ONCOLOGY Vol 16 No 11

According to the results of a landmark study published in a recent issue of the Journal of Clinical Oncology (20:4040-4049, 2002), how painkillers are delivered can make a major difference in patient outcome. The trial, supported by

Calling his initial months as director of the National Cancer Institute (NCI) "absolutely exhilarating," Andrew C. von Eschenbach, MD, described three interrelated themes that will guide his leadership of the Institute. The three, he said at a

The addition of high-dose calcitriol (the active form of vitamin D) to weekly treatment with docetaxel (Taxotere) appears to improve response in men with hormone-refractory prostate cancer without compromising safety, according to the results of a

Since the implementation of highly active antiretroviral therapy (HAART) in the United States in 1996, the number of persons diagnosed with acquired immunodeficiency syndrome (AIDS) and the number of deaths among persons with AIDS have

A phase II study found that the use of trastuzumab (Herceptin) in combination with docetaxel (Taxotere) and cisplatin shrank breast tumors so significantly that locally invasive cancers became undetectable in 1 of 4 women (26%) who participated in the

At the recent Department of Defense Breast Cancer Research Program "Era of Hope" meeting, held in Orlando, Fla, researchers presented a prototype for a simple test that can rapidly screen tiny samples of tissue for biomarkers of breast

Genentech Inc, Idec Pharmaceuticals, and Roche recently announced the initial results of a randomized multicenter study of extended therapy with single-agent rituxan (Rituximab) in patients with chemotherapy-naive and relapsed indolent non-

National cancer advocacy groups leveled harsh criticism at Senate negotiators from both parties for their failure to include any significant enhancements of beneficiary entitlements in a pending Medicare legislative package. Ellen Stovall, president of the

Radiation therapy alone is an adequate treatment for some patients with rectal cancer, according to a study published in a recent issue of the International Journal of Radiation Oncology, Biology, Physics (54:142-149, 2002).

Although the title might be slightly misleading, Oncologic Imaging is actually a compendium of information on the detection, diagnosis, imaging, staging, and treatment of cancer. This is the second edition of a multiauthor book that first appeared in

Women who received radiation therapy for Wilms’ Tumor are at increased risk of complications during pregnancy and, therefore, should be carefully assessed and monitored by their obstetricians. These conclusions were part of a National Wilms’

In their review, Drs. Kim, Alvarez, and Omura have outlined a diverse group of clinical trials in a very limited space. Their summary highlights some of the most important insights gained from these trials, placing particular emphasis on the role and perspective of the Gynecologic Oncology Group (GOG). Although their review appropriately divides these studies into three major groups (early cervical cancer, locally advanced cervical cancer, and vulvar cancer), the results also reveal common themes that can be used to guide the overall management of women with carcinomas of the female lower genital tract.

Drs. Lieberman and Schold have presented a comprehensive up-to-date review of paraneoplastic syndromes affecting the nervous system. The points are all well made, but a few deserve special comment:

Despite significant advances in the treatment of a variety of malignancies, highly effective therapies for most patients with metastatic renal cell carcinoma or metastatic melanoma are rare. Traditional oncologic treatment methods, such as

Cancer-related thrombocytopenia is a clinical problem. Unfortunately, the qualitative nature and quantitative extent of the problem has been poorly defined to date. Without knowing these two parameters, the risk/benefit ratio of any management option for cancer-related thrombocytopenia is impossible to calculate accurately. Drs. Goodnough and DiPersio have done an excellent job of delineating many of the potential risks of managing the problems associated with platelet transfusions.

Drs. Goodnough and DiPersio present an authoritative and informative discussion of the management of thrombocytopenia in the cancer patient, emphasizing the risks of platelet transfusions, the safety of a platelet count threshold of < 10,000/µL for prophylactic transfusions, and issues related to the optimal type of platelet product and dose of platelets. The authors make the important point that although the risk of transmission of viral infections has decreased markedly due to the addition of nucleic acid testing for hepatitis C and human immunodeficiency virus (HIV),[1] sepsis due to bacterial contamination remains a serious risk, particularly for the neutropenic patient.[2] The fever and chills that occur within 6 hours after a platelet transfusion usually are associated with nonhemolytic febrile transfusion reactions, but the more dangerous possibility of bacterial sepsis from contamination should be considered, particularly in the neutropenic patient, and treated empirically until bacterial cultures prove otherwise.

Dr. Nemunaitis gives a scholarly and informative historical review of antineoplastic viral therapy using recombinant DNA biotechnologies. The field predates the polymerase chain reaction and restriction enzymes; it has its roots in observations by Jenner and experiments that are over 100 years old.

Approximately 30 years passed between the first description of a paraneoplastic neurologic disorder[1] and the demonstration of an immunologic pathogenesis for one of these syndromes.[2] In the almost 4 decades since, the paraneoplastic neurologic disorders have been subjected to study far out of proportion to their clinical prevalence. These disorders stimulate clinical research because (1) paraneoplastic neurologic syndromes are frequently the presentation of a malignancy, (2) they may bode well for a more favorable tumor prognosis,[3,4] and most importantly, (3) they yield insight into the workings of malignancy and the pathogenesis of neurologic disorders, particularly neurologic degenerations.

