ONCOLOGY Vol 16 No 1

The number of women receiving mammograms is higher than ever, according to the results of a study conducted by the Board of Sponsors for National Breast Cancer Awareness Month (NBCAM). The study found that more women are getting

Management of Patients at High Risk for Breast Cancer, edited by Victor G. Vogel, MD, is designed for all physicians involved in breast cancer risk assessment and prevention. It does not assume a baseline familiarity with cancer risk

New data presented at the recent San Antonio Breast Cancer Symposium demonstrated that anastrozole (Arimidex), as an adjuvant treatment in postmenopausal women with early breast cancer, significantly reduced disease recurrence.

Andrew C. von Eschenbach, MD, has been named director of the National Cancer Institute (NCI) by President Bush. This appointment follows his recent selection as president-elect of the American Cancer Society.

Legislation that would force all states to collect data on benign brain tumors got a hearing before a House subcommittee in mid-November. That was the critical first step needed before Rep. Barbara Lee (D-Calif), the measure’s sponsor, could

A federal judge in Oregon has temporarily blocked Attorney General John Ashcroft’s ability to prosecute Oregon physicians who use controlled substances to help a patient in pain end his or her life. Mr. Ashcroft’s announcement in early

The results of a 10-year study of a three-pronged treatment (surgical resection followed by chemotherapy and radiotherapy) for adenocarcinoma of the stomach showed that patients who underwent both surgical resection and postoperative

The article by Drs. Levy and Wiersema is an excellent overview of the indications, technical nuances, and efficacy of endoscopic ultrasound in the diagnosis and staging of pancreatic neoplasms. Endoscopic ultrasonography was introduced into the diagnostic armamentarium for gastroenterology approximately 15 years ago. Although the literature suggests a general increase in the utility and experience with endoscopic ultrasound, the technique remains most effective in the hands of experienced experts like Drs. Levy and Wiersema. Their article is a complete and thorough review of the indications and expected accuracy of the technique when evaluating a variety of different pancreatic lesions.

Two decades have elapsed since publication of the first papers describing the examination of the pancreas via the stomach and the duodenum using an ultrasound probe fixed to an endoscope tip. Initial attempts to image the pancreas in this fashion proved difficult and frustrating, but they were promising enough that instrument makers and gastrointestinal endoscopists persisted in developing increasingly effective devices.

Patients with signs and symptoms suggestive of a pancreatic neoplasm typically undergo initial imaging with transabdominal ultrasound or computed tomography. This evaluation often reveals the presence of a pancreatic mass or fullness.

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,

Cancer researchers can almost feel the ground rumble beneath their feet as they walk through their clinics and laboratories. A veritable explosion of information has radically altered the way we think about cancer, and has introduced new concepts

Drs. Levy and Wiersema have provided an authoritative review of the role of endoscopic ultrasonography in the diagnosis and staging of pancreatic cancer. As outlined in their article, endoscopic ultrasound has emerged as an important tool in the diagnostic evaluation of many patients with suspected pancreatic neoplasms. We concur that endoscopic ultrasound is part of the standard preoperative evaluation of patients with biochemically confirmed insulinoma and gastrinoma syndromes and of at-risk patients with multiple endocrine neoplasia type 1. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration (FNA) can also accurately determine the etiology of a cystic pancreatic neoplasm by differentiating between mucinous, serous, and inflammatory (pseudocyst) lesions.

Barton, Loprinzi, and Gostout provide a comprehensive, accurate, and multidisciplinary review of the management of menopausal symptoms in patients with a previous diagnosis of cancer. The article is clearly enhanced by the authorship of individuals from different backgrounds, each of whom bring a valuable perspective to the subject. Additional attention to several issues would, however, make interpretation of the data on this subject, and hence, the management of patients with these problems, more clear.

