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Despite a decreasing incidence in the United States, small-cell lung cancer (SCLC) remains a major clinical problem, with approximately 30,000 new cases each year. The diagnosis of SCLC is usually not difficult. The Veterans Administration Lung Study Group (VALSG) staging system is less accurate than the American Joint Committee of Cancer tumor-node-metastasis (TNM) system (7th edition) at predicting survival in SCLC, especially in lower stage disease. Surgery has not played a major part in the management of SCLC, but emerging data suggest that resection may have a role in earlier stage disease. While the frontline treatment of SCLC has not changed significantly in the past decade, newer agents that are currently being investigated provide hope for better treatment of relapsed/refractory disease for the future.

Until recently, standard treatment of multiple myeloma (MM) in elderly patients who were not candidates for autologous stem cell transplantation was with the combination of melphalan plus prednisone (MP). Novel agents (thalidomide, lenalidomide, bortezomib) are dramatically changing frontline therapy of MM. Randomized studies have shown the superiority of adding one novel agent to MP, either thalidomide (MPT) or bortezomib (MPV). The combination of lenalidomide with low doses of dexamethasone is another attractive alternative. Recent results show that maintenance therapy with low-dose lenalidomide may prolong progression-free survival. The objective of these improved treatment regimens should be to achieve complete response, as in younger patients. However, toxicity is a significant concern, and doses of thalidomide and of myelotoxic agents should be reduced in patients who are older than 75 years or who have poor performance status. Weekly bortezomib appears to induce severe peripheral neuropathy less frequently than the same agent administered twice weekly. Autologous stem cell transplantation is feasible in selected fit patients over 65 years of age, and its results are improved by the addition of novel agents before and after high-dose therapy. However, considering the progress in non-intensive therapy, autologous transplantation should not currently be offered to elderly patients outside of a clinical trial.

The variety of treatment options available to patients of all ages who have multiple myeloma has improved considerably in the past decade. However, elderly patients have benefited more than patients of other ages. Because elderly patients, as a group, are usually not offered autologous stem cell transplant (ASCT) as a treatment option, they have been unable to benefit from the wide application of this technique, first introduced in the late 1980s. In the past 8 years, however, thalidomide, bortezomib, and very recently lenalidomide, when combined with conventional doses of alkylators and corticosteroids, have produced marked improvements in progression-free survival (PFS) and overall survival (OS) in elderly patients. Harousseau has thoroughly reviewed the important studies documenting these benefits for this population.

David S. Alberts, MD, director of Tucson’s Arizona Cancer Center, is honored by the Association of Community Cancer Centers. Learn more about the latest accolades and appointments in cancer care.

The United States is unique in the developed world in that the majority of Americans have private health insurance that they receive through the workplace.

Researchers find that patients lacking private health insurance or are poor or black fare worse than other cancer patients.

Second-Guessing FDA: CMS’ Expanding Regulatory Role

The U.S. Food and Drug Administration issued a final rule that clarifies what safety information must be reported during clinical trials of investigational drugs and biologics.

Medicare only covers 57% of the actual costs of delivering chemotherapy and provided related infusion room services to seniors with cancer: Watch this important video: Cancer Care is in Crisis: Stop The Cancer Care Cuts

The Oregon Health Plan was considered by many to be a masterpiece of health care delivery for the poor. It attracted international attention when its plan of explicit rationing of care promised to provide basic health care to virtually every Oregonian living in poverty. Did the plan live up to its promise?

The regulatory agency isn’t represented on the board of governors of the new Patient Centered Outcomes Research Institute.

The skin eruptions that plague most patients on EGFR inhibitor therapy and disrupt treatment in some may occur in two recognizable stages, which could have implications for both research and treatment.

It establishes a menu of preventive procedures, like colonoscopies, mammograms and immunizations that must be covered without co-payments.

E board review in Breast Cancer February 2008 Word from Editor

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