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Since the topic of risk-stratified management of patients with myelodysplastic syndromes (MDS) was last reviewed in ONCOLOGY in 2007,[1] a few additional clinically relevant studies have emerged that can help inform decision-making in the consultation room.

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Along with various imaging modalities, serologic tumor markers such as CA 15-3 and CA 27.29 have been used for decades to monitor treatment response in patients with metastatic breast cancer (MBC). Despite the frequent use of these markers, they lack high sensitivity and specificity for breast cancer progression. The prognostic significance of these markers remains indeterminate because of the conflicting outcome of many clinical trials. The circulating tumor cell (CTC) test has recently been studied in clinical trials in patients with MBC. Some of the studies showed that high levels of CTCs are correlated with poor survival in MBC. An intergroup trial is underway to determine the implication of changing treatment based on the CTC level. This article will discuss the current data on these markers, with special emphasis on the CTC test. The potential clinical utility of these markers will also be discussed.

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Dr. Krasna provides a well-illustrated review of the applications of thoracoscopy in lung and esophageal tumors. These include: staging of tumors; diagnosis of indeterminate pulmonary nodules; definitive resections of various tumors, especially in cases of poor reserve; and diagnosis and treatment of malignant pleural disease [1]. However, there remains considerable disagreement among thoracic surgical oncologists over the proper applications of these techniques.

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Intracranial germinomas are uncommon tumors. In the past, patients have traditionally been diagnosed with a trial of focal radiotherapy without biopsy. If the tumor was radiosensitive, it was presumed to be a germinoma.

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Ibritumomab tiuxetan (Zevalin) consists of an anti-CD20 murine IgG1 kappa monoclonal antibody covalently bound to tiuxetan (MX-DTPA), which stably chelates yttrium-90 for therapy. Ibritumomab tiuxetan therapy involves pretreatment with

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Rituximab (Rituxan), when combined with CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone) chemotherapy (R-CHOP) in the treatment of patients with CD20-positive diffuse large B-cell lymphoma (DLCL), significantly prolongs event-free and overall survival (GELA [Groupe d’Etude des Lymphomes de l’Adulte] LNH 98-5 study). Our objective was to estimate the cost-effectiveness of R-CHOP based on the evidence currently available.

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Rituximab (Rituxan) has shown high activity in relapsed follicular lymphomas when given alone, and phase II studies indicate that its addition to chemotherapy may further improve response rates substantially. Because prospective randomized studies have not been available so far, the German Low Grade Study Group (GLSG) started a multicenter national trial in patients with relapsed or refractory follicular cell lymphoma (FCL) or mantle cell lymphoma (MCL). As patients were treated for first-line therapy with CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone), the FCM (fludarabine [Fludara], cyclophosphamide, mitoxantrone [Novantrone]) combination was chosen for salvage chemotherapy.

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Mendenhall and colleagues provide a useful review of the management of squamous cell carcinoma of the anal margin. Although I generally agree with their conclusions and recommendations for treatment, their paper highlights the continuing difficulties in developing a universally agreed-upon descriptive terminology for the anal region.

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The world’s population is aging. Older age is associated with an increase in the incidence of cancer, especially cancer of the breast, lung, prostate, and colon. The management of older patients with cancer is biased by the

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This study was designed to evaluate the cardiac safety of the combined treatment of HER2-positive metastaticbreast cancer patients with trastuzumab (Herceptin) plus epirubicin and cyclophosphamide (EC) incomparison with EC alone in HER2-negative metastatic breast cancer patients. Patients included those withmetastatic breast cancer without any prior anti-HER2 treatment, anthracycline therapy, or any other chemotherapyfor metastatic disease. This was a nonrandomized, prospective, dose-escalating, multicenter, openlabel,phase II study in Germany. A control group of 23 patients received EC 90/600 mg/m2 3-weekly for sixcycles (EC90 alone). A total of 26 HER2-positive patients were treated with trastuzumab, or H (2 mg/kg weeklyafter an initial loading dose of 4 mg/kg), and EC 60/600 mg/m2 3-weekly for six cycles (EC60+H); another 25HER2-positive patients received H and EC 90/600 mg/m2 3-weekly for six cycles. Asymptomatic reductions inleft ventricular ejection fraction (LVEF) of more than 10% points were detected in 12 patients (48%) treatedwith EC60 + H and in 14 patients (56%) treated with EC90 + H vs 6 patients (26%) in the EC90 alone cohort.LVEF decreases to < 50% occurred in one patient in the EC60+H cohort and in two patients in the EC90+Hcohort during the H monotherapy. No cardiac event occurred in the cohort with EC90 alone. The overallresponse rates for EC60+H and EC90+H were >60%, vs 26% for EC90 alone. The interim results of this studysuggest the cardiac safety of the combination of H with EC may be greater than that of H with AC (doxorubicin[Adriamycin]/cyclophosphamide); however, studies in larger numbers of patients are warranted. The combinationregimen revealed promising efficacy.

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We previously reported the efficacy of concurrent cisplatin (Platinol)/etoposide (PE) and radiotherapy in stage IIIB non–small-cell lung cancer in which biopsy confirmation of T4 (noneffusion) or N3 status was required (S9019). In view of the activity of docetaxel (Taxotere) as second-line therapy and potential molecular mechanisms of action favoring taxane sequencing, we designed the present study to maintain a core of concurrent PE/radiotherapy, but to substitute docetaxel consolidation for the two additional cycles of PE.

