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Langerhans Cell Histiocytosis: Emerging Insights and Clinical ImplicationsLangerhans cell histiocytosis is a disorder characterized by lesions that include CD207+ dendritic cells along with an inflammatory infiltrate. Langerhans cell histiocytosis has a highly variable clinical presentation, ranging from a single lesion to potentially fatal disseminated disease.
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LHRH Antagonists vs LHRH Agonists: Which Is More Beneficial in Prostate Cancer Therapy?Crawford and Hou[1] review the data on luteinizing hormone-releasing hormone (LHRH) antagonists in prostate cancer. They describe the results of a phase III trial comparing monthly degarelix to monthly leuprolide in men with advanced prostate cancer. Degarelix treatment was associated with a more rapid decline of serum testosterone, and was not associated with an initial surge of serum testosterone seen during the first few days of treatment with leuprolide. They discuss the role of this new form of medical gonadal suppression for the treatment of prostate cancer.
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Epidemiology and Pathogenesis of AIDS-Related LymphomasDr. Aboulafia provides an accurate overview of the relationship between immunodeficiency and malignant lymphoma, the lymphoproliferative disorders that occur following solid organ transplantation, and the epidemiology and pathogenetic mechanisms possibly involved in acquired immunodeficiency syndrome (AIDS)-related lymphomagenesis.
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Commentary (Miller): Adjuvant Chemotherapy for Resected Non–Small-Cell Lung CancerLung cancer continues to be themost common cause of cancerdeaths in the United States forboth men and women. Unfortunately,the majority of patients presentwith local or distant disease at thetime of diagnosis. Surgical resectioncontinues to offer the best chance forlong-term survival; however, less than25% of patients have surgically resectabledisease. Even after surgicalresection for early-stage disease a significantnumber of patients will developrecurrent disease, with themajority being distant in nature. Developmentof distant disease usuallyproves to be the terminal event inmost patients. Multiple treatmentmodalities have been investigated asadjuvant therapy to decrease the incidenceof distant disease after completesurgical resection. Untilrecently, no modality has shown asurvival advantage in patients afterresection for non–small-cell lung cancer(NSCLC).
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In Hormone-Naive Metastatic Prostate Cancer, Should All Patients Now Receive Docetaxel? Yes; We Must Beware of Drawing Conclusions From a Subset AnalysisUltimately, while further follow-up will be enlightening, we believe that there is sufficient evidence now from the primary analysis of CHAARTED to justify the combination of docetaxel and androgen deprivation therapy in all men with metastatic hormone-sensitive prostate cancer.
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KS Clearly Not a Conventional NeoplasmSAN FRANCISCO-“Kaposi’s sarcoma (KS) conforms very poorly to conventional notions about cancer,” Donald Ganem, MD, of the University of California, San Francisco, said at a conference on globally emerging viral infections. “It’s properly classified as in the gray zone between proliferative hyperplasia and frank neoplasm.”
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Current Issues in the Diagnosis and Management of Wilms' TumorPaulino has thoughtfully reviewed the etiology, diagnosis, and management of Wilms' tumor. Investigators from the National Wilms' Tumor Study Group (NWTSG) first divided Wilms' tumors into two groups: those with a favorable histology and those with an unfavorable histology.[1]
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The Surgical Management of Peritoneal Carcinomatosis of Colorectal OriginIn the United States, approximately 20% of patients with colorectal cancer present with distant metastasis at diagnosis. In 25% of cases, the peritoneal cavity is the only site of metastatic disease, which is not indicative of a generalized systemic disease, as is the case with lung or liver metastases.
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Cancer Survivors’ Employment and Insurance Rights: A Primer for OncologistsFrom the survivor’s viewpoint, Ms.Hoffman’s paper addresses a critical need, expressed in both its title and its conclusions: Medical professionals who treat cancer patients need to be aware of the anxieties faced by those diagnosed with cancer “so
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Oncology Peer Review On-The-Go: Cancer Pain and Opioid Use DisorderAuthors Daniel C. McFarland, DO, and Kirk Harris, MD, spoke with CancerNetwork® about their manuscript on cancer pain’s relationship with opioid use disorder that was recently published in the journal ONCOLOGY®.
