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HER2-Directed Therapy for Metastatic Breast CancerThis article reviews clinical data informing the effective management of HER2-positive metastatic breast cancer, including the optimal sequence of HER2-targeted agents.
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Extended Pelvic Lymph Node Dissection for Prostate Cancer: Do More Nodes Mean Better Survival?At the present time, without clear data to suggest improved survival for patients undergoing extended pelvic lymph node dissection, the procedure cannot be universally recommended.
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Pemetrexed in Gastric CancerGastric cancer is a major clinical challenge, with poor overall prognosisand limited life expectancy for patients with advanced disease.Even with surgery and other modalities, palliation is often difficult.Improvement of response rates has evolved with the development ofstandard regimens and those incorporating newer chemotherapy agents,such as oral fluoropyrimidines, the taxanes, camptothecins, novel platinums(eg, oxaliplatin [Eloxatin]), and antifolates (eg, pemetrexed[Alimta]). Ongoing trials with these regimens aim toward improvingsurvival, as well as improving the safety profile. It is hoped that in conjunctionwith molecular research in the pathogenesis of gastric cancerand development of targeted therapies in this disease, these trial datamight lead to the evolution of treatment strategies that could prove effective.
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More on the Treatment of Anal Margin CarcinomasAnal carcinomas are an uncommon group of heterogeneous lesions that have represented a therapeutic enigma for many years. The mere rarity of these cancers alone has proven to be a major impediment to the formulation of a standardized
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Modern Immunotherapy for the Treatment of Advanced Gastrointestinal CancersAlthough immunotherapy is not yet approved for the treatment of gastrointestinal cancers, it is already clear that many gastrointestinal cancers can be sensitive to it. We will review recent clinical trial results demonstrating this, and offer our perspective on the role that immunotherapy might play in the treatment of advanced gastrointestinal malignancies in the years ahead.
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Stereotactic Body Radiation TherapyStereotatic body radiation therapy (SBRT) is a rapidly evolving cancertreatment method in which concepts and techniques previously developedfor brain tumor radiosurgery are adapted to eradicate tumorselsewhere in the body. The spatial accuracy, conformality, and steepradiation dose gradients of radiosurgery, which have been critical to itssuccess in the treatment of intracranial tumors, are applied in SBRT totreat a variety of extracranial tumors. Early results demonstrate excellentresponse rates and low toxicity with a variety of hypofractionateddose regimens and localization/immobilization techniques. This articleprovides an overview of the rationale and results of SBRT for specificindications, descriptions of some methods of treatment delivery, anddiscussion of potential areas of future investigation.
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Molecular Testing: How Can Oncologists Work Better With Pathologists?Dr. Aisner discusses some of the key ways oncologists can work better with pathologists at their institutions.
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Commentary (Bryan/Berek): Ovarian Cancer in Elderly WomenAs the population ages over thenext 50 years, the number ofcancer patients is expected todouble from the current 1.3 million to2.6 million, and the majority of thosepatients will be at least 75 years old.[1]Projected increases in life expectancyaccount for this change. For womenliving in industrialized countries, it isestimated that the average life span infuture decades will reach 90 years.[2]Most cancers increase in incidenceand mortality as a population ages,although the causal link between oncogenesisand senescence remainscomplex and elusive. Within the contextof an upsurge in cancer incidence,an analysis of the inequitable treatmentof older patients afflicted withcancer takes on an urgent need.
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The ABCDs of moles and melanomasWhen you inspect moles, pay special attention to their sizes, shapes, edges, and color. A handy way to remember these features is to think of the A, B, C, and D of skin cancer-asymmetry, border, color, and diameter.
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The Management of Advanced Germ Cell Tumors in 2016: The Memorial Sloan Kettering ApproachIn this paper, we review the use of serum tumor markers in risk assignment and response evaluation; the treatment of previously untreated and relapsing patients; the role of surgical resection of residual disease, including retroperitoneal node dissection; and the importance of clinical trials for addressing unanswered questions and testing new therapies.
