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The aromatase inhibitors (AIs) anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) are significantly more effective than the selective estrogen-receptor modulator (SERM) tamoxifen in preventing recurrence in estrogen receptor-positive early breast cancer. Aromatase inhibitors are likely to replace SERMs as first-line adjuvant therapy for many patients. However, AIs are associated with significantly more osteoporotic fractures and greater bone mineral loss. As antiresorptive agents, oral and intravenous bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), pamidronate (Aredia), and zoledronic acid (Zometa) have efficacy in preventing postmenopausal osteoporosis, cancer treatment-related bone loss, or skeletal complications of metastatic disease. Clinical practice guidelines recommend baseline and annual follow-up bone density monitoring for all patients initiating AI therapy. Bisphosphonate therapy should be prescribed for patients with osteoporosis (T score < -2.5) and considered on an individual basis for those with osteopenia (T score < -1). Modifiable lifestyle behaviors including adequate calcium and vitamin D intake, weight-bearing exercise, and smoking cessation should be addressed. Adverse events associated with bisphosphonates include gastrointestinal toxicity, renal toxicity, and osteonecrosis of the jaw. These safety concerns should be balanced with the potential of bisphosphonates to minimize or prevent the debilitating effects of AI-associated bone loss in patients with early, hormone receptor-positive breast cancer.

Cases of osteonecrosis of the jaw (ONJ) have been reported with an increasing frequency over the past few years. ONJ is most often identified in patients with cancer who are receiving intravenous bisphosphonate therapy but it has also been diagnosed in patients receiving oral bisphosphonates for nonmalignant conditions. The condition involves exposed bone of the maxilla or mandible. Although it is often associated with a recent dental surgical procedure, spontaneous ONJ can also occur. Patients commonly present with symptoms. Through case reporting and clinical experience, there is a suggestion that the incidence of ONJ in patients with cancer receiving intravenous bisphosphonates ranges between 1% and 10%. Management of ONJ focuses on maximizing oral health, conservative actions with mouth rinses, antibiotics, and avoidance of unnecessary invasive dental procedures. The currently available data on ONJ are reviewed here.

As the aging population in the United States continues to grow, the incidence of diseases of the elderly, such as breast cancer, are increasing. Many more elderly women are expected to be diagnosed with new breast cancers, most of them in an early stage. Appropriate treatment of these women is important, as they have poorer outcomes when undertreated. In this review, we will discuss the biology and treatment of early breast cancer in elderly women. We will focus on the role of comorbidity and its effect on life expectancy, treatment decisions, current recommendations for primary treatment with surgery, radiation and neoadjuvant strategies, and adjuvant treatment including local radiation therapy and systemic treatment with endocrine therapy, chemotherapy, and newer agents. Finally we will discuss the importance of clinical trials in the elderly.

As the aging population in the United States continues to grow, the incidence of diseases of the elderly, such as breast cancer, are increasing. Many more elderly women are expected to be diagnosed with new breast cancers, most of them in an early stage. Appropriate treatment of these women is important, as they have poorer outcomes when undertreated. In this review, we will discuss the biology and treatment of early breast cancer in elderly women. We will focus on the role of comorbidity and its effect on life expectancy, treatment decisions, current recommendations for primary treatment with surgery, radiation and neoadjuvant strategies, and adjuvant treatment including local radiation therapy and systemic treatment with endocrine therapy, chemotherapy, and newer agents. Finally we will discuss the importance of clinical trials in the elderly.

As the aging population in the United States continues to grow, the incidence of diseases of the elderly, such as breast cancer, are increasing. Many more elderly women are expected to be diagnosed with new breast cancers, most of them in an early stage. Appropriate treatment of these women is important, as they have poorer outcomes when undertreated. In this review, we will discuss the biology and treatment of early breast cancer in elderly women. We will focus on the role of comorbidity and its effect on life expectancy, treatment decisions, current recommendations for primary treatment with surgery, radiation and neoadjuvant strategies, and adjuvant treatment including local radiation therapy and systemic treatment with endocrine therapy, chemotherapy, and newer agents. Finally we will discuss the importance of clinical trials in the elderly.

