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Commentary (Rai/Mehrotra): Current Status of Monoclonal Antibody Therapy for Chronic Lymphocytic LeukemiaDrs. Nabhan, Dyer, and Rosenprovide an excellent and comprehensivereview of the therapeuticrole of rituximab (Rituxan)and alemtuzumab (Campath) inchronic lymphocytic leukemia (CLL).We take this opportunity to offer ourcomments concerning these two monoclonalantibodies in CLL.
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Bisphosphonates in the Prevention and Treatment of Bone MetastasesBisphosphonates have an established role in treating tumor-inducedhypercalcemia and decreasing the incidence of skeletal-related events.Recent data suggest that these agents may also prevent skeletal metastases.This review explains how cancer metastasizes to bone and howbisphosphonates may block this process, with a summary of clinicaltrials supporting the use of bisphosphonates to treat and prevent bonemetastases. For skeletal metastases in patients with breast cancer,multiple myeloma, or other solid tumors, bisphosphonates are importantadjuncts to systemic therapy. Despite promising results in metastaticprostate cancer, additional trials are needed before bisphosphonatesbecome part of standard treatment in this setting. Ongoing trials areevaluating the preventive role of the third-generation bisphosphonatesin breast cancer patients. Until the results of these trials are presented,bisphosphonates should only become a component of adjuvant treatmentin the context of a clinical trial. Bone loss, a common consequenceof cancer treatment, should be treated with the usual measures indicatedfor the management of osteoporosis, including bisphosphonates.
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AIDS-related Kaposi's Sarcoma: Options for Today and TomorrowPrior to 1981, Kaposi sarcoma (KS) was considered a rare human cancer occurring primarily among elderly Italian and Jewish men of eastern European ancestry. I wrote a review of KS research and clinical experiences that appeared in CA: A
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Solitary Extramedullary and Bone Plasmacytomas versus Multiple Myeloma with Extramedullary ManifestationExtramedullary disease in plasma cell disorders can occur as a solitary plasmacytoma or can involve multiple sites with vastly different clinical outcomes. The article by Khaliq et al reports an unusual case of solitary extramedullary plasmacytoma (SEP) of the bladder in which the patient had a favorable outcome with lenalidomide/dexamethasone after failing first-line treatment with radiotherapy. In this context it is interesting to compare clinical outcomes of this entity to two other clinical variants of myeloma: solitary plasmacytoma of bone (SPB), and multiple myeloma with extramedullary plasmacytomas (MM/EP).
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Stereotactic Body Radiation TherapyThe article by Song, Kavanagh,Benedict, and Schefter is an insightfuland interesting summaryof this new technologic approachto the treatment of extracranial tumors.The work summarizes thesalient aspects of the emerging stereotacticbody radiation therapy (SBRT)paradigm, and characterizes the rationale,methodologies, and perceivedpotential for this promising new approachto treatment. The authorspresent interesting perspectives on thechallenges facing early adopters ofthe approach and, as early adopters,we find that our own experience supportsmany of the conclusions drawnby the authors.
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ACR Appropriateness Criteria® Nonsurgical Treatment for Locally Advanced Non–Small-Cell Lung Cancer: Good Performance Status/Definitive IntentThe treatment of inoperable stage III non–small-cell lung cancer (NSCLC) remains a challenge due to high rates of distant metastasis, local recurrence, and toxicity associated with definitive therapy.
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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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Clinical Trial Simulation of a 200-µg Fixed Dose of Darbepoetin Alfa in Chemotherapy-Induced AnemiaOur objective was to assess, using clinical trial simulation, the feasibility of a fixed 200-µg dose of darbepoetin alfa (Aranesp) administered every 2 weeks in chemotherapy-induced anemia. A pharmacokinetic/pharmacodynamic
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Ground-Glass Opacity Lung Nodules in the Era of Lung Cancer CT Screening: Radiology, Pathology, and Clinical ManagementThis review focuses on the radiologic and pathologic features of ground-glass opacity nodules, along with the clinical management of these lesions.
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Paclitaxel and Epirubicin as First-Line Therapy for Patients With Metastatic Breast CancerPaclitaxel (Taxol) has aroused considerable interest for its high single-agent activity in breast cancer and novel mechanism of action. Epirubicin (Farmorubicin), the 4'epimer of doxorubicin (Adriamycin), also has high activity in
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Commentary (Lewis): Percutaneous Endoscopic Stomas for Enteral Feeding and DrainageEndoscopically guided percutaneous gastrostomy tube placement was developed in 1980 by Jeffrey Ponsky [1].In the ensuing years, this procedure has evolved rapidly. The procedure began with a homemade kit consisting of urinary and intravenous catheters. Now the endoscopist has a choice of three different techniques and a host of commercially available kits from which to choose [2]. By 1989, percutaneous endoscopic gastrostomy became the preferred method of gastrostomy (over surgery), and presently is the second most common indication for EGD (esophago-gastro-duodenoscopy) in hospitalized patients in the United States (the most common indication is upper gastrointestinal bleeding). The long-term complication rate is extremely low [3,4], and both patients and nurses alike prefer percutaneous endoscopic gastrostomy to nasogastric tubes [3].
