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Oxaliplatin (Eloxatin) is a novel platinum compound that has activityin a wide variety of tumors. Several hypersensitivity reactions distinctfrom laryngopharyngeal dysesthesia have been described. We retrospectivelyanalyzed 169 consecutive patients who received oxaliplatinfor esophageal or colorectal cancer between 1/1/00 and 7/31/02 andreviewed any significant adverse reactions labeled as hypersensitivityreactions. Thirty-two patients (19%) reportedly experienced hypersensitivity.Skin rash was the most common event (22 patients), occurringafter a median of three infusions. Fever was seen in five patients aftera median of two infusions. Five patients experienced respiratory symptomsat median infusion number 6. Ocular symptoms of lacrimationand blurring of vision were seen in two patients. Five patients experiencedmore than one type of reaction. Treatments prescribed forhypersensitivity were antihistamines, steroids, and topical emollients.One patient developed grade 4 hypersensitivity during cycle 6, characterizedby laryngeal edema, tongue swelling, and labored breathing.This patient underwent a desensitization procedure, adapted from guidelinesfor carboplatin (Paraplatin) allergy. Subsequently, three cycleswere administered over 6 hours and were well tolerated. However,during the fourth infusion postdesensitization, the patient developedrecurrent signs of hypersensitivity. In conclusion, hypersensitivity isfrequently seen with oxaliplatin, but most reactions are mild.

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Carcinoembryonic antigen (CEA) monitoring in patients with stage I-IV colorectal cancer has been, and remains, a controversial issue in oncology practice. Recommendations vary from bimonthly monitoring to no monitoring in the surveillance setting (for stage I-III disease). In the metastatic setting, there are no clear guidelines for CEA follow-up, although continued monitoring in such patients is common in the oncology community. This manuscript reviews the accuracy of CEA testing, its value as a prognostic indicator, and its role in surveillance and response assessment. The limitations of the test in the adjuvant and metastatic settings are illustrated through several case reports from the Colorectal Oncology Clinic at Roswell Park Cancer Institute. Guidelines for CEA monitoring are provided, based on a detailed literature review and institutional experience.

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In patients with advanced, unresectable NETs, there are several treatment options; which of these may be considered depends on the site of origin of the tumor.

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Panelists offer concluding perspectives on the future role of circulating tumor DNA in colorectal cancer management.

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A 55-year-old Hispanic male presents with a family history of gastric cancer in one sibling and prostate cancer in an older brother. CT performed in March 2015 for IMT surveillance showed a heterogeneous prostate with local invasion involving the bladder, seminal vesicles, and perirectal fat.

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The latest addition to the Contemporary Neurology series, devoted to the neurologic complications of cancer, is authored solely by Dr. Posner. Although this book has been written for both the student and trained professional, who can quickly adapt to the definitive nature of the tables, diagrams, and clinical approaches, it is likely to be most appealing to the neuro-oncologic specialist.

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This video examines a phase III trial of ibrutinib in combination with bendamustine and rituximab in patients with previously treated chronic lymphocytic leukemia/small lymphocytic lymphoma.

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Skin cancer is the single most common form of cancer, accounting for more than 75% of all cancer diagnoses. More than 1 million cases of squamous cell and basal cell carcinomas are diagnosed annually, with a lifetime risk of more than one in five.

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Despite the higher risk of VTE in patients with bladder cancer, ironically, their risk of bleeding and anemia, and greater need for transfusion of blood products, poses an equally significant risk of morbidity and mortality, especially among those who undergo cystectomy.

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Ashish Saxena, MD, PhD, from Weill Cornell Medicine, discussed how immunotherapy may lead to an increase in overall survival of patients at the Annual New York Lung Cancers Symposium®.

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In this review, we will discuss multidisciplinary considerations in treating patients with neoadjuvant therapy and highlight areas of controversy and ongoing research.

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In this review we will discuss how to evaluate older breast cancer patients, including estimating survival, defining functional limitations, and providing guidelines for optimal adjuvant therapies.

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In both primary care and oncology settings, screening patients for sleep-wake disturbances comorbid with cancer and their daytime consequences can reduce the economic burden of untreated sleep problems.

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Closing out their discussion, the panel shares remaining unmet needs in the treatment of newly-diagnosed and relapsed multiple myeloma.

