In writing and editing the first edition of Cancer Management: A Multidisciplinary Approach, published in 1996, three consistent goals guided our editorial policies. These goals continue to direct this 13th edition:
• To provide practical information for physicians who manage cancer patients;
• To present this information concisely, uniformly, and logically; and
• To emphasize a collaborative multidisciplinary approach to patient management that involves surgical, radiation, and medical-hematologic oncologists, as well as other health care professionals, working as a cohesive team.
Chapters in the current volume have been authored jointly by practicing medical-hematologic, surgical, and radiation oncologists. In some cases, other specialists have been asked to contribute their expertise to a particular chapter. The 40 chapters and four appendices in the Handbook represent the efforts of more than 100 contributors from approximately 50 cancer treatment centers. All of our contributors personally manage patients using a multidisciplinary approach in their respective institutions. These chapters reflect the recommendations of practitioners cognizant that decisions and recommendations regarding therapies must be founded on evidence-based research directed at practical patient care in a cost-effective manner.
Over the 15-year period since the first edition was published, important advances have occurred in our understanding of cancer and the treatment of patients with malignant diseases. Quality cancer care is dependent on this integrated approach involving the medical and hematologic, surgical, and radiation oncologists, along with numerous other health professionals. The 13th edition of Cancer Management: A Multidisciplinary Approach reflects the ongoing commitment of the authors, editors, and publisher to disseminate to oncologists and the cancer care community the most current information on the multidisciplinary management of patients with cancer.
In this latest edition the editors and contributors make every effort to bring you the newest clinical data relevant to the day-to-day care of patients with cancer. To present this information in the most concise and practical manner possible, we focus solely on the clinical management of disease. The more than 10,000 clinicians and cancer specialists who receive this publication annually have helped us craft the current edition. Many of these clinicians told us that they use this publication daily as a practical resource for clinical information where and when they need it most: in the clinic and with the patient. Therefore, we have updated the staging systems tables in all tumor types, with major changes in a few.
Recent scientific advances in the field of molecular oncology have led to the identification of large numbers of potential targets for novel anticancer therapies. “Personalized medicine” is frequently included in the discussion of breast, sarcoma, lung, and colorectal cancers. This has resulted in an expansion of the drug development pipeline, and the number and diversity of clinically useful novel anticancer therapeutic agents is growing at an unprecedented rate. The 13th edition of Cancer Management: A Multidisciplinary Approach focuses on the agents currently available and includes information that is emerging at peer-reviewed meetings. Other advances include the advent of high-quality invasive diagnostic approaches guided by radiologic imaging modalities; combination therapy with both chemotherapy and molecularly targeted drugs, and the use of charged particles, most commonly, protons; and better tumor targeting using intensity modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT). Finally, the use of combinations of chemotherapy/radiation and surgery to limit functional losses has become a guiding principle. All of these advances have contributed to improvements in the multidisciplinary approach to cancer management detailed further within the 13th edition of the Handbook.
The substantial changes that were made in previous editions to the chapters on breast cancer, non–small-cell lung cancer, colon, rectal, and anal cancers, cervical cancer, and melanoma were well received by our readers. The 13th edition of Cancer Management: A Multidisciplinary Approach has major additions to the chapters dealing with non-Hodgkin lymphoma; soft-tissue sarcomas; and cancers of the prostate, ovary, uterine cervix, rectum, colon, and brain. All chapters have been updated to reflect the latest information about cancer treatment, and the most current data on novel therapies and clinical trials. Changes to TNM staging systems have been noted in this Handbook. Readers are referred to the AJCC Cancer Staging Manual, 7th edition (Edge SB et al, eds, Springer, New York, 2010) for a comprehensive review of updates or changes to TNM staging systems. Watch also for updates to individual chapters online at www.cancernetwork.com/cancer-management.
Important new drugs and new indications have emerged and changed our treatment paradigms. New therapies for prostate cancer, including cabazitaxel (Jevtana) and the first-approved autologous cellular immunotherapy (sipuleucel-T [Provenge]) have been introduced into clinical practice. New therapies for hematological malignancies, including romidepsin (Istodax) for the treatment of cutaneous T-cell lymphoma and ofatumumab (Arzerra) for the treatment of patients with refractory chronic lymphocytic leukemia (CLL), have been approved.
Drugs that have been previously used in the treatment of hematological malignancies have been investigated for new indications and have received acceptance in our treatment plans. This includes an expanded indication for nilotinib(Drug information on nilotinib) (Tasigna) for the treatment of adult patients with newly diagnosed chronic myeloid leukemia in chronic phase and the expanded use of rituximab ([Rituxan] in combination with fludarabine and cyclophosphamide(Drug information on cyclophosphamide)) for the treatment of CLL. Women with breast cancer whose tumors are hormone receptor–positive with HER2 overexpression now have the option of being treated with lapatinib (Tykerb) in combination with letrozole(Drug information on letrozole) (Femara). Selected patients with non–small-cell lung cancer now have treatment options for “maintenance therapy” with erlotinib (Tarceva) or pemetrexed(Drug information on pemetrexed) (Alimta).
