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The Evolving Role of Radiation Therapy in DLBCL: From Early-Stage to Refractory DiseaseGavin Jones, MD, and colleagues explore the landscape of radiation therapy in diffuse large B-cell lymphoma.
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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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POINT: Is Lymphadenectomy Required in Endometrial Cancer for Adequate Surgical Staging?The diagnostic benefits of SLN evaluation include an ability to identify the extent of tumor dissemination and the utility of SLN mapping in guiding targeted adjuvant treatment in high-risk patients.
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Management of Pregnant Patients With CancerApproximately 1 in 1,000 pregnancies are complicated by a cancer diagnosis, and there is speculation that the incidence of cancer during pregnancy will increase as more women delay childbearing. The cancers that most commonly afflict pregnant women include breast and cervical cancer, as well as melanoma, lymphoma, and acute leukemia.
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When to Use Prophylactic Antibiotics in Neutropenic PatientsCurrent guidelines recommend antimicrobial prophylaxis with fluoroquinolones in patients at high risk for infection-related morbidity and mortality, but this practice provides a short-term benefit to individual patients.
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Is Neoadjuvant Chemotherapy in Ovarian Cancer an Excuse for Insufficient Surgery?Surgical debulking of epithelial ovarian carcinoma has been a mainstay of therapy for more than 50 years-since the approach was first advocated by Meigs in 1934.[1] In 1968, Munnell[2] introduced the idea of the "maximum surgical effort”-essentially the removal of as much cancer as possible.
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Hodgkin's Lymphoma in the Elderly: A Different Disease in Patients Over 60With improved prognosis for patients with Hodgkin's lymphoma (HL), interest has increasingly focused on high-risk groups such as elderly patients. Advanced age at presentation is still one of the strongest negative risk factors. Many different factors influence the prognosis in elderly patients. These include biologic differences such as more aggressive histology, different distribution of disease, more frequent diagnosis of advanced stage, and shorter history of disease. In addition, however, aging itself and associated factors such as comorbidity, reduced tolerability of conventional therapy, more severe toxicity and treatment-related deaths, failure to maintain dose intensity, shorter survival after relapse, and death due to other causes contribute to the poorer outcome in elderly patients. Besides the evaluation of specific causes and risk factors, this review highlights recent and ongoing studies for elderly patients with HL as well as international approaches and recommendations for this age group.
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Empiric Antifungal Therapy for the Neutropenic PatientThe article written by Drs. Wingard and Leather presents a thoughtful review of the current approaches to empiric antifungal therapy in neutropenic patients. Empiric antifungal therapy has evolved as a standard of care for the prevention of invasive fungal infections in neutropenic patients who remain persistently febrile despite the use of broad-spectrum antibacterial antibiotics.[1-3] Empiric antifungal therapy in this setting provides early treatment for clinically occult invasive fungal infections and systemic prophylaxis for neutropenic patients at highest risk.
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Irinotecan in Relapsed or Refractory Non-Hodgkin’s LymphomasBecause irinotecan (CPT-11, Camptosar) is a topoisomerase I inhibitor with a broad spectrum of antitumor clinical activity, we investigated its activity in relapsed or refractory non-Hodgkin’s lymphomas (NHLs). Irinotecan at 300 mg/m² IV was administered every 21 days with intensive loperamide management of diarrhea.
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Paclitaxel and UFT Plus Oral Calcium Folinate in Pretreated Metastatic Breast CancerThis phase I study was designed to determine the maximum tolerated dose (MTD) and dose-limiting side effects of combination treatment with paclitaxel (Taxol) and UFT (uracil and tegafur in a 4:1 molar ratio) plus oral
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Controversies in Early-Stage Hodgkin’s DiseaseThe optimal choice of treatment for early-stage Hodgkin’s disease depends on (1) knowledge of the prognostic factors that may influence treatment outcome and (2) the risk of acute and long-term complications incurred by treatment. For prognostic and therapeutic considerations, patients are divided into those with early-stage, favorable-prognosis disease (clinical stage I/II without risk factors) and those with early-stage, unfavorable-prognosis or intermediate-stage disease (clinical stage I/II with risk factors).
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Andreas Rimner, MD, on Immunotherapy Combined with Radiation in Lung CancerThe radiation oncologist from Memorial Sloan Kettering Cancer Center, discusses several ongoing trials combining immunotherapy and radiation at the 14th Annual New York Lung Cancers Symposium®.
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DNA Microarrays in Lymphoid MalignanciesGene expression profiling using cDNA microarrays has the potentialto improve current lymphoma classification schemes by establishinga molecular diagnosis of these malignancies. The use of this technologyled to the discovery of biologically and clinically distinct subtypesof diffuse large B-cell lymphoma (DLBCL). Gene expression datacan also be used to formulate powerful mathematical algorithms thatpredict the clinical outcome in patients with DLBCL and mantle celllymphoma. In B-cell chronic lymphocytic leukemia, gene expressionprofiling identified ZAP70, an important prognostic marker whose expressioncorrelates with the mutational status of the immunoglobulinheavy chain gene and, therefore, with survival in these patients. Theseexamples illustrate that gene expression profiling may pave the way fordetailed molecular characterization of lymphoid malignancies that willultimately lead to tailored, disease-specific therapies.