The aromatase inhibitors (AIs) anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) are significantly more effective than the selective estrogen-receptor modulator (SERM) tamoxifen in preventing recurrence in estrogen receptor-positive early breast cancer. Aromatase inhibitors are likely to replace SERMs as first-line adjuvant therapy for many patients. However, AIs are associated with significantly more osteoporotic fractures and greater bone mineral loss. As antiresorptive agents, oral and intravenous bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), pamidronate (Aredia), and zoledronic acid (Zometa) have efficacy in preventing postmenopausal osteoporosis, cancer treatment-related bone loss, or skeletal complications of metastatic disease. Clinical practice guidelines recommend baseline and annual follow-up bone density monitoring for all patients initiating AI therapy. Bisphosphonate therapy should be prescribed for patients with osteoporosis (T score < -2.5) and considered on an individual basis for those with osteopenia (T score < -1). Modifiable lifestyle behaviors including adequate calcium and vitamin D intake, weight-bearing exercise, and smoking cessation should be addressed. Adverse events associated with bisphosphonates include gastrointestinal toxicity, renal toxicity, and osteonecrosis of the jaw. These safety concerns should be balanced with the potential of bisphosphonates to minimize or prevent the debilitating effects of AI-associated bone loss in patients with early, hormone receptor-positive breast cancer.

Cases of osteonecrosis of the jaw (ONJ) have been reported with an increasing frequency over the past few years. ONJ is most often identified in patients with cancer who are receiving intravenous bisphosphonate therapy but it has also been diagnosed in patients receiving oral bisphosphonates for nonmalignant conditions. The condition involves exposed bone of the maxilla or mandible. Although it is often associated with a recent dental surgical procedure, spontaneous ONJ can also occur. Patients commonly present with symptoms. Through case reporting and clinical experience, there is a suggestion that the incidence of ONJ in patients with cancer receiving intravenous bisphosphonates ranges between 1% and 10%. Management of ONJ focuses on maximizing oral health, conservative actions with mouth rinses, antibiotics, and avoidance of unnecessary invasive dental procedures. The currently available data on ONJ are reviewed here.

Remote robotic nephrectomy performed over the public internet is an inexpensive form of tele-surgery that appears feasible, according to a proof-of-concept study presented at the 101st Annual Meeting of the American Urological Association (abstract 1075).

Current evidence suggests that colonoscopy screening can reduce mortality from colorectal cancer&#151;if these procedures are performed in a high-quality manner, David A. Lieberman, MD, said at the 2006 Gastrointestinal Cancers Symposium.

FDA Approves Priority Review of Merck's Zolinza (Vorinostat)

Montefiore Medical Center has opened a state-of-the-art Center for Radiation Therapy within walking distance of the Montefiore-Einstein Cancer Center. The new 15,000 square foot, two-story radiation therapy center is part of the burgeoning facilities located in the Morris Park campus, which services the approximately 1.25 million residents of the Bronx.

Phase III Trial of Enzastaurin for NHL Patients Initiated

Department of Health and Human Services Secretary Michael Leavitt has appointed John Niederhuber, MD, as the National Cancer Institute's acting director after Andrew C. von Eschenbach, MD, resigned the post he had held for 4.5 years.

Two phase III international randomized trials of sunitinib (Sutent) and of the investigational mTOR kinase inhibitor temsirolimus indicate targeted therapy may provide both clinical and survival benefits to patients with advanced renal cell carcinoma (RCC). Sunitinib is an oral multi-targeted receptor tyrosine kinase inhibitor of the VEGF and PDGF receptors.

This new department summarizes current congressional activity relevant to the delivery of cancer care. Two bills recently introduced in the House of Representatives are designed to improve the quality of care for cancer patients on the Medicare program.

Faced with increasing patient care needs for chemotherapy, a team of nurses and administrators at Roswell Park Cancer Institute (RPCI) performed a study to identify challenges to the current system and develop methods to improve patient flow.

"I am a cancer survivor," Lance Armstrong said at a plenary session of the 2006 American Society of Clinical Oncology annual meeting when he accepted the Society's Special Recognition Award. "Seven-time Tour de France winner will be the fine print on the tombstone," he said.

Prescreening patients before transfer from one cancer facility to another gives the receiving hospital an opportunity to prepare needed services for that patient, "thereby maximizing resources and providing quality care more efficiently," Kathy Rogala-Scherer, RN, Department of Case Management, Roswell Park Cancer Institute (RPCI), said at the 31st Annual Congress of the Oncology Nursing Society (abstract 35).

As part of the "Good Grief" support groups at the Ohio State University James Cancer Hospital, children coping with the illness or death of a loved one from cancer are the stars of their own movie posters, complete with the name of their fictional movie, story line, characters, and opening date (generally the child's birthday).

Preliminary results of studies employing hepatic transplantation with radiation therapy are encouraging. Although these new approaches hold promise, the prognosis in patients with biliary cancers remains poor, and the integration of novel therapeutic strategies is indicated.

