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Follicular Lymphoma: a Focus on Current and Emerging TherapiesThis review article written by Kirk E. Cahill, MD, and Sonali M. Smith, MD, discusses standard and emerging therapies for the treatment of follicular lymphoma.
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Prophylactic Cranial Irradiation Improved Survival in Metastatic SCLCThis video examines the results of a retrospective study that compared chemotherapy alone or with prophylactic cranial irradiation in extensive-stage SCLC patients with no brain metastases.
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Deferasirox for the Treatment of Chronic Iron Overload in Transfusional HemosiderosisThis report describes the Food and Drug Administration's review of data and analyses leading to the approval of the oral iron chelator, deferasirox for the treatment of chronic iron overload due to transfusional hemosiderosis.
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Highlighting Childhood Brain CancersIn this interview we discuss updates, challenges, and contributing factors associated with pediatric brain cancers.
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An Alternative Algorithm for Dosing Transdermal Fentanyl for Cancer-Related PainMany cancer patients are undermedicated and inappropriately managed for pain, leading to a diminished quality of life. Patients with moderate to severe pain often require opioid analgesics. Recently published guidelines
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Topotecan in Combination With Cisplatin for the Treatment of Stage IVB, Recurrent, or Persistent Cervical CancerTopotecan, a camptothecin analog previously approved for the treatment of ovarian cancer and small-cell lung cancer, was granted regular approval by the US Food and Drug Administration (FDA) on June 14, 2006, for use in combination with cisplatin to treat women with stage IVB, recurrent, or persistent carcinoma of the cervix not amenable to curative treatment with surgery and/or radiation therapy. The purpose of this summary is to review the database supporting this approval.
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A Novel Weekday - on/Weekend - off UFT ScheduleIn a step toward a clinical trial, the tumor response and survival of a weekday-on/weekend-off schedule of UFT was compared with its conventional daily schedule in a cancer-bearing rat model. The dose-intensive schedule-600 mg of UFT for 5 days followed by 2 drug-free days-amounts to a weekly dose similar to the conventional schedule of 400 mg/day. The weekday-on/weekend-off schedule provided increased survival and significantly greater antitumor activity than the conventional daily schedule, with no difference in adverse reactions.
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Momelotinib May Become ‘No. 1 Choice’ for Second-Line Therapy in Myelofibrosis, Expert SaysMomelotinib continues to show benefit in reducing splenic symptoms and anemia in myelofibrosis in the second-line setting, making it a likely first treatment choice, according to an expert from the University of Texas MD Anderson Cancer Center.
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Race and Cancer Genetics: Lessons From BRCA1The study of cancer in specific populations can offer clues useful in determining the extrinsic and intrinsic factors influencing cancer in all populations. Extrinsic factors are sometimes called "environmental" in the broadest sense of the word. They are modifiable or mutable. Intrinsic factors are more inherent to the individual. They are almost always genetic and are immutable or unchangeable. Targeting research on specific populations is and should be a significant ethical issue.
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Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast CancerA phase II trial evaluated the effectiveness and toxicity of combination paclitaxel (Taxol), gemcitabine (Gemzar), and trastuzumab (Herceptin) as first-line therapy for patients with newly diagnosed HER2-overexpressing
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Recent Advances in the Treatment of Pediatric Brain TumorsCentral nervous system (CNS) cancers are the second most frequent malignancy in childhood. In recent years, significant advances in surgery, radiotherapy, and chemotherapy have improved survival in children with these tumors. However, a significant proportion of patients with CNS tumors suffer progressive disease despite such treatment.
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Novel Combinations With OxaliplatinOxaliplatin (Eloxatin) is a novel antineoplastic platinum derivative that may exert its cytotoxic effects by blocking DNA replication/transcription, thus resulting in cell death in proliferating cells, as well as apoptosis.
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Researchers identify regulatory protein domains that contribute to tumor cell survival and cancer progressionThe p90 ribosomal S6 kinase protein contributes to tumor cell proliferation and survival, the genetic disease Carney complex, and cardiac hypertrophy.
