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NEW YORK--Some oncology social workers got a chance to talk about their problems with a psychiatrist at a Cancer Care seminar, and they not only got to ventilate, they got some good advice and some laughs. The psychiatrist was Samuel C. Klagsbrun, MD, executive medical director of Four Winds Hospital, Westchester County, New York, who has been called in to help entire medical school faculties and even hospitals when demoralization sets in.

SAN FRANCISCO--As AIDS has become a chronic disease, not necessarily a fatal one, HIV-infected patients are increasingly turning to family physicians and other primary care providers for medical care. And such providers are getting on-the-job experience in delivering a very complex therapy--antiretroviral drugs.

NIAGARA-ON-THE-LAKE, Ontario, Canada--Survivors of childhood cancer may not be completely aware of their disease, their treatments, and potential late effects of treatment, Cristina M. Checka said at a conference on long-term complications of childhood cancer, hosted by Roswell Park Cancer Institute.

SAN FRANCISCO--Establishing clinical care guidelines for hereditary (BRCA1 or BRCA2) breast cancer is increasingly important for managed care organizations as well as private physicians, Susan Kutner, MD, said at the American Cancer Society Second National Conference on Cancer Genetics.

SAN DIEGO--New data on rituximab (Rituxan), a chimeric anti-CD20 monoclonal antibody, show a projected median time to progression of 13 months among patients who responded to the drug (76 of 166 patients with relapsed or refractory indolent lymphoma). To date, nearly 70% of these patients (53) continue to respond to outpatient therapy with rituximab; only nine have died, all of progressive lymphoma.

The University of Minnesota Cancer Center has been designated a "comprehensive cancer center" by the National Cancer Institute. To quality for the title "comprehensive," a center must conduct basic and clinical research, as well as prevention,

WASHINGTON--Results of a new national survey underscore what cancer patients already know: The fatigue that commonly follows chemotherapy has a sweeping impact on patients’ physical and emotional health, as well as their economic well being.

PHILADELPHIA--The Radiation Therapy Oncology Group (RTOG) has just begun work on a potentially ground-breaking study of the use of radioactive seed implants (brachytherapy) for cancer that is confined to the prostate gland. The study will be the first multi-institutional evaluation of the treatment. To date, a number of single-institution studies have been conducted, showing the technique to be effective in controlling the disease.

BETHESDA, Md--"Patient satisfaction" is one measure used to assess the need for quality improvements in the hospital setting. However, since "satisfaction" is a personal evaluation by the patient of health services or providers, the parameters being measured may vary widely

Over the past several years, a number of biotechnology companies have developed enhanced screening methods designed to improve Pap smear accuracy. Until recently, however, these screening methods were used only as quality control devices, ie, as a way for laboratories to check their work. Since federal guidelines only require that 10% of all slides be rescreened, there is still an opportunity for error.

Given the clinical utility of myeloid growth factors and erythropoietin (Epogen, Procrit) in the management of many cancer patients, it is understandable that the cloning and introduction into clinical trials of thrombopoietin was greeted with great expectations for the future utilization of this molecule in oncology. Drs. Prow and Vadhan-Raj have written a well-referenced review that summarizes the preclinical biology of thrombopoietin and the evidence that it is the physiologic regulator of thrombopoiesis in animals and humans. The authors also synopsize some of the data from early clinical trials. My own interpretation of the clinical data obtained to date with both the full-length clone (recombinant human thrombopoietin [rhTPO]) and the pegylated, truncated molecule (pegylated recombinant human megakaryocyte growth and development factor [PEG-rHuMGDF]) differs somewhat from both our initial expectations and the perspective provided by the authors.

In the first of a two part series on cancer chemoprevention, Drs. Singh and Lippman provide a concise, yet complete overview of the principles of chemoprevention. They discuss issues most pertinent to the design and conduct of cancer chemoprevention trials: tolerance of drug toxicities among healthy and high-risk populations, study designs used to test chemopreventive agent toxicity and efficacy, and the mechanism of action of chemopreventive agents (eg, blocking and suppressing agents).

As comprehensively described by Drs. Prow and Vadhan-Raj, lineage-specific preparations of thrombopoietin are now in clinical development: pegylated recombinant human megakaryocyte growth and develop- ment factor (PEG-rHuMGDF) and recombinant human thrombopoietin (rhTPO). These preparations produce marked increases in megakaryocyte mass and platelet count after SC dosing.

The urge to control the manifestations of incurable chronic diseases, such as the anemia, renal failure, and bony disease of myeloma and the bone disease of breast cancer, is understandable. Successful control of these disease manifestations greatly improves a patient’s quality of life. This is especially important since patients with either of these malignancies may live with the disease for 20 years or more. Considerable success has been achieved in the correction of anemia with erythopoietin (Epogen, Procrit), and simple hydration has reversed renal failure and improved the survival of patients with myeloma.[1] Anyone who has witnessed the frightening spasms of back pain in myeloma patients, precipitated by a sneeze or an attempt to turn over in bed, understands the dreadful fear that patients have of uncontrolled bone pain.

