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Intraoperative Radiotherapy for Breast Cancer: Its Perceived SimplicityWith many centers seeking to adopt IORT, there are licensing, proctoring, staffing, technical support, and reimbursement issues that need to be considered. We have reviewed the current international experience and describe one community cancer center’s experience with initiating an IORT breast cancer program.
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CDK4/6 Inhibitors: Game Changers in the Management of Hormone Receptor–Positive Advanced Breast Cancer?Here, we review the current use of and potential next directions for CDK4/6 inhibitors in the treatment of patients with HR-positive breast cancer.
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Oncogenes Driving Squamous Cell Lung CarcinomaIn this interview we discuss the oncogenes driving the development of squamous cell carcinoma of the lung, a type of non-small-cell lung cancer.
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Strategies for Identification and Clinical Evaluation of Promising Chemopreventive AgentsStrategies for chemopreventative drug development are based on the use of well-characterized agents, intermediate biomarkers correlating to cancer incidence, and suitable cohorts for efficacy studies. Since
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POINT: Surgical Management of Lymph Node Basin in Sentinel Lymph Node–Positive MelanomaCLND as standard of care for patients with SLN-positive metastatic melanoma is supported by a wealth of compelling prospective data.
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Radiosurgery and Immunotherapy for Melanoma Patients With Brain MetastasesIn this video we discuss the use of concurrent immunotherapy and stereotactic radiosurgery for treatment of melanoma brain metastases.
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Breast Cancer After Hodgkin Lymphoma: The Price of SuccessCurative therapy, including chest RT for Hodgkin lymphoma, is associated with a definitively increased risk of breast cancer, most often manifesting approximately 20 years after treatment. These breast cancers tend to be more aggressive, with greater frequency of hormone receptor negativity and potential HER2 positivity.
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Addressing Psychological Challenges After Cancer: A Guide for Clinical PracticeThe person diagnosed with cancer typically is confronted with a variety of difficult challenges. Treatment for cancer can be physically arduous, it generally disrupts patients’ social and work life, and it may even limit their ability to care for themselves or live independently for some period of time. In addition to these physical and functional burdens, cancer patients often face fears of death or disability, and may be prone to feelings of isolation or depression.
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Update on European Adjuvant Trials With Irinotecan for Colorectal CancerRecent combinations of chemotherapy have significantly improved the response rate and survival time for patients with metastatic colorectal cancer.
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Review of Docetaxel/Doxorubicin Combination in Metastatic Breast CancerDocetaxel (Taxotere) and doxorubicin (Adriamycin) have each demonstrated significant activity in metastatic breast cancer. Thus, the combination of docetaxel and doxorubicin has been evaluated in phase I trials to
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The Promise of Pharmacogenomics: Gemcitabine and PemetrexedAlthough 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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Primary Chemotherapy With Docetaxel for the Management of Breast CancerSeveral clinical trials have explored the efficacy of docetaxel (Taxotere) as primary chemotherapy for breast cancer. Docetaxel has been evaluated as single-agent therapy, sequentially as a single agent following anthracycline-containing regimens, and in combination with anthracyclines, cisplatin, and trastuzumab (Herceptin) in patients with high-risk early breast cancer.
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Non-Hodgkin's Lymphoma in the Elderly (Part 2: Treatment of Diffuse Aggressive Lymphomas)As 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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Cytotoxic Chemotherapy for Adult Soft-Tissue Sarcomas: A Lesson in HumilityThe unfortunate fact remains that the main chemotherapy option for patients with adult soft-tissue sarcoma is doxorubicin, a drug first identified 4 decades ago.
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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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Treating Anaplastic Oligodendrogliomas and WHO Grade 2 Gliomas: PCV or Temozolomide? The Case for PCVIn most cases, PCV chemotherapy will provide an edge in outcomes over TMZ for glioma patients, primarily because of the former regimen’s use of multiple drugs and their complementary interactions.
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Commentary (Neel/Sober)-Mohs Micrographic Surgery: Established Uses and Emerging TrendsPennington and Leffell have reviewedthe literature with regardto the relative efficacy ofthe Mohs technique vs conventionalsurgery in the treatment of commonand uncommon cutaneous neoplasms.The reason for the success of Mohssurgery can be summarized simply: TheMohs surgeon examines the entire microscopicsurgical margin for tumor,whereas the pathologist working with aconventional surgeon does not.
