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Initial Control of Chemotherapy-Induced Nausea and Vomiting in Patient Quality of LifeThe side effects commonly experienced by patients receiving chemotherapy for the treatment of cancer can challenge many aspects of daily life. Nausea and vomiting, the most common side effects reported by patients, affect the ability to continue with usual life activities and, thus have a pronounced impact on quality of life.
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Stereotactic Breast Biopsy: Indications and ResultsThis paper will address various issues relevant to core-needle biopsy of the breast under stereotactic imaging guidance. Patient and equipment selection, indications, contraindications, complications, limitations, and advantages will be discussed. The role of stereotactic core biopsy in patient management will also be addressed.
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Increased Efficacy Through Moderate Dose Escalation of Chemotherapy: Interim Report From the HD9 Randomized Trial for Advanced Hodgkin’s DiseaseThis report aims to assess the effect of increased drug dose on the efficacy and toxicity of the BEACOPP regimen with
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2 Cycles of ABVD Plus Radiotherapy Is More Effective Than Radiotherapy Alone in Early Stage HD-Interim Ahan Radiotherapy Alone in Early Stage HD-Interim Analysis of the HD7 Trial of the GHSG Clinic of Internal Medicine I University of Cologne/GermanyBACKGROUND: Extended-field radiotherapy is effective in patients with early-stage Hodgkin’s disease, and more than
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Phase II Study of Rituximab in Combination With Fludarabine in Patients With Chronic Lymphocytic LeukemiaThis phase II trial investigated the safety and efficacy of a combined-modality treatment with rituximab (Rituxan) and fludarabine (Fludara) in patients with fludarabine- and anthracycline-naive chronic lymphocytic lymphoma (CLL).
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An Argument Against Routine Use of Radiotherapy for Ductal Carcinoma In SituIn his article, Dr. Silverstein reviewsthe changing incidence of ductalcarcinoma in situ (DCIS) in theUnited States over the past 25 years,discusses the results of various clinicaltrials evaluating treatment optionsfor the disease, and, using the VanNuys Prognostic Index (VNPI), identifiesa subgroup of DCIS patientstreated by lumpectomy who, he feels,may be able to avoid breast irradiation.During several presentations atnational meetings, I have had the opportunityto debate Dr. Silverstein onthis topic. He is a powerful and articulateproponent of the idea thatcertain DCIS patients could be exemptedfrom radiation therapy withoutconsequences.
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Docetaxel vs Mitomycin Plus Vinblastine in Anthracycline-Resistant Metastatic Breast CancerThis nonblinded, multicenter, randomized phase III study compares the median time to progression (primary endpoint), response rate, and quality of life, safety, and survival of
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UFT/Leucovorin Plus Bolus Epirubicin and Cyclophosphamide in Advanced/Metastatic Breast CancerThis article describes the design and early results of an open-label, nonrandomized phase I/II trial of oral UFT plus leucovorin therapy in combination with bolus injections of epirubicin and cyclophosphamide in patients with advanced or metastatic breast cancer. This study was designed as a cohort dose-escalation study with the principal aims being to determine dose-limiting toxicity, overall toxicity, maximum tolerated dose, tumor response, and time to disease progression.
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Commentary (Stinchcombe et al): Perspectives on Salvage Therapy for Non–Small-Cell Lung CancerWe applaud Dr. Cappuzzo andcolleagues for an excellentreview of an emerging fieldin lung cancer treatment. Since 2000,three drugs (docetaxel [Taxotere],pemetrexed [Alimta], and erlotinib[Tarceva]) have been approved by theUS Food and Drug Administration(FDA) for second-line therapy in non–small-cell lung cancer (NSCLC) basedon the results of phase III trials (seeTable 1).[1-4] It is also possible thatsimilar approval will be sought for otherdrugs (eg, topotecan [Hycamtin]),[5]and gefitinib (Iressa) remains an optionfor treatment in the third-line setting.
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Consolidation TherapyWe previously reported the efficacy of concurrent cisplatin (Platinol)/etoposide (PE) and radiotherapy in stage IIIB non–small-cell lung cancer in which biopsy confirmation of T4 (noneffusion) or N3 status was required (S9019). In view of the activity of docetaxel (Taxotere) as second-line therapy and potential molecular mechanisms of action favoring taxane sequencing, we designed the present study to maintain a core of concurrent PE/radiotherapy, but to substitute docetaxel consolidation for the two additional cycles of PE.