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Clinical Applications of The Cancer Genome Atlas Project (TCGA) for Squamous Cell Lung CarcinomaWe summarize here key findings from the comprehensive analysis of squamous cell lung cancer by The Cancer Genome Atlas group and discuss the clinical implications of these findings.
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The Role of Irinotecan and Oxaliplatin in the Treatment of Advanced Colorectal CancerColorectal carcinoma is one of the most common malignancies in the western world, and although fluorouracil (5-FU) has been used in its treatment for almost 40 years, new agents with significant activity have been introduced recently. Irinotecan (CPT-11, Camptosar), a topoisomerase I inhibitor, administered at 300 to 350 mg/m2 every 3 weeks is significantly more active than continuous-infusion 5-FU in patients who have experienced disease progression after conventional therapy with 5-FU. In comparison to best supportive care, irinotecan improves survival and preserves quality of life despite treatment-related toxicity. Moreover, the combination of irinotecan and 5-FU has been explored in a number of different schedules. In previously untreated patients, overall response rates are high. Irinotecan can also be combined with mitomycin (mitomycin-C [Mutamycin]), oxaliplatin, or raltitrexed (Tomudex). Oxaliplatin is a new-generation platinum compound that has demonstrated activity against colorectal carcinoma in preclinical trials. It has been evaluated as a single agent against advanced colorectal carcinoma in the salvage setting and also in combination with 5-FU as initial therapy for metastatic disease (where it shows significant activity). The toxicity profile of oxaliplatin (chiefly characterized by neurotoxicity) differs from that of irinotecan (primarily producing diarrhea) and the potential, therefore, exists for combining these agents or for exploiting their possible synergy with 5-FU. The introduction of these two new active agents of different pharmacologic classes promises to enable significant improvements in the treatment of patients with colorectal carcinoma. [ONCOLOGY 15(4):415-434, 2001]
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Docetaxel/Doxorubicin/Cyclophosphamide in the Treatment of Metastatic Breast CancerPreliminary results from phase I trials suggest that the use of docetaxel (Taxotere) and doxorubicin (Adriamycin) is a well tolerated and highly active combination regimen for
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Primary and Metastatic Brain TumorsIntracranial neoplasms can arise from any of the structures or cell types present in the cranial vault, including the brain, meninges, pituitary gland, skull, and even residual embryonic tissue.
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Future Directions in mHSPC Management: An Evolving Treatment LandscapeKey opinion leaders in the field of prostate cancer close out their discussion by sharing excitement for future evolutions in the setting of hormone-sensitive disease management.
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New Directions With Capecitabine Combinations in Advanced Breast CancerCapecitabine (Xeloda) offers a unique mode of action. The drug is currently being combined with other active agents in the treatment of advanced breast cancer. The recent demonstration of improved disease-free and overall
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New Targets and New Mechanisms in Lung CancerThis review will describe the well-known use of VEGF antibodies; the current uses of EGFR and ALK tyrosine kinase inhibitors; newer agents being used against MET, FGFR, and other intracellular targets; insights regarding the field of immunotherapy in lung cancer; and finally, newer developments in chemotherapy.
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Cancer Network Faceoff: Conclusion of the Event and Presentation of AwardsConclusion of the discussion and award presentation.
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Peaceful DyingPeaceful Dying is a work of considerable effort and organization. Dr. Tobin has painstakingly analyzed his experience as a physician caring for patients with terminal illness and compiled a step-by-step guide to help both patients and their families
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Alternatives to Fee for Service Involve RisksTo do better than merely survive under managed care, oncologists who are accustomed to fee-for-service practice must plan new strategies, particularly if they expect to stay in practice more than a few more years.