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Commentary (Cohen/Khuri): Treatment of Non–Small-Cell Lung Cancer in Older PersonsThe importance of cancer as aproblem in the elderly is gainingincreasing appreciationdue, in part, to the demographicchanges taking place in this countryand around the world and their associationto the incidence of cancer.Ongoing epidemiologic research overthe past several decades has consistentlyconfirmed the continuing trendtoward an aging population. In theUnited States, an anticipated 20.1%of the population will be 65 years ofage or older by 2030, the number ofpeople 75 years of age or older willhave tripled, and the 85-or-older agegroup will have doubled.[1]
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Preventing Breast Cancer in High-Risk Women, 2008Several large, prospective trials have evaluated tamoxifen compared with placebo for breast cancer risk reduction in women at increased risk for breast cancer. Analysis of the large, prospective breast cancer risk-reduction trials that used tamoxifen estimated that tamoxifen decreased breast cancer incidence by 38% on average and estrogen receptor–positive tumors by 48%.
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Gemcitabine and Paclitaxel as Salvage Therapy in Metastatic Breast CancerIn a phase II trial, 29 patients with anthracycline-pretreated or anthracycline-resistant metastatic breast cancer in whom anthracycline-containing first- or second-line chemotherapy failed received combination paclitaxel
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Pediatric Cancers in the New Millennium: Dramatic Progress, New ChallengesOver 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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Book Review:Pediatric Hematology, Second EditionThe 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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Helping Patients Access Protections of the ADAWhen she learned that she had breast cancer, Patricia Garrett did what many people with cancer do: she continued working.
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Treatment of Advanced Head and Neck Cancer: Past, Present, and FutureBruce Culliney and colleagues have provided a thorough and well written summary of the literature regarding multimodality treatment of patients with locoregionally advanced or unresectable head and neck malignancies. In particular, they offer a detailed outline of recent insights into radiation dosing and fractionation and their optimal use in the combined-modality setting.
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Supportive Care of the Patient With Pancreatic Cancer: The Role of the Oncology Social WorkerThe goals of oncology social work are to facilitate patient and family adjustment to the diagnosis and treatment of the disease; to promote psychosocial recovery and rehabilitation
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Chemotherapy-Induced Peripheral Neuropathy in Cancer SurvivorsChemotherapy-induced peripheral neuropathy (CIPN) is one of the most challenging and complex complications of cancer chemotherapy.
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The Role of Cytotoxic Chemotherapy in Prostate CancerIn this review, we describe how clinical investigators addressed some of the challenges in prostate cancer chemotherapy trials 20 years ago, and we indicate what has evolved in the field since that time. We consider the impact that prostate-specific antigen measurement had in this setting, evolving clinical paradigms, multidisciplinary programs, and the current armamentarium of cancer treatment, including targeted molecular therapy, for patients with hormone-refractory disease.
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Future Directions for the Management of HER2+ mBCNeil Iyengar, MD; Claudine Isaacs, MD; Virginia Kaklamani, MD; and Vijayakrishna Gadi, MD, PhD, share clinical pearls for the evolving treatment landscape of HER+ metastatic breast cancer.
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Is There a Role for Octreotide in the Treatment of Hormone-Refractory Prostate Cancer?Normal and hyperplastic prostate glandular epithelium does not express somatostatin receptors. Neuroendocrine prostatic cells contain bioactive secretory products such as chromogranin A, serotonin, and neuron-specific enolase. The stromal smooth muscle cells around glandular epithelium and ganglion cells of the prostatic plexus are positive for somatostatin subtype 2 receptors (sst 2).[1] In prostate cancer, however, there is nonhomogeneous distribution of sst 1. In the peritumoral veins of prostate cancer, sst 2 receptors were found by Reubi et al in 14 of 27 samples.[2]
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Clinical Status and Optimal Use of the Cardioprotectant, DexrazoxaneDr. Blum has written a comprehensive summary of the natural history, pathology, prevention, and management of anthracycline-induced cardiotoxicity. His excellent state-of-the-art review updates readers on most of the recent advances in this field.
