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Fertility Preservation in Patients With Cervical CancerFertility preservation for patients diagnosed with early-stage cervical cancer is feasible and has gained acceptance within the gynecologic oncology community.
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UFT Plus Cisplatin With Concurrent Radiotherapy for Locally Advanced Non–Small-Cell Lung CancerA phase II study of combined-modality treatment consisting of uracil and tegafur (in a molar ratio of 4:1 [UFT]) plus cisplatin (Platinol) and concurrent radiotherapy was conducted to evaluate the activity of this regimen in
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The Evolution of Liver-Directed Treatments for Hepatic Colorectal MetastasesThis article will review the current practice of hepatic resection for colorectal liver metastases, including the possibility of combined resection of hepatic metastases at the time of resection of the primary cancer.
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Systemic Therapy for Lung Cancer Brain Metastases: A Rationale for Clinical TrialsDespite the high prevalence of brain metastases in patients with metastatic lung cancer, these patients have been excluded from enrollment in clinical trials of new therapeutic drugs. The reasons for exclusion have centered on concerns that the blood-brain barrier may impede drug delivery into brain metastases, that brain metastases confer a dismal survival for metastatic lung cancer patients, and that brain metastases carry risk for cerebrovascular hemorrhage. A focused, updated review of these issues, however, clearly shows that these particular concerns are unwarranted. An extensive review of clinical trials on the efficacy of chemotheraputic agents against lung cancer brain metastases is also provided. This collective information describes an area in need of therapeutic development and supports an initiative to evaluate novel targeted therapies for lung cancer brain metastases.
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Hepatocellular Carcinoma: The Search for Innovative Adjuvant TherapiesThis review summarizes the current data on efficacy and rationale of adjuvant treatment for hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT). The authors review prognostic factors for disease recurrence and adjuvant therapy after OLT, including systemic chemotherapy, intra-arterial chemoembolization, immunosuppressant effects, and sorafenib (Nexavar). Several interesting questions are raised in the article, including: (1) When is the best time to apply systemic chemotherapy?
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Bladder CancerIt is estimated that, in 1995, about 50,500 new cases of urinary bladder cancer will be diagnosed and that 11,200 patients will die of the diease. The most common malignant tumor of the urinary tract, bladder cancer accounts for 6.5% of all cancers annually. It is the fifth most common cancer among American men [1], and approximately three quarters of all cases occur in men.
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Commentary (Lim et al): Revisiting Induction Chemotherapy for Head and Neck CancerArgiris and colleagues report asystematic review evaluatingthe activity and potential roleof induction chemotherapy in patientswith previously untreated, locoregionallyadvanced squamous cell head andneck cancer.[1] They consider bothphase II and III published trials. Thedata reviewed in their paper, and theirthoughtful synthesis and interpretationof these data, highlight certain themes:
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UFT Plus Carboplatin for Head and Neck CancerCisplatin plus fluorouracil (5-FU) is widely accepted as neoadjuvant and adjuvant chemotherapy in the treatment of head and neck squamous cell carcinoma; UFT is also an active agent against this disease. In the first retrospective study, we examined the efficacy of UFT as adjuvant chemotherapy in patients with maxillary cancer.
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Resection for Thoracic Metastases From SarcomaIn this article, we provide an extensive review of patient selection criteria and surgical approaches, as well as of controversies regarding resection for metastatic sarcoma.
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Ground-Glass Opacity Lung Nodules in the Era of Lung Cancer CT Screening: Radiology, Pathology, and Clinical ManagementThis review focuses on the radiologic and pathologic features of ground-glass opacity nodules, along with the clinical management of these lesions.
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Neoadjuvant Endocrine Therapy for Breast Cancer: An Overlooked Option?For many oncologists, neoadjuvant treatment for breast cancer issynonymous with preoperative cytotoxic chemotherapy, regardless oftumor characteristics. Preoperative therapy with an endocrine agent isgenerally considered suitable only for the frail elderly or the medicallyunfit. However, favorable information regarding third-generationaromatase inhibitors in the treatment of all stages of breast cancerprompts a reconsideration of this bias. In light of the fact thatneoadjuvant therapy with aromatase inhibitors is restricted to postmenopausalwomen with strongly estrogen-receptor–positive tumors, the assumptionthat neoadjuvant combination chemotherapy is more efficaciousthan a third-generation aromatase inhibitor can be reasonablyquestioned. It is particularly remarkable that the outcome of a comparisonof adjuvant tamoxifen vs anastrozole (Arimidex)-the Arimidex,Tamoxifen Alone or in Combination (ATAC) trial-in more than 6,000patients was predicted by a neoadjuvant trial that showed an efficacyadvantage for a third-generation aromatase inhibitor (letrozole[Femara]) compared to tamoxifen in a sample of 337 patients afteronly 4 months of treatment. The potential of the neoadjuvant setting inefforts to identify new biologic agents that could build on the effectivenessof adjuvant aromatase inhibitors is therefore beginning to be appreciated.Finally, neoadjuvant therapy with an aromatase inhibitorcould be considered a sensitivity test of endocrine therapy that might beincorporated into strategies to individualize treatment according to response.For this possibility to be realized, however, a better understandingof the relationship between surrogates from the neoadjuvant settingand the long-term outcome of adjuvant aromatase inhibitor therapywill have to be established through practice-setting clinical trials.