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Is Axillary Dissection Always Indicated in Invasive Breast Cancer?It is not often that a reviewer agrees entirely with material presented in an article. I find myself in the happy situation of largely agreeing with the basic thrust of this interesting report by Chadha and Axelrod. They begin by describing the increased incidence of breast cancer over the recent decade, but do not mention that since 1990 there has actually been a decreased incidence of breast cancer.[1] In retrospect, it has become clear that the statistical increase in breast cancer during the 1980s was an artifact of extensive mammographic screening, which caught the initial appearance of disease earlier and artificially created a temporary surge of cases that has since abated.[2]
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New Developments in Colorectal CancerBlase Polite, MD, assistant professor of medicine at the University of Chicago and the track leader for the GI Colorectal Scientific Program Committee at ASCO, discusses the latest research in the field of colorectal cancer.
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What We Can Learn From Our PatientsPatient satisfaction data can give practices insight into their operations and make specific, practice-level adjustments accordingly, and with aggregated data we can gain insights into global practice responsiveness and patient perceptions regarding care.
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Current Management of Menopausal Symptoms in Cancer PatientsMenopause can be experienced prematurely by women with cancer and, as such, is often accompanied by symptoms that are becoming salient management issues. It is common practice to avoid estrogen replacement therapy in women with estrogen-sensitive tumors.
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Effect of Adjuvant Chemo on Elderly Patients’ Quality of LifeIn this Medical News Minute developed exclusively for Cancer Network, Dr. Bobby Lazzara discusses recently published research that looks at quality of life outcome measures for elderly breast cancer patients who receive adjuvant chemotherapy.
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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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Head and neck tumorsIn 2009, approximately 35,720 men and women (25,240 men and 10,480 women) in the United States will be diagnosed with cancer of the oral cavity and pharynx, and 7,600 will succumb to these diseases. Further, an estimated 12,290 men and women (9,920 men and 2,370 women) in the United States will be diagnosed with laryngeal cancer, and 3,660 will die from this malignancy. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).
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Tamoxifen's Impact on the Management of Breast Cancer: Patient PerspectivesTamoxifen citrate has been prescribed to millions of women with breast cancer and has been one of the most important advances in breast cancer treatment over the past 25 years. Because she is a female physician, the
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Lung Cancer-Related Brain Metastases: Further ConsiderationsDespite the high prevalence of brain metastases in patients with metastatic lung cancer, these patients have been excluded from enrollment in clinical trials of new therapeutic drugs. The reasons for exclusion have centered on concerns that the blood-brain barrier may impede drug delivery into brain metastases, that brain metastases confer a dismal survival for metastatic lung cancer patients, and that brain metastases carry risk for cerebrovascular hemorrhage. A focused, updated review of these issues, however, clearly shows that these particular concerns are unwarranted. An extensive review of clinical trials on the efficacy of chemotheraputic agents against lung cancer brain metastases is also provided. This collective information describes an area in need of therapeutic development and supports an initiative to evaluate novel targeted therapies for lung cancer brain metastases.
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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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Advances in Cancer Research, Volume 79In this time-honored series, the editors have assembled a panel of internationally recognized experts and accomplished a "tour de force" in presenting an overview of the past year’s most salient discoveries in cancer research. They have chosen
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Neoadjuvant Therapy for Gastric CancerGastric cancer is a global health issue. Most cases are diagnosed atan advanced stage with poor prognosis. Current therapies have a modestimpact on survival. Surgery remains the only potentially curativetreatment, but is associated with a high rate of locoregional recurrenceand distant metastases. Total gastrectomy for proximal cancers is complicatedby postoperative morbidity and quality-of-life impairment.Combined-modality therapy may improve outcomes in this disease.Adjuvant therapy for gastric cancer has now become the standard inthe Western world. However, adjuvant therapy improves survival by onlya few months and is associated with high morbidity. Neoadjuvant therapyis commonly used for esophageal and gastroesophageal junction cancers,but is still regarded as investigational in gastric cancer. Severalsmall phase II studies indicate the feasibility of neoadjuvant strategies.The incorporation of novel, targeted agents into neoadjuvant programsand an assessment of biologic changes within the tumor may refinetherapy. This article provides a concise review of the literature onneoadjuvant therapy for gastric cancer and suggests avenues for furtherinvestigation.
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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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A Survivor’s Perspective on Young Adults With CancerWhen my doctor told me that I would have to put my life on hold at age 25 because tests confirmed that I had Hodgkin’s disease-cancer!-my life changed totally. I had to quit my job, move back in with my parents, and wonder about the quantity and quality of the rest of my life.
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Patterns of Chemotherapy Administration in Patients With Intermediate-Grade Non-Hodgkin’s LymphomaRecords from 653 patients treated between 1991 and 1998 in the Oncology Practice Patterns Study (OPPS) were analyzed to determine contemporary chemotherapy delivery patterns in patients with intermediate-grade non-
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Propelling Immunotherapy Combinations Into the ClinicThis review summarizes promising new targets and immunotherapy combination strategies currently under clinical development.
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A Comparison of FDA and EMA Drug Approval: Implications for Drug Development and Cost of CareThe development and approval of oncology therapeutics has been facilitated by the cooperation and coordination of regulatory practices between the EMA and the FDA. However, there continue to be important differences between the decisions of the two agencies.
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Radiation Therapy in Diffuse Large B-Cell Lymphoma: A Little Boost Gets You Over the Finish LineBradford S. Hoppe, MD, MPH, and Omran Saifi, MD, offer a peer perspective on research by Gavin Jones, MD, and colleagues into radiation therapy in diffuse large B-cell lymphoma.