More women, and especially more premenopausal women, are surviving their cancer diagnosis. However, due to their therapy, these women may become symptomatic from iatrogenic ovarian failure. For some, the use of hormone replacement therapy (HRT) is contraindicated because it may affect the course of their disease. Other women and their physicians may feel uncomfortable with the use of hormones because research is inconclusive regarding long-term survival or disease recurrence. Women who experience a cessation of menses due to adjuvant therapy for breast cancer are more likely than women undergoing a natural menopause to experience severe hot flashes, night sweats, and fatigue.[1] However, nonhormonal interventions appear to benefit many of these women[2] and should be used to decrease their symptoms. Barton, Loprinzi, and Gostout address these concerns in their excellent review and offer recommendations for pharmacologic and nonpharmacologic interventions.

The search for effective postoperative adjuvant therapy for patients with resected non-small-cell lung cancer (NSCLC) has been spurred by a high rate of failure after definitive surgery. Except for patients with resected T1, N0, M0 lesions, failure rates exceed 30%. Widespread application of adjuvant therapy has been reined in by a disappointing lack of effectiveness in this setting.

The study of cancer in specific populations can offer clues useful in determining the extrinsic and intrinsic factors influencing cancer in all populations. Extrinsic factors are sometimes called "environmental" in the broadest sense of the word. They are modifiable or mutable. Intrinsic factors are more inherent to the individual. They are almost always genetic and are immutable or unchangeable. Targeting research on specific populations is and should be a significant ethical issue.

Health disparities among populations within the United States are well documented. In order to eliminate these disparities, we must further understand their sources. Are they the result of the unequal distribution of resources, racism, or inherent characteristics of ethnically or "racially" defined groups? How we define and discuss "race" has major scientific and moral consequences. In this issue, Leslie Klein Hoffman asks two major questions as they pertain to research on ethnic or "racially" defined groups. When is genetic research on a population appropriate? How should researchers define a given population? These questions are timely, and it is both humbling and instructive that the answers to these questions remain unclear.

Dr. Movsas has written a thorough, accurate description of the state of the art on postoperative, adjuvant therapy for resected "high risk" non-small-cell lung carcinoma (NSCLC). Management of this common situation indeed remains an "art," since the results of "scientific" randomized trials have been singularly disappointing.

Neuroblastoma is a pediatric malignant tumor of the postganglionic sympathetic nervous system that usually develops in the adrenal gland or in nonadrenal abdominal or thoracic sites.[1] It is the most common malignancy in infants and the most common extracranial solid tumor of childhood, with approximately 650 cases diagnosed annually in the United States.[2] The dramatic age-related survival differences among neuroblastoma patients with a similar tumor stage emphasize the heterogeneity of neuroblastoma pathobiology. Early research efforts to understand the pathobiology of neuroblastoma[3-5] and the significant progress made in neuroblastoma molecular biology[6] have informed the clinical treatment of neuroblastoma.

Immune deficiency in cancer patients is well documented, and tumor cells have developed a variety of cellular and molecular mechanisms to avoid antitumor immune responses. These mechanisms include defective presentation of tumor antigens on the cell surface and/or an inability of the host to effectively recognize these cells and target them for destruction. Tumor-induced defects are known to occur in all major branches of the immune system. The continuous administration of vascular endothelial growth factor (VEGF), a factor produced by most solid tumors, inhibits the functional maturation of dendritic cells, significantly decreases T-cell to B-cell ratios in the peripheral lymphoid organs, and induces rapid and dramatic thymic atrophy in tumor-bearing animals. VEGF is abundantly expressed by a large percentage of solid tumors, and defective antigen presentation, T-cell defects, and premature thymic atrophy are known to occur in cancer patients and tumor-bearing animals. This review will encompass the major mechanisms responsible for tumor evasion of immune surveillance and highlight a role for VEGF as a principal contributor to tumor-associated immune deficiencies. [ONCOLOGY 16(Suppl 1):11-18, 2002]

