ONCOLOGY Vol 16 No 4

The Fourth Investigators’ Workshop sponsored by The University of Texas M. D. Anderson Cancer Center was held on July 25-29, 2001, in Colorado Springs, Colorado.

Grant Williams, MD, recently assumed the position of deputy director of the Division of Oncology Drug Products, Center for Drug Evaluation and Research (CDER), US Food and Drug Administration (FDA). Dr. Williams joined the FDA in 1989 as a medical officer and was named oncology medical team leader in 1996.

InTouch magazine, the Good Health Guide to Cancer Prevention and Treatment, has joined forces with the American Society of Clinical Oncology (ASCO).

ChromaVision Medical Systems, Inc, announced recently that investigators using their automated cellular imaging system (ACIS) concluded that the number of metastatic tumor cells found in the sentinel lymph node correlates with the size of the primary breast tumor.

I had the pleasure of reviewing the 8th edition of Philip Rubin’s Clinical Oncology: A Multidisciplinary Approach for Physicians and Students. This is another in a long line of excellent clinical textbooks edited by Dr. Rubin and associate editor Jacqueline P. Williams, PhD. Dr. Rubin is a pioneer in oncology and, in particular, radiation oncology. The current edition consists of 34 chapters authored by 95 contributors spanning all oncologic specialties and numerous institutions.

The US Food and Drug Administration (FDA) has approved ibritumomab tiuxetan (Zevalin) for the treatment of relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin’s lymphoma (NHL), including rituximab (Rituxan)-refractory disease.

Sen. Dianne Feinstein (D-Calif), whose second husband died of colon cancer, seems to be following in the footsteps of retired Sen.

The US Food and Drug Administration (FDA) has approved zoledronic acid (Zometa) for the treatment of bone complications in patients with multiple myeloma and patients with solid tumors, in conjunction with standard antineoplastic therapy.

Treating recurrent ovarian cancer requires a new perspective on the disease and the objectives of therapy, according to Deborah K. Armstrong, MD, assistant professor of gynecology and obstetrics at Johns Hopkins University School of Medicine.

A number of molecularly targeted agents directed at critical cell survival and cell proliferation pathways have recently entered clinical evaluation in children with cancer. These agents offer the potential for more effective anticancer therapy while simultaneously diminishing acute and long-term toxic effects. Systematic evaluations of targeted agents are essential to achieving continued improvements in outcome for children with cancer. Brief summaries of the rationale for conducting studies of several agents in children are provided below. Following these summaries is a listing of phase I, phase I/II, phase II, and pilot studies of these and other agents in pediatric populations.

Dr. Alan Sandler’s sweeping review of the role of irinotecan (CPT-11, Camptosar) in the treatment of small-cell lung cancer (SCLC) leaves few stones unturned. Some perspective, however, is necessary. To date, with the exception of the Japan Clinical Oncology Group trial, which demonstrated the superiority of irinotecan in combination with cisplatin compared to standard therapy with etoposide and cisplatin, no other new platinum agent combination has proven superior to standard therapy in the treatment of extensive SCLC.[1] The Noda study, published recently in the New England Journal of Medicine, has sparked considerable interest and anticipation in the medical oncology community.

Recent combinations of chemotherapy have significantly improved the response rate and survival time for patients with metastatic colorectal cancer.

Drs. Choi and Billings provide an excellent summary of the historical developments, clinical issues, and ethical dilemmas associated with palliative care. As they recount, the British hospice movement of the 1960s began as a fringe movement away from the main academic centers and organized medicine. This separation provided a safe environment in which palliative-care practitioners could deliver clinical care while establishing a new body of knowledge. On the other hand, because of this lack of connection, palliative care is still not recognized as a specialized area of medical practice in many countries, including the United States. This perception persists despite the fact that palliative care developed earlier than other fully recognized subspecialties such as emergency medicine and critical care.

Dr. Armitage is an experienced investigator in both lymphoma research and marrow/stem cell transplantation. As such, he is ideally suited to comment on the attributes of mitoxantrone (Novantrone) in the treatment of malignant lymphoma.