William Pirl and Jeffrey Mello present an informative overview of the psychological impact of prostate cancer. They also provide a practical framework for distress management, as promulgated by the National Comprehensive Cancer Network (NCCN).

As a result of the availability and clinical efficacy of trastuzumab (Herceptin), clinicians are now faced with a dilemma regarding the accurate identification of patients with HER2 overexpression. In the October 2002 issue of ONCOLOGY,

The authors challenge the notion that men with prostate cancer exhibit little psychological difficulty. In fact, we do not know much about actual distress rates in men with prostate cancer because few studies have directly measured distress in this population. Likewise, we do not know if the distress experienced by prostate cancer patients is qualitatively different from that of other cancer patients. By assuming that all men with prostate cancer "do well," we, as clinicians and researchers, may fail to ask patients important questions.

Drs. Goodnough and DiPersio should be commended for contributing such a well-written, well-referenced, objective, and authoritative review of issues in the management of cancer-related thrombocytopenia. Their article focuses primarily on platelet transfusion risks, rational transfusion thresholds, and potential novel pharmaceutical triumphs. The general lack of large-scale, definitive clinical trials in this field is appreciated and emphasized throughout. Much to my disappointment, the authors seem to have passed on the opportunity to provide the oncology community with any form of evidence-based (or evidence-lacking, as the case may be) and practical guideline for the treatment of thrombocytopenia.

Two things become apparent to the reader of this excellent article. First, the National Cancer Institute clearly had great foresight in 1970, when they began funding the Gynecologic Oncology Group (GOG) so that phase I, II, and III trials could be conducted in a systematic manner. Second, the authors have written a thorough review of over 3 decades of research into the biology and clinical aspects of cervical and vulvar cancer. In this short space, it would be impossible to adequately comment on the 50 studies reviewed by the authors. However, based on these studies, I would posit the rationale for a paradigm shift in the staging of cervical cancer, and would add (to paraphase Mark Twain), "the report of the complete demise of hydroxyurea as a radiation sensitizer may be an exaggeration."

Thrombocytopenia remains a significant clinical problem for patients with cancer. Management approaches include watchful waiting, platelet transfusions, and the use of pharmacologic agents. Although platelet

Two recent multicenter randomized trials have greatly advanced our understanding of the role of postoperative radiation therapy in operable cervical cancer. In locally advanced cervical cancer, such studies have shown a

Over the past decade, interest has been growing in the quality of life of men with prostate cancer. Traditionally considered a group with few psychological complications, 10% to 20% of men with prostate cancer are found to have clinically significant levels of psychological distress. This article reviews the prevalence of psychiatric symptomatology among prostate cancer patients, the psychological challenges of coping with the disease, and general guidelines for treatment. [ONCOLOGY 16:1448-1467, 2002]

Although antitumor activity and a low toxicity profile have been demonstrated for several oncolytic viruses, the development of viral therapy in cancer treatment has been limited by a lack of definitive phase III trials. The use

Paraneoplastic disorders of the nervous system are important to the practicing oncologist, because these syndromes, although uncommon, produce significant neurologic dysfunction and disability. The neurologic disorder may be the first manifestation of an unrecognized systemic malignancy, and appropriate diagnosis of the paraneoplastic disorder can lead to a focused search for an underlying cancer. Paraneoplastic disorders may involve any component of the central or peripheral nervous system, and diagnosis requires careful neurologic assessment. The diagnosis is made by recognition of clinical neurologic syndromes and the use of selected laboratory studies as indicated by the clinical picture. Over the past 10 years, the application of molecular biologic techniques to the study of these disorders has elucidated much about the mechanisms that cause neurologic injury. In most cases, disordered humoral and cellular immunity has been demonstrated, and the role of novel targets for autoimmune attack is being clarified. For some paraneoplastic disorders, treatment of the underlying tumor may lead to improvement of the neurologic disorder. For others, various forms of immunosuppressive therapy may be indicated. Unfortunately, for several of the more common paraneoplastic syndromes such as paraneoplastic cerebellar degeneration or limbic encephalitis, treatment is still unsatisfactory, and further research into the exact pathophysiology is clearly needed. [ONCOLOGY 16:1539-1556, 2002]

The American Cancer Society has estimated that in 2002 ovarian cancer will strike 23,300 women, and 13,900 women will die from the disease.[1] Five-year survival is about 80% for women with stage I disease, 50% for women with stage II disease, 25% for women with stage III disease, and 15% for women with stage IV disease. Among women with advanced-stage disease, optimal debulking surgery, as well as platinum/taxane-based adjuvant therapy prolongs disease-free and median survival.[2,3] Population-based data suggests that guidelines for therapy are not uniformly followed in community practice.[4] In addition, older patients appear to receive less aggressive treatment than younger patients.

The use of live viruses for the treatment of cancer has been extensively studied in several preclinical and clinical models, as discussed in Nemunaitis’ thorough historical review of the subject.