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Lung Cancer in ‘Never-Smokers’: A Unique EntityLung cancer in “never-smokers” constitutes only a small proportion of patients with lung cancer. Nevertheless, the topic has recently attracted a good deal of attention. Initially this was due to the fact that never-smokers with lung cancer had better outcomes with epidermal growth factor receptor–tyrosine kinase (EGFR-TK) inhibitors, compared to tobacco smokers with lung cancer. More recently the identification of molecular changes unique to lung cancer in never-smokers has generated further interest in this disease. These findings have the potential to enhance our knowledge of lung cancer biology and lead to the development of new, more effective treatments for lung cancer. In this review, we summarize the existing body of knowledge on lung cancer in never-smokers.
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Man With Recurring Chordoma and Progressive Disease Despite Radiotherapy and Radical ResectionA 60-year-old man presented with lower limb claudication and a painful mass on his left buttock. Physical examination revealed a firm round mass, fixed to deep planes. A biopsy was performed and revealed a chordoma.
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Research restores yoga’s role in active therapyAs yoga continues to grow in popularity worldwide, questions regarding its use as a therapeutic modality are becoming increasingly important,” said Dr. Dhruva, who is an assistant clinical professor at the University of California, San Francisco and at the UCSF Osher Center for Integrative Medicine.
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Radiation Therapy in the Management of Malignant MelanomaMelanoma has historically been considered a radioresistant tumor. Emerging data have challenged this viewpoint. The potential roles of radiation therapy in the treatment of patients with melanoma will be reviewed here.
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The Evolving Treatment Landscape and Patient PerspectivesDrs Jain and Shah discuss the future of patient care in metastatic bladder cancer, while Mr. and Mrs. Ehas share advice for patients with bladder cancer, advice for caregivers and closing thoughts on their overall journey.
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Cancer of the Cervix: Current Management and New ApproachesThis article summarizes the current management of patients with newly diagnosed cervical cancer. The topics range from the management of early-stage disease to the phase III randomized studies that have established the current standard of care for patients with locally advanced cancer of the cervix. New approaches to combined-modality therapy with the goal of improving outcomes and decreasing complications are also described.
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Current Status of Robot-Assisted Radical Prostatectomy: Progress Is InevitableThere is no question that the robot has leveled the playing field. It has allowed more surgeons to offer patients a minimally invasive approach. In terms of perioperative outcomes, there is clear evidence showing shorter hospital stays, less blood loss, lower complication rates, and shorter convalescence with robotic-assisted laparoscopic prostatectomy.
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ACR Appropriateness Criteria® Recurrent Hodgkin LymphomaBy combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the complex decision-making associated with the management of recurrent Hodgkin lymphoma.
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The Management of Nongastric MALT LymphomasNo definite guidelines exist for the management of nongastric MALT lymphoma. Retrospective series have included patients treated with different modalities, and excellent cause-specific and overall survival have been demonstrated, independent of the type of treatment adopted.
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A Clinician’s Perspective on ASCO 2001: Going After the Epidermal Growth Factor ReceptorAmong the most exciting new anticancer products presented at the 2001 ASCO meeting were new drugs that block the epidermal growth factor receptor (EGFR). About 30% to 90% of carcinomas express high levels of EGFR. These include, among others, head and neck cancer, lung cancer, pancreatic cancer, colon cancer, breast cancer, ovarian cancer, and bladder cancer.
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UFT/Leucovorin Combined With Mitomycin-C in Metastatic Colorectal Cancer TestUFT is an investigational agent that may be useful treatment for colorectal carcinoma and other cancers for which fluorinated pyrimidines are a useful treatment. The combination of continuous-infusion fluoro-uracil (5-FU) with leucovorin and mitomycin-C can significantly delay recurrence and may prolong life.
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Can Adding Radiotherapy to Endocrine Treatment Increase Survival in Locally Advanced Prostate Cancer?A Scandinavian study challenges the efficacy of endocrine treatment alone, compared to endocrine treatment plus radiotherapy for the treatment of locally advanced prostate cancer. All patients in the study receive neoadjuvant total androgen blockade for 3 months and then continue with antiandrogens alone. After 3 months, radiotherapy will be started in one arm of the study. The primary end point of the study is survival, with secondary end points of prostate-specific antigen (PSA) progression, clinical progression, and quality of life. [Oncol News Int 6(Suppl 3):18-19, 1997]
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The Role of Irinotecan and Oxaliplatin in the Treatment of Advanced Colorectal CancerColorectal carcinoma is one of the most common malignancies in the western world, and although fluorouracil (5-FU) has been used in its treatment for almost 40 years, new agents with significant activity have been introduced recently. Irinotecan (CPT-11, Camptosar), a topoisomerase I inhibitor, administered at 300 to 350 mg/m2 every 3 weeks is significantly more active than continuous-infusion 5-FU in patients who have experienced disease progression after conventional therapy with 5-FU. In comparison to best supportive care, irinotecan improves survival and preserves quality of life despite treatment-related toxicity. Moreover, the combination of irinotecan and 5-FU has been explored in a number of different schedules. In previously untreated patients, overall response rates are high. Irinotecan can also be combined with mitomycin (mitomycin-C [Mutamycin]), oxaliplatin, or raltitrexed (Tomudex). Oxaliplatin is a new-generation platinum compound that has demonstrated activity against colorectal carcinoma in preclinical trials. It has been evaluated as a single agent against advanced colorectal carcinoma in the salvage setting and also in combination with 5-FU as initial therapy for metastatic disease (where it shows significant activity). The toxicity profile of oxaliplatin (chiefly characterized by neurotoxicity) differs from that of irinotecan (primarily producing diarrhea) and the potential, therefore, exists for combining these agents or for exploiting their possible synergy with 5-FU. The introduction of these two new active agents of different pharmacologic classes promises to enable significant improvements in the treatment of patients with colorectal carcinoma. [ONCOLOGY 15(4):415-434, 2001]
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Extremely Pruritic Skin on 52-Year-Old PatientA 52-year-old male presents with a 3-month history of extremely pruritic skin on the wrist and hand. On exam the patient exhibits generalized erythroderma and lymphadenopathy. What is the diagnosis?
