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Trastuzumab: Mechanisms of Resistance and Therapeutic OpportunitiesThe human epidermal growth factor receptor 2 (HER2) is a transmembrane receptor with tyrosine kinase activity overexpressed in about 20% to 25% of invasive carcinomas of the breast.
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Adjuvant Chemotherapy for Stage II Colon CancerAdjuvant therapy is defined as any treatment administered after surgical resection of a primary tumor with the intent of improving the patient’s outcome by eliminating any occult, viable tumor cells that may have remained after surgery.
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Pancreatic, Neuroendocrine GI, and Adrenal CancersThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of pancreatic cancer, pancreatic cystic neoplasms, pancreatic endocrine tumors (PETs), carcinoid tumors of the GI tract, adrenocortical carcinoma, and pheochromocytoma.
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Prostate Cancer in a Man With Multiple Previous Cancerspatient is a 67-year-old male with mild obstructive symptoms and an American Urology Association symptom score of 8.[1] He was noted to have a prostate-specific antigen (PSA) level of 3.2 ng/mL. Because this represented a significant increase in his PSA velocity (rate of change over time), he proceeded to have a biopsy, which was positive for prostate cancer. He has no other complaints and visits us for an opinion on the treatment of his prostate cancer.
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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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How We Treat Tumor Lysis SyndromeWhen tumor cells are rapidly broken down and their contents released into the extracellular space, the released ions and compounds can cause metabolic disturbances too great to be neutralized by the body's normal mechanisms.
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UFT and Oral Calcium Folinate as First-Line Chemotherapy for Metastatic Gastric CancerLocally advanced or metastatic adenocarcinoma of the stomach still carries a poor prognosis, with 5-year survival rates of < 15%. Palliative chemotherapeutic regimens for this disease are largely 5-FU–based. We
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Is Neoadjuvant Chemotherapy in Ovarian Cancer an Excuse for Insufficient Surgery?Surgical debulking of epithelial ovarian carcinoma has been a mainstay of therapy for more than 50 years-since the approach was first advocated by Meigs in 1934.[1] In 1968, Munnell[2] introduced the idea of the "maximum surgical effort”-essentially the removal of as much cancer as possible.
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Proposed Algorithm for Managing Ibrutinib-Related Atrial FibrillationAlthough ibrutinib-related atrial fibrillation (IRAF) occurs in up to 11% of patients in clinical trials, these studies have rarely fully characterized bleeding events or risk factors for bleeding when ibrutinib is combined with anticoagulation. Furthermore, guidelines do not provide direction regarding the preferred anti-arrhythmic agent for IRAF.
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The Timing of Breast Cancer Surgery During the Menstrual CycleContemporary breast cancer treatment research has focused on systemic postoperative adjuvant treatment and the elimination of established micrometastases. An alternative approach addresses the potential for seeding at the time of primary surgery. Several retrospective reports have suggested that the hormonal milieu during lumpectomy or mastectomy impacts on the likelihood of tumor cell shedding and implantation at distant sites.
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Every-2-Week Darbepoetin Alfa Is Comparable to rHuEPO in Treating Chemotherapy-Induced AnemiaThe safety and efficacy of darbepoetin alfa (Aranesp) at 3.0 µg/kg administered every 2 weeks and recombinant human erythropoietin (rHuEPO) given as 40,000 U weekly or 150 U/kg three times weekly were evaluated by
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Advanced Non-Small-Cell Lung CancerIt's been an interesting time for those of us who treat patients with lung cancer. Over the past few years, non-small-cell lung cancer (NSCLC) has been a target for the numerous companies developing agents that inhibit receptors, growth factors, signaling molecules, and genes involved in tumor growth and development. The "biologic-targeted" approach to treatment is still in its infancy, but it has already given us great expectations, some surprises, some disappointments, and, ultimately, satisfaction that we now have a nonchemotherapeutic option.
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Role of Calcium/Magnesium Infusion in Oxaliplatin-Based Chemotherapy for Colorectal Cancer PatientsThe combination of oxaliplatin plus fluorouracil/leucovorin is known as the FOLFOX regimen, and it has become a standard regimen for colorectal cancer (CRC), both as adjuvant therapy and as treatment for metastatic disease. Unfortunately, platinum-based chemotherapies also produce neurotoxicity as a side effect. Neurotoxicity is the most common dose-limiting toxicity of oxaliplatin, and it is one of the major causes for patients to stop receiving chemotherapy. It can manifest as either of two distinct syndromes: a transient, acute syndrome that can appear during or shortly after the infusion (~1%–2% of patients), and a dose-limiting, cumulative sensory neuropathy. Calcium/magnesium (Ca/Mg) infusions have been used to decrease the incidence of oxaliplatin-induced neuropathy. The actual utility of Ca/Mg infusions in this setting has been an interesting and controversial topic. They may reduce the severity of neurotoxicity, but some investigators have questioned whether they also will alter the efficacy of these chemotherapy regimens. In this paper, we review the clinical data concerning the usefulness of Ca/Mg infusions in reducing the incidence of oxaliplatin-induced neuropathy as well as their effect on responsiveness to chemotherapy.
