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Jeannine S. Mccune, PharmD
Latest Article

Myalgias and Arthralgias Associated With Paclitaxel

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.

Jed G. Nuchtern, MD
Latest Article

Neuroblastoma: Biology and Therapy

Neuroblastoma is a clinically heterogeneous disease which can have a benign, localized behavior or a rapidly progressive, widely disseminated, lethal character. In recent years, knowledge of tumor biology-genetic changes and other biological markers-has allowed for reliable prediction of patient outcomes. These markers, when combined with clinical staging and histologic findings, determine the relative risk for a given patient and allow therapy to be tailored to that particular level of risk.

Jedd D. Wolchok, MD, PhD
Latest Article

CTLA-4 Antibodies: New Directions, New Combinations

This review will summarize the preclinical and clinical development of CTLA-4–blocking antibodies, discuss recent insights into the biology of CTLA-4 blockade, review the use of these antibodies in combination with established and novel therapeutic modalities, and comment on ongoing questions regarding their administration.

Jeff Boyd, PhD
Latest Article

Molecular Genetics of Hereditary Ovarian Cancer

Approximately 10% of all epithelial ovarian carcinoma cases are associated with inheritance of an autosomal-dominant genetic mutation conferring a predisposition to cancer with variable penetrance. Two such manifestations

Jeff Forringer
Latest Article

Myth Busting: Does Real-World Experience Lead to Better Drug Choices?

In the era of evidence-based medicine, clinical guidelines, and personalized medicine, one would think that convincing clinical trial data would influence clinical practice if disseminated in an appropriate manner. However, it has been estimated that only 50% of current medical practice is evidence-based, clearly demonstrating a compelling need to collect and analyze additional data to better inform practice. Current data are usually gathered from a variety of sources, including clinical trials, observational studies, and meta-analyses. Yet according to Jeff Forringer, CEO of IntrinsiQ, data from oncology practices provide real-world outcomes that give better insight into the efficacy of cancer therapeutics.

Jeff J. Meyer, MD
Latest Article

Association Between the Rates of Synchronous and Metachronous Metastases: Analysis of SEER Data

Patients with cancer are usually staged based on the presence of detectable regional and/or distant disease. However, staging is inexact and cM0 patients may have microscopic metastases (cM0pM1) that later cause relapse and death. Since the clinical tools used to stage patients are fairly similar for different tumors, the ratio of the rates of metachronous to synchronous metastases should be similar for different tumors (hypothesis #1). Improvements in diagnostic tools should have caused the ratio of metachronous-to-synchronous metastases to have decreased over time (hypothesis #2). Finally, the fraction of patients with either metachronous or synchronous metastases should have declined over time due to increased screening and earlier diagnoses (hypothesis #3). To test these hypotheses, Surveillance, Epidemiology, and End Results (SEER) data from 1973-1998 were analyzed for 19 solid tumors. A linear relationship was seen between the rates of metachronous and synchronous metastases, with modestly strong correlation coefficients, consistent with hypothesis #1. Over time, changes in staging methods have not significantly altered the ratio of metachronous/synchronous metastases, contrary to hypothesis #2. Also over time, a decrease in the number of patients with metastases was found, consistent with hypothesis #3. Therefore, the rate of anticipated metachronous metastases can be estimated from the rate of clinically evident metastases at presentation. Changes in screening/staging of disease over time may have reduced the overall fraction of patients with metastases.

Jeff M. Michalski, MD, MBA
Latest Article

PSA Screening for Colorectal Cancer Patients: Proceeding With Caution

It may be appropriate to offer prostate cancer screening to carefully selected men with a previous history of colorectal cancer. However, the risks and benefits of establishing the diagnosis in this setting need to be considered and discussed with them.

Jeffery C. Ward, MD
Latest Article

ICD-10: Getting Sucked in and Surviving

ICD-10 is a massive undertaking that expands our current 13,000 codes to 68,000 codes. It will impact nearly all business processes in a physician's practice: verification of eligibility, pre-authorization, clinical documentation, research activities, public health reporting, quality reporting, and claim submission.

Jeffrey A. Barnes, MD, PhD
Latest Article

Adult T-cell Leukemia/ Lymphoma: Complexities in Diagnosis and Novel Treatment Strategies

In this issue of ONCOLOGY, Dr. Tobinai presents a thorough and thoughtful review of the current state of the art of HTLV-related adult T-cell leukemia/lymphoma (ATLL). As described, ATLL is most prevalent in Asia, where it has also been most studied, but is also seen in patients from other HTLV-endemic areas including the Caribbean, South America, and parts of Africa. ATLL is rare in North America and Europe, representing 1% to 2% of T-cell lymphomas compared to 25% in Asia.[1]

Jeffrey A. Gilreath, PharmD
Latest Article

Proposed Algorithm for Managing Ibrutinib-Related Atrial Fibrillation

Although ibrutinib-related atrial fibrillation (IRAF) occurs in up to 11% of patients in clinical trials, these studies have rarely fully characterized bleeding events or risk factors for bleeding when ibrutinib is combined with anticoagulation. Furthermore, guidelines do not provide direction regarding the preferred anti-arrhythmic agent for IRAF.

