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Irinotecan/Gemcitabine Followed by Twice-Weekly Gemcitabine/Radiation in Locally Advanced Pancreatic CancerEarly clinical studies combining irinotecan (CPT-11, Camptosar) and gemcitabine (Gemzar) have yielded encouraging results. Gemcitabine administered via a twice-weekly schedule results in an enhanced radiation-sensitizing effect.
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Adjuvant Chemotherapy for Resected Non–Small-Cell Lung CancerBecause of the high rate of distant disease recurrence, the 5-yearsurvival of patients who have undergone complete surgical resectionof localized non–small-cell lung cancer (NSCLC) is approximately 50%.Initial results from early studies of adjuvant postoperative chemotherapyreported an adverse effect of alkylating agent and older chemotherapyregimens on survival. Cisplatin-based combinations were the first toshow a survival advantage. A 1995 meta-analysis of these studies suggesteda 13% reduction in the hazard ratio for death (HR = 0.87), leadingto a 5% survival benefit at 5 years. Still, these trials involved limitednumbers of patients (N = 1,394), and the results failed to reach statisticalsignificance (P = .08). Of the five largest subsequent randomizedtrials of platinum-based adjuvant therapy, three showed a significantsurvival advantage. Although it is impossible to determine the reasonsfor the differing outcomes of these studies, several key features distinguishthem, and the data suggest that medically fit patients with resectedstage IB or II NSCLC should be offered chemotherapy with a platinum/new drug combination.
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Cancer Epigenetics and Targeted TherapiesThe review by Drs. Boumber and Issa of epigenetic drugs that target human cancers nicely summarizes recent progress in this hot area and points out future lines of investigation.
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Combinations of Hormones and Local Therapies in Locally Advanced Prostate CarcinomaLocally advanced adenocarcinoma of the prostate (American Urological Association stages B2, C; American Joint Committee on Cancer stages T2c, T3) has been difficult to control by either external-beam irradiation or
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Squamous Cell Carcinoma Recurring to the Great Auricular NerveA 74-year-old man presented with a 2.5-cm ulcerated mass occupying the middle third of his left outer ear, approximating the helical rim.
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Commentary (Fox)-Melanoma Vaccines: What We Know So FarDrs. Bystryn and Reynoldspresent an overview of melanomavaccines, including atheoretical rationale to support the approach,criteria for an effective vaccine,and a discussion of the challengesto optimal vaccine design. Results ofclinical trials where vaccine-inducedimmune responses correlated withimproved clinical outcome are discussed,as well as limitations of monitoringvaccine-induced immuneresponses. A series of randomized, concurrentlycontrolled trials with complex,polyvalent whole-cell vaccines,extracts, lysates, or shed antigens arereviewed. The authors conclude thatmelanoma vaccines' "potentially mostsignificant application" may be the preventionof melanoma in individuals athigh risk of developing the disease.Their review discusses the generallyaccepted rationale for selecting vaccineantigens and does a thoughtfuljob of reviewing the current state ofcomplex melanoma vaccines.
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Society of Surgical Oncology Practice Guidelines: Introductory RemarksThousands of practice guidelines/practice parameters have been published by various professional organizations. The American Medical Association,[1] American College of Physicians,[2,3] and others[4-6] have written extensively about
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Bladder Cancer Treatment: Optimize, Don't CompromisePatient selection based on a much more comprehensive biologic assessment of both host and tumor is likely the key to further advances in the treatment of all bladder cancer patients. Until such time, there can be no compromise in the careful application of the rigorous therapy required to optimize outcomes.
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The Role of Psychological Factors in Cancer Incidence and PrognosisThe relationships between psychological variables and the presence of cancer, its prediction, and the prediction of cancer mortality and course of disease have been studied extensively. From a limited list of about 50 such
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Metastatic RCC: Moving Towards a Chronic DiseaseThe article by Posadas and Figlin on systemic therapy in advanced renal cell carcinoma (RCC) provides a very interesting and comprehensive review of our current knowledge concerning the treatment of RCC.
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Complete Guide to Colorectal CancerNearly 150,000 people will be diagnosed with colorectal cancer in the United States in 2006. The impact of this diagnosis will be felt by countless family members, coworkers, and friends. Although screening tests for colorectal cancer have been available and encouraged by medical associations such as the American Cancer Society (ACS) and others, public awareness and compliance has been dismal.
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The Clinical Problem of Chemotherapy-Induced Nausea and VomitingBeyond the current recommendations for management of chemotherapy-induced nausea and vomiting, recent research has shown significant improvement in emesis control with use of triplet therapy using dexamethasone, an NK1 receptor antagonist, and a 5-HT3 receptor antagonist in patients undergoing non–anthracycline-plus-cyclophosphamide-based moderately emetogenic chemotherapy.
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The Key to Reducing Quackery Lies in Healing Patients and Treating Their ExperienceIf doctors were trained in communication skills, then quackery would diminish greatly. When you are told what day you are going to die and all hope is taken away, why not seek alternative therapies?
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Liver, Gallbladder, and Biliary Tract CancersThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of liver, gallbladder, and biliary tract cancers using radiation, surgery, and medical treatment.
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When Can R-CHOP Not Be Used in an Elderly Patient?Elderly patients may have several such comorbidities, but their impact on normal life is minimal-and so most of these patients may receive a curative treatment such as R-CHOP. Very elderly patients have more comorbidities with greater impact, with the result that some of their vital organs exhibit functional deficiency.
