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Authors

Margaret Joyce, MSN, RN, AOCN, PhD
Latest Article

The Patient With Cancer-Related Dyspnea

The patient, "JD," is a 62-year-old Caucasian female who had stage IV non–small cell lung cancer (NSCLC) diagnosed 3 months ago. Her medical history is significant for chronic obstructive pulmonary disease (COPD). She quit smoking cigarettes more than 6 months ago after having smoked a pack per day for 40 years.

Margaret K. Callahan, MD, PhD
Latest Article

Improving the Therapeutic Benefits of Ipilimumab

Currently there are only three FDA-approved drugs available for the treatment of metastatic melanoma: dacarbazine, interleukin-2, and the lesser-used hydroxyurea. None of these drugs has been shown to improve overall survival (OS). The review by Thumar and Kluger provides a well-balanced overview of ipilimumab, the first agent to demonstrate a survival benefit in patients with metastatic melanoma.[1] The response to ipilimumab is most notable for its durability, a feature rarely observed in patients with high tumor burden or in response to other systemic therapies. However, a minority of patients (10% to 15%) treated with ipilimumab meet standard criteria for radiographic response. In this commentary, we focus on the question of how we can build on the success of ipilimumab. We briefly review one area of active investigation: the combination of ipilimumab with targeted inhibitors of BRAF.

Margaret K. Ma, PharmD
Latest Article

Phase II Study of Docetaxel and Irinotecan in Metastatic or Recurrent Esophageal Cancer: A Preliminary Report

The outcomes for patients with metastatic or recurrent esophagealcancer are dismal, with 1-year survival rates of approximately 20%. Inthis phase II study, we studied the combination of docetaxel (Taxotere)and irinotecan (CPT-11, Camptosar) in patients with metastatic orrecurrent esophageal cancer. Eligible patients included those withhistologic or cytologic diagnosis of adenocarcinoma or squamouscancer of the esophagus or gastroesophageal junction who had receivedno previous chemotherapy for metastatic esophageal cancer. Previouschemotherapy in the neoadjuvant or adjuvant setting was allowed.Patients received irinotecan at 160 mg/m2 over 90 minutes followed bydocetaxel at 60 mg/m2 intravenously over 1 hour, with chemotherapycycles repeated every 21 days. Patients were reevaluated every twocycles. Of a planned 40 patients, 15 were enrolled, with 14 patientsevaluable for toxicity and 10 evaluable for response and survival. Thecombination of docetaxel and irinotecan resulted in a response rate of30%. An additional 40% achieved stable disease. The median survivalwas 130 days, with three patients still alive at the time of this analysis.The toxicities included 71% incidence of grade 4 hematologic toxicities,with 43% febrile neutropenia. One patient died of cecal perforationafter one cycle. There was no evidence of pharmacokinetic interaction,as systemic clearance of both drugs was similar to that seen after singleagentadministration. In conclusion, the regimen of docetaxel andirinotecan is active in metastatic or recurrent esophageal cancer.However, this combination chemotherapy regimen has an unacceptablerate of febrile neutropenia. This regimen needs to be modified toreduce the incidence of febrile neutropenia.

Margaret M. Mcgrath, MS
Latest Article

Economic Savings and Costs of Periodic Mammographic Screening in the Workplace

his article discusses the costs and benefits of mammographic screening in the workplace. The cost of mammography itself and of diagnostic work-up are two of the largest costs involved.

Margaret M. Reilly, RN, BSN, MSN, APRN, BC
Latest Article

Case Study: Osteonecrosis of the Jaw

The patient, RJ, a 61-year-old female, was diagnosed with stage IIIA, hormone-positive, HER2-negative infiltrating ductal breast cancer 4 years ago. Following a lumpectomy and axillary node dissection, she was treated with systemic chemotherapy, radiation therapy, and hormonal therapy with an aromatase inhibitor. At her 3-year follow-up visit, she complained of a persistent cough, dyspnea, and vague bone pain in her lower back and hips. Staging diagnostic exams revealed several pulmonary nodules and multiple bone metastases, primarily in the bilateral hips, left ribs, and left femur.