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We Have Not ‘Come a Long Way, Baby’: Dr. Alan Blum on Smoking Cessation and PreventionSmoking cessation and relapse prevention expert Alan Blum, MD, discusses how oncologists and other clinicians can and should play a larger role in tobacco control.
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Shining a Warm Light on CryoglobulinemiaWe recommend screening for cryoglobulinemia in all patients with HCV infection, livedo reticularis, vasculitic cutaneous ulcers, positive rheumatoid factor or rheumatoid vasculitis, membranoproliferative glomerulonephritis, or atypical Waldenström macroglobulinemia.
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Corticosteroids in Advanced CancerCorticosteroids play a vitally important role in the treatment of patients with advanced cancer. While the scientific data, as reviewed by Wooldridge et al, are often slim, most physicians who treat patients with cancer quickly become comfortable with prescribing synthetic glucocorticoids for a variety of indications. Wooldridge et al have provided a much needed synthesis of the medical literature on the use of steroids, both as part of chemotherapeutic treatment for a variety of malignancies and in symptom control.
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Melanoma in the Older PersonMelanoma incidence and mortality continue to rise unabated in older individuals. Early clinical detection should take into account the different subtypes.
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Paclitaxel, UFT, and Calcium Folinate in Metastatic Breast CancerThis is a phase I dose-escalation study of uracil and tegafur (in a molar ratio of 4:1 [UFT]) administered in combination with calcium folinate and paclitaxel in metastatic breast cancer. This trial was initiated to 1)
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Diagnosis and Treatment of Depression in Cancer PatientsDrs. Pirl and Roth describe various problems that complicate efforts to accurately diagnose and appropriately treat depression in cancer patients. These include the subjective nature of symptoms, multiple possible diagnoses within the spectrum of mood
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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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Clinical Update on PemetrexedThe articles in this supplement to ONCOLOGY, “Clinical Update onPemetrexed,” are presented by leading international clinical andpreclinical investigators in the arenas of thoracic, gastrointestinal, breast, andgynecologic cancers. They cover a wide range of topics that focus on the promisingagent pemetrexed (Alimta).
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Getting to the Heart of Improving Outcomes for Patients With Acute Promyelocytic LeukemiaThe management of patients with acute promyelocytic leukemia (APL) has been transformed over the course of the last two decades following the introduction of successful molecularly targeted therapies-all-trans retinoic acid (ATRA) and arsenic trioxide (ATO)- which act in concert to induce degradation of the PMLRARα oncoprotein formed by the chromosomal translocation t(15;17)(q22;q21).
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The Absent-Minded Professor: An Unusual Complication of MelanomaThe University of Colorado Health Sciences Center holds weekly second opinion conferences focusing on cancer cases that represent most major cancer sites. Patients seen for second opinions are evaluated by an oncologist.
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Rationale for Trials Studying Pegylated Liposomal Doxorubicin in Metastatic Breast CancerBreast cancer is second only to lung cancer as a leading cause of cancer mortality in women. In women with metastatic, hence, essentially incurable disease, we strive to find effective chemotherapeutic regimens that offer a
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Myelodysplastic SyndromesMyelodysplastic syndromes (MDS) are a group of hematologic malignancies of the pluripotent hematopoietic stem cells. These disorders are characterized by ineffective hematopoiesis, including abnormalities in proliferation, differentiation, and apoptosis.
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The Developing Role of Anti–Epidermal Growth Factor Receptor Agents in the Treatment of Advanced or Metastatic Colorectal CancerAnti-EGFR therapy is a valuable addition to the armamentarium of treatment options for patients with metastatic colorectal cancer. However, RAS mutation status is an imperfect biomarker for prediction of therapeutic outcomes in this setting. The recent discovery of tumor sidedness as a predictor of response highlights how little we understand about which patients are the most appropriate to receive drugs that target EGFR.
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Molecular Profiling in the Practice of Radiation OncologyAs specific candidate genes become more well established and gene expression assays gain sophistication, the value in clinical outcomes prediction and treatment selection is expected to transform the practice of radiation oncology.
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Preserving Values in Managed CareIn this column, Dr. Alan Nelson, past president of the American Medical Association, has provided a set of goals for oncologic treatment under managed care contracts that can be embraced by all oncologists--choice, broad scope of practice, and communication. But the real message to oncologists is: Work together with internal medicine and primary care physicians to build a system that provides quality care of which everyone can be proud. Such cooperation is needed to help convert these treatment goals into workable contracts with primary care groups, HMOs, and/or insurers.
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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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Hodgkin's Disease: Management of First RelapseIn most patients with newly diagnosed Hodgkin's disease, initial therapy is curative. However, a small portion of patients treated with radiotherapy alone for limited favorable disease, and a larger percentage of patients treated with combination chemotherapy, with or without radiotherapy, for advanced-stage or unfavorable disease relapse after initial remission. Patients relapsing after radiotherapy alone should do as well with salvage combination chemotherapy as patients with advanced disease who have never received radiation. In patients who relapse after combination chemotherapy, retreatment with the same regimen or employment of a non-cross-resistant regimen offers high response rates among those with favorable characteristics.