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Optimizing the Benefit of CNS Radiation Therapy in the Pediatric Population-PART 1: Understanding and Managing Acute and Late ToxicitiesMinimizing late treatment toxicities in these patients remains an important priority due to both the young age of the patients and the high cure rate that can be achieved.
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Defining Value in Radiation Oncology: Approaches to Weighing Benefits vs CostsValue in its essence is preference or outcome divided by cost, or described in terms of a mathematical equation, value = outcome (preference)/cost. It follows, then, that value is increased by holding outcome constant and reducing cost, or by improving outcome while holding cost constant.
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Next Generation of CAR-T Therapies in LymphomaExperts comment on the future of CAR T-cell therapy development and the use of dual CAR-T and CAR-T retreatment.
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ASCO Update: Chronic Lymphocytic LeukemiaThese reports are written by oncologists from Pacific Shores Medical Group (a large group practice in Long Beach, California). The reports are primarily based on notes taken at the American Society of Clinical Oncology yearly meeting (San Francisco, May 2001). The reports include our impressions (shown in italic type) of the clinical significance of the studies. The information is intended to help you get updated on new developments in oncology. The coverage of the meeting is not meant to be comprehensive, but rather focused on highlights that we consider most interesting or relevant.
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Paclitaxel and Gemcitabine as Salvage Treatment in Metastatic Breast CancerBoth paclitaxel and gemcitabine (Gemzar) have shown activity andmanageable toxicity when used as single agents in heavily pretreatedpatients with metastatic breast cancer. This phase II study evaluatedtheir use in combination for metastatic breast cancer patients whosedisease recurred or progressed following treatment with anthracyclinecontainingregimens.
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Cisplatin/Paclitaxel vs Cisplatin/Teniposide for Advanced Non-Small-Cell Lung CancerA total of 332 patients with advanced non-small-cell lung cancer were randomized by the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative
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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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New Era of Bladder Cancer Treatments Has BegunIn this interview we discuss the changing landscape of systemic therapies for the treatment of bladder cancer.
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The Evolving Role of Radiation Therapy in DLBCL: From Early-Stage to Refractory DiseaseGavin Jones, MD, and colleagues explore the landscape of radiation therapy in diffuse large B-cell lymphoma.
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New Therapeutic Strategies for Triple-Negative Breast CancerRelatively few clinically important therapeutic advances have occurred in the treatment of triple-negative breast cancer since the introduction of taxanes as adjuvant therapy over 20 years ago. However, this is rapidly changing due to a variety of conceptually important clinical trials and emerging new options.
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POINT: Is Lymphadenectomy Required in Endometrial Cancer for Adequate Surgical Staging?The diagnostic benefits of SLN evaluation include an ability to identify the extent of tumor dissemination and the utility of SLN mapping in guiding targeted adjuvant treatment in high-risk patients.
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Management of Pregnant Patients With CancerApproximately 1 in 1,000 pregnancies are complicated by a cancer diagnosis, and there is speculation that the incidence of cancer during pregnancy will increase as more women delay childbearing. The cancers that most commonly afflict pregnant women include breast and cervical cancer, as well as melanoma, lymphoma, and acute leukemia.
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When to Use Prophylactic Antibiotics in Neutropenic PatientsCurrent guidelines recommend antimicrobial prophylaxis with fluoroquinolones in patients at high risk for infection-related morbidity and mortality, but this practice provides a short-term benefit to individual patients.
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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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Hodgkin's Lymphoma in the Elderly: A Different Disease in Patients Over 60With improved prognosis for patients with Hodgkin's lymphoma (HL), interest has increasingly focused on high-risk groups such as elderly patients. Advanced age at presentation is still one of the strongest negative risk factors. Many different factors influence the prognosis in elderly patients. These include biologic differences such as more aggressive histology, different distribution of disease, more frequent diagnosis of advanced stage, and shorter history of disease. In addition, however, aging itself and associated factors such as comorbidity, reduced tolerability of conventional therapy, more severe toxicity and treatment-related deaths, failure to maintain dose intensity, shorter survival after relapse, and death due to other causes contribute to the poorer outcome in elderly patients. Besides the evaluation of specific causes and risk factors, this review highlights recent and ongoing studies for elderly patients with HL as well as international approaches and recommendations for this age group.
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Empiric Antifungal Therapy for the Neutropenic PatientThe article written by Drs. Wingard and Leather presents a thoughtful review of the current approaches to empiric antifungal therapy in neutropenic patients. Empiric antifungal therapy has evolved as a standard of care for the prevention of invasive fungal infections in neutropenic patients who remain persistently febrile despite the use of broad-spectrum antibacterial antibiotics.[1-3] Empiric antifungal therapy in this setting provides early treatment for clinically occult invasive fungal infections and systemic prophylaxis for neutropenic patients at highest risk.
