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Gilbert G. Fareau, MD
Gilberto Schwartsmann, MD, PhD
Latest Article

A Phase II Study of Doxorubicin/Paclitaxel Plus G-CSF for Metastatic Breast Cancer

This phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line

Gina Brown, MD, FRCR
Latest Article

Guiding Post-Treatment Decisions in Rectal Cancer: mrTRG Is a Practical Place to Start

The authors propose that current policies regarding the use of chemoradiotherapy or short-course preoperative radiotherapy have resulted in an approach to rectal cancer management that often represents overtreatment, with significant loss of quality of life for patients.

Gina G. Chung, MD
Latest Article

Tailoring Endocrine Therapy in Breast Cancer Patients

The majority of invasive breast cancer patients present with hormone receptor-positive disease, and modulation of estrogen receptor (ER) activation is an essential component of systemic adjuvant therapy for these women. While tamoxifen has traditionally been the primary adjuvant endocrine therapy for all ER-positive women, recent trials evaluating the use of aromatase inhibitors (AIs) have challenged this standard in postmenopausal women, and ongoing trials are examining the optimal use of endocrine therapy in younger women. Issues regarding the optimal approach to endocrine therapy in both pre- and postmenopausal women are examined in this review.

Gini F. Fleming, MD
Latest Article

POINT: LHRH Agonists vs Ovarian Ablation for Suppression of Ovarian Function in Premenopausal Breast Cancer Patients

Reversible ovarian function suppression using LHRH agonists is the preferred first treatment for most premenopausal breast cancer patients.

Ginny Mason, RN
Latest Article

Management of a Patient With Inflammatory Breast Cancer

Two years after her first mammogram the patient, EC, noticed swelling and skin changes in one breast. A bone scan, chest and abdomen CT, and PET scan were negative for metastatic spread, staging the cancer at IIIB.

Giorgio Gandaglia, MD
Latest Article

Node-Positive Prostate Cancer: A Call for Level 1 Evidence

Despite the lack of level 1 evidence, retrospective studies support the need for appropriate local treatment, even in the context of node-positive disease.

Giorgio V. Scagliotti, MD, PhD
Latest Article

Histologic Subtype in NSCLC: Does It Matter?

Since the publication of a meta-analysis in 1995 that demonstrated a modest survival benefit compared to best supportive care, platinum-based chemotherapy became the cornerstone of therapy in the first-line setting in advanced-stage non–small-cell lung cancer (NSCLC) for patients with good performance status.[1] A recent meta-analysis of 16 randomized trials including 2,714 patients demonstrated an advantage of chemotherapy over best supportive care with an absolute improvement in survival of 9% at 12 months.[2]

Giorgio Vittorio Scagliotti, MD
Latest Article

Gemcitabine/Cisplatin as Induction Therapy for Stage IIIA N2 Non–Small-Cell Lung Cancer

Because the majority of patients with stage IIIA N2 non–small-cell lung cancer (NSCLC) ultimately die of distant metastases, recent efforts to improve their intermediate- and long-term survival have focused on neoadjuvant

Giovanna Finocchiaro, MD
Latest Article

Perspectives on Salvage Therapy for Non–Small-Cell Lung Cancer

Platinum-based chemotherapy offers a modest survival advantage overbest supportive care in chemotherapy-naive patients with a good performancestatus and advanced/metastatic non–small-cell lung cancer(NSCLC). Despite the survival benefit associated with first-line chemotherapy,the majority of patients will experience relapse or disease progression.In clinical practice, an increasing number of patients maintaina good performance status after first-line treatment and are eligible forfurther treatments. Docetaxel (Taxotere) at 75 mg/m2 given once every3 weeks has been the standard of care for second-line chemotherapy sincethe year 2000. Pemetrexed (Alimta) is a novel multitargeted antifolateagent with single-agent activity in first- and second-line treatment ofNSCLC. A large phase III study comparing docetaxel to pemetrexed insecond-line therapy demonstrated that pemetrexed is equally active andless toxic than docetaxel. Based on these results, pemetrexed is a reasonablesecond-line chemotherapy option for patients with recurrent, advancedNSCLC. Progress made in the field of molecular biology has led to theidentification of drugs active against specific cellular targets. Gefitinib(Iressa) and erlotinib (Tarceva) are both orally active tyrosine kinase inhibitorsof the epidermal growth factor receptor. Phase II and III trialshave demonstrated that these agents are active particularly in a subgroupof patients with specific biologic characteristics. Both drugs have beenapproved for the treatment of pretreated NSCLC. Other drugs, such ascetuximab (Erbitux) and bevacizumab (Avastin) have shown promisingactivity in NSCLC and are currently being tested in clinical trials.