In addition to discussions of many of these new anticancer agents, new indications for existing drugs, and new standards of care for a variety of malignancies, appendix 3 of the 13th edition of the Handbook provides a snapshot of selected cancer drugs newly approved or newly labeled by the US Food and Drug Administration, from October 2009 through September 2010. We hope you find this year’s edition of Cancer Management: A Multidisciplinary Approach valuable in your daily practice.
To write, edit, and publish this 1,000+-page 13th edition of Cancer Management: A Multidisciplinary Approach requires the dedication of all of the authors, as well as a professional publication staff to coordinate the technical aspects of editing and publishing. We acknowledge the following individuals at UBM Medica: Angela Cibuls, project manager; Susan Reckling, Marie-Louise Best, and Anne Landry, editors; Ian Ingram, Editorial Assistant; Nancy Bitteker, Creative Director; and Rachel Warren, Editorial Director.
15 Years of Advances in Cancer Management, 1996–2010a
1996
FDA approves:
• Topotecan (Hycamtin), for the treatment of metastatic ovarian cancer, becoming the first of a class of drugs that interferes with the enzyme topoisomerase I. Topotecan(Drug information on topotecan) is derived from the bark of a Chinese tree known as Camptotheca acuminata.
• Irinotecan(Drug information on irinotecan) (Camptosar), another topoisomerase inhibitor, for the treatment of metastatic colorectal cancer.
1997
It is recommended by the National Cancer Advisory Board that NCI advise all women age 40 years and older to receive screening mammograms every 1 to 2 years.
Cancer stem cells are first identified in acute myelogenous leukemia.
FDA approves:
• Rituximab (Rituxan) to treat non-Hodgkin lymphoma (NHL), becoming the first biotechnology product approved by the FDA to treat patients with cancer.
1998
Tamoxifen can reduce the incidence of breast cancer by 50% in women who are at increased risk of the disease, according to data from the Breast Cancer Prevention Trial. Tamoxifen(Drug information on tamoxifen) is subsequently approved by the FDA for the prevention of breast cancer.
FDA approves:
• Trastuzumab(Drug information on trastuzumab) (Herceptin), for the treatment of metastatic breast cancer.
1999
FDA approves:
• Hybrid Capture II human papillomavirus (HPV), a DNA test that can be used in conjunction with the Pap smear in screening for cervical cancer.
2000
The most common form of NHL, diffuse large B-cell lymphoma (DLBCL), is identified as two distinct diseases, germinal center B-like DLBCL and activated B-like DLBCL. In the pre-rituximab (Rituxan) era patients with germinal center B-like DLBCL had significantly improved overall survival; this prognostic difference between these two groups is less apparent now.
2001
Imatinib mesylate (Gleevec) is shown to be effective against chronic myelogenous leukemia (CML), becoming the first anticancer drug developed specifically to target the molecular defect that causes a particular type of cancer.
FDA approves:
• Letrozole (Femara), for first-line treatment of advanced breast cancer in postmenopausal women with estrogen-dependent tumors.
2002
The National Lung Screening Trial (NLST) is launched by the NCI to determine whether spiral computed tomography is better than single-view chest x-ray in reducing deaths among current and former heavy smokers. Second-hand smoke is classified as carcinogenic to humans by the International Agency for Research on Cancer.
FDA approves:
• Zoledronic acid(Drug information on zoledronic acid) (Zometa) for multiple myeloma and bone metastases from solid tumors.
2003
Daily use of aspirin(Drug information on aspirin) for as little as 3 years reduces the development of colorectal polyps by 19% to 35% in individuals at high risk for colorectal cancer.
Men taking finasteride(Drug information on finasteride) (Proscar) had 25% fewer diagnoses of prostate cancer than men taking a placebo, indicating that prostate cancer can be prevented, according to results from the Prostate Cancer Prevention Trial (PCPT).
Postmenopausal women diagnosed with early-stage breast cancer who took the aromatase inhibitor letrozole after completing an initial 5 years of adjuvant tamoxifen had a significantly reduced risk of cancer recurrence compared with women taking a placebo, according to results from an NCI- supported international clinical trial.
FDA approves:
• Bortezomib(Drug information on bortezomib) (Velcade), for the treatment of multiple myeloma.
2004
Women who take estrogen in combination with the hormone progestin have a greater risk of developing breast cancer than women who take estrogen alone, according to data from the Women’s Health Initiative (WHI) study.
