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Current Perspectives on Locally Advanced Pancreatic CancerThis year, approximately 40% of the 28,300 patients diagnosed with pancreatic carcinoma in the United States will present with locally advanced disease. Radiotherapeutic approaches are often employed, as these patients
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UFT Plus or Minus Calcium Folinate for Metastatic Colorectal Cancer in Older PatientsTwo studies were carried out to determine the activity and evaluate the toxicity of oral chemotherapy with uracil and tegafur in a 4:1 molar ratio (UFT) plus or minus calcium folinate in elderly patients with advanced colorectal
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The UFT/Leucovorin/Etoposide Regimen for the Treatment of Advanced Gastric CancerGastric cancer is the most chemosensitive adenocarcinoma among digestive neoplasms. A few years ago, we performed a phase II trial with the FLEP regimen, in which fluorouracil (5-FU) and leucovorin are combined
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A Phase II Study of Doxorubicin/Paclitaxel Plus G-CSF for Metastatic Breast CancerThis phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line
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Studies to Watch at SABCS 2014In this preview of the 2014 San Antonio Breast Cancer Symposium, we take a look at some of the studies to watch for at this year's event.
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Irinotecan, Epirubicin, and Capecitabine in Metastatic Adenocarcinomas: Preliminary Results of a Phase I StudyThe combination of irinotecan (Camptosar), epirubicin, andcapecitabine (Xeloda) has shown an acceptable toxicity profile. In thisopen-label phase I study, irinotecan was administered IV at a fixeddose of 250 mg/m2 on day 1 in combination with capecitabine at a fixeddose of 1,500 mg/m2 for days 2 to 7 and epirubicin starting at a dose of40 mg/m2 and escalating by 10 mg/m2 in cohorts of three patients forthose with metastatic adenocarcinomas. With the addition of granulocytecolony-stimulating factor (G-CSF [Neupogen]) to the regimen,patients received epirubicin at clinically relevant doses after dose-escalation.Results of the topoisomerase activity will be reported with thefinal results of this phase I study. The dose-limiting toxicity has not yetbeen reached. This combination regimen in patients with upper gastrointestinalmalignancies and breast cancer will be investigated as partof phase II studies, once the dose-limiting toxicity is determined. Theappropriate sequencing of the regimen to maximize clinical efficacywill also be determined.
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New Combinations With Epirubicin in Advanced Breast CancerSeveral trials have shown that anthracyclines and taxanes can be combined to achieve response rates ranging from 70% to 90%, with complete responses ranging from 19% to 41%. In an attempt to increase the activity while
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New Antifolates in Clinical DevelopmentNumerous new antifolate drugs have been developed in an attempt to overcome the potential mechanisms of tumor cell resistance to methotrexate, which can include decreased drug transport into cells; decreased
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Oncologic Emergencies and Paraneoplastic SyndromesThis management guide covers the oncologic emergencies such as superior vena cava syndrome, deep venous thrombosis, pulmonary embolism, and other paraneoplastic syndromes.
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Paraneoplastic Leukocytosis: An Unusual Manifestation of Squamous Cell Carcinoma of the Urinary BladderA 76-year-old woman with a history of dementia, hypertension, type 2 diabetes mellitus, and newly diagnosed squamous cell carcinoma of the urinary bladder was referred to Indiana University Medical Center after 3 to 4 weeks of hospitalization at two other hospitals.
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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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Follow-up Care for Cancer: Making the Benefits Equal the CostThe premise that early diagnosis of certain types of malignancies improves outcome and survival is a cornerstone of modern medicine. Routine use of the Pap smear has been associated with reduced mortality from cervical cancer. Randomized trials
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Docetaxel Plus Cisplatin: An Active Combination Regimen in Non-Small-Cell Lung CancerDocetaxel (Taxotere) isa semisynthetic taxoid that possesses significant activity as a single
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Improving Outcomes in Resectable Gastric Cancer: A Review of Current and Future StrategiesHere we review the evidence supporting current approaches to resectable gastric cancer, including discussion of the optimal extent of surgery and lymphadenectomy, adjuvant chemotherapy, postoperative chemotherapy with chemoradiation, and perioperative chemotherapy.