Giovanni Begossi, MD
Latest Article

Commentary (Begossi/Wanebo): Surgery in the Older Patient

With this insightful manuscript, Drs. Termuhlen and Kemeny shed some light on the surgical management of older cancer patients. The authors highlight pitfalls in patient selection and offer proposals to improve the surgical oncologist’s approach to patient care. They review the role of curative surgical management of the most common forms of cancer in the elderly, while emphasizing the role of surgical palliation to improve the quality of life of older cancer patients.

Giovanni D. Aletti, MD
Latest Article

Ovarian Cancer Care: It’s Time for “Personalized” Approaches

As outlined in the excellent, comprehensive review by Drs. Liu and Matulonis, ovarian cancer is the most lethal gynecologic malignancy in the United States, with approximately 16,000 deaths and 22,000 new cases yearly.[1] The vast majority of patients present with intra-abdominal spread of disease at the time of diagnosis, resulting in low overall cure rates. As outlined, patients are primarily managed with primary surgical resection and subsequent platinum-based chemotherapy.

Giovanni Luca Frassineti, MD
Latest Article

Doxorubicin and Paclitaxel (Sequential Combination) in the Treatment

Based on preclinical data, we designed a phase I/II clinical trial to determine the efficacy and toxicity of doxorubicin followed by paclitaxel in the treatment of advanced breast cancer (either untreated or relapsed after

Giovanni Palladini, MD, PhD
Latest Article

Uniform Risk-Stratification and Response Criteria Are Paving the Way to Evidence-Based Treatment of AL Amyloidosis

In less than a decade, the resources available to treat light chain (AL) amyloidosis have increased impressively.

Giovanni Scambia, MD
Latest Article

COUNTERPOINT: Primary Debulking Surgery vs Neoadjuvant Chemotherapy for Newly Diagnosed Advanced Ovarian Cancer

In a Significant Percentage of Patients, Neoadjuvant Therapy Yields Equivalent Survival, With Better Quality of Life and Lower Costs

Giovanni Selvaggi, MD
Latest Article

Histologic Subtype in NSCLC: Does It Matter?

Since the publication of a meta-analysis in 1995 that demonstrated a modest survival benefit compared to best supportive care, platinum-based chemotherapy became the cornerstone of therapy in the first-line setting in advanced-stage non–small-cell lung cancer (NSCLC) for patients with good performance status.[1] A recent meta-analysis of 16 randomized trials including 2,714 patients demonstrated an advantage of chemotherapy over best supportive care with an absolute improvement in survival of 9% at 12 months.[2]

Giselle J. Moore, AMP, MSN, AOCN
Latest Article

Quality of Life After Radiation Therapy for Base of Tongue Cancer

Quality-of-life (QOL) research in patients treated for head and neck cancer is in its infancy. Early research focused on psychosocial issues related to extensive surgical resection and its consequences. Many advances

Giulia Federici, MS
Latest Article

Breast Cancer Stem Cells: A New Target for Therapy

The cancer stem cell (CSC) theory was first proposed to explain the fact that only a small proportion of leukemia or solid tumor cells have the capacity to induce growing tumors in immunodeficient mice.[1,2]

