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Management of Resistance to EGFR TKI–Targeted Therapy of Lung Cancer: Lessons in Monitoring Cancer EvolutionCancer cells undergo accelerated evolutionary changes; thus, under the pressure of novel generations of EGFR TKIs, we should expect to see new mechanisms of resistance.
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New Directions in the Systemic Treatment of Metastatic Thyroid CancerAbout 30,000 new cases of thyroid cancer are diagnosed annually in the United States.[1] The incidence among men has risen more dramatically than any other malignancy in recent years (2.4% annual increase).[2] Thyroid cancers arise from one of two cell types, namely follicular and parafollicular cells.
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A 40-Year-Old Woman With a New Triple-Negative Breast Mass, Shown on Biopsy to Be Metaplastic CarcinomaA 40-year-old woman noted a large mass in her right breast. A diagnostic mammogram and ultrasound confirmed a 3.4-cm mass with associated microcalcifications.
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The Pathway Ahead in Melanoma TrialsReviewing treatment modalities for melanoma provides many sobering reminders that advances in our scientific understanding have not yet translated into meaningful clinical benefit. As clearly delineated by the authors, the “standard” treatment of dacarbazine chemotherapy has a poor response rate and lacks durability.
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Neoadjuvant Chemotherapy and Surgical Management of the Axilla in Breast Cancer: A Review of Current DataThis review will discuss the current status of surgical management of the axilla for patients treated with neoadjuvant chemotherapy.
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Management of Primary and Metastatic Tumors to the LiverPrimary and metastatic liver tumors continue to be a significant health problem in the United States. Hepatic resection or, in selected cases, transplantation are the only curative therapies for patients with resectable
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POEMS Syndrome: Still an Enigma?Because of challenges in making the correct diagnosis and the physician’s reluctance to administer chemotherapy for a disease characterized by such a low tumoral mass, patients may experience a delay in the initiation of appropriate treatment.
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Stereotactic Body Radiotherapy in the Management of Painful Bone MetastasesBone metastases are a common feature of many solid cancers, especially those originating from the prostate, breast, lung, kidney, melanoma, and other sites. Up to 80% of patients with these cancers will develop painful bony disease during the course of their disease.
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High-Dose Therapy for Follicular LymphomaMost patients with advanced-stage follicular non-Hodgkin’s lymphoma (NHL) are not cured with conventional therapy. The use of high-dose therapy and autologous stem-cell transplantation in patients with relapsed follicular
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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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Commentary (Melman): Morbidity of Contemporary Radical Retropubic Prostatectomy for Localized Prostate CancerThis article compares the results of radical retropubic prostatic surgery done by a group of urologists at the Mayo Clinic during a recent 3-year period with results obtained in a similar group of patients operated on prior to 1987. The authors show that when a surgical procedure is done often, with modern techniques and attention paid to surgical and anatomic detail, very good results can be achieved.
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Adjuvant Endocrine Therapy in Premenopausal Women With Operable Breast Cancer: Understanding the IssuesResearch and development of adjuvant therapies for premenopausal women with endocrine-responsive breast cancer is unfortunately lacking.
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Carcinoma of the Uterine CervixOver the past four decades, the incidence and mortality rates for uterine cervical carcinoma have decreased in the United States by as much as 70% to 75% [1]. This improvement is among the largest seen for any cancer site and has been attributed to the use of cervical cytologic screening [2].
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Medical Ethicist Arthur Caplan Explains Why He Opposes ‘Right-to-Try’ LawsIn this Q&A we examine Right-to-Try drug laws and discuss tips for clinicians with terminally ill patients who have exhausted all their therapy options.
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The Prostate Cancer Intervention Versus Observation Trial (PIVOT)The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is a randomized trial designed to determine whether radical prostatectomy or expectant management provides superior length and quality of life for men with clinically localized prostate cancer. Conducted at Department of Veterans Affairs and National Cancer Institute medical centers, PIVOT will enroll over 1,000 individuals less than 75 years of age. The primary study end point is all-cause mortality. Secondary outcomes include prostate cancer- and treatment-specific morbidity and mortality, health status, predictors of disease-specific outcomes, and cost-effectiveness. Within the first 3 years of enrollment, over 400 men have been randomized. Early analysis of participants' baseline characteristics indicate that enrollees are representative of men diagnosed with clinically localized prostate cancer throughout the United States. Therefore, results of PIVOT will be generalizable. These results are necessary in order to determine the preferred therapy for clinically localized prostate cancer. [ONCOLOGY 11(8):1133-1143, 1997]
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Distant Effects of Cancer on the Nervous SystemApproximately 30 years passed between the first description of a paraneoplastic neurologic disorder[1] and the demonstration of an immunologic pathogenesis for one of these syndromes.[2] In the almost 4 decades since, the paraneoplastic neurologic disorders have been subjected to study far out of proportion to their clinical prevalence. These disorders stimulate clinical research because (1) paraneoplastic neurologic syndromes are frequently the presentation of a malignancy, (2) they may bode well for a more favorable tumor prognosis,[3,4] and most importantly, (3) they yield insight into the workings of malignancy and the pathogenesis of neurologic disorders, particularly neurologic degenerations.