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Neuroblastoma: Biology and TherapyNeuroblastoma is the most common solid extracranial tumor in children. Although the outcome of patients with localized disease has improved substantially, the prognosis for those with advanced disease is still poor, despite multimodality therapeutic efforts of increasing intensity over the last 20 years. Dr. Matthay provides an excellent overview review of the biology and treatment of this devastating but fascinating childhood malignancy.
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Patient Quality of Life Endpoints in Oncology Trials, Part IIThis interview covers symptom management and quality-of-life outcomes in cancer clinical trials, which are being incorporated more readily as secondary and sometimes primary trial endpoints.
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Problems in Lymphoma Management: Special Sites of PresentationDr. Connors has written an excellent review of the management of five unusual sites of lymphomatous involvement. Several basic principles are illustrated in his discussion of rare entities:
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Current Issues in the Treatment of Resistant Bloodstream InfectionsBloodstream infections cause significant morbidity and mortality for patients with hematologic malignancy. Antimicrobial drugs are the most reliable currently available treatment for infection, but several issues must be
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Implications of the New Face of Head and Neck CancerAlthough screening methods for HPV-OPSCC have not yet been developed, population-based prevention may be achievable through HPV vaccination, but only if concerted efforts are made to increase vaccine uptake in the United States.
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Unexpected Benefit Links Hypertension to Better Ovarian Cancer OutcomesNew research suggests that hypertension and diabetes and the use of medications to treat these conditions may influence the survival of ovarian cancer patients.
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Strategies for Identification and Clinical Evaluation of Promising Chemopreventive AgentsStrategies for chemopreventative drug development are based on the use of well-characterized agents, intermediate biomarkers correlating to cancer incidence, and suitable cohorts for efficacy studies. Since
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High-Dose Chemotherapy With Autologous Stem Cell Rescue in the Outpatient SettingOutpatient bone marrow transplant (BMT) strategies, as reviewed by Dix and Geller, have evolved for various reasons—from social to medical. If high-dose approaches are to become a viable treatment for common cancers, such as breast cancer, the refinement of transplants to a “kinder and gentler” approach is essential.
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FDA simplifies patient access to investigational drugsRules balance access to promising new therapies against the need to protect patient safety.
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Implementing Change: A View From the TrenchesWith perhaps 100 patients scheduled for chemotherapy each day and about the same number of consultations, the nurses, physicians, and staff in any medium-sized oncology clinic are fully booked. Changing their routines may be the last thing anyone wants to think about.
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Thrombocytopenia: Optimizing Approaches in Cancer PatientsChemotherapy-induced thrombocytopenia causes nearly two-thirds of cases of thrombocytopenia in the cancer setting. In patients receiving chemotherapy, thrombocytopenia leads to dose reductions in 15% of treatment cycles and chemotherapy delays in 6% of cycles.
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BRAF, MEK Inhibition Shows Strong Long-Term Survival Benefit in MelanomaIn this video we discuss 3-year results of the COMBI-d trial, which studied dabrafenib and trametinib in patients with unresectable or metastatic BRAF-mutated melanoma.
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Commentary (Meltzer): The Role of PET-CT Fusion in Head and Neck CancerIn their article, Rusthoven and colleagueshighlight the utility ofcombined positron-emission tomography/computed tomography(PET-CT) imaging for diagnosing primaryand recurrent head and neckcarcinoma, and for defining tumor targetvolumes for radiotherapy treatmentplanning in the head and neck. PEToffers noninvasive measures of tumorbiology yet suffers from limited spatialresolution; the physiologic informationobtained with PET is complementaryto the high-resolution structural informationobtained with CT or magneticresonance imaging (MRI).
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Quality-of-Life End Points in Oncology Drug TrialsMany advances in the treatment and care of cancer patients have been closely linked to the availability of more effective pharmaceutical agents. As research continues to develop new and improved chemotherapeutic agents, it is heartening that the FDA maintains a flexible approach to the drug approval process and will consider an array of indicators of drug efficacy, including patient self-reports of health-related quality of life.
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Prevalence of Complementary and Alternative Medicine Use in Cancer PatientsInterest in complementary and alternative medicine (CAM) has grown dramatically over the past several years. Cancer patients are always looking for new hope, and many have turned to nontraditional means. This study was
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How Heterogeneous Cell Populations, Cancer Cell Dormancy, and Minimal Residual Disease Influence the Natural History of CancersThe authors of “How Long Have I Had My Cancer, Doctor?” have addressed a question often contemplated by patients when they receive a diagnosis of cancer.