Giulio Metro, MD
Latest Article

Perspectives on Salvage Therapy for Non–Small-Cell Lung Cancer

Platinum-based chemotherapy offers a modest survival advantage overbest supportive care in chemotherapy-naive patients with a good performancestatus and advanced/metastatic non–small-cell lung cancer(NSCLC). Despite the survival benefit associated with first-line chemotherapy,the majority of patients will experience relapse or disease progression.In clinical practice, an increasing number of patients maintaina good performance status after first-line treatment and are eligible forfurther treatments. Docetaxel (Taxotere) at 75 mg/m2 given once every3 weeks has been the standard of care for second-line chemotherapy sincethe year 2000. Pemetrexed (Alimta) is a novel multitargeted antifolateagent with single-agent activity in first- and second-line treatment ofNSCLC. A large phase III study comparing docetaxel to pemetrexed insecond-line therapy demonstrated that pemetrexed is equally active andless toxic than docetaxel. Based on these results, pemetrexed is a reasonablesecond-line chemotherapy option for patients with recurrent, advancedNSCLC. Progress made in the field of molecular biology has led to theidentification of drugs active against specific cellular targets. Gefitinib(Iressa) and erlotinib (Tarceva) are both orally active tyrosine kinase inhibitorsof the epidermal growth factor receptor. Phase II and III trialshave demonstrated that these agents are active particularly in a subgroupof patients with specific biologic characteristics. Both drugs have beenapproved for the treatment of pretreated NSCLC. Other drugs, such ascetuximab (Erbitux) and bevacizumab (Avastin) have shown promisingactivity in NSCLC and are currently being tested in clinical trials.

Giuseppe Fornarini, MD
Latest Article

Pemetrexed in Gastric Cancer

Gastric cancer is a major clinical challenge, with poor overall prognosisand limited life expectancy for patients with advanced disease.Even with surgery and other modalities, palliation is often difficult.Improvement of response rates has evolved with the development ofstandard regimens and those incorporating newer chemotherapy agents,such as oral fluoropyrimidines, the taxanes, camptothecins, novel platinums(eg, oxaliplatin [Eloxatin]), and antifolates (eg, pemetrexed[Alimta]). Ongoing trials with these regimens aim toward improvingsurvival, as well as improving the safety profile. It is hoped that in conjunctionwith molecular research in the pathogenesis of gastric cancerand development of targeted therapies in this disease, these trial datamight lead to the evolution of treatment strategies that could prove effective.

Giuseppe Fraschini, MD
Giuseppe Giaccone, MD, PhD
Latest Article

EGFR Inhibitors in Lung Cancer

Targeted therapies inhibiting the epidermal growth factor receptor(EGFR) have been introduced in the treatment of patients with advancednon–small-cell lung cancer (NSCLC). Many inhibitors of theEGFR have been developed, targeting either the extracellular receptordomain with antibodies or the intracellular tyrosine kinase bindingdomain with small molecules. The tyrosine kinase inhibitor (TKI)gefitinib (Iressa) was the first targeted drug to be registered for thetreatment of NSCLC after failure of chemotherapy. Given concurrentlytogether with platinum combination chemotherapy both TKIs gefitiniband erlotinib (Tarceva) failed to increase activity. Sequential targetedtherapy after chemotherapy is currently being investigated further. Studieswith the monoclonal antibody cetuximab (Erbitux) combined withchemotherapy are ongoing. Side effects of the small molecules aremainly skin rash and diarrhea, whereas the antibodies do not give diarrhea.Selection of patients, based on molecular markers and patientcharacteristics, has become an important issue for the further developmentof these drugs, given there is activity in a relatively small group ofpatients with NSCLC. Newer drugs inhibiting more than one receptorpathway are being investigated in order to find activity in a broadergroup of patients.

Giuseppe Mottino, MD
Latest Article

Key Issues in Treating Frail Elderly Breast Cancer Patients

By the year 2030 most patients with breast cancer will be aged 65 years or more and many will be frail. Frailty implies diminished physiologic reserve; contributors include diminished organ function, comorbidities, impaired physical function, and geriatric syndromes. Time-efficient tools for assessing frailty are being developed and, once validated, can be used to identify frail cancer patients and help direct therapy. Screening mammography in frail patients is questionable, and a clinical breast exam is likely to identify breast cancers that warrant intervention. Hormonal therapy may be a reasonable primary therapy in older frail women with hormone receptor–positive lesions. For estrogen receptor– and progesterone receptor–negative lesions, excision of the primary tumor may be adequate. Adjuvant hormonal therapy may be appropriate in frail elders with high-risk hormone receptor–positive breast cancer; chemotherapy is rarely indicated regardless of tumor status. The majority of frail elders with metastases will have hormone receptor–positive breast cancers, and endocrine therapy should be considered; those with receptor-negative tumors may be treated with single-agent chemotherapy or supportive care measures. Oncologists need to acquire the skills to appropriately identify frail elders so they select appropriate therapies that will minimize toxicity and maintain quality of life.

