ONCOLOGY Vol 11 No 10

During the past 5 years, real strides have been made in the management of advanced non-small-cell lung cancer (NSCLC). The introduction of newer chemotherapeutic agents and novel treatment regimens is paving the way for marked improvements in both clinical outcomes and quality of life.

Paclitaxel (Taxol) and vinorelbine (Navelbine) are both microtubule toxins but with opposite mechanisms of action. Paclitaxel promotes the assembly of microtubules, whereas vinorelbine prevents microtuble assembly.

Data from North American clinical trials have shown that vinorelbine (Navelbine) is well tolerated when used as a single agent for the treatment of non-small-cell lung cancer, advanced breast cancer, or ovarian cancer. Myelosuppression is the primary dose-limiting toxicity.

Cisplatin (Platinol) has played a major role in the treatment of non-small-cell lung cancer (NSCLC). As a single agent, cisplatin has produced a response rate of approximately 21% in a large number of trials.

Chemotherapy has been shown to prolong survival in patients with stage IV non-small-cell lung cancer (NSCLC). However, traditional cisplatin (Platinol)-containing regimens are associated with significant toxicity.

The past 5 years have witnessed an evolution in the management of unresectable non-small-cell lung cancer (NSCLC) in the United States. Combined-modality treatment with chemotherapy plus irradiation has become the standard of care for stage III (locally advanced) disease. Most patients with stage IIIB disease and cytology-positive pleural effusion are now considered candidates for chemotherapy, as are those with stage IV disease.

Newer chemotherapy drugs have shown encouraging activity in advanced non-small-cell lung cancer. Based on these improved outcomes, as well as the high rate of distant relapse in patients with locally advanced disease, several recent studies have evaluated the use of systemic therapy in patients with earlier-stage disease.

Randomized trials in patients with advanced non-small-cell lung cancer (NSCLC) have demonstrated that the combination of vinorelbine (Navelbine) and cisplatin

Two large-scale, randomized, phase III trials have offered new information on the response rates, survival benefits, and safety profile of vinorelbine (Navelbine) in non-small-cell lung cancer (NSCLC). In a multicenter, European trial, the response rate was significantly higher with vinorelbine/cisplatin (Platinol) than with vindesine (Eldisine)/cisplatin (P < .02) or vinorelbine alone (P < .001).

As health-care costs escalate, health-care planners must determine how the allocation of health-care dollars should be prioritized. One approach is to assess the cost of achieving a quality-adjusted year of life and then allocating the dollars in descending order, from least to most expensive, until all available money has been expended. Of course, calculating the cost per life-year is the real challenge because it is usually determined from mathematical decision models, which include many assumptions that may be subject to criticism.

The usefulness of doxorubicin (Adriamycin) in the treatment of a variety of malignancies is limited by its concomitant toxicity. The encapsulation of chemotherapeutic agents, including doxorubicin, in

Albert H. Owens, Jr, MD, President of the National Coalition for Cancer Research (NCCR), urged the National Cancer

Researchers at The M.D. Anderson Cancer Center and Memorial Sloan-Kettering are embarking on a study that may evolve

Clinical data supporting the use of leukocyte-reduced blood indicates a significant decrease in the risk of infection and cost of recovery in surgical patients, according to a panel of experts.

Researchers may be close to developing an additional weapon for treating a type of rapidly growing, fatal brain tumor that

Women being treated postsurgically with tamoxifen (Nolvadex) to prevent breast cancer recurrence may also gain some

Women who choose breast reconstruction with autogenous tissue rather than an implant may experience better psychosocial

The Eastern Cooperative Oncology Group (ECOG), The National Cancer Institute’s (NCI) clinical trials cooperative group,

Cancer researchers, led by Antonio Giordano, MD, PhD, associate professor at Jefferson Medical College, have for the first

A team of researchers has disrupted the natural progression of division and death in human cells, endowing the cells with an

The July issue of ONCOLOGY contained an article by Alan Venook, MD, entitled “Update on Hepatic Intra-

Waselenko and Dawson provide a summary of the extensive experience in the management of metastatic prostate cancer. Their article follows a traditional descriptive format and is quite informative. The part that is missing is a general discussion of the various biological aspects involved in the complex process of prostate cancer progression, which has been the focus of major research over the past few years.[1] Undoubtedly, this emerging body of knowledge will provide the background for the design and development of new treatments. There are a few issues, however, that deserve more emphasis.

