgery, representing over 1,700 patients and more than 2,700 lesions. Variable reporting in the studies precludes a definitive, rigorous analysis, but the composite data reveal an average local control rate of 83% and median survival of 9.6 months, both of which are comparable to results in recent surgical reports. The most important prognostic factors for survival appear to be fewer than three lesions, controlled extracranial disease, and Karnofsky performance score (KPS). The exact impact of dose has not been clarified, but a dose-response relationship, especially for ³ 18 Gy, is emerging. The role of whole-brain radiotherapy remains unresolved. It may enhance local control but does not convincingly improve survival and, in some series, is associated with an increased risk of late complications. Chronic steroid dependence and increased intracranial edema do not appear to be common problems. This is an opportune time for the completion of ongoing randomized trials to validate these observations. [ONCOLOGY 13(10):1397-1409,1999]
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Commentary (Collins/Hurwitz)-Epidermal Growth Factor Receptor Inhibitors for the Treatment of Colorectal Cancer: A Promise Fulfilled?Damjanov and Meropol havedone an excellent job of reviewingboth the complex biologyof epidermal growth factor signalingand the current status ofepidermal growth factor receptor(EGFR, ErbB-1) inhibition for thetreatment of colorectal cancer. As theypoint out, several factors have madeEGFR a potentially high-value targetin cancer therapy. In addition, theyreview several phase II studies thathave demonstrated clinical activity foranti-EGFR antibodies in patients withadvanced colorectal cancer.
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Is Personalized Medicine Here?This review describes the achievements in therapeutic and molecular diagnostics, details evolving molecular platforms, and highlights the challenges for the translation of these developments to daily clinical practice.
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Lymphatic Mapping in the Treatment of Breast CancerDeveloped initially for the treatment of malignant melanoma, lymphatic mapping and sentinel lymph node biopsy have recently been introduced into the treatment of early breast cancer. In breast cancer patients, harvested
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Management of Lymph Node–Positive Prostate Cancer: The Role of Surgery and Radiation TherapyCurrent evidence for the management of lymph node–positive prostate cancer suggests both a disease-control and survival benefit to systemic ADT plus surgery and radiation.
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Health Resource Utilization in ABMT With and Without G-CSF in Stage III/IV Breast Cancer PatientsG-CSF has been available since 1991 for use in patients receiving high-dose chemotherapy/ABMT, and while it has been shown to effectively reduce the risk of febrile neutropenia, its cost effectiveness has been open to question. In this small retrospective study, five indicators of the consumption of health care resources were examined in stage III/IV breast cancer patients who received high-dose chemotherapy with ABMT or peripheral stem cell support. The study covered the time periods before and after the availability of G-CSF. The results showed that patients who received G-CSF had reductions in length of hospital stay of 20% (the purged marrow group) and 17% (nonpurged group), compared with similar groups that did not receive the growth factor; the shortest lengths of stay were seen in the peripheral stem cell group, all of whom received G-CSF. Other findings, including number of days the ANC fell below 500, total days of G-CSF use, and total days of antibiotic use, are presented. [ONCOLOGY 9(Suppl):107-110, 1995]
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Managing Glioblastoma in the Elderly Patient: New OpportunitiesThis review discusses best practices for the treatment of glioblastoma in patients older than 65 years, and highlights management concerns in caring for this particular patient population.
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Novel and Expanded Oncology Drug Approvals of 2016-PART 1: New Options in Solid Tumor ManagementThis article focuses on the new agents and indications that emerged in 2016 for solid tumor treatment. We review the drug indications, mechanisms of action, pivotal trial data, pertinent toxicities, use in special populations, and the appropriate clinical contexts for treatment planning.
