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ONCOLOGY Vol 29 No 4

With each passing year, chemotherapy is less and less a focus of interest. Instead, the focus is on the abundance of exciting new biologic and targeted agents that are bulldozing the therapeutic landscape in the lymphomas and chronic lymphocytic leukemia.

Chemotherapy-induced thrombocytopenia causes nearly two-thirds of cases of thrombocytopenia in the cancer setting. In patients receiving chemotherapy, thrombocytopenia leads to dose reductions in 15% of treatment cycles and chemotherapy delays in 6% of cycles.

Clinical trials of the new thrombopoietin receptor agonists in the management of chemotherapy-induced thrombocytopenia are needed to address concerns about the safety and practical efficacy new agents before we accept them as standard therapies.

This review will focus on the general approach to, and treatment of, thrombocytopenia in cancer patients, including thrombopoietin treatment in patients receiving non-myeloablative chemotherapy.

There is no evidence that PCV is more effective than TMZ for the treatment of glioblastoma. However, there is unequivocal evidence that PCV is more toxic than TMZ.

In most cases, PCV chemotherapy will provide an edge in outcomes over TMZ for glioma patients, primarily because of the former regimen’s use of multiple drugs and their complementary interactions.

Some targeted systemic therapies have demonstrated evidence of activity in the brain—specifically in melanoma, lung cancers, and breast cancers—and these agents warrant further study in clinical trials.

It is time to put aside the pessimism of the past when it comes to brain metastases and embrace the wide array of clinical investigational opportunities arising in this field.

Conventional methods for treating brain metastasis, such as surgery, WBRT, and SRS, each compete with and complement one another. A plethora of recent studies have helped define and expand the utility of these tools.

We may find that in the case of recurrence surveillance, doing less than we now do is better. Conversely, for persistent symptoms, adoption of lifestyle behaviors by survivors, and the meeting of family needs, doing more than we do now is better.

In this review, we discuss the established guidelines and current evidence regarding post-treatment surveillance, and we propose general management strategies in prostate, colorectal, and breast cancers.

The message seems to be emerging that for some diseases, clinical monitoring for relapse and recurrence has a strong evidence base, is safe, and is associated with lower costs.

 

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