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Unmet Needs and Future Perspectives in Multiple MyelomaA panel of experts discuss unmet needs in multiple myeloma and offer perspectives on the future treatment landscape.
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Natural History and Treatment of Malignant ThymomaThymomas are rare, slow-growing neoplasms that are considered to be malignant because of their potential invasiveness. The most widely used staging system is that of Masaoka and colleagues, which takes into account
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Renal Cancer Management in a Patient With Chronic Kidney DiseaseA 69-year-old man presented in the urology clinic for evaluation of bilateral renal masses, discovered incidentally during routine exams for follow-up of his chronic kidney disease.
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The Variegated Morphology of HPV-Related Neoplasms of the PenisOur commentary aims to expand on the evolution and present state of the art in the pathology of HPV in penile cancer and precancerous lesions.
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Revisiting Induction Chemotherapy for Head and Neck CancerSquamous cell carcinomas of the head and neck are highly responsiveto induction chemotherapy. However, randomized trials have failedto demonstrate a survival advantage with the addition of induction chemotherapyto locoregional therapy consisting of surgery and/or radiationtherapy. Currently, concomitant radiation and chemotherapy hasemerged as a standard and has optimized locoregional control in headand neck cancer. In this setting, the addition of induction chemotherapymay further improve outcome by enhancing both locoregional and distantcontrol. As interest in induction regimens is renewed, we elected toconduct a systematic review of trials of induction chemotherapy forlocoregionally advanced head and neck cancer. The most studied combination-cisplatin plus fluorouracil (5-FU)-achieves objective responserates of about 80%. In a meta-analysis, induction with platinum/5-FU resulted in a small survival advantage over locoregionaltherapy alone. The introduction of a taxane into induction chemotherapyregimens has produced promising results. Induction chemotherapyshould be the subject of further clinical research in head andneck cancer. Randomized clinical trials in which the control arm isconcurrent chemoradiotherapy and the experimental arm is inductionchemotherapy followed by concurrent chemoradiotherapy are planned.Platinum/taxane combinations are the preferred regimens for furtherstudy in the induction setting and a suitable platform with which toinvestigate the addition of novel targeted agents.
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UFT/Leucovorin Plus Weekly Irinotecan in Advanced or Metastatic Colorectal CancerThis is an open-label, nonrandomized phase I trial to determine the safety and maximum tolerated dose of irinotecan with a fixed dose of UFT plus oral leucovorin in patients with advanced or metastatic colorectal cancer.
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Anthracycline and Trastuzumab in Breast Cancer TreatmentThis study was designed to evaluate the cardiac safety of the combined treatment of HER2-positive metastaticbreast cancer patients with trastuzumab (Herceptin) plus epirubicin and cyclophosphamide (EC) incomparison with EC alone in HER2-negative metastatic breast cancer patients. Patients included those withmetastatic breast cancer without any prior anti-HER2 treatment, anthracycline therapy, or any other chemotherapyfor metastatic disease. This was a nonrandomized, prospective, dose-escalating, multicenter, openlabel,phase II study in Germany. A control group of 23 patients received EC 90/600 mg/m2 3-weekly for sixcycles (EC90 alone). A total of 26 HER2-positive patients were treated with trastuzumab, or H (2 mg/kg weeklyafter an initial loading dose of 4 mg/kg), and EC 60/600 mg/m2 3-weekly for six cycles (EC60+H); another 25HER2-positive patients received H and EC 90/600 mg/m2 3-weekly for six cycles. Asymptomatic reductions inleft ventricular ejection fraction (LVEF) of more than 10% points were detected in 12 patients (48%) treatedwith EC60 + H and in 14 patients (56%) treated with EC90 + H vs 6 patients (26%) in the EC90 alone cohort.LVEF decreases to < 50% occurred in one patient in the EC60+H cohort and in two patients in the EC90+Hcohort during the H monotherapy. No cardiac event occurred in the cohort with EC90 alone. The overallresponse rates for EC60+H and EC90+H were >60%, vs 26% for EC90 alone. The interim results of this studysuggest the cardiac safety of the combination of H with EC may be greater than that of H with AC (doxorubicin[Adriamycin]/cyclophosphamide); however, studies in larger numbers of patients are warranted. The combinationregimen revealed promising efficacy.