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General and Statistical Hierarchy of Appropriate Biologic EndpointsThe introduction of newer classes of chemotherapeutic agents, with varying mechanisms of action by which they affect tumor growth and viability, has challenged the traditional norms of clinical trial design and drug approval in oncology. Most notably, the emergence of cytostatic biologic agents with antitumor efficacy has necessitated reassessment of appropriate primary endpoints for phase II and III trials in advanced disease from both a clinical and regulatory standpoint. Recent data in the field establishes an endpoint hierarchy, which places progression-free survival (PFS) between overall survival (OS) and response rate (RR) as appropriate primary endpoints for assessing the clinical efficacy of cytostatic and cytotoxic agents.
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Sentinel Lymph Node Biopsy in a Young Child With Thick Cutaneous MelanomaThe article by Bisseck and colleagueshighlights an importantissue encountered increasinglyby physicians-melanoma in childrenand adolescents. The incidence andmortality of melanoma continues torise.[1] It is now the fifth most commoncancer in men and the seventhmost common cancer in women. Inour practice at the Johns HopkinsMelanoma Center, we have treated agrowing number of children and adolescentswith melanoma, includingmany with stage III disease identifiedby sentinel node technology, similarto that described by Bisseck andcolleagues.
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The Multidisciplinary Approach to Bone MetastasesWith recent advances in the management of cancer, the clinicalcourse of patients with metastatic bone disease is more likely to beprolonged and accompanied by morbidity, including severe pain, hypercalcemia,pathologic fracture, and spinal cord and/or nerve root compression.The early identification of patients at higher risk for developingbone metastases enables practitioners to be proactive in their diagnosisand treatment. A multidisciplinary approach that integrates the diagnosisand treatment of the cancer, symptom management, and rehabilitationensures optimal care. Bisphosphonates can reduce the number ofskeletal-related complications, delay the onset of progressive disease inbone, and relieve metastatic bone pain caused by a variety of solidtumors with a resulting enhanced quality of life. The complexity of theclinical problem and the need to involve an array of health-careproviders present a logistical and clinical challenge. A strong argumentis made for a thematically integrated bone metastases program as partof the primary care of patients with cancer.
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Locoregional Recurrence of an HPV-Positive Squamous Cell Carcinoma of the Head and NeckLocoregional recurrences are a major source of morbidity and mortality for patients with squamous cell carcinomas of the head and neck (HNSCC).
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Lobular Neoplasia: How to Manage With Partial UnderstandingIn this issue of ONCOLOGY, Drs Oppong and King provide an organized and comprehensive summary of guidelines for the clinical management of patients with lobular carcinoma in situ (LCIS).
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Impact of Screening on Early- and Late-Stage Colorectal CancersA study on screening colonoscopy for colorectal cancers, originally presented at ASCO 2013, found that from 1976 to 2009 late-stage cancer incidence decreased from 117 to 74 cases per 100,000 people, and early-stage incidence decreased from 77 to 68 cases per 100,000.
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Immune Checkpoint Inhibitor Therapy in Patients With Autoimmune DiseaseIn this article, we detail the experience with immune checkpoint inhibitors in patients with autoimmune disease.
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Perioperative Treatment of Gastrointestinal Stromal TumorsGastrointestinal stromal tumors (GISTs) originate from the interstitial cells of Cajal or a precursor and are the most common mesenchymal neoplasms of the gastrointestinal (GI) tract.[1] Although GISTs often present as localized masses, they are typified by a high risk of metastatic relapse, most commonly in the liver and peritoneum.
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Clinical Hereditary Cancer Syndromes and Gene Panel TestingFor some time, genetic testing has been predictive and prognostic. It is now assuming a therapeutic role as well. An example is the targeting of breast cancer patients with BRCA mutations for treatment with PARP inhibitors.
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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.
