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Commentary (Hewitt): An Alternative Algorithm for Dosing Transdermal Fentanyl for Cancer-Related PainThe inadequate treatment of pain associated with malignancy remains a significant clinical problem.[1-4] Despite published guidelines on the appropriate management of cancer pain, 50% of dying patients experience moderate to severe pain.[1,5-8] One of the greatest barriers to the proper treatment of cancer pain remains health care professionals’ lack of knowledge regarding the appropriate use of analgesic medications.[9-11] The failure to refer to and limited availability of knowledgeable specialists in pain and palliative care also contribute to this pervasive problem.[12]
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Capecitabine/Irinotecan Combination Regimens in Colorectal CancerCapecitabine (Xeloda) and irinotecan (CPT-11, Camptosar) both have demonstrated single-agent activity in patients with colorectal cancer.
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Managing Thrombocytopenia Associated With Cancer ChemotherapyThis review will focus on the general approach to, and treatment of, thrombocytopenia in cancer patients, including thrombopoietin treatment in patients receiving non-myeloablative chemotherapy.
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Mohs Micrographic Surgery: Established Uses and Emerging TrendsMohs surgery has been well-established as the gold standard for the treatment of BCCs and SCCs. And, as described in this article, preliminary reports suggest that it may play an equally important role in the management of several other cutaneous malignancies.
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The Challenges of Treating Cancer Patients on Hemodialysis, or With Chronic Kidney DiseaseIt is challenging to diagnose, manage, and treat patients who have kidney disease in addition to cancer. Second to cardiovascular disease, cancer represents a major cause of mortality and morbidity in the kidney disease population.
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David Sher on the Updated ASTRO Guidelines for Oropharyngeal CancerIn this interview we discuss new clinical guidelines from ASTRO on the use of radiotherapy in treating oropharyngeal cancer.
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Systemic Therapy for Lung Cancer Brain Metastases: A Rationale for Clinical TrialsDespite the high prevalence of brain metastases in patients with metastatic lung cancer, these patients have been excluded from enrollment in clinical trials of new therapeutic drugs. The reasons for exclusion have centered on concerns that the blood-brain barrier may impede drug delivery into brain metastases, that brain metastases confer a dismal survival for metastatic lung cancer patients, and that brain metastases carry risk for cerebrovascular hemorrhage. A focused, updated review of these issues, however, clearly shows that these particular concerns are unwarranted. An extensive review of clinical trials on the efficacy of chemotheraputic agents against lung cancer brain metastases is also provided. This collective information describes an area in need of therapeutic development and supports an initiative to evaluate novel targeted therapies for lung cancer brain metastases.
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Management of Anemia in Patients With Hematologic MalignanciesAnemia is common in patients with hematologic malignancies, and it has negative effects on their quality of life. The current clinical practice guidelines recommend erythropoietic therapy in patients with cancer- or chemotherapy-related anemia, but anemia is often undertreated in patients with hematologic malignancies. Several randomized controlled trials have shown that treatment with erythropoiesis-stimulating proteins such as epoetin alfa (Procrit), epoetin beta, and darbepoetin alfa (Aranesp) increases hemoglobin levels, reduces the need for red blood cell transfusions, and improves quality of life in patients with hematologic malignancies and anemia receiving chemotherapy. Furthermore, preliminary data from a recent open-label study suggest that early treatment of mild anemia in patients with hematologic malignancies treated with chemotherapy produces marked improvements in quality of life and productivity. Increasing patients' hemoglobin levels may also improve their cognitive function. These findings support the use of erythropoietic therapy to manage anemia in patients with hematologic malignancies who are treated with chemotherapy.
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Clinicopathologic Indices Can Improve Patient Selection in Malignant MesotheliomaThe clinical management of malignant mesothelioma may ultimately be transformed by the elucidation of novel biomarkers that can predict the evolution of disease and guide the development of targeted therapies. However, despite relevant advances, more basic research is urgently required to support the development of therapies applicable to the patients for whom surgical resection is not an option.
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Recent Developments in Chemotherapy for Bladder CancerInvasive bladder cancer is a chemotherapy-sensitive neoplasm. Historically, the development of cisplatin (Platinol)-based chemotherapy regimens has represented an important advance for patients with metastatic
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Palliative Care Is Adaptable to a Wide Variety of Oncology Practice SettingsFirst, I need to reiterate what Dr. Alesi and her coauthors have so clearly stated: that there is a paucity of published data on most aspects of the delivery of palliative care (PC) services in the outpatient setting, although this now appears to be changing.
