November 17th 2024
“When thinking about treatment options for refractory DLBCL you consider: Is it safe to give an older patient CAR T-[cell therapy]?,” said Jennifer Amengual, MD.
Community Practice Connections™: 5th Annual Precision Medicine Symposium – An Illustrated Tumor Board
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Annual Hematology Meeting: Preceding the 66th ASH Annual Meeting and Exposition
December 6, 2024
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Community Oncology Connections™: Overcoming Barriers to Testing, Trial Access, and Equitable Care in Cancer
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Translating New Evidence into Treatment Algorithms from Frontline to R/R Multiple Myeloma: How the Experts Think & Treat
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Medical Crossfire: How Has Iron Supplementation Altered Treatment Planning for Patients with Cancer-Related Anemia?
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Medical Crossfire®: The Experts Bridge Recent Data in Chronic Lymphocytic Leukemia With Real-World Sequencing Questions
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Community Practice Connections™: Pre-Conference Workshop on Immune Cell-Based Therapy
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Fighting Disparities and Saving Lives: An Exploration of Challenges and Solutions in Cancer Care
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BURST Expert Illustrations and Commentaries™: Exploring the Mechanistic Rationale for CSF-1R– Directed Treatment in Chronic GVHD
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(CME) Optimizing Management of Ocular Toxicity in Cancer Patients: The Role of Ophthalmologists in the Spectrum of Care
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(COPE) Optimizing Management of Ocular Toxicity in Cancer Patients: The Role of Ophthalmologists in the Spectrum of Care
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Tricking or Treating Myelodysplastic Syndromes
May 13th 2011The myelodysplastic syndromes (MDS) are a heterogeneous spectrum of clonal hematopoietic diseases characterized by bone marrow hypercellularity, dysplasia of cellular elements, and consequent inadequate hematopoiesis, with resultant peripheral blood cytopenias.
The More Things Change, the More They Stay the Same
April 15th 2011About 35 years ago, I encountered several children and adolescents with acute lymphoblastic leukemia or widespread non-Hodgkin lymphoma who presented with or who developed, upon initiation of therapy, severe renal and metabolic derangements.
Overview: Management of Treatable but Incurable Cancers
December 15th 2010The accurate and in-depth documentation of learning gaps is a fundamental aspect of developing continuing education activities. To obtain a better understanding of community-based medical oncology practice patterns, 43 oncologists within the United States were recruited to complete a traditional clinical case–based questionnaire and to contribute specific anonymous demographic and treatment information derived from their actual patients. This information was used to create a cross-sectional case database on two types of cancer in which major clinical advances have been reported in recent years - multiple myeloma and follicular lymphoma. These diseases also are similar in that most patients experience clinically meaningful benefits from systemic treatment but are unlikely to be cured by therapy. As further described in this and the subsequent two articles, this case-based series documents that (a) clinical research advances are being quickly implemented in daily patient care and that (b) although therapeutic strategies vary based on patient age, the short-term outcomes in terms of response to and tolerance of treatment are similar in younger and older patients.
Management of Follicular Lymphoma in the Up-Front and Relapsed Settings
December 15th 2010A number of recent treatment advances in the management of follicular lymphoma (FL), including the introduction of the anti-CD20 monoclonal antibody rituximab, have effectively shifted the primary therapeutic goal away from palliation and avoidance of toxicity toward the more proactive objective of extending survival. This paper reviews recent practice patterns in the broad context of the published findings from major phase III randomized trials; it documents potential gaps between trial results and actual practice, and the implications of these for continuing education of oncologists. Forty-three US-based community oncologists participated in a cross-sectional case survey during which 40 documented their management of 186 patients with newly diagnosed FL and 133 patients with relapsed FL, all of whom were treated after January 1, 2008. The findings from this initiative indicate that the majority of these patients did not have any major symptoms at presentation. Additionally, tolerance of and response to treatment, regardless of the regimen employed, were similar across the different age groups studied (<65, 65-74, ≥75 years). Therapies selected by the physicians surveyed in both the up-front and the relapsed settings broadly corresponded to the evidence-based published literature and were supported by treatment guidelines. In addition, a change in the proportional use of bendamustine/rituximab (BR) in the up-front treatment of FL from 2008 to 2010 was observed, suggesting that community oncologists are rapidly incorporating pivotal clinical trial results when deciding on individual patient management strategies.
Deeper Molecular Responses Seen with Dasatinib in New Chronic Myeloid Leukemia
December 7th 2010The median reductions in Bcr-Abl transcripts at one year were greater with dasatinib (Sprycel) than with imatinib (Gleevec), according to the results of an intergroup phase II trial. A better molecular response should eventually correlate with better outcomes, making dasatinib a serious contender for upfront therapy in CML.