The prognosis of patients with biliary cancers is poor. Although surgery is potentially curative in selected patients, local recurrence is a common pattern of failure. Adjuvant or neoadjuvant radiation therapy improves local control and possibly survival. In locally advanced patients, radiation therapy provides palliation and may prolong survival. Concurrently administered chemotherapy may further enhance these results. Newer radiation therapy techniques, including intraluminal transcatheter brachytherapy, intraoperative radiation therapy, intensity-modulated radiation therapy, and three- and four-dimensional treatment planning, permit radiation dose escalation without significant increases in normal tissue toxicity, thereby increasing the effective radiation dose. Preliminary results of studies employing hepatic transplantation with radiation therapy are encouraging. Although these new approaches hold promise, the prognosis in patients with biliary cancers remains poor, and the integration of novel therapeutic strategies is indicated.

The prognosis of patients with biliary cancers is poor. Although surgery is potentially curative in selected patients, local recurrence is a common pattern of failure. Adjuvant or neoadjuvant radiation therapy improves local control and possibly survival. In locally advanced patients, radiation therapy provides palliation and may prolong survival. Concurrently administered chemotherapy may further enhance these results. Newer radiation therapy techniques, including intraluminal transcatheter brachytherapy, intraoperative radiation therapy, intensity-modulated radiation therapy, and three- and four-dimensional treatment planning, permit radiation dose escalation without significant increases in normal tissue toxicity, thereby increasing the effective radiation dose. Preliminary results of studies employing hepatic transplantation with radiation therapy are encouraging. Although these new approaches hold promise, the prognosis in patients with biliary cancers remains poor, and the integration of novel therapeutic strategies is indicated.

Investigators affiliated with the Children's Oncology Group (COG) have launched a multicenter trial aimed at determining why the relapse and survival rates of children with acute lymphoblastic leukemia (ALL) differ among the major racial and ethnic groups living in the United States.

Thalidomide (Thalomid) has "changed the paradigm" for treating multiple myeloma, and advances in understanding the relationship between myeloma cells and the bone marrow microenvironment promise to change it even more, Kenneth C. Anderson, MD, of the Dana-Farber Cancer Institute, said at the National Comprehensive Cancer Network (NCCN) 11th Annual Conference.

After 2 years of steady failure with a potential cancer drug, Cliff, an oncology postdoc, suddenly achieves dramatic cures in mice, to the point that his findings are questioned as "too good to be true." Is it fraud or sloppy recordkeeping, or maybe a true breakthrough? The pleasure in reading Allegra Goodman's novel Intuition (The Dial Press, 2006) comes not so much from the plotline (the initial giddy celebration of the findings, and then the near destruction of the lab when fraud is alleged) as from the richness of the depiction of an oncology research lab and its motley inhabitants.

"Cancer increases the risk of venous thromboembolism (VTE) by four- to sevenfold, and is a precipitating factor in almost 20% of VTEs," Michael B. Streiff, MD, said at the 11th Annual Conference of the National Comprehensive Cancer Network (NCCN).

Cancer remains the second leading cause of death in the United States, but the disease's mortality rate declined by 2.9% in 2004, according to the Centers for Disease Control and Prevention (CDC). Total US cancer deaths in 2004 numbered 550,270. Preliminary mortality data put the age-adjusted death rate for malignant neoplasms at 184.6 per 100,000 population, down from 190.1 in 2003. The nation's overall death rate fell to a record low of 801 per 100,000 persons, down from 833 the previous year. The preliminary data are based on approximately 90% of the 2004 death records reported by the 50 states.

GPC Biotech AC is accruing patients with advanced solid tumors onto a phase I trial of satraplatin, its investigational oral platinum agent, in combination with capecitabine (Xeloda). The open label study of the oral/oral combination, led by William Gradishar, MD, of Northwestern University, is expected to enroll approximately 24 patients, the company indicated in a news release.

Nereus Pharmaceuticals, Inc. has initiated a phase I trial of its novel, small molecule proteasome inhibitor, NPI-0052, in patients with solid tumors and lymphomas. The trial will enroll approximately 50 patients at two sites, M.D. Anderson Cancer Center and Memorial Sloan-Kettering Cancer Center. NPI-0052 was discovered during the fermentation of Salinispora sp, a new class of Gram-positive marine bacteria, Nereus said in a press release.

Better, cheaper digital video equipment has brought sophisticated movie-making within the reach of the ordinary person. At the Oncology Nursing Society 31st Annual Congress (abstract 3), a team of oncology nurses led by Ellen Carroll, BSN, RN, demonstrated that this gear can be put to use in cancer patient education.