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Neoadjuvant Therapy With Gemcitabine in Breast CancerPrimary systemic therapy (ie, preoperative or neoadjuvant) increasesthe possibility for breast-conserving surgery in patients with primarybreast cancer. Patients with pathologic complete response to primarysystemic therapy have improved survival compared with those with persistenttumors. Several phase II trials have evaluated gemcitabine-containingdoublet or triplet regimens as primary systemic therapy for breastcancer, results of which have shown promising clinical and pathologicresponse rates with manageable toxicity. Results of a phase I/II studyof gemcitabine (Gemzar)/epirubicin (Ellence)/docetaxel (Taxotere), orGEDoc, with prophylactic filgrastim (Neupogen), as primary systemictherapy in 77 evaluable patients with primary breast cancer are reportedherein. Dose-limiting toxicities were grade 3 febrile neutropenia(n = 1) and grade 3 diarrhea (n = 2) at the fourth dose level ofGEDoc tested (gemcitabine at 800 mg/m2 days 1 and 8, epirubicin at90 mg/ m2 day 1, and docetaxel at 75 mg/m2 day 1). As assessed byultrasound, 92% of patients responded overall (22% complete response),and 79% of patients could undergo breast-conserving surgery. Thepathologic complete response rate in resected breast tissue was 26%.
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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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Supraclavicular Extraskeletal Myxoid Chondrosarcoma Presenting With a Sensorimotor Polyneuropathy Associated With Anti-Hu AntibodiesThis case shows the importance of searching for antineural antibodies in oncologic patients with new neurologic deficits, and of having a judicious workup for occult malignancies in patients with known antineural antibodies.
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Oligodendrogliomas: Questions Answered, Answers QuestionedIn light of the high bar that must be met for results to be truly practice-changing, and of the long period of time before survival results are mature in an indolent disease, the primary endpoint for clinical trials in anaplastic oligodendroglial tumors needs rethinking.
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The State of Prostate MRI in 2013Our aims in this article are to describe the various imaging sequences that comprise the multiparametric MRI exam, as well as to review current literature on the strengths/weaknesses of these sequences; to delineate strategies for standardizing interpretation and reporting of MRI results; and to expound on the role of prostate MRI in clinical practice.
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Stereotactic Radiation Therapy Combined With Immunotherapy: Augmenting the Role of Radiation in Local and Systemic TreatmentIn this review we detail the rationale supporting a combination of immunotherapy and stereotactic radiation. Additionally, we discuss the evidence for the immune stimulatory effects of focused radiation and the role that radiation may play in enhancing the systemic treatment effects of immunotherapy.
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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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Molecular Genetics of Hereditary Ovarian CancerApproximately 10% of all epithelial ovarian carcinoma cases are associated with inheritance of an autosomal-dominant genetic mutation conferring a predisposition to cancer with variable penetrance. Two such manifestations
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Clinical and Pathological Features Are Still the Best Determinants of Prognosis in MesotheliomaSignificant advances have been made in our understanding of the factors affecting the prognosis of malignant mesothelioma, and a number of biomarkers appear promising. However, at present it may be more fruitful to better define and characterize clinical factors that are well recognized as significantly impacting patient survival.
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How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management.
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Progress With a Purpose: Eliminating Suffering and Death Due to Cancercancer is the second leading cause of death in the United States, with more than 500,000 men, women, and children succumbing to the disease each year. The idea, then, that we can eliminate the suffering and death due to cancer in the United States by the year 2015 may appear impractical, if not irrational and impossible. It seems inconceivable that in the first part of the 21st century every patient could survive cancer. Doubt can be attributed to awareness of the biologic complexity of cancer and seeing the pace of clinical progress through the prism of the 20th century.
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Cancer and Healthcare Reform: Making the Pieces FitCancer service leaders must create the vision, embrace the change agenda, and drive the roadmap in order to make the strategic and clinical changeover to value.
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Recap Evolving HER2+ Metastatic Breast Cancer LandscapeExperts discussed the changing landscape in treatments for HER2-positive metastatic breast cancer.
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Highlighting “Trickle-Down” Progress in Developing Rare Lymphoma TreatmentCAR T-cell therapy initially developed for mantle cell lymphoma was subsequently assessed in marginal zone lymphoma.
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Longer Term Data Confirm Subcutaneous Rituximab Efficacy in Follicular LymphomaIn this video we discuss longer term results of the phase III SABRINA study, which tested the safety and efficacy of subcutaneous rituximab in patients with follicular lymphoma.
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Eltrombopag for the Treatment of Chronic Immune (Idiopathic) Thrombocytopenic PurpuraOn November 20, 2008, the US Food and Drug Administration (FDA) granted accelerated approval for eltrombopag (Promacta Tablets, GlaxoSmithKline) for the treatment of thrombocytopenia in patients with chronic immune thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulin therapy, or splenectomy.