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Recap: Experts Discuss NRG1 Fusions as Key Oncogenic Drivers for Certain Patients With Lung CancerD. Ross Camidge, MD, PhD, and Alexander I. Spira, MD, PhD, discussed the use of NRG1 fusions as being a driver for patients with lung cancer.
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Relapsed Follicular Lymphoma: Response to a Fludarabine/Mitoxantrone Regimen and the Monoclonal Anti-CD20 Antibody RituximabOur objective was to determine the efficacy of a fludarabine (Fludara)/mitoxantrone (Novantrone) regimen combined with the monoclonal anti-CD20 antibody rituximab (Rituxan) to induce clinical and molecular remissions in patients with relapsed
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Final Results of a Randomized Controlled Study of the Ibritumomab Tiuxetan Radioimmunotherapy Regimen vs a Standard Course of Rituximab Immunotherapy for B-Cell Non-Hodgkin’s LymphomaIbritumomab tiuxetan (Zevalin) is a murine anti-CD20 monoclonal antibody covalently bound to the chelator tiuxetan, which can securely chelate yttrium-90. We performed a randomized controlled trial
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In Vivo Purging With Rituximab Prior to Stem Cell Collection Is Associated With Persistent Molecular Evidence of t(14;18) That Often Disappears Post-Transplant in Patients With Follicular LymphomaWe previously reported that “in vivo purging” with rituximab (Rituxan) during stem-cell collection is safe and does not adversely affect engraftment. We now report on our transplant experience with rituximab. From June 1998 to December
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Applications of Genomic Sequencing in Pediatric CNS TumorsThis review will discuss examples of clinical applications of tumor and germline genomic testing for children with central nervous system (CNS) tumors, as well as promising investigative strategies.
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UFT/Leucovorin Combined With Paclitaxel for Anthracycline-Pretreated Advanced Breast CancerTaxanes are the most active drugs in the treatment of metastatic breast and ovarian cancer. Weekly therapy with paclitaxel produces notable activity, with remarkably low toxicity.
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Diagnostic Dilemma: DermatologyA 49-year-old Caucasian man presented with progressing erythematous plaques on the face and neck in December 2007. He was treated with topical steroids, presumably for dermatitis, without improvement.
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Integrating Genetics and Genomics Into Oncology NursingGenetic and genomic research is creating new and more individualized approaches to better manage a person's disease or predisposition to disease, including cancer.
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Tumor Ablation: Treatment and Palliation Using Image-Guided TherapyImagine destroying a tumor in 6minutes with a small needle electrodeplaced through the skin intoa tumor deep in the human body-thepatient is cured after spending only afew hours in the hospital and leaveswith just a small bandage. This maysound like science fiction, but it isreality in many medical centers aroundthe world.
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Diagnostic and Management Issues in Gallbladder CarcinomaThis paper by Abi-Rached and Neugut provides an overview of the diagnosis and treatment of gallbladder carcinoma, a rare, yet frustratingly difficult disease to manage [1]. Overall, we agree with the risk factors described in this review. We would add that, in addition to chronic cholecystitis, porcelain gallbladder, and retained gallbladder (secondary to cholecystostomy), cholecysto-enteric fistulas have also been associated with a higher incidence of gallbladder carcinoma [2,3] Patients with ulcerative colitis are known to be at higher risk for cholangiocarcinoma, and there is also some evidence that these patients have an increased risk of gallbladder cancer.
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Commentary (Laheru/Jaffee): Novel Vaccines for the Treatment of Gastrointestinal CancersThe identification of key signaltransduction pathways and, inparticular, specific proteins thatare involved in the regulation of cancercell growth has provided unprecedentedopportunities for researchersinterested in targeted cancer treatment.The identification of molecular target-specific therapy offers the potentialof maximal therapeutic benefitwhile minimizing toxicity to normalcells. The accomplishment that led tothe sequencing and analysis of theentire human genome in 2001 has providedresearchers with the basic criticaltools to begin to identify anddifferentiate cancer from normal tissueat the genetic level.[1,2] Whilethe implications of this landmarkachievement are still being realized,it has become evident that the identificationof critical genes and proteinsinvolved in cell division and growthare just the beginning. The complexrelationships between multiple signaltransduction pathways, the surroundingtumor microenvironment, andpathways involved in immune-systemregulation have gained new appreciation.The ability to manipulate thesemultiple interactive systems with targetedtherapies represents a new treatmentparadigm in oncology.
