Sarcoma

In patients with adult soft-tissue sarcoma (ASTS), the use and timing of adjuvant chemotherapy or chemoradiotherapy remains controversial. The appropriate target population is generally accepted as International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) stage III extremity or trunk sarcomas (ie, > 5 cm, grade 3/4, located deep to the superficial fascia, with no evidence of metastases). After definitive local treatment, the 5-year disease-free and overall survival rates in this population are approximately 52% and 56%.

Preclinical advances offer an opportunity to further reduce morbidity and mortality from sarcomas over the next decade. Since no single institution or North American cooperative oncology group has the expertise or patient resources for histology-specific clinical and translational research on adult sarcomas, efforts have been made to develop funding from the National Cancer Institute (NCI). One such initiative was the Intergroup Coalition Against Sarcomas (ICAS), which, building upon the strengths of the multimodality cooperative oncology groups, provided an infrastructure for broad participation by investigators from all treatment disciplines in protocol development and patient entry. However, despite an excellent evaluation in formal peer review, the Division of Cancer Treatment of NCI has ended this initiative claiming insufficient available funds—to the detriment of adult sarcoma patients now and in the future.

Sarcomas are a group of tumors with highly variable character istics and clinical outcomes. Their locations in almost all body locations present unique challenges for diagnosis and management. These challenges have presented opportunities for evaluation and validation of new imaging techniques. Positron-emission tomography (PET) has been evaluated for use in cancer over the years, and in particular, it has been evaluated in sarcoma diagnosis and treatment evaluation.

We now have multiple novel agents that warrant testing in this disease setting. Clinical trials need not only test interesting drugs, but should also correlate information from tumor specimens and clinical responses.

An innovative cancer agent called PHA-739358, which inhibits one of the aurora proteins, has shown indications of potential benefit in 7 of 36 patients (19.4%) with advanced or metastatic solid tumors who participated in a phase I dosing and toxicity study, Dutch researchers reported at the EORTC-NCI-AACR Symposium on Molecular Targets and Cancer Therapeutics

Patients with metastatic gastrointestinal stromal tumors (GIST) who are in complete remission after surgical resection remain at high risk for relapse and should continue long-term treatment with imatinib (Gleevec), according to Binh Nguyen Bui, MD, of Institut Bergonie, Bordeaux, France. Dr. Bui reported results of the French Sarcoma Group BFR14 randomized phase III trial at the American Society of Clinical Oncology 42nd Annual Meeting (abstract 9501).

Drs. Ephraim S. Casper, Memorial Sloan-Kettering Cancer Center, and George D. Demetri, Dana-Farber Cancer Institute, discussed the 2006 National Comprehensive Cancer Network (NCCN) guidelines on soft-tissue sarcomas at the NCCN 11th Annual Conference. The updated guidelines clarify the follow-up schedule for patients with extremity sarcoma.

Primary nonepithelial malignancies of the breast comprise an importantminority of breast neoplasms, including primary breast sarcomas,therapy-related breast sarcomas, the phyllodes tumors, and primarybreast lymphomas. With widespread mammographic detection ofbreast lesions, these tumors represent critical elements of the differentialdiagnosis of even benign-appearing lesions. Each has a distinctclinical profile, including presentation, available therapeutic options,and prognosis, further underscoring the importance of timely recognition.The increasing incidence of breast carcinomas and the subsequenttherapy thereof may be contributing to an increase in the numberof therapy-related breast tumors. This review discusses various featuresof these uncommon malignancies and their treatment, with thegoal of increasing understanding of their clinical behavior andmanagement.

Medicare will grant limited coverage for the use of positronemissiontomography (PET) for certain of its beneficiariessuffering from thyroid cancer, the Centers for Medicare andMedicaid Services (CMS) recently announced. CMS also said that ithad refused a request to provide PET coverage for soft-tissue sarcomabecause imaging techniques currently covered by Medicare providegood diagnostic results.

ORLANDO-Genetic "fingerprinting" of high-grade adult soft-tissue sarcomas by oligonucleotide array ("gene chip") analysis revealed a number of distinct tumor subsets and might help point to new therapeutic approaches, Robert G. Maki, MD, PhD, said at the 38th Annual Meeting of the American Society of Clinical Oncology (abstract 1611).

An advisory group to the Centers for Medicare and Medicaid Services (CMS) has delayed a decision on whether to recommend Medicare coverage for positron-emission tomography (PET) with F-18-fluorodeoxyglucose (FDG) in the

WASHINGTON-An advisory group to the Centers for Medicare and Medicaid Services (CMS) has delayed a decision on whether to recommend Med-icare coverage for positron emission tomography (PET) with the radiopharmaceutical F-18-fluorodeoxyglucose (FDG) in the management of thyroid cancer and soft tissue sarcoma.

Flavopiridol [2-(2-chlorophenyl 5 ,7-dihydroxy-8-[cis-(3-hydroxy-1-methyl-4-piperidinyl)-4H-1-benzopyran-4-one, hydrochloride] is a semisynthetic flavone with a novel structure compared with that of polyhydroxylated flavones, such as quercetin and genistein.[1] It is derived from rohitukine, an alkaloid isolated from the stem bark of Dysoxylum binectariferum, a plant indigenous to India.[2] Originally synthesized and supplied by Hoechst India Limited, flavopiridol is provided to the Division of Cancer Treatment and Diagnosis of the National Cancer Institute (NCI) by Aventis Pharmaceuticals, Inc.