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More on Facing the Reality of Our Aging Population With Breast CancerFor appropriate older women screening provides a benefit in this age group by identifying early-stage breast cancer.
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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.
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Genetic Testing: The Bigger PictureSchrader and colleagues provide four compelling examples of the power of genetic testing to impact medical management for probands and their family members.
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Commentary (Overmoyer): Breast Cancer During PregnancyThe care of a pregnant breast cancer patient is a challenging clinical situation that historically has placed the welfare of the mother in conflict with that of the fetus. For the woman in this situation, the emotions usually
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Disparities in Cancer Care Among Racial and Ethnic MinoritiesEliminating cancer disparities-not only for racial/minority groups but for all underserved populations-must be a priority for those involved in cancer care. For individual practitioners, the first step in addressing disparities is accomplished through understanding the possibility that disparities exist in varying depth and complexity for each racial or ethnic minority patient.
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It’s Time for Clinicians to Reconsider Their Proscription Against the Use of Soyfoods by Breast Cancer PatientsRecently published research questions the need for the advised restriction against the use of soyfoods by women with a history of breast cancer.
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‘Futile Care’: An Oncology Nurse’s PerspectiveThe article by Khatcheressian and colleagues addresses the important topic of futility in chemotherapy use. While extensive previous literature has addressed the use of futile treatment by oncologists, Khatcheressian and coauthors pose interesting perspectives on patient persistence in seeking futile treatment.
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Primary Cutaneous and Systemic Anaplastic Large Cell LymphomaAnaplastic large cell lymphoma (ALCL) is a biologic and clinically heterogenous subtype of T-cell lymphoma. Clinically, ALCL may present as localized (primary) cutaneous disease or widespread systemic disease. These two forms of ALCL are distinct entities with different clinical and biologic features. Both types share similar histology, however, with cohesive sheets of large lymphoid cells expressing the Ki-1 (CD30) molecule. Primary cutaneous ALCL (C-ALCL) is part of the spectrum of CD30+ lymphoproliferative diseases of the skin including lymphomatoid papulosis. Using conservative measures, 5-year disease-free survival rates are>90%. The systemic ALCL type is an aggressive lymphoma that may secondarily involve the skin, in addition to other extranodal sites. Further, systemic ALCL may be divided based on the expression of anaplastic lymphoma kinase (ALK) protein, which is activated most frequently through the nonrandom t(2;5) chromosome translocation, causing the fusion of the nucleophosmin (NPM) gene located at 5q35 to 2p23 encoding the receptor tyrosine kinase ALK. Systemic ALK+ ALCLs have improved prognosis compared with ALK-negative ALCL, although both subtypes warrant treatment with polychemotherapy. Allogeneic and, to a lesser extent, autologous stem cell transplantation play a role in relapsed disease, while the benefit of upfront transplant is not clearly defined. Treatment options for relapsed patients include agents such as pralatrexate (Folotyn) and vinblastine. In addition, a multitude of novel therapeutics are being studied, including anti-CD30 antibodies, histone deacetylase inhibitors, immunomodulatory drugs, proteasome inhibitors, and inhibitors of ALK and its downstream signaling pathways. Continued clinical trial involvement by oncologists and patients is imperative to improve the outcomes for this malignancy.
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Recognizing and Managing Side Effects Associated With Novel Targeted Therapies:Nursing management of patients with advanced malignancies presents a formidable challenge. In addition to the discomfort and debilitation these diseases can cause, side effects of traditional treatment modalities such as surgery, chemotherapy, and radiation may lead to severe and sometimes fatal sequelae. New targeted therapies promise an effective treatment with more easily tolerated and managed side effects. Basic understanding of the drugs' mechanism of action contributes to the successful management of the toxicities that can be manifested. Effective patient education results in improved compliance with treatment regimens and potentially improved clinical outcomes. Nursing intervention remains a vital component in the successful use of these novel agents.
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Multidisciplinary Management of Pediatric Soft-Tissue SarcomaSoft-tissue sarcomas comprise approximately 7% of all pediatric malignancies. Surgery, chemotherapy, and radiation therapy have significantly improved survival.
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Current Status and Future Potential of Advanced Technologies in Radiation OncologyPart 2. State of the Science by Anatomic SiteOn November 30–December 2, 2006, the Radiation Research Program of the Division of Cancer Treatment and Diagnosis of the National Cancer Institute (NCI) hosted a workshop entitled “Advanced Technologies in Radiation Oncology: Evaluating the Current Status and Future Potential of Proton and Other Heavy Charged-Particle Radiation Therapy, Intensity Modulated Radiation Therapy and Stereotactic Radiation Therapy.”
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The Relationship Between Inflammation and Cancer Is Analogous to That Between Fuel and FireFatigue, fever, depression, confusion, and memory loss are general symptoms that can all indicate inflammation, which itself can often be caused by physical or psychological stress or a common infection such as influenza.
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Multidisciplinary Management of Pediatric Soft-Tissue SarcomaThe management of pediatric soft-tissue sarcomas has improved drastically through the use of multimodal therapy. These tumors include rhabdomyosarcomas and nonrhabdomyosarcomas. Both are staged using
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The Circuitous Path of PARP Inhibitor Development in Epithelial Ovarian CancerOvarian cancers account for more than 50% of gynecologic cancer deaths. This is attributable to the late stage of the disease at diagnosis.
