As further described in this and the subsequent two articles, this case-based series documents that clinical research advances are being quickly implemented in daily patient care and that although therapeutic strategies vary based on patient age, the short-term outcomes in terms of response to and tolerance of treatment are similar in younger and older patients.

The management of multiple myeloma has undergone rapid change with the recent emergence of several effective novel agents that have added complexity to individualized treatment decision-making.

This paper reviews recent practice patterns in the broad context of the published findings from major phase III randomized trials; it documents potential gaps between trial results and actual practice, and the implications of these for continuing education of oncologists.

Hematologists/oncologists and other physicians can expect to encounter an increasing number of patients with multiple myeloma in the coming years. Between 1997 and 2006, the incidence rate of myeloma declined in the United States, but the burden (the number of incident cases) increased.

Although prognostic factors in the context of relapsed and refractory disease require further characterization, high-risk patients include those with certain cytogenetic abnormalities, high β2-microglobulin, and low serum albumin.

No survival advantage of autologous stem cell transplantation (ASCT) has been documented for patients older than 65 years, and in the era of thalidomide (Thalomid), bortezomib (Velcade), and len­alidomide (Revlimid), ASCT has a diminished role in the front-line treatment of older patients with myeloma.

High-dose melphalan (Alkeran) and autologous stem cell transplantation are commonly incorporated into the initial line of therapy for patients newly diagnosed with multiple myeloma.

Two decades since the first demonstration that fluorouracil (5-FU)-based adjuvant chemotherapy improves outcomes in resected colon cancer, clinicians are still struggling with the question of which patients with stage II colon cancer should receive postoperative therapy.
• New Developments in the Adjuvant Therapy of Stage II Colon Cancer
• Risk Assessment in Stage II Colorectal Cancer
• How to Evaluate Risk and Identify Stage II Patients

The age-adjusted cancer death rates related to colorectal cancer have steadily declined over the past 2 decades. This improvement is a direct consequence of advances in prevention and treatment, including colorectal cancer screening, diagnostic tests, surgical technique, adjuvant therapies, and medical support.

Possibly the most difficult and confusing subject in colon cancer today is the decision-making involved in the treatment of stage II colon cancer. The pendulum has been swinging back and forth over the past several decades as to whether stage II colon cancer patients should receive postoperative adjuvant chemotherapy or not.

Colon cancer is estimated to have accounted for 106,100 new cancer cases and 49,920 cancer-related deaths in 2009. Over half of these new diagnoses and deaths occur in individuals age 70 and older.

In addition to the direct effects of primary tumors in bone, bone complications in cancer patients occur from metastasis to bone and through the effects of cancer-related treatments and conditions. Bone is a very common metastatic site for many cancers, including myeloma, melanoma, and breast, prostate, thyroid, lung, bladder, and kidney cancers.

Over 40 million men and women in the United States have osteoporosis and low bone mineral density (BMD), placing them at risk for adverse skeletal events such as fractures and their sequelae. There are over 12 million cancer survivors in this country.

Bone renewal is essential for bone strength. During childhood and early adulthood, bone formation prevails over bone resorption, as bones increase in size and strength. Peak bone mass is achieved during the third decade in life, with a higher peak bone mass being protective against osteoporosis later in life.

Despite the significant progress that has occurred in recent decades in the treatment of many advanced malignancies, skeletal morbidity remains a major problem for patients affected by cancers that metastasize to or grow primarily within bone.

More than 50% of patients with advanced breast or prostate cancer have identifiable bone metastasis, and 30% to 40% of patients with non–small-cell lung cancer ultimately develop metastases to bone. Most tumors preferentially metastasize to the axial skeleton, targeting the vertebrae, pelvis, proximal ends of long bones, and skull.

SUPPLEMENT
Infusion reactions are a well-known phenomenon in cancer treatment, occurring with both cytotoxic and biologic agents. The severity, symptomatology, and time course of these hypersensitivity events differ significantly among agents, ranging from simple cutaneous manifestations and urticaria to life-threatening hypotension, bronchospasm, and vascular collapse.

SUPPLEMENT
In recent years, both the cost and efficiency of medical care have emerged as important considerations and areas of research. These considerations are of particular importance in the outpatient community oncology setting, where the demands for clinical productivity and evidence for quality and effectiveness are increasing amidst an evolving reimbursement system.

Oncology clinicians administer monoclonal antibodies as part of the armamentarium against cancer. Nurses are skilled in the management of general treatment-related symptoms and are knowledgeable regarding the care of patients receiving these therapies. New therapies require expanded knowledge bases regarding unique and selective side effects, such as those seen with targeted therapy agents.

SUPPLEMENT
Infusion reactions can be broadly categorized by their immunologic mechanism. Anaphylaxis is a systemic, immediate hypersensitivity reaction mediated by factors released from interactions between immunoglobulin E and mast cells that produce an antigen-antibody reaction. Anaphylactoid reactions can be differentiated from anaphlaxis by the fact that they are not IgE-mediated but rather cytokine-mediated.

SUPPLEMENT
The use of engineered monoclonal antibodies as antineoplastic therapy has been a significant advance within the past 15 years. These agents target various receptors and ligands required for the proliferation, survival, or maintenance of angiogenesis of tumors.

SUPPLEMENT
The phenomenon of anaphylaxis was discovered by Portier and Richet in 1903. They injected dogs with toxins from sea anemone with the intent of generating protective antibodies. Unexpectedly, they found that certain dogs became ill with a rapid heartbeat and collapse. Because this syndrome was the precise opposite of protection or prophylaxis, they termed it anaphylaxis.