Margaret Mushinski
Latest Article

Average Charges for a Radical Prostatectomy and a Transurethral Resection of the Prostate (TURP): Geographic Variations, 1994*

More American men are living longer. An estimated 13,850,000 were over age 65 as of July 1, 1996 [1]. This total represents a 1.01% increase over that in 1995, a 10.3% increase over the 1990 total and more than a 34% increase over the

Margaret Piper, PhD
Latest Article

Systematic Review of Controlled Trials on Erythropoietin to Support Evidence-Based Guidelines

To support evidence-based clinical guidelines on erythropoietin use for anemia in oncology, we conducted systematic reviews of controlled trials on four patient groups. These were patients with treatment-related anemia; patients with disease-related anemia; patients transplanted with allogeneic hematopoietic stem cells; and those transplanted with autologous hematopoietic stem cells.

Margaret R. O'Donnell, MD
Latest Article

Acute Leukemias

This management guide covers the risk factors, screening, diagnosis, staging, and treatment of acute leukemias.

Margaret T. Kasner, MD
Latest Article

Treatment of Adult ALL: More Questions Than Answers

It is clear that the management of adult patients with ALL is an area in which little progress has been made in the last 30 years. Given the disappointing outcomes, the field is one that lends itself to the study of the incorporation of novel agents, including monoclonal antibodies and tyrosine kinase and proteasome inhibitors, as well as to further study of allogeneic transplant.

Margaret Tempero, MD
Latest Article

Outline of Oncology Therapeutics

Outline of Oncology Therapeutics is a well-written, concise, and up-to-date book providing detailed descriptions of a variety of medications and issues important to the overall care and treatment of patients with cancer. Oncology practice today

Margaret Von Mehren, MD
Latest Article

Honing in on Subtypes to Guide More Individualized Treatment of Soft Tissue Sarcoma

Dr. von Mehren discusses current considerations and challenges in the management of patients with soft tissue sarcoma, as well as recent clinical trial data.

Margarita Fernández, MD
Latest Article

Biweekly Gemcitabine, Doxorubicin, and Paclitaxel as First-Line Treatment in Metastatic Breast Cancer

In a single-center, open, phase II trial, we assessed the toxicity and activity of a triple combination therapy-doxorubicin at 30 mg/m2 (day 1), paclitaxel (Taxol) at 135 mg/m2 (day 2), and gemcitabine (Gemzar) at 2,500 mg/m2

Margo Nash
Latest Article

Pilots for AirLifeLine Donate Flights to Patients in Need

It used to take Mike Natishak, Sr., his wife Mary Alice, and their 9-year-old son Mike Jr., 6 hours to make the weekly drive from their home in Apalachin, NY, to Boston Children's Hospital. They had to stay over at a hotel to be at the hospital the next morning. So in addition to travel expenses, the Natishaks each lost 2 days of work.

Margot J. Fromer
Latest Article

Patients look for answers on Web but trust it less

Glut of e-health information has put public in a ‘data smog.’

Maria A. Rodriguez, MD
Latest Article

Irinotecan in Relapsed or Refractory Non-Hodgkin’s Lymphomas

Because irinotecan (CPT-11, Camptosar) is a topoisomerase I inhibitor with a broad spectrum of antitumor clinical activity, we investigated its activity in relapsed or refractory non-Hodgkin’s lymphomas (NHLs). Irinotecan at 300 mg/m² IV was administered every 21 days with intensive loperamide management of diarrhea.

Maria Andrea Cuevas, MD
Latest Article

Uracil/Tegafur Plus Oral Calcium Folinate in Advanced Breast Cancer

Uracil and tegafur (in a molar ratio of 4:1 [UFT]) has proven activity against breast cancer and is delivered in an easy-to-administer oral formulation. Orzel, which combines UFT with the oral biomodulator, calcium folinate, may

Maria Antonietta Gambacorta, MD
Latest Article

One for All or One for One?

The authors review the main evidence from the literature on neoadjuvant approaches in locally advanced rectal cancer, starting with the use of radiotherapy only in the pre–total mesorectal excision (TME) era, through fluorouracil (5-FU)–based chemoradiation in the TME era, to the most modern administration of “targeted therapy” in association with radiotherapy and traditional chemotherapy.

Maria Cristina Figueroa-magalhães, MD
Latest Article

Bone-Modifying Agents as Adjuvant Therapy for Early-Stage Breast Cancer

In this review we describe the current evidence for use of bisphosphonates as part of the adjuvant treatment of patients with early-stage breast cancer.

Maria Diaz-puente, MD
Latest Article

Cisplatin/Paclitaxel vs Cisplatin/Teniposide for Advanced Non-Small-Cell Lung Cancer

A total of 332 patients with advanced non-small-cell lung cancer were randomized by the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative

Maria E. Suarez-Almazor, MD, PhD
Latest Article

Management Considerations in Cancer Patients With Rheumatoid Arthritis

Patients with cancer and concomitant rheumatoid arthritis pose special challenges. Many therapies for rheumatoid arthritis can increase the risk of adverse events during cancer therapy because they are immunosuppressive.