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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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QOL and Outcomes Research in Prostate Cancer Patients With Low Socioeconomic StatusThe VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate
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Painful Osteoblastic Metastases: The Role of Nuclear MedicineAlthough bone pain from osteoblastic metastases can be ameliorated 50% to 80% of the time by use of intravenously or orally administered radiopharmaceuticals, we cannot accurately predict who will or will not
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Why Haven’t Older Adults Been Included in More Oncology Clinical Trials?In this video, Dr. Arti Hurria discusses resources addressing the disconnect between cancer as a growing problem in the elderly and the fact that clinical trials mostly enroll younger patients.
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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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Clinical Status and Optimal Use of Rituximab for B-Cell LymphomasThe standard management of low-grade lymphoma remains controversial. Long-term follow-up studies of patients treated with conventional regimens have shown that currently available treatments are not curative.
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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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Neoadjuvant Therapy for Soft-Tissue Sarcomas-One Size Does Not Fit AllImprovements in neoadjuvant therapy for soft-tissue sarcomas will require the development of more efficacious systemic therapies and, if possible, the performance of histology-specific, prospective, randomized clinical trials to advance the field.
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Venous Thromboembolism and Bleeding Risk in Bladder CancerDespite the higher risk of VTE in patients with bladder cancer, ironically, their risk of bleeding and anemia, and greater need for transfusion of blood products, poses an equally significant risk of morbidity and mortality, especially among those who undergo cystectomy.
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Hypersensitivity Reactions to Oxaliplatin: Incidence and ManagementOxaliplatin (Eloxatin) is a novel platinum compound that has activityin a wide variety of tumors. Several hypersensitivity reactions distinctfrom laryngopharyngeal dysesthesia have been described. We retrospectivelyanalyzed 169 consecutive patients who received oxaliplatinfor esophageal or colorectal cancer between 1/1/00 and 7/31/02 andreviewed any significant adverse reactions labeled as hypersensitivityreactions. Thirty-two patients (19%) reportedly experienced hypersensitivity.Skin rash was the most common event (22 patients), occurringafter a median of three infusions. Fever was seen in five patients aftera median of two infusions. Five patients experienced respiratory symptomsat median infusion number 6. Ocular symptoms of lacrimationand blurring of vision were seen in two patients. Five patients experiencedmore than one type of reaction. Treatments prescribed forhypersensitivity were antihistamines, steroids, and topical emollients.One patient developed grade 4 hypersensitivity during cycle 6, characterizedby laryngeal edema, tongue swelling, and labored breathing.This patient underwent a desensitization procedure, adapted from guidelinesfor carboplatin (Paraplatin) allergy. Subsequently, three cycleswere administered over 6 hours and were well tolerated. However,during the fourth infusion postdesensitization, the patient developedrecurrent signs of hypersensitivity. In conclusion, hypersensitivity isfrequently seen with oxaliplatin, but most reactions are mild.
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CEA Monitoring in Colorectal CancerCarcinoembryonic antigen (CEA) monitoring in patients with stage I-IV colorectal cancer has been, and remains, a controversial issue in oncology practice. Recommendations vary from bimonthly monitoring to no monitoring in the surveillance setting (for stage I-III disease). In the metastatic setting, there are no clear guidelines for CEA follow-up, although continued monitoring in such patients is common in the oncology community. This manuscript reviews the accuracy of CEA testing, its value as a prognostic indicator, and its role in surveillance and response assessment. The limitations of the test in the adjuvant and metastatic settings are illustrated through several case reports from the Colorectal Oncology Clinic at Roswell Park Cancer Institute. Guidelines for CEA monitoring are provided, based on a detailed literature review and institutional experience.
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Initial Treatment of Well-Differentiated Neuroendocrine TumorsIn patients with advanced, unresectable NETs, there are several treatment options; which of these may be considered depends on the site of origin of the tumor.
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Exploring the Future of ctDNA and Novel Treatment StrategiesPanelists offer concluding perspectives on the future role of circulating tumor DNA in colorectal cancer management.
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Man With Locally Advanced, High-Risk Prostate Cancer Asks About Adding Chemotherapy to His TreatmentA 55-year-old Hispanic male presents with a family history of gastric cancer in one sibling and prostate cancer in an older brother. CT performed in March 2015 for IMT surveillance showed a heterogeneous prostate with local invasion involving the bladder, seminal vesicles, and perirectal fat.
