ONCOLOGY Vol 16 No 2

A recent report on obesity released by US Surgeon General Dr. David Satcher said that about 300,000 people in the United States die each year from diseases related directly to being overweight, including heart disease and cancer.

Outpatient cancer clinics received a 3-month reprieve before Medicare institutes its new prospective payment system, which is expected to result in a big drop in reimbursement for some newer cancer drugs.

The National Cancer Institute (NCI) recently released Cancer Progress Report 2001-the first in a new series of reports designed to make scientific information on cancer more accessible and understandable. The new report describes and illustrates the nation’s progress in reducing the cancer burden across the full cancer continuum, from prevention through death.

For many people, a picture is much more instructive and memorable than text. The second edition of the Atlas of Breast Cancer is designed for such people. With 154 pages and 213 figures, it is a graphic overview of the pathophysiology, diagnosis, and treatment of breast cancer.

Data from a phase II study of subcutaneous amifostine (Ethyol) presented at the 43rd annual meeting of the American Society for Therapeutic Radiology and Oncology suggested that subcutaneously administered amifostine may provide the same protective effects against radiation therapy-induced xerostomia as intravenous administration.

The cancer community is expressing unanimous approval of President George W. Bush’s appointment of Andrew von Eschenbach, MD, as director of the National Cancer Institute (NCI). Dr. von Eschenbach was director of the Genitourinary Cancer Center and Prostate Cancer Research Program at the University of Texas M. D. Anderson Cancer Center. "[His] extensive experience in cancer research, treatment, and prevention has prepared him extraordinarily well to head the NCI," said Larry Norton, MD, president of the American Society of Clinical Oncology. "As both a recognized leader in the oncology community and as a cancer survivor, Andy brings a distinctive perspective to this position."

New research from the AIDS Institute at the University of California, Los Angeles (UCLA), reveals that stress enables the human immunodeficiency virus (HIV) to spread more quickly in infected persons and prevents antiretroviral drugs from restoring immune system function. The study, which was reported in the Proceedings of the National Academy of Sciences (98:12695-12700, 2001), is the first to pinpoint the molecular mechanisms linking stress and HIV infection. "Popular science has widely suspected that stress weakens the immune system," said Steve Cole, MD, lead author and UCLA assistant professor of hematology-oncology. "Now we’ve uncovered two reasons why."

The Association of Community Cancer Centers (ACCC), a national interdisciplinary organization defining quality cancer care, has launched a public policy website-www.accc-cancer.org/publicpolicy/-dedicated to the regulatory and legislative issues affecting patients with cancer. The website was developed to assist in educating patients and their families about public policy that has an impact on cancer care.

A new study published in the Journal of Clinical Oncology (19:3918-3928, 2001) reported that radioimmunotherapy with tositumomab/iodine-131 tositumomab (Bexxar), produced more durable complete or partial clinical responses in patients with low-grade and transformed low-grade non-Hodgkin’s lymphoma (NHL) than did their last round of chemotherapy. All patients in the study had chemotherapy-refractory NHL. Typically, response rates and durations of response in refractory patients decline with each successive therapy, but in this study, the tositumomab/iodine-131 tositumomab combination was shown to reverse the expected outcome.

A study conducted by the Southwest Oncology Group reported that a short course of chemotherapy followed by radiation significantly improves time to disease progression and minimizes toxicity in patients with early-stage Hodgkin’s disease. The study evaluated whether chemotherapy should be part of the treatment regimen for patients with early-stage Hodgkin’s disease. Earlier studies of other chemotherapy combinations followed by radiation also demonstrated improved progression-free survival rates; however, patients experienced excessive toxicities.

A new study found that lack of adherence to pain medication regimens and inadequate analgesic prescriptions are the main reasons cancer patients do not achieve adequate pain relief. The study observed cancer patients in their homes in order to determine whether they were adhering to the pain management regimens prescribed by their doctors. Researchers from the Schools of Nursing, Medicine, and Pharmacy at the University of California in San Francisco (UCSF) conducted the study, which was reported in the Journal of Clinical Oncology (19:4275-4279, 2001).

For the past 20 to 30 years, enormous resources have been directed toward the development of effective cancer immunotherapies. The interest in immunotherapeutic approaches comes from the potential specificity imparted by the recognition of tumor-specific antigens combined with the powerful cytolytic properties of cellular and humoral immune effector arms. Earlier attempts to induce and/or expand tumor antigen-specific immune responses in patients involved the systemic administration of cytokines such as interleukin-2 (Proleukin), or immunization with vaccines prepared from whole tumor cells or tumor cell lysates admixed with powerful immunologic adjuvants (stimulators). Unfortunately, only limited efficacy was achieved.

