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The Neutropenic Diet....Still Ageless?As practicing doctors and a practicing nutritionist in a large pediatric oncology program, we applaud Nicole Fox and Alison Freifeld for questioning the utility of the neutropenic diet.
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ACR Appropriateness Criteria® Ductal Carcinoma in SituManagement of ductal carcinoma in situ (DCIS) commonly involves excision, radiotherapy, and hormonal therapy. Radiotherapy is employed for local control in breast conservation. Evidence is evolving for several radiotherapy techniques exist beyond standard whole-breast irradiation.
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Challenges of Rural Cancer Care in the United StatesRural cancer patients often face substantial barriers to receiving optimal treatment, including availability of cancer care providers, distance to services, lack of public transportation, financial barriers, and limited access to clinical trials. However, a number of promising approaches may address some of these challenges.
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Should expectant management serve as the primary treatment option in prostate cancer?Prostate cancer experts agree on one issue: No single treatment can be considered universal for men diagnosed with prostate cancer. There are myriad choices and considerations to be reviewed with every diagnosis. In addition, there are conflicting data about when, or if, men require screening for prostate cancer as well as when to start therapy for confirmed disease.
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PALB2-Positive Breast Cancer in a 40-Year-Old ManIn July 2003, an asymptomatic 40-year-old man presented to his primary care physician for routine care and was found to have a palpable right axillary lymph node.
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Sixty Is the New Forty-or Is It the Other Way Around?Until more data are available, we reserve bisphosphonates for women with evidence of decreased bone mineral density who are at increased risk of fracture and for those on clinical trials.
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Treatment of Ovarian Cancer With Intraperitoneal ChemotherapyOvarian cancer is the most deadly gynecologic malignancy. In the US alone, an estimated 21,500 new cases will be diagnosed in 2009, and an estimated 14,600 women will die from this disease.
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Should We Recommend Screening Mammography for Women Aged 40 to 49?Although there is general agreement that screening women over age 50 years with mammography reduces mortality from breast cancer, there has been controversy over the effectiveness of mammography in women 40 to 49 years old. Until 1993, the most widely accepted recommendation for screening mammography included baseline mammography between ages 35 and 40, mammography every 1 to 2 years between ages 40 and 50, and annual mammograms after age 50.
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Nodal Marginal Zone Lymphoma: Impersonalized MedicineUntil we fully engage in understanding the biologic mechanisms that separate NMZL from other indolent NHLs, however, we will continue to deliver “impersonalized medicine” that does not exploit the unique properties of the former.
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Physical Activity Across the Cancer ContinuumIn our commentary, we will address ways to consider this research across the cancer continuum, with a focus on the cancer survivor, highlighting some of the challenges in interpreting the research evidence for translation into clinical practice and noting some research gaps.
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Cancer- and Treatment-Related Cognitive Changes: What Can We Do Now? What Lies Ahead?Much of the existing research into the phenomenon commonly referred to as “chemobrain” has been descriptive, and we know enough now to identify some patients at risk for cognitive changes after a diagnosis of cancer.
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Local Recurrence Risk Factors in Women Treated With BCT for Early-Stage Breast CancerThe article by Revesz and Khan is an excellent summary of the state of our knowledge of margin width in relation to breast cancer recurrence.
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Early Detection of Cutaneous LymphomaCutaneous lymphomas comprise a spectrum of diseases characterized by infiltration of the skin by malignant lymphocytes. The clinical manifestations of cutaneous lymphomas vary, and they can mimic benign dermatoses,
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Catherine S. Diefenbach, MD, Talks Future of CAR T-cell Therapy Following Liso-Cel Approval in Second-Line LBCLCatherine S. Diefenbach, MD, spoke about refining understanding of CAR T-cell therapies after the approval of lisocabtagene maraleucel for patients with relapsed/refractory large B-cell lymphoma.
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Updates in Splenic and Nodal Marginal Zone LymphomaThis video reviews updates on the treatment and biology of splenic and nodal marginal zone lymphoma.
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Osteoclast Inhibitors: A Multifaceted Tool in the Management of Breast CancerThere 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.
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Expertise of Genetic Counselors ClarifiedIn his article, "Genetic Testing for Cancer Susceptibility: Challenges for Creators of Practice Guide-lines" [11(11A):171-176, 1997], Henry Greely, JD, provides a comprehensive review of the complex issues that patients consider when deciding
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ACR Appropriateness Criteria® Adjuvant Management of Early-Stage Endometrial CancerAfter a review of the published literature, the panel voted on three variants to establish best practices for the utilization of imaging, radiotherapy, and chemotherapy after primary surgery for early-stage endometrial cancer.