Patients with locally advanced cancers have a poor prognosis when treated with radiotherapy and/or surgery alone. The appearance of distant metastases shortly after removal of the primary tumor indicates that micrometastases are already present at the time of diagnosis. We observed a favorable outcome in patients with locally advanced breast cancer treated with a prolonged regimen of neoadjuvant chemotherapy plus granulocyte-macrophage colony-stimulating factor (GM-CSF [Leukine]) compared with patients receiving fewer chemotherapy cycles prior to surgery and radiotherapy. These results can partly be explained by the dose-intensive regimen used, but biologic and immunologic processes inherent to the prolonged presence of the primary tumor and its draining lymph nodes might also contribute to the beneficial outcome. The effects of the prolonged presence of the primary tumor during chemotherapy and GM-CSF administration on the antitumor immune response, and more specifically the functional properties of dendritic cells and T cells, are currently being investigated in a multicenter randomized clinical trial comparing prolonged neoadjuvant chemotherapy plus cytokines with a conventional treatment schedule. Aside from investigations concerning the immune system, other biologic processes, such as tumor angiogenesis, are being investigated at the same time. [ONCOLOGY 16(Suppl 1):32-39, 2002]

The effect of a patient’s race or ethnicity on cancer incidence and mortality rates remains a neglected area of cancer research. However, with cancer statistics differing among various populations, research on racial and ethnic groups could provide clues to cancer trends.

The role of adjuvant therapy following complete resection of node-positive (stage II/IIIA) non-small-cell lung cancer remains controversial. Five-year survival rates in pathologic stage II disease range from 30% to 50% and in resected stage IIIA disease from 10% to 30%. The majority of recurrences following surgery are distant metastases.

In 2001, the American Joint Committee on Cancer Melanoma Staging Committee proposed and created a new staging system for melanoma. This new system will become official in 2002, with the publication of the sixth

Menopause can be experienced prematurely by women with cancer and, as such, is often accompanied by symptoms that are becoming salient management issues. It is common practice to avoid estrogen replacement therapy in women with estrogen-sensitive tumors.

Intraoperative lymphatic mapping and sentinel lymphadenectomy has become an increasingly popular technique for staging the regional lymph nodes in early-stage melanoma. This operative technique allows for detailed pathologic analysis of the first (or sentinel) lymph node in direct connection with the primary tumor, and provides a unique opportunity for assessing potential immunologic interactions between the primary tumor and regional lymph node basin. We performed lymphatic mapping and sentinel lymphadenectomy on 25 patients with early-stage melanoma and resected an additional nonsentinel node in each case. Sentinel and nonsentinel nodes were evaluated by routine pathologic analysis. A portion of each node was processed for expression of the dendritic markers of activation CD80, CD86, and CD40, and their corresponding T-cell receptors CTLA-4 and CD28. Of 25 patients undergoing lymphatic mapping and sentinel lymphadenectomy, 20 (80%) had matched sentinel and nonsentinel nodes. A total of 26 matched lymph node sets were obtained: three pairs from one patient and two from an additional two patients. Reverse transcription polymerase chain reaction analyses of corresponding sections of the sentinel and nonsentinel nodes demonstrated a marked reduction in semiquantitative expression of CD80 (77%), CD86 (77%), and CD40 (85%), as well as CTLA-4 (88%) and CD28 (85%) in sentinel as compared to nonsentinel nodes. The diminished expression of the dendritic cell markers appeared to be unrelated to the B-cell (CD20) and T-cell (CD2) expression. Lymphatic mapping and sentinel lymphadenectomy allows for detailed pathologic and molecular characterization of sentinel nodes. Our results suggest a quantitative reduction in dendritic cell markers in sentinel as compared to nonsentinel nodes, which may be important in the immunologic interaction between the primary site and regional lymph node basin and may also serve as useful criteria for identifying sentinel nodes. [ONCOLOGY 16(Suppl 1):27-31, 2002]

Advances in the treatment of lung cancer have been precious and few over the past 40 years, as reflected in the minimal rise in overall survival from this disease since 1960. Significant progress has occurred in staging accuracy, surgical morbidity, radiation delivery, and new chemotherapeutics. And yet, patients with stage II disease have a 5-year survival rate of 50% or less, while patients with stage III disease fare poorly overall.