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New Treatment Options and Management Considerations in Borderline Resectable Pancreatic CancerIn this article we will discuss the definitions of resectability, describe the current diagnostic tests for pancreatic cancer, and review strategies for maximizing treatment outcomes in patients with resectable pancreatic cancer.
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Hyperthermia as a Treatment for Bladder CancerModern cancer care is characterized by a focus on organ-sparing multi-modal treatments. In the case of non–muscle-invasive bladder cancer this is particularly true; treatment is focused on reducing the frequency of low-risk recurrences and preventing high-risk progression. Deep regional hyperthermia is an oncologic therapeutic modality that can help achieve these two goals. The combination of hyperthermia with chemotherapy and radiotherapy has improved patient outcomes in several tumor types. In this review, we highlight the biology of therapeutic fever-range hyperthermia, discuss how hyperthermia is administered and dosed, demonstrate how heat can be added to other treatment regimens, and summarize the data supporting the role of hyperthermia in the management of bladder cancer.
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UFT Plus Leucovorin for Metastatic Colorectal Cancer: Japanese ExperienceIn the United States and Europe, the combination of oral UFT plus leucovorin has been reported to produce objective responses and survival rates similar to those achieved with standard intravenous 5-fluorouracil plus leucovorin in patients with metastatic colorectal cancer, with reduced toxicity.
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Commentary (Zhong/Lynn): Some Elements of Prognosis in Terminal CancerThe claim that physicians make substantial, systematically optimistic errors in prognostication undergirds the article by Lamont and Christakis. This claim seems to contrast with our experience in the Study to Understand Prognoses and Preferences for
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Benefits, Barriers, and Challenges to Using Proton Therapy for Cancer TreatmentThis video reviews the benefits of proton therapy and some of the barriers and challenges preventing the integration of the technology into regular practice.
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Commentary (Dotan/Herr): Management of Patients With Muscle-Invasive and Metastatic Bladder CancerOptimal therapy for locally advancedbladder cancer aimsto prevent local recurrence,reduce the probability of distant metastasis,and improve survival. Radicalcystectomy coupled with a pelviclymph node dissection is the mainstaytreatment of locally invasive bladdercancer, curing the majority ofpatients with organ-confined bladdertumors, about half with extravesicaldisease, and a significant minoritywith lymph node metastases. Althoughradical cystectomy providesgood local and regional control of invasivebladder cancer, the recurrencefreeand overall survival rates are stillonly 63%–72% and 59%–66%, respectively,among all patients. Themajor predictors for disease-specificsurvival of patients following radicalcystectomy for bladder cancer are thepathologic stage of the primary tumorand status of lymph nodes at time ofcystectomy. Freedom from recurrenceat 5 years after cystectomy is 63%–72% for patients with organ-confineddisease and only 25%-37% for non-organ-confined disease.
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HER2-Targeted Therapy for Early-Stage Breast Cancer: A Comprehensive ReviewThis review discusses the treatment of primary, nonmetastatic HER2-positive breast cancer in the adjuvant and neoadjuvant settings-settings in which tremendous progress has been made.
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Zsofia K. Stadler, MD, on the Importance of Germline Analyses in Advanced CancerGermline analysis in patients with advanced cancer may play an important role in selecting FDA-approved treatments and clinical trial participation with germline-targeted therapeutics.
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Double Trouble: A Case of Concurrent De Novo T790M and L858R EGFR Mutations in Treatment-Naive Advanced Non–Small-Cell Lung CancerAn 81-year-old Chinese male never-smoker with a medical history of hypertension and hyperlipidemia presented with a productive cough and a 5-lb weight loss over 3 months.
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Proton Therapy for Prostate CancerThis review discusses the rationale, history, and current status of proton therapy for prostate cancer-and controversies regarding it.
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Optimizing Outcomes With Bevacizumab by Better Targeting Patients and TumorsNumerous preclinical and clinical studies have demonstrated a role for angiogenesis in the growth and progression of breast cancer. Elevated vascular endothelial growth factor (VEGF) levels have been demonstrated in association with poor outcomes, and thus, this finding is an attractive target for therapeutic intervention.
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Breast Implants Linked to Anaplastic Large-Cell LymphomaIn this interview we discuss the link between breast implants and anaplastic large-cell lymphoma, a rare type of T-cell lymphoma.
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Periodontal Disease Linked to Certain Cancer TypesIn this interview we discuss a recent study that linked periodontal disease with an increased cancer risk, specifically melanoma and cancers of the lung, breast, esophagus, and gallbladder.
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Adjuvant Endocrine Therapy in Postmenopausal Breast CancerThis video highlights trials studying the long-term impact of adjuvant tamoxifen and aromatase inhibitors for the treatment of patients with postmenopausal breast cancer.
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Breast Implants Linked to Anaplastic Large-Cell LymphomaIn this interview we discuss the link between breast implants and anaplastic large-cell lymphoma, a rare type of T-cell lymphoma.
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Role of Surgery in MesotheliomaThis video reviews the role of surgery in the management of patients with mesothelioma.
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Using Patient Variables in CML to Guide TreatmentThis video highlights patient variables, including kidney function or history of diabetes, that can help guide treatment in chronic myeloid leukemia.