Rituximab Instead of ‘Watch and Wait’ Policy in Asymptomatic Follicular Lymphoma Causes Controversy
December 7th 2010Study leader Kirit M. Ardeshna, MD, tells Oncology NEWS International that he predicts this pretreatment approach will become the standard of care and will prove attractive to patients because chemotherapy can be deferred for even longer than it can now. But participants at an ASH 2010 plenary session questioned aspects of the trial design.
Dose-escalated BEACOPP should become new standard of care for early unfavorable Hodgkin’s lymphoma
December 6th 2010The intensified regimen of BEACOPP plus standard therapy ABVD plus radiotherapy bested four cycles of ABVD alone, leading to a significant improvement in tumor control. Final results from the German Hodgkin Study Group trial saw a 7% improvement in terms of freedom from treatment failure between the standard and new treatment arms.
Lower Dose Chemotherapy Plus Radiation Offers Favorable Prognosis in Hodgkin’s Lymphoma Patients
December 5th 2010Patients with early-stage Hodgkin’s lymphoma and a favorable prognosis can be treated with less intensive chemotherapy and radiotherapy regimens without affecting outcomes. This is the first study to show that less intensive therapy can be used without sacrificing benefits, according to lead author Andreas Engert, MD, and colleagues.
Radiation for Diffuse Large B-Cell Lymphoma: More Questions Than Answers
December 1st 2010Radiation therapy has an essential role for certain patients with DLBCL. It is hoped that ongoing and future trials will identify the patients who will benefit from this treatment and those for whom it is unnecessary.
Pediatric Anaplastic Large Cell Lymphoma Presenting as Generalized Lymphadenopathy
September 22nd 2010Here we present the case of a 3-year-old girl with generalized lymphadenopathy and fever, in whom the cause of the symptoms was initially thought to be infectious. Ultimately, however, anaplastic large cell lymphoma (ALCL) was diagnosed. Using this case as a backdrop, we discuss the wide range of systemic illnesses that the differential diagnosis of generalized lymphadenopathy encompasses.
Cheson heads Lymphoma Research Foundation board
July 14th 2010Bruce Cheson, MD, has become chair of the Lymphoma Research Foundation Scientific Advisory Board. Dr. Cheson is professor of medicine, head of hematology, and director of hematology research at the Lombardi Comprehensive Cancer Center at Georgetown University Hospital in Washington DC. His two-year term as chair began in July 2010.
Primary Cutaneous and Systemic Anaplastic Large Cell Lymphoma
Anaplastic large cell lymphoma (ALCL) is a biologic and clinically heterogenous subtype of T-cell lymphoma. Clinically, ALCL may present as localized (primary) cutaneous disease or widespread systemic disease. These two forms of ALCL are distinct entities with different clinical and biologic features. Both types share similar histology, however, with cohesive sheets of large lymphoid cells expressing the Ki-1 (CD30) molecule. Primary cutaneous ALCL (C-ALCL) is part of the spectrum of CD30+ lymphoproliferative diseases of the skin including lymphomatoid papulosis. Using conservative measures, 5-year disease-free survival rates are>90%. The systemic ALCL type is an aggressive lymphoma that may secondarily involve the skin, in addition to other extranodal sites. Further, systemic ALCL may be divided based on the expression of anaplastic lymphoma kinase (ALK) protein, which is activated most frequently through the nonrandom t(2;5) chromosome translocation, causing the fusion of the nucleophosmin (NPM) gene located at 5q35 to 2p23 encoding the receptor tyrosine kinase ALK. Systemic ALK+ ALCLs have improved prognosis compared with ALK-negative ALCL, although both subtypes warrant treatment with polychemotherapy. Allogeneic and, to a lesser extent, autologous stem cell transplantation play a role in relapsed disease, while the benefit of upfront transplant is not clearly defined. Treatment options for relapsed patients include agents such as pralatrexate (Folotyn) and vinblastine. In addition, a multitude of novel therapeutics are being studied, including anti-CD30 antibodies, histone deacetylase inhibitors, immunomodulatory drugs, proteasome inhibitors, and inhibitors of ALK and its downstream signaling pathways. Continued clinical trial involvement by oncologists and patients is imperative to improve the outcomes for this malignancy.
