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Commentary (Barker/Garden): The Multidisciplinary Management of Paragangliomas of the Head and NeckWe have reviewed with interestthe article by Drs. Huand Persky and would liketo congratulate them on an excellentand comprehensive overview of theevaluation and management ofparagangliomas of the head and neck.Their review begins with an excellentlydetailed description of thedisease and staging work-up. Withmodern imaging, most paragangliomasare convincingly diagnosed basedon typical location (carotid bifurcation,nodose ganglia of the vagusnerve, middle ear along tympanic plexus,or near jugular bulb) and characteristicradiographic appearance(hypervascular, intensely enhancingmass). A tissue diagnosis is usuallyunnecessary for such lesions.
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The Use of Serum hCG as a Marker of Tumor Progression and of the Response of Metastatic Urothelial Cancer to Systemic ChemotherapyA 55-year-old woman with a history of metastatic melanoma in remission for 8 years presented to the emergency department with gross hematuria. A CT scan, ordered because the patient was in menopause, demonstrated a bladder tumor.
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Adil Daud, MD, on the Importance of Testing Patients with Melanoma for BRAF MutationsAdil Daud, MD, spoke about the emergence of next-generation sequencing and the importance of testing patients with melanoma for BRAF mutations.
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Evaluation and Management of Testicular Cancer After Late RelapseThe clinical quandary by Langer et al discusses a contralateral late relapse of the original right nonseminomatous germ cell tumors.
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Circulating Tumor DNA as a Liquid Biopsy: Current Clinical Applications and Future DirectionsHere we review the clinical data supporting these different plasma genotyping methodologies, and present a practical approach to the interpretation of the results of these tests.
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Implementing Survivorship Care Plans Within an Electronic Health RecordSurvivorship care is “a distinct phase of care for cancer survivors that includes four components: (1) prevention and detection of new cancer or recurrent cancer; (2) surveillance for cancer spread, recurrence, or second cancers; (3) intervention for consequences of cancer and its treatment; and (4) coordination between specialists and primary care providers to ensure that all of the survivor’s health needs are met.”
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Cancer Metabolism as a Therapeutic Target: Metabolic Synthetic LethalityDrugs targeting different metabolic pathways induced in tumors may be used in combination with one another to induce synthetic lethality in cancer cells, while preserving the survival of normally proliferating cells.
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Erlotinib/Gemcitabine for First-Line Treatment of Locally Advanced or Metastatic Adenocarcinoma of the PancreasErlotinib (Tarceva) is a human epidermal growth factor receptor type 1/epidermal growth factor receptor (HER1/EGFR) tyrosine kinase inhibitor initially approved by the US Food and Drug Administration for the treatment of patients with locally advanced or metastatic non–small-cell lung cancer after failure of at least one prior chemotherapy regimen. In this report, we present the pivotal study that led to the approval of erlotinib in combination with gemcitabine (Gemzar) in patients with locally advanced/metastatic chemonaive pancreatic cancer patients. The combination demonstrated a statistically significant increase in overall survival accompanied by an increase in toxicity. Physicians and patients now have a new option for the treatment of locally advanced/metastatic adenocarcinoma of the pancreas.
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Commentary (Beart/Ortega): Role of Laparoscopic Techniques in Colorectal Cancer SurgeryThe authors have nicely reviewed many of the issues surrounding laparoscopic colon cancer surgery. However, we would like to offer a slightly different perspective on several points which they make.
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The Evolving Role of Multi-Gene Tests in Breast Cancer ManagementIf MGTs could predict which patients were most prone to late recurrence and thus might benefit from extended adjuvant endocrine therapy, it would be a huge advancement in the care and survivorship of our patients. More studies of MGTs are required to clarify their role in evaluating prognosis and predicting response to therapy in breast cancer.
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A Patient With Newly Diagnosed Metastatic Type 2 Papillary Renal Cell CarcinomaA 42-year-old man presented with increasing right hip pain that limited his ability to walk. Magnetic resonance imaging (MRI) revealed a right lytic acetabular lesion. Further work-up included a computed tomography (CT) scan, which revealed an 8-cm left kidney tumor.
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Exciting Developments in Relapsed/Refractory Multiple MyelomaThe panel concludes the discussion by offering future perspectives on the evolving treatment landscape in multiple myeloma, highlighting exciting developments and ongoing research.
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Should Men Diagnosed With Prostate Cancer Hit the Gym?Despite the clearly established overall health benefits of exercise, its role in reducing prostate cancer risk is unclear. Whereas some studies found often dramatic reductions in prostate cancer risk, others found no effect.