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Targeted Therapy in Rectal CancerEpidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) are often overexpressed in colorectal cancer and are associated with inferior outcomes. Based on successful randomized phase III trials, anti-EGFR and anti-VEGF therapeutics have entered clinical practice. Cetuximab (Erbitux), an EGFR-specific antibody, is currently approved in the United States in combination with irinotecan (Camptosar) for patients with metastatic colorectal cancer refractory to irinotecan or as a single agent for patients unable to tolerate irinotecan-based therapy. In retrospective analyses, patients with EGFR-expressing rectal cancer undergoing neoadjuvant radiation therapy had a significantly inferior disease-free survival and lower rates of achieving pathologic complete response. Based on the positive data in metastatic colorectal cancer and synergy with radiation therapy seen in preclinical models, there is a strong rationale to combine cetuximab with neoadjuvant radiation therapy and chemotherapy in rectal cancer. Bevacizumab (Avastin), a VEGF-specific antibody, was the first antiangiogenic agent to be approved in the United States for use in combination with standard chemotherapy in the first- and second-line of treatment in metastatic colorectal cancer. VEGF-targeted therapy may lead to indirect killing of cancer cells by damaging tumor blood vessels, and may increase the radiosensitivity of tumor-associated endothelial cells. VEGF blockade can also "normalize" tumor vasculature, thereby leading to greater tumor oxygenation and drug penetration. This review will address completed and ongoing trials that have established and continue to clarify the effects of these agents in rectal cancer.
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Commentary (Longo)-Follicular Lymphoma: Expanding Therapeutic OptionsDr. Ganti and colleagues from the University of Nebraska provide a thorough review of the management of patients with follicular lymphoma, including many recent additions to the therapeutic armamentarium. The field is rapidly changing, and this article will be an enduring resource both for clinicians currently managing these patients and for anyone in the future who wants to understand what the state of the art was in 2004. Follicular lymphoma accounts for about one-third of non- Hodgkin’s lymphomas in the United States, making it likely that an individual oncologist will see one to three patients with follicular lymphoma each year. As the authors point out, numerous active agents have been developed for use in patients with follicular lymphoma over the past 5 years and additional promising new therapeutic agents and novel approaches (eg, vaccination) are in the development pipeline.
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Impact of Uracil/Tegafur Plus Oral Calcium Folinate on Resource UtilizationData from a multinational phase III trial were analyzed to evaluate the use of in- and outpatient services for 373 patients with metastatic colorectal cancer being administered uracil/tegafur (in a molar ratio of 4:1 [UFT]) plus
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Clinical Decision Making in Surveillance of Non–Muscle-Invasive Bladder Cancer: The Evolving Roles of Urinary Cytology and Molecular MarkersIn this article, we discuss the requirements for development and validation of urine markers and the factors that hamper their clinical implementation. We also review current surveillance guidelines for NMIBC and provide an overview of approved urine markers for the detection and surveillance of NMIBC.
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Treatment of Early-Stage Pancreatic CancerEarly trials of adjuvant therapy in pancreatic cancer had multiple limitations including small sample size, population heterogeneity, and inability to distinguish between components of combined modality treatment.
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Obesity and Metabolic Disease After Childhood CancerIn this review, childhood cancer survivor populations at risk for metabolic late effects, as well as mechanisms and ongoing intervention studies, will be detailed.
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Commentary (Goldman): Evaluating the Total Costs of CancerLongitudinal cohort studies ofspecific populations providesome of the most compellingevidence for research spanning epidemiology,medicine, and social science.The Framingham Heart Study(FHS) is a good example. Initiated in1948, the FHS tracks a cohort of whitemen and women who reside in thetown of Framingham, Massachusetts.The study population receives biennialmedical exams and personal interviews,and an additional study hasfollowed their offspring. The FHShas contributed much of our knowledgeabout cardiovascular disease incidenceand prevalence, and its riskfactors.
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Expanding Androgen- and Androgen Receptor Signaling–Directed Therapies for Castration-Resistant Prostate CancerThis article reviews the most recent advances in androgen receptor-directed therapies for castration-resistant prostate cancer, and new agents under development.
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How We Treat Tumor Lysis SyndromeWhen tumor cells are rapidly broken down and their contents released into the extracellular space, the released ions and compounds can cause metabolic disturbances too great to be neutralized by the body's normal mechanisms.