Jeffrey A. Meyerhardt, MD, MPH
Latest Article

Perioperative Chemotherapy for Colorectal Cancer Liver Metastases

There is limited data available to guide decision making in the management of colorectal liver metastases. Despite a trend toward increased use of perioperative chemotherapy, others have questioned the role of this approach in patients with solitary lesions and a longer disease-free interval.

Jeffrey A. Norton, MD
Latest Article

Surgical Management of Neuroendocrine Tumors of the Gastrointestinal Tract

This article reviews the surgical management of gastrointestinal neuroendocrine tumors, including the preoperative control of hormonal symptoms, extent of resection required, postoperative outcomes, and differing management strategies as determined by whether the tumor has arisen sporadically or as part of a familial disorder, such as multiple endocrine neoplasia type 1.

Jeffrey A. Shih, MD
Latest Article

Cardiovascular Toxicity of Newer Chemotherapeutic Agents: The Heart of the Matter

Standard heart failure regimens remain the mainstay of therapy for chemotherapy-related cardiac dysfunction until newer randomized trials suggest otherwise, and earlier detection of toxicity through judicious surveillance with biomarkers and noninvasive imaging remains the cornerstone of management for the foreseeable future.

Jeffrey A. Stephenson, MD
Latest Article

Current Techniques in Three-Dimensional CT Simulation and Radiation Treatment Planning

The modern CT simulator is capable of interactive three-dimensional (3D) volumetric treatment planning; this allows radiation oncology departments to operate without conventional x-ray simulators. Treatment planning is performed at the time of virtual simulation by contouring the organs or volumes of interest and determining the isocenter.

Jeffrey Berger, MD
Latest Article

Diagnostic Dilemma

A 65-year-old man with a history of a "bleeding ulcer" 7 years earlier presents with complaints of progressive dysphagia for solids and liquids over the past 4 months. The patient states that he has had a 40-pound weight loss during this time, but denies any fevers, chills, abdominal pain, melena, or anorexia. He states that recently he cannot go to his favorite restaurant, as whenever he eats he experiences severe coughing fits. He also describes regurgitation of undigested materials soon after eating.

Jeffrey C. Allen, MD
Latest Article

Controversies in the Management of Intracranial Germinomas

Dr. Paulino and his coauthors present a thoughtful, comprehensive survey of the literature regarding the evolving management of intracranial germinoma. They review promising areas of clinical research and acknowledge an increasing

Jeffrey C. Buchsbaum, MD, PhD
Latest Article

Proton Therapy for Lung Cancer: New Data to Consider

The role of radiation therapy (RT) in lung cancer is long established; some of the earliest Radiation Therapy Oncology Group reports dealt with non-small cell lung cancer (NSCLC).[1,2] More recently, the advent of stereotactic body RT (SBRT) techniques has provided significant local control rates after focused treatment of selected small metastases and inoperable early stage lesions.[3,4] Our center has been in the forefront of examining SBRT and its role in central [5] or bilateral [6] lesions, its effect on PET imaging [7] and pulmonary function testing,[8] and subsequent frequency of brachial plexopathy,[9] chest wall toxicity,[10] or pneumonitis.[11] Still, even this highly conformal technique comes with potentially significant dose to adjacent normal tissue. This is in the context of an emerging appreciation for the pulmonary consequences of elevated mean lung dose,[12] or V5 after pneumonectomy.[13] For each lung cancer patient requiring RT, an effective mechanism to deliver dose to the tumor while minimizing dose to uninvolved lung is called for. Enter protons.

Jeffrey Crawford, MD
Latest Article

Hematopoietic growth factors

For years, chemotherapy-associated myelosuppression has represented a major limitation to a patient’s tolerance of anticancer therapy. In addition, the clinical consequences of chemotherapy-induced myelosuppression (such as febrile neutropenia, dose reductions, or lengthy dose delays) may have had significant negative effects on quality of life or even response to treatment.