After an almost 40-year search for a primary regulatory of platelet production, thrombopoietin has recently been purified and cloned. Thrombopoietin regulates all stages in the production of platelets by promoting both the

WASHINGTON--Vice President Al Gore called on Americans to demand that their senators and representatives provide increased funding for cancer research. "We want to be the generation that wins the war against cancer," he told thousands gathered here as part of "The March," a nationwide effort to make cancer the number one medical research and health care priority.

This is the beginning of an exceedingly exciting era for the study of the non-Hodgkin’s lymphomas. A new pathologic classification system has been developed to incorporate the biology that has been developed since the introduction of the Working Formulation more than 15 years ago. Large enough numbers of patients have been uniformly treated and followed so as to enable the development of new and accurate prognostic indices. These will allow us to adapt our treatment strategies to the patients' individual risk of failure. Finally after years of similar treatment strategies that have yielded at best marginal improvement, new therapeutic modalities are now available and offer the promise of improved survival and even lessened toxicity for our patients.

It was not until 1995 that a phase III randomized trial demonstrated that autologous stem cell transplants (ASCT) improve the progression-free and overall survival of patients with relapsed refractory diffuse aggressive non-Hodgkin’s lymphoma. Investigators are now focusing on improving the clinical benefit of transplants. The relative contributions made by more intensive preparative regimens, purging, concomitant immunotherapy, and the timing of transplants are under study. Also, as transplant trials shift from relapsed disease to initial therapy, anticipated benefits must be balanced against both short-term and long-term toxicities.[ONCOLOGY 12(Suppl 8):56-62, 1998]

Significant advances have been made in the application of monoclonal antibody-based therapies to the treatment of patients with lymphoma. The most promising areas appear to be the use of unconjugated monoclonal

Successful therapy for most of the non-Hodgkin’s lymphomas requires an accurate pathologic diagnosis. Routine morphologic examination of excisional biopsies from nodal or extranodal sites provides the cornerstone for establishing a definitive diagnosis. The list of ancillary studies, however, used to complement these routine approaches is increasing both in number and complexity. Proper use of these diagnostic tools can be of great help in arriving at the correct diagnosis in difficult cases. Fine-needle aspiration and needle-core biopsies have a role in lymphoma staging and in the assessment of recurrent disease, but are limited as primary diagnostic tests. This review will focus on the standard approaches used to establish a diagnosis of malignant lymphoma, and the clinical utility of immunophenotypic, molecular genetic, and cytogenetic studies in providing useful data for diagnosis. The standard practice of synthesizing all of the data from multiparameter analysis to arrive at a diagnosis in difficult cases will be emphasized. [ONCOLOGY 12(Suppl 8):11-16, 1998]

Progress in the treatment of indolent non-Hodgkin’s lymphoma has been slow and the disease remains incurable despite the relatively long median survival of patients. Decades of clinical trials resulted in standard

Intermediate-grade lymphomas are defined by the Working Formulation to include four histologic subgroups: follicular large-cell, diffuse small-cleaved-cell, diffuse mixed small- and large-cell, and diffuse large cell (Groups

High-grade non-Hodgkin’s lymphomas generally refer to immunoblastic lymphoma, lymphoblastic lymphoma, and small-noncleaved-cell lymphoma, three histological subtypes that were associated with the worst prognosis at the

The non-Hodgkin’s lymphomas are a biologically heterogeneous group of diseases with varying clinical presentations and outcomes. A number of studies have identified variables that carried independent prognostic significance. Although several staging systems had evolved that incorporated these prognostic variables, they were still unable to predict outcome. Ideally, the object of a staging system is to predict the likelihood of treatment response, time to progression or disease-free survival, and overall survival, and to provide a way to compare the outcome of similar groups of patients among various clinical trials. The need for such a system led to the creation of prognostic models such as the M. D. Anderson Tumor Score and, more recently, the International Prognostic Index. These prognostic models may identify those patients at highest risk for treatment failure, thereby identifying those patients who may require different therapeutic approaches. [ONCOLOGY 12(Suppl 8):17-24, 1998]

BETHESDA, Md--Nutrition scientists have a responsibility to translate their research into a message that "heads straight out the lab door and onto the breakfast table," said Jerianne Heimen-dinger, ScD, a research scientist at the AMC Cancer Research Center, Denver, Colorado.

In 1992, the FDA decided that silicone gel-filled breast implants would be available only through controlled clinical studies, despite the fact that they had been used for mammoplasty in millions of women around the world

WASHINGTON--The National Cancer Institute is getting more comfortable with the idea of seriously evaluating complementary and alternative medicine (CAM) approaches to treating cancer.

BETHESDA, Md--The National Cancer Institute (NCI) is seeking technology systems to revolutionize cancer detection, diagnosis, and treatment. Under a new $48 million, 5-year program dubbed the Unconventional Innovations Program, NCI is looking for new technologies "that will enable sensing of molecular alterations in the body in a way that is highly sensitive and specific, yet nonintrusive."

Scientists at the University of Pittsburgh have discovered how a novel form of vitamin K exerts its cancer-killing effects in primary liver cancers, which are notoriously resistant to chemotherapy. The research results, published in the May issue of the

BETHESDA, Md--The National Institute of Allergy and Infectious Diseases (NIAID) will collaborate with VaxGen, Inc. (South San Francisco), in research projects to expand the scientific range of the phase III trial of VaxGen’s AIDSVAX vaccine. The Institute will also provide the company with expertise in certain areas of immunology.