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Minimally Invasive Lung Resection: When Is a VATS Not a VATS?Lung resection is gaining momentum among thoracic surgeons because it allows the operating surgeon the convenience of performing a dissection that in many ways is similar to open surgery, yet that has the advantages of a minimally invasive approach. Hopefully, surgical robotics, along with VATS, will make it possible for the thoracic surgery community to offer minimally invasive lung resection to nearly all early-stage lung cancer patients.
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Oral UFT Plus Leucovorin in Patients With Relapsed or Refractory Colorectal CancerTherapeutic options for patients with advanced colorectal cancer who have failed treatment with fluorouracil (5-FU) are limited. Responses have been reported in this setting with a protracted venous infusion of 5-FU. Daily oral therapy with tegafur and uracil (UFT) plus leucovorin (LV) has the potential to mimic the pharmacology of continuous infusion 5-FU. Therefore, we undertook a phase II study of a 28-day schedule of a combination chemotherapy regimen containing oral UFT/leucovorin in patients with measurable metastatic colorectal cancer who had failed treatment with bolus 5-FU. In addition, we sought to determine whether coadministration of UFT and leucovorin alters the bioavailability of these agents. In a pretreatment phase, each patient underwent sequential pharmacokinetic sampling following a single dose of UFT alone, leucovorin alone, and the combination of UFT plus leucovorin. The preliminary results of this trial suggest that tegafur pharmacokinetics are not affected by coadministration of leucovorin and that folate pharmacokinetics are not affected by UFT. [ONCOLOGY 11(Suppl 10):22-25, 1997]
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Brachytherapy for Carcinoma of the LungAn estimated 157,000 patients died of lung cancer in the United States in the year 2000.[1] Although surgery can be curative, only about 20% of patients are amenable to complete surgical resection. Most of the other patients are treated with radiation
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Simultaneously Detected Bilateral Testicular Cancer of Different Histopathological OriginA 36-year-old male with a history of cryptorchidism of the right side, treated with orchidopexy at the age of 4, presented with bilateral testicular swelling. Investigations included laboratory workup, ultrasound of both testes, as well as CT-scan of the chest, abdomen, and pelvis. Initial treatment was bilateral orchiectomy.
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Are There Regional Differences in Survival Rates of Metastatic Breast Cancer?A new study examined differences in breast cancer recurrence and survival by region.
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Management of Resectable Pancreatic CancerThis video examines the management of resectable pancreatic cancer, including how this type of disease is best defined, the latest standard of care in the adjuvant setting, and emerging trends in surveillance.
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Commentary (Asch): Some Elements of Prognosis in Terminal CancerYou’ve got to accentuate the positive,Eliminate the negative,Latch onto the affirmative,Don’t mess with Mister In-between.-Johnny Mercer, 1944
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Expert Consultations in Breast Cancer: Critical Pathways and Clinical Decision MakingThis book is the 17th volume in the Basic and Clinical Oncology series edited by Bruce D. Cheson, MD. Like other volumes in this series, Expert Consultations in Breast Cancer follows a unique format and seeks to integrate advances in the basic understanding of breast cancer with promising new therapies and changing health- care economics. The integration of these different perspectives provides both a conceptual and pragmatic framework for clinical decision-making.
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Proton Radiation Therapy for Lung Cancer: Is There Enough Evidence?Proton radiation for cancer offers the ability to conform the high-dose region of radiation therapy to the tumor while reducing the dose of radiation to adjacent normal tissues. In lung cancer, this equates to greater sparing of uninvolved lung, heart, esophagus, and spinal cord. Sparing these normal tissues permits the delivery of higher-radiation doses to the tumor. Studies that compare the distribution of radiation doses for lung cancer show that proton radiation is superior, even when factors such as respiratory motion are considered. Clinical experience confirms the feasibility of proton radiation for early-stage non-small-cell lung cancers, and clinical trials are being conducted in locally advanced tumors: To date, evidence indicates that proton radiation should be further explored.