In the 1950s, a group of clinicians, who later would be the forerunners of the discipline to be known as oncology, completed the first clinical trial in acute lymphoblastic leukemia. This beginning led to the formation of a learned society in oncology. In the mid-1980s, the American Board of Internal Medicine recognized the field of oncology by providing a qualifying examination to establish its importance in the development and treatment of cancer. The impressive growth in this field over the past decade evolved through a variety of basic research advances and the introduction of clinical trials.

In their article, Drs. Choi and Billings address a number of strategic areas in palliative care. These topics include the definition and scope of the evolving field, the complexities involved in the use of modalities that carry burden or risk (such as artificial nutrition and bowel decompression), and the underappreciated importance of communication skills and a capacity for ethical reasoning.

Dr. Armitage presents a succinct and thorough review of the role of mitoxantrone (Novantrone) in patients with non-Hodgkin’s lymphoma (NHL). He begins by emphasizing the importance of accurate diagnosis as described in the World Health Organization classification which evolved from the Revised European American Lymphoma classification. Both of these present day classifications are based on the immunologic principles separating lymphomas into B- and T-cell disorders developed in the 1970s by Lennert, Lukes, and Collins.[1,2] His review addresses multiple issues in mitoxantrone therapy, including dose intensity, cardiotoxicity, combination therapy with nucleoside analogs in low-grade lymphomas, the impact of rituximab (Rituxan), therapy for acquired immunodeficiency syndrome (AIDS)-related lymphoma, and the role of high-dose mitoxantrone as part of a preparative regimen for autologous transplants.

Dr. Sandler has written a thorough and cogent review of the literature on irinotecan (CPT-11, Camptosar) in the treatment of small-cell lung cancer. The most promising data are those from a randomized trial by Noda et al, which showed that irinotecan, compared to etoposide, in combination with cisplatin resulted in an approximately 3-month survival benefit in patients with extensive disease, good performance status, and an age < 70 years. The results of this trial were published recently in The New England Journal of Medicine and, therefore, will attract wide readership and, presumably, much enthusiasm and excitement.[1]

Tumor angiogenesis is a complicated process that is regulated by numerous factors simultaneously and in a coordinated fashion.

Cyclooxygenase-2 (COX-2) is the enzyme that normally synthesizes prostaglandins during an inflammatory response.

The prognosis for patients with metastatic colorectal cancer is poor. Use of irinotecan (CPT-11, Camptosar) results in modest response rates of approximately 20% in refractory patients diagnosed with this advanced stage of disease and offers a side-effect profile that improves on that of previous standard treatments.

In the United States, hospice and palliative care are two distinct expressions of the hospice interdisciplinary team approach to end-of-life care, which originated in Great Britain in the 1960s. The hospice movement developed largely as a home-care program and alternative to conventional care.

The DNA topoisomerase inhibitor irinotecan (CPT-11, Camptosar) is being evaluated as a novel chemotherapeutic agent that may complement other agents and treatment modalities for small-cell lung cancer (SCLC). Combination chemotherapy is the most effective means of improving the survival of patients with extensive disease, but until recently, no combination demonstrated superior efficacy.

The introduction of highly active antiretroviral therapy (HAART) has had a dramatic impact on the morbidity and mortality of individuals living with human immunodeficiency virus (HIV). In addition to contributing to declines in the incidence of several opportunistic infections, HAART is affecting the incidences of several acquired immunodeficiency syndrome (AIDS)-defining malignancies.

The development of doxorubicin was an important advance in the treatment of patients with non-Hodgkin’s lymphoma (NHL). Alternatives to doxorubicin, such as mitoxantrone (Novantrone), have less nonhematologic toxicity and could offer a therapeutic advantage in some situations if similar antilymphoma activity exists. Several combination regimens that include mitoxantrone have been shown to be active.

Capecitabine (Xeloda) and irinotecan (CPT-11, Camptosar) both have demonstrated single-agent activity in patients with colorectal cancer.

The Genitope Corporation is sponsoring a phase III double-blind, randomized trial of recombinant idiotype immunotherapy in previously untreated patients with follicular lymphoma.