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Molecular Classification of Diffuse GliomasSignificant progress has been made in defining molecular signatures in diffuse gliomas. The clinically significant genetic alterations identified to date probably represent the tip of the iceberg, since new, potentially significant biomarkers are continuously described.
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Treatment of Pancreatic Cancer: Current Limitations, Future PossibilitiesIn an attempt to improve the grave prognosis associated with the diagnosis of pancreatic cancer, researchers have explored a number of novel therapies. These include hormonal therapy, immunotherapy, radiopharmaceuticals, and novel chemotherapeutic agents.
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Cost-Effectiveness of Genomic Testing for Colorectal Cancer: Are We There Yet?Although genomic testing can improve the cost-effectiveness of a treatment, assessing the cost-effectiveness of genomic testing outside the context of its impact on treatment is not practical.
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Intraoperative Radiotherapy for Breast Cancer: Its Perceived SimplicityWith many centers seeking to adopt IORT, there are licensing, proctoring, staffing, technical support, and reimbursement issues that need to be considered. We have reviewed the current international experience and describe one community cancer center’s experience with initiating an IORT breast cancer program.
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Prostate Cancer Risk Assessment ProgramProstate cancer is the most common form of cancer (except skin cancer) in men. Several factors have been associated with an increased risk for prostate cancer, including age, ethnicity, family history, lifestyle, and
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Management of Venous Thromboembolism in Cancer PatientsVenous thromboembolism is a common complication in patients with cancer. The management of deep-vein thrombosis and pulmonary embolism can be a considerable challenge in these patients. Diagnosing venous
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Looking Ahead: What’s on the Horizon in Advanced MelanomaPanelists discuss how emerging advances in melanoma treatment include next-generation tumor-infiltrating lymphocyte therapy, oncolytic immunotherapy, bispecific antibodies, cancer vaccines, and neoadjuvant approaches that may allow de-escalation of both surgery and systemic therapy while improving treatment-free survival.
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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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Irinotecan and Gemcitabine in Patients With Solid Tumors: Phase I TrialUsing a day 1 and 8, every-3-week schedule, our purpose was to determine the maximum tolerated dose of irinotecan (CPT-11, Camptosar) that can be administered immediately after gemcitabine (Gemzar) at a dose of 1,000 mg/m² IV. In this phase I trial, the maximum tolerated dose was defined as the dose level immediately below the level in which two of the first three patients in any cohort, or at least two of six patients in any expanded cohort, experienced dose-limiting toxicity. Dose-limiting toxicity pertained only to toxicity during the first cycle of treatment. Escalation of irinotecan was planned in groups of three patients, with three additional patients added at the first indication of dose-limiting toxicity. A total of 19 patients have been enrolled.
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Brain Metastases in Small Cell Lung CancerThe purpose of this paper is to provide an overview of the clinical presentation, diagnosis, and treatment of brain metastases in patients with SCLC, with a focus on current trends and developments in the treatment of this disease.
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Prophylaxis Against Fungal Infections and Cytomegalovirus Disease After Bone Marrow TransplantationAmong the serious complications associated with bone marrow transplantation are invasive fungal infections caused by organisms such as Candida and Aspergillus species and end-organ disease caused by
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At the Crossroads: The Intersection of the Internet and Clinical OncologyThe Internet is rapidly becoming a third party in the doctor-patient relationship. The World Wide Web, electronic mail (e-mail), and discussion groups have dramatically increased the quantity of medical and health
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Pemetrexed in Advanced Colorectal CancerPemetrexed (Alimta) shows single-agent activity in advancedcolorectal cancer. In two phase II studies in which patients receivedpemetrexed at 600 mg/m2 or 500 mg/m2 as first-line treatment for metastaticdisease, objective response rates were 15.4% and 17.2%.
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Key Takeaways in CAR-T Therapy for Multiple MyelomaPanelists discuss a clinical scenario involving a 56-year-old male man with myeloma and del 17p deletion, treated with RVD induction, auto transplant, and lenalidomide maintenance, who relapsed after 2 years and is now referred to discuss chimeric antigen receptor (CAR) CAR-T versus vs standard therapy, sharing key takeaways and pearls from the case.
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Gamma Knife Radiosurgery for 5 to 10 Brain Metastases: A Good Option for Upfront TreatmentThe aggressive management of brain metastases with SRS has supplanted radiation therapy in an effort to maintain patient quality of life in an era of advancing systemic cancer options.
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ACR Appropriateness Criteria® Management of Vaginal CancerThis article represents the consensus opinion of an expert panel and may be used to inform clinical recommendations in vaginal cancer management.