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The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in

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The use of high-dose chemotherapy and autologous stem cellsupport in the past decade has changed the outlook for patients withmultiple myeloma. In newly diagnosed patients, complete remissionrates of 25% to 50% can be achieved, with median disease-free andoverall survivals exceeding 3 and 5 years, respectively. Despite theseresults, autologous transplantation has not changed the ultimatelyfatal outcome of the disease, as there is no substantial evidence of“cure” in most published studies. An additional high-dose chemotherapycourse (with tandem transplants) appears to improve progressionfreesurvival, although the effect is not discernible until 3 to 5 yearsposttransplant. The recent reports of tandem autologous transplant formaximum cytoreduction followed by nonmyeloablative allogeneictransplant for eradication of minimal residual disease appears promisingand deserve further investigation. A central issue of tandemtransplants, whether they involve autologous or allogeneic transplants,revolves around defining the subsets of patients who will benefitfrom the procedure. Good-risk patients (defined by normal cytogeneticsand low beta-2–microglobulin levels), especially those who achievea complete or near-complete response after the first transplant, appearto benefit the most from a second cycle. High-risk patients (defined bychromosomal abnormalities usually involving chromosomes 11 and 13and high beta-2–microglobulin levels) whose median survival aftertandem transplant is less than 2 years should be offered novel therapeuticinterventions such as tandem “auto/allo” transplants. Until theefficacy and safety of this procedure is fully established, it should belimited to high-risk patients.

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Immunoglobulin light chain (AL) amyloidosis develops in 2% of individuals with monoclonal plasma cell dyscrasias. In this issue of ONCOLOGY, Drs. Gertz and Dispenzieri discuss AL amyloidosis, highlighting progress in the field along with outstanding challenges.

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Over the past 5 years, several studies have investigated the molecular profiling of penile carcinomas, examining both genomic and epigenetic alterations. These studies have revealed distinct molecular pathways associated with HPV status.

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In this review, we examine the currently approved options available for these disease processes, including the newer agents and selected combinatorial approaches under investigation, and we attempt to identify the role of high-dose IL-2 in the context of current clinical practice.

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The development of metastatic disease in patients with paraganglioma is an unusual and challenging event. This case report and review describes the specific features of this disease and the multiple therapeutic options.

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More than 60 years ago, Karnofsky and colleagues reported promising results with the introduction of nitrogen mustard, the prototype of alkylating agents, for the treatment of lung cancer.[1] Subsequent milestones in the development of lung cancer chemotherapy included the use of platinum agents in the 1970s and 1980s, while the 1990s brought several active agents that could be combined with platinum, namely the taxanes, gemcitabine (Gemzar), and vinorelbine.

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The review by Drs. Ruta Rao and Melody Cobleigh in this issue of ONCOLOGY summarizes the state-of-the-art adjuvant hormonal therapy for breast cancer concisely and appropriately.

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The prospect of even more compressed radiotherapy options for women requiring adjuvant breast radiotherapy is exciting. However, we urge readers to be cautious in their interpretation of the current intraoperative literature as they implement their programs.

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This testicular cancer management guide covers the diagnosis, staging, and treatment of germ-cell tumors and seminoma.

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Among patients with lung cancer, approximately 15% have smallcelllung cancer (SCLC). The clinical characteristics of SCLC tend tobe more aggressive, but also more sensitive to chemotherapy and radiationtherapy than those of non-SCLC. Irinotecan (Camptosar) is aderivative of camptothecin, an inhibitor of the nuclear enzymetopoisomerase I. Irinotecan has been shown to exhibit excellent antitumoractivity against SCLC in monotherapy regimens and in combinationwith cisplatin. A phase III trial comparing irinotecan and cisplatin(IP) with etoposide and cisplatin (EP) in patients with previously untreatedextensive-stage SCLC (ED-SCLC) was conducted. Patients inthe IP arm responded significantly better than patients in the EP arm.In the IP arm, the response rate was 84%, and median overall survivalwas 12.8 months. A phase II trial of irinotecan, cisplatin, and etoposide(IPE) administered weekly (arm A) or every 4 weeks (arm B) for EDSCLC(JCOG 9902-DI) was also performed. In arm B, the responserate was 77% and the median overall survival was 12.9 months. A randomizedtrial comparing IP with IPE administered every 3 weeks inpatients with previously untreated ED-SCLC is presently being performedin Japan.

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In this video, Dr. Atsushi Ohtsu discusses the use of TAS-102, an oral combination of trifluridine and tipiracil hydrochloride, in refractory colorectal cancer.

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Cancer patients experience pain in multiple sites and from several pathophysiologies of the symptom complex. The fluctuating nature of cancer pain intensity is a relevant clinical feature and depends on disease patterns and pain mechanisms. Breakthrough pain is defined as episodes of pain that "break through" the control of an otherwise effective analgesic therapy.

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The patient is an otherwise healthy 45-year-old female who presented to her primary care physician with 6 weeks of increasing left upper quadrant abdominal pain with radiation to the back. She underwent an abdominal ultrasound, which revealed a large cystic abdominal mass.

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It is clear that in a subset of patients with GI malignancies, particularly the low-grade appendiceal neoplasms, CS + HIPEC can result in improved outcomes and in some cases, long-term remission and occasionally cure.