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Reirradiation of the Breast: Is This an Option?Breast-conservation therapy (BCT) is a well-characterized treatment for early-stage breast cancer that has been studied for decades. The risk of local recurrence following BCT for invasive breast cancer ranges from 8.8% to 14.3% at 20 years.
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Fire Without Smoke: Lung Cancer in ‘Never-Smokers’Lung cancer remains the leading cause of cancer mortality, accounting for over 160,000 deaths in the United States and 1.18 million deaths worldwide each year.[1,2] Though tobacco smoking remains the most strongly associated risk factor for the development of lung cancer, 10% to 15% of lung cancer patients in the United States lack any history of tobacco use.
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The Role of Radiation, With or Without Chemotherapy, in the Management of NSCLCLung cancer is the leading cause of cancer death in the United States. Surgery is the treatment of choice for early stage patients. Despite radical surgery, patients with early stage lung cancer remain at risk for recurrence. The
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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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Proteomics to Diagnose Human Tumors and Provide Prognostic InformationProteomics is a rapidly emerging scientific discipline that holds greatpromise in identifying novel diagnostic and prognostic biomarkers forhuman cancer. Technologic improvements have made it possible to profileand compare the protein composition within defined populationsof cells. Laser capture microdissection is a tool for procuring pure populationsof cells from human tissue sections to be used for downstreamproteomic analysis. Two-dimensional polyacrylamide gel electrophoresis(2D-PAGE) has been used traditionally to separate complex mixturesof proteins. Improvements in this technology have greatly enhancedresolution and sensitivity providing a more reproducible and comprehensivesurvey. Image analysis software and robotic instrumentationhave been developed to facilitate comparisons of complex protein expressionpatterns and isolation of differentially expressed proteins spots.Differential in-gel electrophoresis (DIGE) facilitates protein expressionby labeling different populations of proteins with fluorescent dyes.Isotope-coded affinity tagging (ICAT) uses mass spectroscopy for proteinseparation and different isotope tags for distinguishing populationsof proteins. Although in the past proteomics has been primarilyused for discovery, significant efforts are being made to developproteomic technologies into clinical tools. Reverse-phase protein arraysoffer a robust new method of quantitatively assessing expressionlevels and the activation status of a panel of proteins. Surface-enhancedlaser-desorption/ionization time-of-flight (SELDI-TOF) mass spectroscopyrapidly assesses complex protein mixtures in tissue or serum. Combinedwith artificial intelligence–based pattern recognition algorithms,this emerging technology can generate highly accurate diagnostic information.It is likely that mass spectroscopy–based serum proteomicswill evolve into useful clinical tools for the detection and treatment ofhuman cancers.
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Current Status of Prophylactic MastectomyWith the advent of methods for determining genetic susceptibility to breast cancer, there is a growing focus on prevention as a primary strategy. In this context, more women will receive information about the role of prophylactic mastectomy as a definitive management strategy. Drs. Ghosh and Hartmann have provided a thorough review of the salient issues in prophylactic mastectomy. Their discussion of the procedure and its history set the stage for further discussion of the relative efficacy of prophylactic mastectomy in reducing the risk of breast cancer in women.
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Irinotecan, Cisplatin, and Radiation in Esophageal CancerThe limited effectiveness of currently available chemotherapy in the treatment of advanced esophageal cancer, and the poor survival achieved in locally advanced disease with combined chemoradiotherapy with or without surgery, have prompted the evaluation of new agents. Irinotecan (CPT-11, Camptosar) has promising single-agent activity in gastrointestinal cancers.