María Elena Martínez, PhD
Latest Article

Chemoprevention of Colorectal Cancer: Dietary and Pharmacologic Approaches

Remarkable progress has been made in recent years in our understanding of colorectal cancer etiology. The various hypotheses of causality continue to be tested in human observational and intervention studies, as well as experimental models. Drs. Garay and Engstrom provide a comprehensive review of the dietary and chemopreventive factors for colorectal cancer. While their conclusions are noteworthy, those related to dietary factors are debatable.

Maria Ignez Braghiroli, MD
Latest Article

Is Surgery Always Necessary in Rectal Cancer?

In this article, we review risks and benefits of the standard treatment approach for rectal cancer and compare standard treatment with alternative methods aimed at rectal preservation.

Maria Jacobs, MD
Latest Article

Advances in the Treatment of Gynecologic Malignancies

Historically, two-thirds of patients with endometrial carcinoma had disease confined to the uterus, and the cornerstone of treatment was total abdominal hysterectomy and bilateral salpingo-oophorectomy. Since the introduction of surgical staging in 1988, however, more patients are found to have disease outside the uterine cavity. Unfortunately, the current rules for staging are not followed by every practitioner, and the required specimens for pathologic examination are not always obtained. Therefore, recommendations for postoperative adjuvant therapy are usually based on the surgico-pathologic information available for each patient.

Maria Jose Echarri Gonzalez, MD
Latest Article

Intraperitoneal Drug Delivery for Ovarian Cancer: Why, How, Who, What, and When?

Epithelial ovarian cancer (EOC) spreads prominently within the peritoneal cavity. In fact, we now know that high-grade serous cancers are often of tubal origin, and their presentation as tubo-ovarian masses renders it likely that intraperitoneal spread occurs as an early event in their clinical evolution.

Maria Jose Fernandez-Nestosa, PhD
Latest Article

The Variegated Morphology of HPV-Related Neoplasms of the Penis

Our commentary aims to expand on the evolution and present state of the art in the pathology of HPV in penile cancer and precancerous lesions.

Maria Laura Avantaggiati, MD
Latest Article

Cancer Metabolism as a Therapeutic Target: Finding the Right Target(s) in the Context of Tumor Heterogeneity, Evolution, and Metabolic Plasticity

Since Otto Warburg first formulated his theory on the importance of metabolism in cancer, our knowledge of this process and of its complexity has expanded, as has our ability to target many metabolic pathways that are undoubtedly necessary for cancer proliferation.

Maria Lomas, MD
Latest Article

The UFT/Leucovorin/Etoposide Regimen for the Treatment of Advanced Gastric Cancer

Gastric cancer is the most chemosensitive adenocarcinoma among digestive neoplasms. A few years ago, we performed a phase II trial with the FLEP regimen, in which fluorouracil (5-FU) and leucovorin are combined

Maria Q. Baggstrom, MD
Latest Article

The Role of Surgery in Stage III Non-Small-Cell Lung Cancer

In this edition of Clinical Quandaries, Ramalingam et al present a 67-year-old man who seeks care for a new, asymptomatic left upper lobe lung mass, which was found incidentally on a routine chest x-ray as part of a preoperative work-up for an elective surgery. Further staging studies included a computed tomography (CT) scan of the chest and a positron-emission tomography (PET) scan followed by a magnetic resonance imaging (MRI) scan of the liver. Pathology from a fine-needle aspiration biopsy of the left lingular lesion was consistent with poorly differentiated adenocarcinoma and immunohistochemical stains consistent with a lung primary. The left lingular lesion and the prevascular lymph node were felt to be the only sites of involvement, making this stage IIIA (T1, N2, M0) lung cancer.

Maria Sandoval, MS
Latest Article

Cancer Stem Cells

Treatments that target cancer stem cells have been proposed as alternatives to current cancer therapies. However, the clonal evolution model suggests that multiple tumor cell populations may need to be targeted for these treatments to be successful.

María T. Bourlon, MD, MSc, FASCO
Latest Article

Hereditary Renal Tumor Syndromes and the Use of mTOR Inhibitors

A 47-year-old woman with a history of drug-resistant epilepsy during childhood presented to the emergency department with sudden dyspnea and chest pain. Upon admission, her oxygen saturation was 88%.

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