Giuseppe Sanguineti, MD
Latest Article

Evaluating Advanced Technologies in Radiation Oncology: When and How Should Randomized Trials Be Done?

The ultimate goal of radiation therapy (RT) is to deliver enough radiation to eradicate all tumor clonogens within the irradiated field while also minimizing dose to adjacent normal structures so as to cause no (or minimal) normal tissue injury. With few exceptions, the dose of radiation currently delivered to most anatomic sites is limited by the tolerance of these adjacent normal organs, thereby restricting the dose of radiation deposited in tumors to an amount that may or may not be ideal to realize an optimal cure. The goal of many advanced technologies introduced into RT are aimed at addressing this problem.

Gladys Rodriguez, MD
Latest Article

Docetaxel in Combination With Flourouracil: Study Design and Preliminary Results

The relatively recent introduction of a new class of chemotherapeutic agents--the taxoids--has raised hope of improved survival for patients with advanced or metastatic cancer. Following encouraging preclinical results of taxoid combinations, this phase I, nonrandomized trial was designed to evaluate a 1-hour intravenous infusion of docetaxel (Taxotere) on day 1 combined with fluorouracil (5-FU) as a daily intravenous bolus for 5 consecutive days.

Glen J. Weiss, MD
Latest Article

From Radiotherapy to Targeted Therapy: 20 Years in the Management of Non-Small-Cell Lung Cancer

Non-small-cell lung cancer (NSCLC) is the leading cause of cancer death worldwide. Before 1980, radiotherapy was considered the only real recourse in advanced disease. In 1995, a landmark meta-analysis of trials conducted in the 1980s and early 1990s demonstrated a survival benefit with platinum-based chemotherapy. Newer chemotherapy agents and improved supportive care measures have allowed more patients to benefit from chemotherapy with reduced toxicity. Concurrent platinum-based chemotherapy and radiotherapy has improved the survival in stage III disease, and recently chemotherapy has also demonstrated improved survival in resected early-stage disease. The majority of patients still present with advanced unresec disease for whom the prognosis remains poor, but for key subpopulations the outlook has improved markedly since the emergence of targeted therapies directed against the epidermal growth factor receptor and vascular endothelial growth factor receptor pathways. Patient selection and the incorporation of targeted therapies with cytotoxic chemotherapy are the focus of many ongoing studies, and there is an abundance of new agents undergoing clinical trials. Together, these developments have moved us away from the nihilism of 20 years ago into an era of unprecedented optimism in taking on the many remaining challenges of managing NSCLC in the 21st century.

Glenn J. Bubley, MD
Latest Article

Prostate Cancer in the Older Man

Most men diagnosed with prostate cancer are more than 65 years of age. Therefore, a discussion of the issues surrounding the diagnosis, prevention, and treatment of prostate cancer in older men is, in many ways, a review of

Glenn J. Lesser, MD, FACP
Latest Article

Bevacizumab and Glioblastoma: The Ecstasy and the Agony

The absence of any effective combinatorial therapy in patients progressing on bevacizumab and evidence supporting both continuation and discontinuation of bevacizumab in this setting remain important areas for additional clinical trial evaluation in order to better guide our therapeutic decision making in the clinic.

Gloria Cherry, BS, RN
Latest Article

Understanding Novel Molecular Therapies

The science supporting molecularly targeted therapies for the treatment of patients with solid tumors continues to evolve. Nurses are challenged to understand cell signaling, molecular targeting, and the mechanism of action of targeted agents. Two cell signal transduction pathways regulate the development, proliferation, and metastasis of solid tumors: the human epidermal growth factor (HER) receptor pathway and the vascular endothelial growth factor (VEGF) receptor pathway. Several novel pharmacologic agents with distinct indications and methods of administration target the HER and VEGF molecular pathways.

Gloria H. Heppner, PhD
Latest Article

Tumor Heterogeneity Is Fundamental to the Tumor Ecosystem

It may be necessary to broaden our concept of the malignant process beyond that of a disease to be attacked-to one that reflects a deeper understanding of the fundamentals of living systems.