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Inflammatory Breast Cancer: the Road to ProgressDrs. Dawood and Cristofanilli provide a concise review of inflammatory breast cancer (IBC) and succinctly cover its most salient features, including its clinicopathologic characteristics, its key molecular features, and an overview of treatment outcomes.
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Functional Assessment of the Older Patient With CancerThe population of the United States and other industrialized nations is aging rapidly. The increased life span allows for longer exposure to carcinogens and the accumulation of genetic alterations. Thus, the incidence of cancer is increasing along with the aging of the population.
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Clinical Trial ConundrumA group of several ovarian cancer patients have either called or visited me in my office recently to ask for information and validation to begin a vaccine clinical trial on a tropical island in the Atlantic.
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Experts Discuss Impact of Fruquintinib Approval in Metastatic CRCArvind N. Dasari, MD, lead investigator of the FRESCO-2 trial, spoke about the recent approval of fruquintinib for patients with previously treated metastatic colorectal cancer.
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Genetic Testing for Cancer PatientsAs part of our coverage of the 2015 ONS Annual Congress, we discuss genetic testing for cancer patients and the role of oncology nurses.
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Uracil/Tegafur Plus Oral Calcium Folinate in Advanced Breast CancerUracil 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
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Uncertainty in Medicine: A Talk With Dr. DjulbegovicIn part 2 of this interview, Benjamin Djulbegovic, MD, PhD, discusses the uncertainty principle in clinical trials. Dr. Djulbegovic is associate professor of medicine, Divisions of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa.
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Psychosocial Consequences of DNA Analysis for MEN Type 2Multiple endocrine neoplasia type 2 (MEN-2) is characterized by medullary thyroid carcinoma in combination with pheochromocytomas and, sometimes, parathyroid adenomas. Since 1993, the psychosocial implications of DNA analysis for MEN-2 have been studied in the Netherlands. This article summarizes the first results of that study. Individuals who applied for DNA analysis cited the need to reduce uncertainty as the major reason for wanting the test. An unfavorable test outcome resulted in anxiety and depression but also relief.
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Complications of Androgen Deprivation Therapy: Prevention and TreatmentThe myriad effects of androgendeprivation therapy (ADT) inmen were really not appreciateduntil those without metastatic prostatecancer received such treatment.For example, fatigue-now recognizedas a common toxicity of ADT-was once more likely attributed tometastatic disease. Today, however,patients who are otherwise fully functional,healthy, and asymptomatic arebeing treated for a rising prostate-specificantigen level after primary therapy.In these men, the side effects ofADT can be very dramatic and aremore clearly related to the initiationof therapy.
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Targeting the Androgen Receptor Signaling Axis to Reduce Testosterone Levels in Prostate Cancer: How Low Should We Go?It is now well established that castration-resistant disease can be effectively treated using newer androgen receptor-targeting agents such as abiraterone and enzalutamide.
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Gemcitabine/Paclitaxel as First-Line Treatment of Advanced Breast CancerGemcitabine (Gemzar) and paclitaxel exhibit good activity and goodsafety profiles when used alone and together in the treatment of advancedbreast cancer. In a phase II trial, 45 patients with metastaticbreast cancer received gemcitabine at 1,200 mg/m2 on days 1 and 8 andpaclitaxel at 175 mg/m2 on day 1 every 21 days. Twenty-seven patients(60.0%) had prior adjuvant therapy. Objective response was observedin 30 patients (objective response rate 66.7%, 95% confidence interval[CI] = 52%–71%), including complete response in 10 (22.2%) and partialresponse in 20 (44.4%). Median duration of response was 18 months(95% CI = 11–26.7 months), median time to tumor progression for theentire population was 11 months (95% CI = 7.1–18.7 months), medianoverall survival was 19 months (95% CI = 17.3–21.7 months), and the1-year survival rate was 69%. Treatment was well tolerated, with grade3/4 toxicities being infrequent. Grade 3/4 leukopenia, neutropenia, andthrombocytopenia were each observed in six patients (13.3%). No patientwas discontinued from the study due to hematologic ornonhematologic toxicity. Thus, the gemcitabine/paclitaxel combinationshows promising activity and tolerability when used as first-line treatmentin advanced disease. The combination recently has been shownto be superior to paclitaxel alone as first-line treatment in anthracyclinepretreatedadvanced disease according to interim results of a phase IIItrial and it should be further evaluated in comparative trials in breastcancer.
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Surgical Treatment of Metastatic Pulmonary Soft-Tissue SarcomaThe lung is the most frequent site of metastasis from soft-tissue sarcomas. Due to the relative resistance of sarcoma to either chemotherapy or radiotherapy, compared to other solid tumors, surgical management of