LONDON-Since the introduction of highly active antiretroviral therapy (HAART), the incidence of HIV-related Kaposi’s sarcoma has plummeted (ASCO abstract 1639). "Of the more than 4,500 HIV-positive patients we’ve been following since January of 1996 in the post-HAART era, about two-thirds have been on HAART," said lead investigator Mark Bower, FRCP, PhD, consultant in oncology at Chelsea and Westminster Hospital in London. "The chance of developing Kaposi’s sarcoma is dramatically reduced in those patients on antiretroviral therapy."

MOUNTAIN VIEW, California-Pegylated liposomal doxorubicin (Doxil, Caelyx) offered a sustained clinical benefit to 37% of patients with AIDS-related Kaposi’s sarcoma vs 16% of patients treated with liposomal daunorubicin (DaunoXome) in a randomized trial comparing the two drugs (ASCO abstract 1640).

A new study conducted by researchers at the Mayo Clinic shows that samarium-153 lexidronam (Quadramet), approved by the US Food and Drug Administration (FDA) in 1997 for the treatment of pain in patients with metastatic bone lesions, can be used at higher doses to treat osteosarcoma. The results of the study were published recently in the Journal of Clinical Oncology (20:189-196, 2002).

A dramatic spike in the incidence of Kaposi’s sarcoma (KS) in never-married men in New York and California in 1981 was one of the first indications of a new disease now known as acquired immunodeficiency syndrome (AIDS). We now appreciate a number of mechanisms by which human immunodeficiency virus (HIV) infection contributes to the pathogenesis of these tumors. The article by Drs. Gates and Kaplan provides an excellent review of changes in the epidemiology, presentation, and treatment of these tumors since the development of potent combination anti-HIV therapy.

CHICAGO-For many years, researchers have known that individuals who are seropositive for the human immunodeficiency virus (HIV) are at much greater risk of developing two forms of cancer-Kaposi’s sarcoma and non-Hodgkin’s lymphoma.

The association between HIV infection and the development of cancer was noted early in the acquired immunodeficiency syndrome (AIDS) epidemic. The AIDS-defining malignancies are Kaposi’s sarcoma, intermediate- or high-grade B-cell non-Hodgkin’s lymphoma (NHL), and cervical cancer. All of these cancers feature specific infectious agents in their etiology. These agents are human herpesvirus 8/Kaposi’s sarcoma-associated herpesvirus, or HHV-8/KSHV (implicated in Kaposi’s sarcoma), Epstein-Barr virus, or EBV (in primary central nervous system lymphoma and a subset of systemic B-cell NHL) and human papillomavirus, or HPV (in cervical cancer).[1]

Thalidomide (Thalomid) is recognized to have antiangiogenic properties and has been shown to be effective in the treatment of refractory myeloma.[1] As a result, thalidomide is now being investigated for use in a number of malignancies, including breast,

SEATTLE-A new study shows that human herpesvirus 8 (HHV-8), thought to be the cause of Kaposi’s sarcoma, is more likely to be found in mucosal samples than in anal/genital samples, and is found at higher levels in saliva than in samples from the genital tract. Consequently, viral spread is more likely from oral than from genital exposure.

At the end of its session, Congress passed a children’s health bill (H.R. 4365) that established a variety of new health programs. One section of the bill authorizes the CDC to study environmental and other risk factors for childhood cancers,

Soft-tissue sarcomas comprise approximately 7% of all pediatric malignancies. Surgery, chemotherapy, and radiation therapy have significantly improved survival.

The management of pediatric soft-tissue sarcomas has improved drastically through the use of multimodal therapy. These tumors include rhabdomyosarcomas and nonrhabdomyosarcomas. Both are staged using

The management of pediatric soft-tissue sarcomas has improved drastically through the use of multimodal therapy. These tumors include rhabdomyosarcomas and nonrhabdomyosarcomas. Both are staged using

In his excellent review, Dr. Mitsuyasu correctly highlights the three most important ingredients that play a role in the pathogenesis of acquired immunodeficiency syndrome (AIDS)-related Kaposi’s sarcoma (KS)-Kaposi’s sarcoma herpesvirus/human herpesvirus type 8 (KSHV/HHV-8); altered expression and response to cytokines; and stimulation of KS growth by the human immunodeficiency virus (HIV)-1 trans-activating protein, Tat. Recent studies have provided tremendous insight into the process whereby KSHV/HHV-8 creates the inflammatory-angiogenic state that characterizes KS.

Dr. Mitsuyasu has been doing clinical research in patients with AIDS-related Kaposi’s sarcoma (KS) since the beginning of the AIDS epidemic, and his review reflects this breadth of experience. It provides a well-rounded and up-to-date assessment of the pathophysiology, evaluation, and treatment of AIDS-related KS that should be a useful guide for practicing physicians.

In his article, Dr. Mitsuyasu concisely reviews a large body of data concerning the etiology, pathogenesis, epidemiology, and treatment of Kaposi’s sarcoma (KS) in the setting of the human immunodeficiency virus (HIV) infection. As he correctly points out, effective highly active antiretroviral therapy (HAART), with its consequent improvements in immune function and decrease in production of viral and cytokine cofactors that promote KS growth, has been partly responsible for the decline of KS incidence in areas with ready access to HIV therapy.

The criteria for successfully resecting pulmonary metastasis have not changed since they were originally described by Ehrenhaft in 1958.[1] They are (1) that the primary tumor site has been removed without evidence of local recurrence, (2) that no extrathoracic organ metastasis exists, and (3) that pulmonary disease has been completely removed without compromising pulmonary function.

In their literature survey, Drs. Chao and Goldberg reach the conclusion that surgical metastasectomy is the clear treatment of choice and should be the standard of care for patients with pulmonary recurrences of soft-tissue sarcoma. It is assumed that survival without this operation is negligible, even while there are no survival statistics for sarcoma patients who are eligible for metastasectomy and who choose to forgo this option.