Jeffrey D. Forman, MD
Latest Article

Rising PSA After Local Therapy Failure: Immediate vs Deferred Treatment

Dr. Moul has done a wonderful job of outlining the scope and magnitude of the “phenomenon” of patients found to have a progressively rising prostate-specific antigen (PSA) level after potentially curative local treatment for prostate cancer. His

Jeffrey D. Seidman, MD
Latest Article

Ovarian Tumors of Low Malignant Potential

The Trimbles have provided auseful overview of the majorclinical and pathobiologic issuesinvolving ovarian borderlinetumors (also termed atypical proliferativetumors or tumors of low malignantpotential). The borderline category ofovarian tumors comprises a heterogeneousgroup of neoplasms that, whensubdivided according to histologicappearance and the presence of peritoneallesions, form distinctive subgroups,each with characteristicpathologic features and a distinctiveclinical course. Thus, retrospectivereviews of thousands of reported caseshave shown that borderline tumors ofall types that are confined to the ovaries(ie, lack peritoneal “implants”)are associated with virtually 100%survival and an extremely low recurrencerate.[1]

Jeffrey F. Hines, MD
Latest Article

Human Papillomaviruses: Their Clinical Significance in the Management of Cervical Carcinoma

Studies have shown a strong association between certain human papillomaviruses and the development of cervical carcinoma and its precursor lesions. The oncogenic potential of papillomaviruses has been clearly

Jeffrey Glassroth, MD
Latest Article

The Granulomatous Disorders

The editors of this impressive new book indicate in their preface that this text was compiled to give "undivided attention" to granulomatous disorders other than sarcoidosis. Toward that end, they have assembled an impressive array of experts from

Jeffrey Hammerbacher, BA
Latest Article

Mutation-Derived Tumor Antigens: Novel Targets in Cancer Immunotherapy

Because of the abundance of promising preclinical and early-phase clinical data, mutation-derived tumor antigens an exciting new class of targets in cancer immunotherapy.

Jeffrey J. Meyer, MD
Latest Article

Intensity-Modulated Radiation Therapy for Anal Cancer

Historically, the treatment of squamous cell carcinoma of the anal canal has been an abdominoperineal resection (APR), resulting in loss of the anus and rectum with need for a permanent colostomy.

Jeffrey J. Olson, MD, FACS
Latest Article

Commentary (Olson): Extended Transbasal Approach to Skull Base Tumors

In this manuscript, Drs. Chandlerand Silva describe the extendedtransbasal approach as a modificationof the commonly used frontoorbitalcraniotomy, which maximizesanterior skull base exposure whileminimizing brain retraction. This conceptis now in its ninth decade, havingbeen described by Frazier inrudimentary form in 1913.[1] The approachwas subsequently reported ina more formalized fashion in the Europeanliterature by Derome and thenexpanded upon by various surgeonsin the United States.[2-4]

Jeffrey K. Browne, PhD
Latest Article

Development and Characterization of Darbepoetin Alfa

Studies on human erythropoietin (EPO) demonstrated that there is a direct relationship between the sialic acid-containing carbohydrate content of the molecule and its serum half-life and in vivo biological activity, but an

Jeffrey K. Cohen, MD
Latest Article

Targeted Focal Therapy in Prostate Cancer: Too Soon for a Paradigm Shift

The morbidities associated with prostate cancer treatments have improved over the years. However, potential overtreatment and the risks of adverse events associated with radical treatment still pose a considerable challenge. Targeted focal therapy (TFT) of prostate cancer appears to be part of a logical continuum in the quest to improve upon the management of early organ-confined disease. TFT is a procedure in which only the cancer in the gland is ablated. The normal gland, sphincter, and in most cases the neurovascular bundles are preserved. Therefore, this approach averts some of the common complications of more radical therapy. Initial experience has been encouraging; however, long-term data and full implementation of emerging advances in imaging are urgently needed before the widespread adoption of this approach. In this review, we present the current status of our knowledge about this procedure and the most important challenges that need to be addressed. We also present the initial results with this approach at our center.

Jeffrey M. Holzbeierlein, MD
Latest Article

Complications of Androgen Deprivation Therapy: Prevention and Treatment

Androgen deprivation, as a form of treatment for prostate cancer,has been used for decades. Within the last decade, however, its use hasincreased significantly. Therefore, it is incumbent upon the physicianto be familiar with the side effects associated with this treatment. Someof these side effects (eg, osteoporosis, changes in lipid profiles, andanemia) may be associated with significant morbidity, whereas others(eg, impotence, decreased libido, fatigue, and hot flashes) primarilyaffect the patient’s quality of life. Prevention strategies and treatmentsexist for many of these side effects. In addition, alternative forms ofantiandrogen therapy such as intermittent hormone ablation andantiandrogen monotherapy may be effective, with the added benefit ofminimizing side effects. This review focuses on the wide range of sideeffects associated with androgen ablation as well as preventive and treatmentstrategies.

Jeffrey M. Ignatoff, MD, FACS
Latest Article

Intravesical Therapy for Superficial Bladder Cancer

Baselli and Greenberg have presented a comprehensive overview of intravesical strategies for the management of superficial urothelial malignancies of the bladder, both past and present. A number of points made in the article deserve further

Jeffrey M. Trent, PhD
Latest Article

Role of Genomics in Identifying New Targets for Cancer Therapy

The detailed map of the human genome can potentially transform future cancer therapy by merging genomics with pharmacology, thereby identifying which patients will benefit from specific therapeutic agents. Single-nucleotide polymorphisms (SNPs) provide a valuable tool for this pharmacogenetic approach to cancer therapy.
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