Robert B. Livingston, MD

Scheithauer and Blum have madean important contribution to thediscussion of hand-foot syndrome,an increasingly common disorder.They emphasize the occurrenceof hand-foot syndrome in the contextof therapy with capecitabine (Xeloda),a prodrug for fluorouracil (5-FU)that in many ways mimics the continuousinfusion of that compound. Theauthors point out that the only provenmethod for managing hand-foot syndromeis interruption and/or reductionin the dose of the administeredtreatment, and they cite retrospectivedata from completed trials in colorectalcancer to support the hypothesisthat such a policy does not impair treatmentefficacy. We feel that severalpoints deserve further amplification.

Paclitaxel-induced myalgias and arthralgias occur in a significantfraction of patients receiving therapy with this taxane, potentiallyimpairing physical function and quality of life. Paclitaxel-inducedmyalgias and arthralgias are related to individual doses; associationswith the cumulative dose and infusion duration are less clear. Identificationof risk factors for myalgias and arthralgias could distinguisha group of patients at greater risk, leading to minimization of myalgiasand arthralgias through the use of preventive therapies. Optimalpharmacologic treatment and possibilities for the prevention of myalgiasand arthralgias associated with paclitaxel are unclear, partially dueto the small number of patients treated with any one medication. Theeffectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) is themost frequently documented pharmacologic intervention, although noclear choice exists for patients who fail to respond to NSAIDs. However,the increasing use of weekly paclitaxel could necessitate daily administrationof NSAIDs for myalgias and arthralgias and leave patients at riskfor adverse effects. This concern may also limit the use of corticosteroidsfor the prevention and treatment of paclitaxel-induced myalgias andarthralgias. Data from case reports suggest that gabapentin (Neurontin),glutamine, and, potentially, antihistamines (eg, fexofenadine [Allegra])could be used to treat and/or prevent myalgias and arthralgias. Giventhe safety profile of these medications, considerable enthusiasm existsfor evaluating their effectiveness in the prevention and treatment ofpaclitaxel myalgias and arthralgias, particularly in the setting ofweekly paclitaxel administration.

The demonstration of the activity of capecitabine (Xeloda) in advanced breast cancer and of the ability of capecitabine/docetaxel (Taxotere) to improve tumor response, time to disease progression, and survival in this

Many patients treat themselves with oral antioxidants and other alternative therapies during chemotherapy, frequently without advising their conventional health care provider. No definitive studies have demonstrated

During the past 5 years, real strides have been made in the management of advanced non-small-cell lung cancer (NSCLC). The introduction of newer chemotherapeutic agents and novel treatment regimens is paving the way for marked improvements in both clinical outcomes and quality of life.

The past 5 years have witnessed an evolution in the management of unresectable non-small-cell lung cancer (NSCLC) in the United States. Combined-modality treatment with chemotherapy plus irradiation has become the standard of care for stage III (locally advanced) disease. Most patients with stage IIIB disease and cytology-positive pleural effusion are now considered candidates for chemotherapy, as are those with stage IV disease.

This is the seventh in a well-known series of conference summaries, organized and edited by Dr. Salmon. A perusal of the contents of these volumes over the past two decades reveals the evolution of concepts related to combined-modality therapy