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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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The Role of Adjuvant Radiation in Endometrial CancerEndometrial cancer is the most common gynecologic malignancy, with an estimated 40,100 cases and 7,470 deaths in 2008. This malignancy represents 6% of all cancers, and 3% of cancer deaths in women. Endometrial cancer is more prevalent in older women, with an incidence of 1 in 142 for women 40 to 59 years old, increasing to 1 in 81 women over 70 years old.[1] Median age at diagnosis is 62.[2] The mortality of endometrial cancer has decreased from 4.18 to 4.12 per 100,000 from 1991 to 2004.
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Paclitaxel and Carboplatin as First-Line Chemotherapy for Advanced Breast CancerIn a phase II study, 66 patients with advanced breast cancer (median age 56 years; range, 28 to 75 years) were treated with paclitaxel (Taxol), 175 mg/m² infused over 3 hours, and carboplatin (Paraplatin), dosed to attain an
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The Evolving Landscape of Gastrointestinal Infections in Neutropenic PatientsDiagnosis and management of GI complications in neutropenic patients benefit from the use of collaborative multidisciplinary teams to optimize outcomes.
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Gemcitabine and UFT Plus Oral Calcium Folinate: Phase I StudyGemcitabine (Gemzar) (2-deoxy-2,2-difluorocytidine) is a new antimetabolite being increasingly used in the treatment of solid tumors. It is an analog of deoxycytidine and cytosine arabinoside (Ara-C) (Figure 1) that has shown significant activity
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Anthracycline vs Nonanthracycline Adjuvant Therapy for Breast CancerThe treatment of breast cancer has progressed substantially overthe past 15 years. Data from randomized adjuvant trials have shownthat the risk of disease recurrence and death is significantly reducedwhen adjuvant chemotherapy and/or hormonal therapy is added to treatment.As new strategies are incorporated, one of the continued controversiesin patient management is whether adjuvant anthracyclinesshould be the preferred treatment for all patients. Data from randomizedand translational clinical trials have become available and arehelping to elucidate the proper role of anthracyclines, as well as their acuteand long-term toxicities. In most situations, an anthracycline is currentlypreferred, but other single and combination chemotherapies arecurrently under evaluation and appear promising for use in the adjuvantsetting. Continued breast cancer research using molecular markers(such as topoisomerase II–alpha and gene clusters) as predictors oftreatment response, could help individualize decisions regardingwhether to incorporate anthracyclines into adjuvant therapy regimens.
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Doxorubicin and Paclitaxel (Sequential Combination) in the TreatmentBased 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
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Oncology Clinical Trials During the COVID-19 PandemicABSTRACT The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread all over the world in the past several months. No effective treatment for COVID-19 has been established. High transmissibility and considerable mortality rates have forced many national governments to implement quarantine measures. Many patients with cancer rely on clinical trials to receive their oncologic care, but the routine conduct of clinical trials has substantially changed because of the COVID-19 pandemic. The oncology research community should implement formal policies based on the guidance given from regulatory agencies, with the goal of minimizing the risks of COVID-19 infection while maintaining appropriate oncologic treatments for patients during this pandemic.
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Chemotherapy-Induced Cardiomyopathy: Clinical Scenarios and ChallengesWe will discuss the deleterious cardiovascular effects of anthracyclines and HER2-targeted agents in a case-based format, as well as specific approaches to prevention and treatment of associated cardiotoxicity.
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Four steps to improve the profitability of your oncology practiceRunning a successful oncology practice requires you to be one part doctor, one part CEO. After all, your practice demands a skilled combination of high-quality patient care and business acumen. And with countless office procedures and mountains of paperwork involved, your practice also requires that you pay close attention to even the smallest details, which means that you must also serve as an auditor and a chief financial officer. The survival of the practice, like the quality of the care you deliver, rests in the details.
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Isolated Limb Perfusion for Stage III Melanoma: Does It Still Have a Role in the Present Era of Effective Systemic Therapy?Effective systemic therapy for the treatment of stage III melanoma has emerged. Whether this influences treatment choice in stage III melanoma patients with in-transit metastases is the subject of this review.
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The Flu Vaccine in Cancer Patients: Insights From Other Immune-Suppressed PopulationsInfluenza immunization can have four possible outcomes: (1) the vaccine is well tolerated and protects against subsequent infection; (2) the vaccine is not well tolerated-ie, it is associated with an excess risk of morbidity or mortality-but it protects against subsequent infection; (3) the vaccine is well tolerated but confers no protection; and (4) the vaccine is associated with morbidity and/or mortality and confers no protection. The CDC has evaluated the likelihood of each of these scenarios and recommends vaccination of cancer patients. Boehmer and colleagues have reviewed the efficacy data for influenza vaccination in cancer patients and have arrived at a more differentiated view.