The title of the article by Dr. Stephen Sagar, "Carcinomatous Meningitis: It Does Not Have to Be a Death Sentence" is very provocative. Most oncology specialists consider leptomeningeal dissemination of cancer as an indication of end-stage disease, particularly in patients with solid malignancies. More than 70% of patients found to have neoplastic meningitis have evidence of concurrent progressive systemic disease.[1] Although neoplastic meningitis is thought to have less of an impact on survival in patients with lymphomas or leukemias, the presence of tumor cells in the cerebrospinal fluid (CSF) of these patients significantly complicates the treatment regimen.

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]

Solomon et al have written a valuable primer to guide clinicians in identifying, diagnosing, and treating familial colon cancer syndromes. The authors succinctly describe the essential features of each of the well-defined hereditary colon cancer syndromes, including those associated with colonic adenomas (hereditary nonpolyposis colorectal cancer [HNPCC] and familial adenomatous polyposis [FAP]) and colonic hamartomas (Peutz-Jeghers syndrome, juvenile polyposis, and Cowden syndrome). In addition to the specific features that might trigger recognition of one of these syndromes, we advise health-care providers to consider the possibility of hereditary cancer in cases with the following features:

This article is a comprehensive review of genetic testing for hereditary colorectal cancer detection. There is no longer any doubt that hereditary factors contribute to an increased risk of colon cancer. It remains to be seen how great their contribution is, how best to identify high-risk groups, and how best to care for carriers of the mutated genes. Approximately 25% of colorectal cancers occur in younger individuals or those with a family history of the disease, suggesting a heritable susceptibility.[1]

With this insightful manuscript, Drs. Termuhlen and Kemeny shed some light on the surgical management of older cancer patients. The authors highlight pitfalls in patient selection and offer proposals to improve the surgical oncologist’s approach to patient care. They review the role of curative surgical management of the most common forms of cancer in the elderly, while emphasizing the role of surgical palliation to improve the quality of life of older cancer patients.

Leptomeningeal metastases are a growing problem, particularly among patients whose solid tumors have been controlled with increasingly effective systemic therapies. The central nervous system (CNS) can represent a sanctuary where disease can persist even if it is eradicated or controlled systemically. This is due to the blood-brain barrier that prevents most water-soluble chemotherapeutic agents from reaching tumor cells sequestered in the CNS.

Each year, tobacco use kills nearly 500,000 Americans (430,000 smokers and 53,000 from secondhand smoke)[1]-more than the combined annual number of national deaths from the acquired immunodeficiency syndrome, alcohol, automobile accidents, murders, suicides, and fires. The annual cost of treating tobacco-related diseases is about $89 billion.[2]

The elderly population in the United States increased by a factor of 11 in the past century, while the under age 65 population tripled in that same period.[1] Given that the majority of cancers occur in patients over 65 years old, there is an increasing need for surgical interventions in the elderly.

The review by Drs. Shacter and Weitzman is an excellent and timely contribution to the field of carcinogenesis. The issue of chronic inflammation as a progenitor of cancer development has been a controversial one. To prove the importance of chronic inflammation (and the factors released in the process) to carcinogenesis, the authors provide a thorough and logical presentation of the experimental results described in the literature, including their own work. This compilation of the existing data should dispel any doubts about the association of chronic inflammation to cancer. I will review the main points discussed by the authors.

Surgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients.

Carcinomatous meningitis, specifically leptomeningeal metastases from solid tumors, has a dismal prognosis, with an overall median survival of 2 to 4 months. Lymphomatous meningitis has a better outlook, with a median survival of more than 6 months, but diagnosis may be delayed and treatment is not curative.

Over 130,000 new cases of colon cancer are diagnosed annually. Approximately 20% to 30% of these are attributable to familial risk, and 3% to 5% belong to a hereditary colorectal cancer predisposition syndrome.

In this article, Drs. Shacter and Weitzman present a thoughtful, comprehensive review of the role of chronic inflammation in the multistep process of carcinogenesis. Their cogent discussion encompasses the basic science, clinical correlates, and treatment implications of this subject. It is well balanced, highly informative, and indicative of the complexity of the biochemical events that transpire as chronic inflammation results in malignant transformation of target cells.

Patients with actinic keratoses (AKs) now have increased access to treatment options. The Centers for Medicare & Medicaid Services (formerly known as the Health Care Financing Administration) recently added a new national coverage policy on the treatment of AKs under Medicare. approximately 39 million Medicare recipients will now have coverage for the treatment of AKs, without restriction, using surgical and medical methods.

A substantial body of evidence supports the conclusion that chronic inflammation can predispose an individual to cancer, as demonstrated by the association between chronic inflammatory bowel diseases and the increased risk of colon carcinoma. Chronic inflammation is caused by a variety of factors, including bacterial, viral, and parasitic infections, chemical irritants, and nondigestible particles.