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ONCOLOGY Vol 29 No 1

As a variety of new hormonal agents are increasing survival times for men with metastatic disease, it is becoming increasingly important to consider cardiovascular, renal, and other potentially more serious risks associated with long-term ADT, especially in an aging population.

The problem with large sets of data is the risk of the “GIGO” principle—viz. garbage in, garbage out—and it requires a very careful and thoughtful investigator to rule out the many errors of large-scale data capture.

The unfortunate fact remains that the main chemotherapy option for patients with adult soft-tissue sarcoma is doxorubicin, a drug first identified 4 decades ago.

This article reviews recent evidence suggesting an increased risk of pneumonia, cardiovascular disease, and acute kidney injury in men treated with ADT and consider whether the incidence of such events differs with the treatment modality.

While the future is bright for the development and investigation of novel chemotherapeutics for treatment of soft-tissue sarcoma, investigators will need to gain better insight into the molecular drivers of pathogenesis, and give continued thoughtful consideration to clinical trial design.

In patients with high-risk localized disease, the use of systemic chemotherapy should be strongly considered to delay recurrence and/or reduce the patient’s risk of developing metastatic disease. In patients with metastatic disease, systemic chemotherapy remains the mainstay of treatment.

There are still questions to be answered about the use of osteoclast inhibitors in the care of patients with breast cancer. The optimal duration and dosing schedule and how to improve treatment compliance are important issues to address.

We know that bisphosphonates prevent or delay skeletal-related events in breast cancer metastatic to bone, prevent or treat bone loss in patients receiving adjuvant aromatase inhibitor therapy, and decrease bone recurrences and breast cancer–related deaths when used in the adjuvant setting in postmenopausal women with early-stage breast cancer.

Bisphosphonates have played an important role in the treatment of breast cancer, mainly in patients with bone metastasis, by reducing the risk of fracture, spinal cord compression, and hypercalcemia.

Bisphosphonates or the monoclonal antibody denosumab, have the potential to profoundly affect the entire metastatic process, not just the growth of bone metastases.

A delirious head and neck cancer patient does not have the capacity to make treatment decisions. Can we begin palliative radiation therapy without his consent?

 

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