Diagnosis and Management of Mycosis Fungoides
May 15th 2010Mycosis fungoides (MF), the most common cutaneous T-cell lymphoma, is a low-grade cutaneous lymphoma characterized by skin-homing CD4+ T cells. It is notable for highly symptomatic progressive skin lesions, including patches, plaques, tumors, and erytheroderma, and has a poorer prognosis at later stages. Diagnosis remains difficult owing to MF’s nonspecific skin presentation and identification of the optimal treatment strategy is challenging given the paucity of controlled trials and numerous and emerging treatment options. Management includes topical therapy with the addition of systemic therapy for patients with later-stage disease including tumors; erythroderma; and nodal, visceral, or blood involvement. Topical therapies include mechlorethamine (nitrogen mustard), carmustine (BCNU), steroids, bexarotene gel (Targretin Gel), psoralen plus ultraviolet A (PUVA), ultraviolet B (UVB), and either localized or total skin electron radiotherapy. Systemic therapies include interferon, retinoids, oral bexarotene (Targretin), denileukin diftitox (Ontak), vorinostat (Zolinza), extracorporeal photochemotherapy (photopheresis), and cytotoxic chemotherapy. Herein, we outline clinically relevant aspects of MF, including clinical presentation, pathology, diagnosis, and staging. We describe in detail existing and emerging therapeutics and offer specific recommendations for management of each stage of MF.
New Options in Diagnosis and Management of Mycosis Fungoides and Sézary Syndrome
May 15th 2010The article entitled “Diagnosis and Management of Mycosis Fungoides” by Shira Galper, Benjamin Smith, and Lynn Wilson is an excellent contemporary summary of the workup and management of mycosis fungoides (MF) and its leukemia variant, Sézary syndrome (SS). In their discussion of the diagnosis and staging of MF and SS, the authors include a discussion of proposed revisions by the International Society for Cutaneous Lymphoma and the European Organisation for the Research and Treatment of Cancer (ISCL/EORTC) which seek to identify prognostic subgroups. In addition, there is a complete overview of the various treatment options for management of MF and SS. This treatment overview closely parallels the 2010 National Comprehensive Cancer Network (NCCN) Practice Guidelines for MF and SS.
Navigating the Treatment Choices for Mycosis Fungoides
May 15th 2010Galper et al. should be commended for their concise and useful review of the diagnosis and management of mycosis fungoides (MF). It is notable that all of the authors are radiation oncologists. While the reader may expect a radiation oncologist’s perspective on the management of mycosis fungoides, their review goes beyond highlighting the various radiation techniques used in the treatment of MF. It highlights the major diagnostic dilemmas when evaluating patients with skin lesions that eventually are diagnosed as MF or its leukemic counterpart, Sézary syndrome (SS). It also stresses the importance of a multidisciplinary approach in diagnosing and caring for MF patients involving dermatology, dermatopathology, radiation oncology, and hematology/oncology, and provides a concise review of the treatment options in the MF and SS armamentarium. Navigating these options requires a good understanding of the natural history of the disease, the side effects of treatment, the expected response rates of treatment, the median time to response, the patient’s comorbid conditions, and goals of care.
Current Management of Nasal NK/T-cell Lymphoma
April 15th 2010With better disease definition, staging, and monitoring, treatment of extranodal NK/T-cell lymphoma is becoming more rational. A large proportion of patients with localized nasal disease may enjoy prolonged disease-free survival. On the other hand, early HSCT or novel therapy may be recommended for aggressive extranasal disease.
Extranodal NK/T-cell Lymphoma: Basic Questions Remain
April 15th 2010Extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, is a distinct entity of non-Hodgkin lymphoma with interesting unique biologic and clinicopathologic features. The tumor is characterized by ethnic preponderance, a consistent association with Epstein-Barr virus (EBV) infection, peculiar histopathologic findings, and a predilection to affect primarily the upper aerodigestive tract, inclusive anatomically of the nasal cavity, nasopharynx, paranasal sinuses, oral cavity, hypopharynx, and larynx. The characteristic clinical features are nasal stuffiness, relentless, nonhealing ulcers, or symptoms due to obstruction of the aforementioned areas. Distant metastasis at time of diagnosis is uncommon.
Nasal NK/T-cell Lymphoma: Where Are We Now?
April 15th 2010Since the creation of the World Health Organization’s nasal natural killer (NK)/T-cell lymphoma category, the attempt to further classify, describe, and improve treatment in this entity has been underway. There has been quite a bit of confusion and frustration regarding diagnosis, staging, and treatment approaches. With his article in this issue of ONCOLOGY, Dr. Au has attempted to improve our knowledge of current approaches to NK/T-cell lymphomas, providing a thorough and contemporary review of the clinical management of these difficult tumors. The following commentary reflects a deep appreciation for the author’s work and expands upon a few points not previously highlighted.
Cancer Management Chapter 29: Acute leukemias
March 13th 2010Hematopoietic malignancies account for 6% to 8% of new cancers diagnosed annually. In the year 2009, an estimated 44,790 new cases of leukemia were diagnosed, and 21,870 deaths were attributable to leukemias of all types. The total age-adjusted incidence of leukemia, including both acute and chronic forms, is 9.6 per 100,000 population; the incidence of acute lymphoblastic leukemia (ALL) is 1.5 per 100,000 and of acute myelogenous leukemia (AML) is 2.7 per 100,000 population.