It is not often that a reviewer agrees entirely with material presented in an article. I find myself in the happy situation of largely agreeing with the basic thrust of this interesting report by Chadha and Axelrod. They begin by describing the increased incidence of breast cancer over the recent decade, but do not mention that since 1990 there has actually been a decreased incidence of breast cancer.[1] In retrospect, it has become clear that the statistical increase in breast cancer during the 1980s was an artifact of extensive mammographic screening, which caught the initial appearance of disease earlier and artificially created a temporary surge of cases that has since abated.[2]

The July, 1997 issue of ONCOLOGY(11:947-970, 1997) featured a discussion by Alan Venook, “Update on Hepatic

Although the article by Senie and Tenser reviewing some of the data relevant to whether operative timing within the menstrual cycle affects breast cancer outcome is reminiscent of a recent paper that appeared in the December 1996 issue of the Journal of Women’s Health,[1] the question it considers is potentially important enough that this issue should also be raised in Oncology. The article points out the experimental basis for believing that an important interaction may occur between the host-cancer-surgery and the mammalian reproductive cycle.[2,3] This is an important supposition because clinicians have routinely assumed that no experimental foundation underlaid the first and 31 subsequent analyses of relevant clinical data[4,5]-an assumption that is false.

The authors provide a comprehensive overview of the role of axillary lymphadenectomy in the treatment of early-stage breast cancer. They do not argue against lymphadenectomy for patients with clinical T2 and 3 tumors and clinical N1 and 2 nodes. However, for clinical N0 cancers and for postmenopausal patients with hormone-receptor-positive tumors, the authors propose radiotherapy to the axilla as a modality less expensive than surgery and with fewer complications. They suggest observation only for lesions associated with a less than 10% to 15% chance of axillary metastasis (T1a cancers, tubular carcinomas, ductal carcinoma in situ [DCIS] with microinvasion). However, for patients with lesionsless than 1 cm with “high-risk features (presence of tumor emboli in vessels, poor nuclear grade, etc),” axillary lymphadenectomy “should continue to serve as a refined prognostic indicator for selection of patients for adjuvant therapy.”

The discussions and debates about the use of estrogen replacement therapy (ERT) in women with breast cancer often seem to ignore or at least leave unnoted the extensive data supporting the general premise that increased, but physiologic levels of estrogens are associated with poorer survival in postmenopausal women with breast cancer. Dr. Colditz summarizes various lines of evidence bolstering this general premise, providing us with some needed lessons about the complexities of interpreting epidemiologic studies and about human cancer biology. Particularly illuminating are his discussion of the biases in ERT-breast cancer causation studies and his exploration of the reasons for the apparently better survival in ERT users who develop breast cancer.

Drs. Benoit and Naslund venture into the complex arena of medical economics and cost-effectiveness analysis of prostate cancer screening-a task that is made all the more difficult because of the dual paucity of data on costs and effectiveness. Their underlying premises are that cost control is a dominant concern in the prostate cancer screening debate and that cost-effectiveness analyses have been used to “justify denial of prostate cancer screening.” Both of these assumptions bear scrutiny.

A number of recent studies have suggested that survival among premenopausal women after primary treatment of breast cancer may be affected by the estimated hormonal milieu at the time of surgery, especially in those with

Dr. Colditz has reviewed the potential hazards of hormone replacement therapy in breast cancer survivors. Let us presume, for the sake of brevity, that his assumptions are correct. With so many risks, why would a breast cancer survivor consider taking hormone replacement, and why would an oncologist prescribe it?