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The Role of Irinotecan and Oxaliplatin in the Treatment of Advanced Colorectal CancerColorectal carcinoma is one of the most common malignancies in the western world, and although fluorouracil (5-FU) has been used in its treatment for almost 40 years, new agents with significant activity have been introduced recently. Irinotecan (CPT-11, Camptosar), a topoisomerase I inhibitor, administered at 300 to 350 mg/m2 every 3 weeks is significantly more active than continuous-infusion 5-FU in patients who have experienced disease progression after conventional therapy with 5-FU. In comparison to best supportive care, irinotecan improves survival and preserves quality of life despite treatment-related toxicity. Moreover, the combination of irinotecan and 5-FU has been explored in a number of different schedules. In previously untreated patients, overall response rates are high. Irinotecan can also be combined with mitomycin (mitomycin-C [Mutamycin]), oxaliplatin, or raltitrexed (Tomudex). Oxaliplatin is a new-generation platinum compound that has demonstrated activity against colorectal carcinoma in preclinical trials. It has been evaluated as a single agent against advanced colorectal carcinoma in the salvage setting and also in combination with 5-FU as initial therapy for metastatic disease (where it shows significant activity). The toxicity profile of oxaliplatin (chiefly characterized by neurotoxicity) differs from that of irinotecan (primarily producing diarrhea) and the potential, therefore, exists for combining these agents or for exploiting their possible synergy with 5-FU. The introduction of these two new active agents of different pharmacologic classes promises to enable significant improvements in the treatment of patients with colorectal carcinoma. [ONCOLOGY 15(4):415-434, 2001]
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Sentinel Lymph Node Mapping in Breast CancerSentinel node surgery for breast cancer has generated considerable interest, and the timely article by Dr. Cody provides a concise, well-written review of the topic. This commentary will add a few relatively minor points and will offer some alternative viewpoints to the author’s conclusions.
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Can Metastatic Colorectal Cancer Be Cured?This article reviews the main issues that must be considered in metastatic colorectal cancer from the surgical oncology and medical oncology perspectives, respectively.
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Clotting and Bleeding in Oncology Patients: Clinical Scenarios and ChallengesDue to the delicate hemostatic balance in cancer patients, an understanding of both the clotting and bleeding risks in this population is crucial to effectively manage hematologic complications.
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An Argument Against Routine Use of Radiotherapy for Ductal Carcinoma In SituWhy does the debate over theappropriate treatment ofductal carcinoma in situ(DCIS) continue? Three widely publicizedmulti-institutional randomizedtrials have addressed this question,[1-4]and all have reached largely the sameconclusion. Radiation therapy reducesthe risk of local recurrence of DCISby approximately 50%. Despite thisfact, a significant percentage of DCISpatients (50% or more in many settings)in consultation with their cliniciansopt to undergo excision aloneand forgo radiotherapy.
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Addressing Financial, Psychosocial Barriers to CAR T-Cell Access for LBCLSome patients with large B-cell lymphoma may have to travel a great distance for an initial evaluation for CAR T-cell therapy.
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Current Management of Depression in Cancer PatientsIn their paper, Schwartz and colleagues review the risk factors for depression and suicide in patients with cancer and argue convincingly that screening for depression can be simply and quickly performed. They also delineate the efficacy and potential adverse effects of psychotherapeutic or psychopharmacologic treatments for these patients. Buttressing the identification and treatment of depression in the cancer patient are vital, ongoing scientific developments that flow from an increased understanding of interactions among the brain, endocrine system, and immune system. This rapidly evolving body of neurobiological knowledge has catalyzed fundamental changes in how we conceptualize depression in cancer patients and has important ramifications regarding the treatment and prevention of depressive syndromes in this setting.
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Use of Hematopoietic Hormones for Bone Marrow Defects in AIDSBone marrow suppression is a substantial problem in patients infected with HIV. Contributing factors include the underlying HIV infection, alterations in the marrow microenvironment (resulting in abnormal cytokine regulation
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Commentary (Blass): Psychiatric Assessment and Symptom Management in Elderly Cancer PatientsIn this issue of ONCOLOGY,Winell and Roth review the veryimportant topic of assessment andtreatment of psychiatric symptoms inelderly cancer patients. Their reviewis comprehensive and practical. Thiscommentary further develops a numberof themes raised in their article.
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The Role of Amifostine as a RadioprotectorEffective radiotherapy for patients with cancer should include maximal tumor cell killing with minimal injury to normal tissue. Radiation doses that can be delivered, without causing severe damage to surrounding normal
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Improving Cancer Clinical TrialsIn this interview we discuss outcomes in clinical trials and how to improve trials by redefining clinically meaningful outcomes.
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Small-Cell Lung Cancer: A Perspective on the Past and a Preview of the futureDespite advances in the treatment of small-cell lung cancer during the 1970s, with the use of combination chemotherapy, and in the 1980s, with the combination of etoposide and cisplatin plus concurrent radiation