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Current Strategies for the Immunotherapy of Multiple MyelomaHere we outline the most promising novel cellular immune strategies for patients with multiple myeloma. In addition, we highlight combinatorial approaches that, it is hoped, will further optimize cellular immunotherapies for myeloma and lead to deep and durable responses and, possibly, even cures.
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Target Folate Receptor Alpha in Ovarian Cancer?Dr. Dmitriy Zamarin speaks with Cancer Network about the findings of a phase II trial in platinum-resistant ovarian cancer patients.
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The Promise of Pharmacogenomics: Gemcitabine and PemetrexedAlthough no overall differences in survival have been observed betweenthe many chemotherapy combinations in non–small-cell lungcancer, the clinical application of mRNA expression levels of amplifiedgenes may disclose many genetic influences on cytotoxic drug sensitivityand enable clinicians to tailor chemotherapy according to eachindividual’s gene profile. Specifically, the assessment of ribonucleotidereductase subunit M1 and thymidylate synthase mRNA expression levelsmight select patients who benefit from gemcitabine (Gemzar) orpemetrexed (Alimta) combinations. Until recently, clinical prognosticfactors such as performance status, weight loss, and lactate dehydrogenasewere the only parameters used to predict chemotherapy responseand survival. However, accumulated data indicate that overexpressionof genes involved in cancer glycolysis pathways plays an important role,and might be an independent mechanism of chemoresistance. Thedysregulation of glycolytic genes is affected by growth signals involvingthe PI3K/Akt pathway and downstream genes such as hypoxiainduciblefactor-1-alpha. One can thus envision that substantial improvementsin therapeutic outcome could benefit from the integrationof tailored ribonucleotide reductase-dependent chemotherapy, ribonucleotidereductase antisense therapy, and targeted therapy.
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FGFR Inhibitor Shows Preclinical Activity in Breast CancerThis video highlights preclinical activity of a novel FGFR inhibitor that has been tested alone and in combination with antihormonal therapy in breast cancer cell lines.
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Hormone-Resistant Prostate Cancer: New Therapies NeededHormone-refractory prostate cancer (HRCaP) is both heterogeneous and lethal. Multiple treatment options exist, including secondary hormonal manipulations, chemotherapy, experimental options, and best supportive care. Choosing the appropriate therapy for an individual patient depends on several important clinical factors such as the presence or absence of symptomatic metastatic disease, age and comorbidities, and prostate-specific antigen velocity. While only docetaxel (Taxotere)-based chemotherapy has been proven to improve survival in this setting, a wide range of therapies may be effective for any individual. Palliative maneuvers, such as external-beam radiation, bisphosphonate therapy, radiopharmaceuticals, and pain management are critical for appropriate patient management. Several promising novel therapies are in late-stage testing and will hopefully provide more treatment options for these patients.
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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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PET/CT, 3T MRI perform equally well in lung cancer stagingNo clear winner has emerged in a head-to-head comparison of whole-body FDG-PET/CT and whole-body 3T MRI for non-small-cell lung (NSCLC) cancer staging. Unenhanced PET/CT proved better for detecting metastatic lymph nodes and soft-tissue involvement, while MR was more sensitive to the presence of brain and liver metastases.
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Oncology Peer Review On-The-Go: Improving Experience of LGBTQ+ Patients in Cancer CareThis episode features Don Dizon, MD, discussing how LGBTQ+ patients with cancer navigate the world of cancer care, and the critical steps needed to improve their experiences.
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Commentary (Quek et al): Management of Patients With Muscle-Invasive and Metastatic Bladder CancerDrs. Henry, MacVicar, and Hussainprovide a timely reviewof the current management ofmuscle-invasive and metastaticurothelial cancer. The emerging roleof neoadjuvant chemotherapy and thepromise of novel, less toxic targetedtherapies are of particular interest inthe treatment of a disease in whichoutcomes remain poor for locally advancedand metastatic involvementdespite an aggressive multimodalityapproach.[1] We wish to briefly commenton three issues raised by theauthors: (1) the role of surgery in themanagement of invasive disease,(2) the indiscriminate use of neoadjuvantchemotherapy for clinically localizeddisease, and (3) the currentstatus of bladder-sparing approaches.
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Linezolid-A New Option for Treating Gram-Positive InfectionsThe increase in serious gram-positive infections has increased the need for treatment of gram-positive infections in patients with hematologic malignancies. Common gram-positive pathogens exhibit a variety of resistance