FDA approves:
• Letrozole for the adjuvant treatment of early-stage breast cancer after 5 years of tamoxifen therapy.
• Palifermin (Kepivance), to decrease the incidence and duration of severe oral mucositis in patients with hematologic malignancies who receive high doses of chemotherapy and radiation therapy followed by stem cell rescue.
• Three drugs for metastatic colorectal cancer: bevacizumab(Drug information on bevacizumab) (Avastin), cetuximab(Drug information on cetuximab) (Erbitux), and oxaliplatin(Drug information on oxaliplatin) (Eloxatin).
2005
The addition of trastuzumab (Herceptin) to chemotherapy in women with early-stage HER2-positive invasive breast cancer significantly decreases the risk of cancer recurrence compared with chemotherapy alone, according to data reported in two large NCI-sponsored randomized clinical trials.
FDA approves:
• A nanoparticle formulation of paclitaxel(Drug information on paclitaxel) (Abraxane) for use in women with metastatic or recurrent breast cancer.
2006
Raloxifene (Evista) is reported to reduce the incidence of invasive breast cancer by approximately 50% and is less likely to cause some potentially dangerous side effects found with tamoxifen, according to initital results from the STAR Trial.
FDA approves:
• Gardasil vaccine, for protection against persistent infection by two types of HPV that cause approximately 70% of cervical cancers worldwide.
• Trastuzumab (Herceptin), for use with other drugs in the adjuvant treatment of women with early-stage, node-positive, HER2-overexpressing breast cancer.
2007
The addition of arsenic trioxide(Drug information on arsenic trioxide) following standard chemotherapy resulted in longer disease remissions and better overall survival than standard chemotherapy alone in patients with previously untreated acute promyelocytic leukemia, according to data from a large phase III trial.
FDA approves:
• Three drugs for metastatic renal cell carcinoma, including sunitinib (Sutent), sorafenib(Drug information on sorafenib) (Nexavar), and temsirolimus (Torisel).
2008
Virtual colonoscopy is reported to be similar to conventional, optical colon-oscopy in detecting intermediate-size and large colorectal polyps, suggesting that the procedure could serve as an initial screening exam for colorectal cancer.
2009
Results of a preliminary phase II study show a PARP inhibitor (poly ADP ribose polymerase), BSI-201, to have unprecedented effects on inducing tumor responses, delaying time to progression, and improving survival in women with advanced triple-negative breast cancer.
An antibody-based immunotherapy (chimeric anti-GD2 antibody ch.14.18) is reported to reduce the risk of relapse and improved overall survival among children with high-risk neuroblastoma.
Early use of ginger supplements, in combination with traditional antinausea drugs, significantly reduces chemotherapy-related nausea in patients with cancer.
A new gene signature assay predicts risk of recurrence among patients with stage II colon cancer.
EGFR status predicts response to first-line gefitinib(Drug information on gefitinib) (Iressa) for lung cancer.
FDA approves:
• Bevacizumab (Avastin), for renal cell carcinoma and glioblastoma.
• HPV vaccine (Cervarix), a new vaccine to prevent cervical cancer and precancerous lesions caused by HPV types 16 and 18.
• Pemetrexed (Alimta) for maintenance treatment of locally advanced or metastatic nonsquamous non–small-cell lung cancer (NSCLC) patients.
• Pazopanib (Votrient), for the treatment of patients with advanced renal cell carcinoma.
2009 / 2010
FDA approvesb:
• Ofatumumab (Arzerra, also known as HuMax-CD20) for the treatment of patients with chronic lymphocytic leukemia (CLL) whose disease does not respond to treatment with fludarabine (Fludara) and alemtuzumab(Drug information on alemtuzumab) (Campath).
• Lapatinib (Tykerb) in combination with letrozole (Femara) for women with HER2-postive, ER-positive metastatic breast cancer.
• Erlotinib (Tarceva) for first-line maintenance treatment of locally advanced or metastatic NSCLC in patients whose disease has not progressed after 4 cycles of platinum-based therapy.
• Sipuleucel-T (Provenge), a dendritic cell–based vaccine for the treatment of asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone-refractory) prostate cancer.
• Cabazitaxel (Jevtana), in combination with prednisone(Drug information on prednisone), for treatment of men with advanced, hormone-refractory prostate cancer that has worsened during or after treatment with docetaxel(Drug information on docetaxel) (Taxotere).
a Adapted from the National Cancer Institute, 100 Years of Advances Against Cancer. For the full report, visit http://www.cancer.gov/aboutnci/100-years-advances
b See Appendix 3 for a comprehensive list of new drugs approved by the FDA from October 2009 through September 2010.