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Follow-up Care for Cancer: Making the Benefits Equal the CostThe article by Schwartz and colleagues is important and timely, and brings into focus an essential component of the practice of oncology. Posttreatment follow-up is not often emphasized in the training of our residents and fellows, and is often based on
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Fatigue and DyspneaFatigue and dyspnea are two of the most common symptoms associated with advanced cancer. Fatigue is also commonly associated with cancer treatment and occurs in up to 90% of patients undergoing chemotherapy.
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Granulocytic Sarcoma in a Patient With Myelodysplastic SyndromeOur case illustrates the fact that MDS-associated GS can be treated palliatively with radiation and hypomethylating agents in an appropriate setting. With the growing geriatric patient population, effective treatment options are needed in this disease.
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Topoisomerase I Inhibitors in the Treatment of Head and Neck CancerTraditionally, the role of chemotherapy in the treatment ofsquamous carcinoma of the head and neck has been confined to patients with
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Pancreatic Cancer in the Older PatientPancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local
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Active Surveillance of Prostate CancerActive surveillance is an excellent alternative to surgery or radiation in patients with low-risk cancers. However, the current methods of ascertaining whether a patient harbors a low-risk cancer are flawed.
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New Strategies, Targets in Triple-Negative Breast CancerThis video with Stacy Moulder, MD, highlights efforts to identify various subtypes and molecular targets in triple-negative breast cancer, which could lead to treatment options with already approved agents.
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Ductal Carcinoma in SituA 57-year-old patient presents for evaluation of right nipple discomfort. The patient has family history of a mother and sister with premenopausal breast cancer.
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Prostate ca survivor values regular PSA screeningReaders respond to “Two major studies add fuel to fire of PSA controversy,” April 2009, Cancer Care Practice & Policy, page 8.Like the vast majority of men, I was “stupid” where my healthcare was concerned. I never asked for a copy of my blood work or questioned the results of my tests. After all, we treat our doctors like gods.
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Textbook of Medical Oncology, 2nd EditionIn this day of encyclopedic oncology texts, frequently updated online reference sites, and literature searches at the click of a button, is there a place for a basic medical oncology textbook? The second edition of the Textbook of Medical Oncology, edited by Drs. Cavalli, Hansen, and Kaye, is approximately 50% longer than the first edition, due in large part to the inclusion of newer therapeutic approaches.
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Stereotactic Body Radiation TherapyStereotatic body radiation therapy (SBRT) is a rapidly evolving cancertreatment method in which concepts and techniques previously developedfor brain tumor radiosurgery are adapted to eradicate tumorselsewhere in the body. The spatial accuracy, conformality, and steepradiation dose gradients of radiosurgery, which have been critical to itssuccess in the treatment of intracranial tumors, are applied in SBRT totreat a variety of extracranial tumors. Early results demonstrate excellentresponse rates and low toxicity with a variety of hypofractionateddose regimens and localization/immobilization techniques. This articleprovides an overview of the rationale and results of SBRT for specificindications, descriptions of some methods of treatment delivery, anddiscussion of potential areas of future investigation.