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Neuroendocrine Tumors: a Heterogeneous Set of NeoplasmsThe review of surgical management of neuroendocrine tumors (NETs) of the gastrointestinal tract, authored by Huang, Poultsides, and Norton, is both comprehensive and accessible for readers of all backgrounds.
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Commentary (Reardon): Locoregional Therapies for GliomaMalignant glioma, the mostcommon primary centralnervous system (CNS) tumorin adults, remains one of the greatesttherapeutic challenges in oncologytoday due to the limited impact ofconventional cytotoxic therapies onoverall survival for patients with thesetumors. Although surgery and external-beam radiotherapy (XRT) can prolongsurvival, the value of adjuvantchemotherapy has been negligible formost malignant glioma patients. Theexception has been those patients withanaplastic oligodendroglioma and accompanyingchromosomal 1p and 19qloss-a fairly uncommon subset ofmalignant glioma patients who respondvery favorably to alkylatorbasedchemotherapy.[1]
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Complete Guide to Colorectal CancerNearly 150,000 people will be diagnosed with colorectal cancer in the United States in 2006. The impact of this diagnosis will be felt by countless family members, coworkers, and friends. Although screening tests for colorectal cancer have been available and encouraged by medical associations such as the American Cancer Society (ACS) and others, public awareness and compliance has been dismal.
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Epidemiology and Pathogenesis of AIDS-Related LymphomasAmong patients with congenital and acquired immunodeficiencies, non-Hodgkin’s lymphomas (NHLs) are the most common tumors of the immune system. In the setting of human immunodeficiency virus (HIV) infection, as
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Advances in Colorectal Cancer ScreeningIn this interview, Dr. David Ahlquist, gastroenterologist and professor of medicine at the Mayo Clinic in Rochester in Minnesota, discusses early detection methods of colorectal cancer, touching on sigmoidoscopy, colonoscopies, fecal blood testing, and in particular, stool DNA screening.
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Irinotecan/Gemcitabine Followed by Twice-Weekly Gemcitabine/Radiation in Locally Advanced Pancreatic CancerEarly clinical studies combining irinotecan (CPT-11, Camptosar) and gemcitabine (Gemzar) have yielded encouraging results. Gemcitabine administered via a twice-weekly schedule results in an enhanced radiation-sensitizing effect.
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Regimen Improved Survival in Children With High-Risk Wilms TumorsIn this video, Dr. Dix, discusses the results of two phase III trials that showed that in children with high-risk Wilms tumor, treatment with vincristine and dactinomycin plus the addition of doxorubicin improved outcomes.
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ACR Appropriateness Criteria® Recurrent Hodgkin LymphomaBy combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the complex decision-making associated with the management of recurrent Hodgkin lymphoma.
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CTLA-4 Antibodies: New Directions, New CombinationsThis review will summarize the preclinical and clinical development of CTLA-4–blocking antibodies, discuss recent insights into the biology of CTLA-4 blockade, review the use of these antibodies in combination with established and novel therapeutic modalities, and comment on ongoing questions regarding their administration.
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Hodgkin's DiseaseAlthough there have been many advances in the treatment of Hodgkin's disease, diagnosis of the disease still rests on the identification of the Reed-Sternberg cell. This distinctive, though nonspecific, cell was first described by Sternberg in 1898 and further elucidated by Reed in 1902. In most biopsies, the Reed-Sternberg cell accounts for only 1% of the cells present, with the remainder consisting of lymphocytes, granulocytes, histiocytes, plasma cells, and fibroblasts
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Commentary (Berd)-Melanoma Vaccines: What We Know So FarThere have been an astoundingnumber of published reviewson human cancer vaccines, andI take responsibility for my share. Apparentlythe interest of the medicalcommunity in cancer vaccines remainsintense, despite the modest progressthat has been made in our field and thepaucity of convincing, positive clinicalresults. Somehow the idea of treatinga cancer by inducing an antitumorimmune response or strengthening theexisting one is strongly appealing bothto physicians and to patients. Whetherthis enthusiasm is justified by the scienceis a question that should troublethe sleep of all of us who call ourselvestumor immunologists.