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In the November 30, 2007, issue of ­ONCOLOGY, Dr. Tony S. Quang and colleagues have raised some very important and relevant issues regarding the costs and benefits of new technology in the treatment of prostate cancer ("Technologic Evolution in the Treatment of Prostate Cancer: Clinical, Financial, and Legal Implications for Managed Care Organizations," ONCOLOGY 21[13]:1598-1604, 2007).

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We previously reported that “in vivo purging” with rituximab (Rituxan) during stem-cell collection is safe and does not adversely affect engraftment. We now report on our transplant experience with rituximab. From June 1998 to December

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This nonblinded, multicenter, randomized phase III study compares the median time to progression (primary endpoint), response rate, and quality of life, safety, and survival of

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This nonblinded, multicenter, randomized phase III study compares the median time to progression (primary endpoint), response rate, and quality of life, safety, and survival of

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Diarrhea is a common problem in patients receiving pelvic irradiation with concurrent chemotherapy. Virtually all patients develop diarrhea of varying severity during the course of the treatment. The incidence and severity of diarrhea vary with the chemotherapy type and dose, radiotherapy field size, daily fraction size, and total dose of radiation given. Diarrhea (any grade) occurs in 30% to 87% of patients receiving chemotherapy and in 20% to 49% of patients receiving pelvic radiotherapy. The incidence of severe and life-threatening (grade 3/4) diarrhea ranges from 20% to 40% in patients receiving combined chemoradiotherapy.

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In this interview we discuss chemoprevention in breast cancer, including investigational agents and the use of herbal supplements.

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SAN FRANCISCO-While genetics has opened up new possibilities for predicting treatment response in patients with acute myeloid leukemia, there are still unanswered questions about the relationship between genetic mutations and treatment outcome, according to Bob Lowenberg, MD, PhD, who delivered the Ham-Wasserman lecture at ASH 200

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Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most challenging and complex complications of cancer chemotherapy.

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The 5-year survival of patients with locally advanced squamous cell cancers of the head and neck is still less than 30%. Treatment of these cancers involves significant functional impairment, diminished quality of life, and considerable time and expense. Local recurrence and distant metastases are still fairly common, and the development of second primary cancers has a significant impact on survival in patients with initial early-stage disease. Despite the success of combination chemoradiation in locally advanced head and neck cancers, these facts stress the need for improved treatment of this disease.

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Traditionally, the role of chemotherapy in the treatment ofsquamous carcinoma of the head and neck has been confined to patients with

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Although head and neck cancer accounts for only about 5% of all malignancies, the functional and cosmetic changes that result from the tumor or its treatment pose a challenge to the health-care community. In today’s health-care environment, we are being forced or at least encouraged to decrease the length of hospital stay for patients following all types of surgical procedures. As a result, the inpatient census for most units has decreased substantially, causing many specialized patient care units to close.

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Flavopiridol [2-(2-chlorophenyl 5 ,7-dihydroxy-8-[cis-(3-hydroxy-1-methyl-4-piperidinyl)-4H-1-benzopyran-4-one, hydrochloride] is a semisynthetic flavone with a novel structure compared with that of polyhydroxylated flavones, such as quercetin and genistein.[1] It is derived from rohitukine, an alkaloid isolated from the stem bark of Dysoxylum binectariferum, a plant indigenous to India.[2] Originally synthesized and supplied by Hoechst India Limited, flavopiridol is provided to the Division of Cancer Treatment and Diagnosis of the National Cancer Institute (NCI) by Aventis Pharmaceuticals, Inc.

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Patients with early-stage Hodgkin’s lymphoma and a favorable prognosis can be treated with less intensive chemotherapy and radiotherapy regimens without affecting outcomes. This is the first study to show that less intensive therapy can be used without sacrificing benefits, according to lead author Andreas Engert, MD, and colleagues.

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Treatment with toripalimab does not yield the same vascular toxicity seen with pembrolizumab in patients with advanced or metastatic nasopharyngeal carcinoma, according to Barbara Burtness, MD.

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Ferrell and Hassey Dow summarize research on the domains of quality of life (QOL) most important to the adaptation of survivors, and offer insights about possible interventions to support and promote this adaptation. In addition, they note that the field is poised to make great progress in understanding the concerns and needs of survivors, due, in part, to the establishment of the Office of Cancer Survivorship, an institutional home at the National Cancer Institute (NCI) that will coordinate and promote research on this critical topic.

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Inflammatory cytokines plus the human immunodeficiency virus Tat protein apparently trigger the development of early Kaposi's sarcoma. Activated spindle cells provide a self-perpetuating, autocrine-supported mechanism for further development of hyperplastic lesions. In more advanced stages, a true neoplastic process may develop. [ONCOLOGY 10(Suppl):34-36, 1996]

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The Lesage and Portenoy article fulfills several important purposes. First, the authors remind us of the critical need to become more systematic and diligent in assessing and monitoring fatigue, a potentially debilitating symptom that is now recognized as the most common adverse effect experienced by cancer patients undergoing active treatment.[1] In the assessment of fatigue, the authors acknowledge that "the gold standard of evaluation is the patient’s self-report."

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The adverse effects of cancertreatment can be divided intothree groups: those that aresignificant and life-threatening, thosethat are not life-threatening but resultin lifestyle changes, and those that areof minor severity and limited duration.The potential significant and lifethreateningeffects of radiation in thetreatment of breast cancer includecardiac toxicity and carcinogenesis.Two prospective randomized trials ofbreast-conserving surgery and radiationhave demonstrated no increase inthe risk of non–breast cancer death at20 and 25 years among patients whoreceived radiation compared to thosetreated by mastectomy.[1,2]