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Persistence of Lymphedema Reduction After Noninvasive Complex Lymphedema TherapyWe treated 119 consecutive patients with lymphedema with complex lymphedema therapy (CLT). Lymphedema reductions after CLT averaged 62.6% in the 56 patients with one affected arm and 68.6% in the 38 patients with
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Chronic Myelogenous Leukemia: Update on Biology and TreatmentChronic myelogenous leukemia (CML) is a myeloproliferative disorder that follows a characteristic clinical course in which a chronic phase of variable duration precedes an accelerated, and ultimately blastic, phase,
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Perspectives on Salvage Therapy for Non–Small-Cell Lung CancerPlatinum-based chemotherapy offers a modest survival advantage overbest supportive care in chemotherapy-naive patients with a good performancestatus and advanced/metastatic non–small-cell lung cancer(NSCLC). Despite the survival benefit associated with first-line chemotherapy,the majority of patients will experience relapse or disease progression.In clinical practice, an increasing number of patients maintaina good performance status after first-line treatment and are eligible forfurther treatments. Docetaxel (Taxotere) at 75 mg/m2 given once every3 weeks has been the standard of care for second-line chemotherapy sincethe year 2000. Pemetrexed (Alimta) is a novel multitargeted antifolateagent with single-agent activity in first- and second-line treatment ofNSCLC. A large phase III study comparing docetaxel to pemetrexed insecond-line therapy demonstrated that pemetrexed is equally active andless toxic than docetaxel. Based on these results, pemetrexed is a reasonablesecond-line chemotherapy option for patients with recurrent, advancedNSCLC. Progress made in the field of molecular biology has led to theidentification of drugs active against specific cellular targets. Gefitinib(Iressa) and erlotinib (Tarceva) are both orally active tyrosine kinase inhibitorsof the epidermal growth factor receptor. Phase II and III trialshave demonstrated that these agents are active particularly in a subgroupof patients with specific biologic characteristics. Both drugs have beenapproved for the treatment of pretreated NSCLC. Other drugs, such ascetuximab (Erbitux) and bevacizumab (Avastin) have shown promisingactivity in NSCLC and are currently being tested in clinical trials.
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Pemetrexed in Gastric CancerGastric cancer is a major clinical challenge, with poor overall prognosisand limited life expectancy for patients with advanced disease.Even with surgery and other modalities, palliation is often difficult.Improvement of response rates has evolved with the development ofstandard regimens and those incorporating newer chemotherapy agents,such as oral fluoropyrimidines, the taxanes, camptothecins, novel platinums(eg, oxaliplatin [Eloxatin]), and antifolates (eg, pemetrexed[Alimta]). Ongoing trials with these regimens aim toward improvingsurvival, as well as improving the safety profile. It is hoped that in conjunctionwith molecular research in the pathogenesis of gastric cancerand development of targeted therapies in this disease, these trial datamight lead to the evolution of treatment strategies that could prove effective.
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Reassessments of ESAs for Cancer Treatment in the US and EuropeAnemia is a widely prevalent complication among cancer patients. At the time of diagnosis, 30% to 40% of patients with non-Hodgkin lymphoma or Hodgkin lymphoma and up to 70% of patients with multiple myeloma are anemic; rates are higher among persons with myelodysplastic syndromes. Among patients with solid cancers or lymphomas, up to half develop anemia following chemotherapy. For almost 2 decades, erythropoiesis-stimulating agents (ESAs) were the primary treatment for cancer-related anemia. However, reassessments of benefits and risks of ESAs for cancer-associated anemia have occurred internationally. We reviewed guidelines and notifications from regulatory agencies and manufacturers, reimbursement policies, and utilization for ESAs in the cancer and chronic kidney disease settings within the United States, Europe, and Canada. In 2008 the US Food and Drug Administration (FDA) restricted ESAs from cancer patients seeking cure. Reimbursement is limited to hemoglobin levels < 10 g/dL. In the United States, ESA usage increased 340% between 2001 and 2006, and decreased 60% since 2007. The European Medicines Agency (EMEA) recommended that ESA benefits do not outweigh risks. In Europe between 2001 and 2006, ESA use increased 51%; since 2006, use decreased by 10%. In 2009, Canadian manufacturers recommended usage based on patient preferences. In Canada in 2007, approximately 20% of anemic cancer patients received ESAs, a 20% increase since 2004. In contrast to Europe, where ESA use has increased over time, reassessments of ESA-associated safety concerns in the United States have resulted in marked decrements in ESA use among cancer patients.
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Multiple Myeloma: Role of Allogeneic TransplantationIn this article, Pandit and Vesole present a focused overview of allogeneic transplantation for multiple myeloma. Additionally, this article addresses the challenges of allogeneic transplantation, including continued relapse and treatment-related toxicity and mortality.
