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Josephine Faust, MD
Latest Article

Irinotecan/Cisplatin Followed by 5-FU/ Paclitaxel/Radiotherapy and Surgery in Esophageal Cancer

Local-regional carcinoma of the esophagus is often diagnosed inadvanced stages because the diagnosis is established when symptomsare severe. The prognosis of patients with local-regional carcinoma ofthe esophagus continues to be grim. While preoperative chemoradiotherapyincreases the fraction of patients who achieve pathologiccomplete response, that percentage is approximately 25%. In an attemptto increase the number of patients with either no cancer in the surgicalspecimen or only microscopic cancer, we adopted a three-step strategy.The current study utilized up to two 6-week cycles of induction chemotherapywith irinotecan (CPT-11, Camptosar) and cisplatin as step 1.This was followed by concurrent radiotherapy and chemotherapy withcontinuous infusion fluorouracil (5-FU) and paclitaxel as step 2. Oncethe patients recovered from chemoradiotherapy, a preoperative evaluationwas performed and surgery was attempted. All patients signed aninformed consent prior to their participation on the study. A total of 43patients were enrolled. The baseline endoscopic ultrasonography revealedthat 36 patients had a T3 tumor, five patients had a T2 tumor, andtwo had a T1 tumor. Twenty-seven patients had node-positive cancer(N1). Thirty-nine (91%) of the 43 patients underwent surgery; all hadan R0 (curative) resection. A pathologic complete response was noted in12 of the 39 patients. In addition, 17 patients had only microscopic(< 10%) viable cancer in the specimen. Therefore, a significant pathologicresponse was seen in 29 (74%) of 39 taken to surgery or 29 (67%)of all 43 patients enrolled on the study. With a median follow up beyond25 months, 20 patients remain alive and 12 patients remain free ofcancer. Our preliminary data suggest that the proportion of patientswith significant pathologic response can be increased by using thethree-step strategy.

Josette Brière, MD, PhD
Latest Article

Splenic Marginal Zone Lymphoma: Current Knowledge and Future Directions

In this article, we review the current knowledge on the biological findings, clinical features, and therapeutic approaches for splenic marginal zone lymphoma.

Josh Lauring, MD, PhD
Latest Article

TORn in Two Over Breast Cancer Drug Resistance

Knowing the genetic makeup of patient tumors permits the development of new DNA-based diagnostics, such as BEAMing and PARE. By incorporating these new tools into future trials, we should be able to concurrently learn about drug resistance and significantly improve patient responses.

Josh Wisell, MD
Latest Article

Diagnosis of Invasive Lobular Carcinoma in a Young Woman Presenting With Pleomorphic Lobular Carcinoma in Situ on Core Biopsy

A 40-year-old premenopausal woman with a new diagnosis of invasive lobular carcinoma occurring in a background of lobular carcinoma in situ presents to a multidisciplinary second opinion clinic.

Joshi J. Alumkal, MD
Latest Article

Targeted Therapy in Prostate Cancer: Is There Hope Beyond the Androgen Receptor?

We need to understand each patient’s cancer and its microenvironment well enough to develop targeted treatments that will kill the tumor the first time-for if we let it escape, 70 years of prostate cancer research teaches us that our job will only get harder.

Joshua A. Jones, MD, MA
Latest Article

Palliative Radiotherapy for Prostate Cancer: Encouraging Single-Fraction Radiotherapy

As new data and new treatment options emerge, palliative radiotherapy algorithms will need to undergo continuous modifications and updates to ensure that patients receive optimal symptom relief.

Joshua A. Perkel, MD
Latest Article

Irinotecan and Gemcitabine in Patients With Solid Tumors: Phase I Trial

Using a day 1 and 8, every-3-week schedule, our purpose was to determine the maximum tolerated dose of irinotecan (CPT-11, Camptosar) that can be administered immediately after gemcitabine (Gemzar) at a dose of 1,000 mg/m² IV. In this phase I trial, the maximum tolerated dose was defined as the dose level immediately below the level in which two of the first three patients in any cohort, or at least two of six patients in any expanded cohort, experienced dose-limiting toxicity. Dose-limiting toxicity pertained only to toxicity during the first cycle of treatment. Escalation of irinotecan was planned in groups of three patients, with three additional patients added at the first indication of dose-limiting toxicity. A total of 19 patients have been enrolled.

Joshua D. I. Ellenhorn, MD
Latest Article

When It Comes to the Efficacy of Metastasectomy, Biology Is King

“Biology is King; selection of cases is Queen, and the technical details of surgical procedures are princes and princesses of the realm who frequently try to overthrow the powerful forces of the King and Queen, usually to no long-term avail, although with some temporary apparent victories.”

Joshua H. Petit, MD
Latest Article

Metastatic Papillary Adenocarcinoma in a 22-Year-Old: Is Her History of Mayer-Rokitansky-Küster-Hauser Syndrome Causative or Incidental?

A 22-year-old college student with primary amenorrhea due to Müllerian agenesis presented with a headache, dysarthria, nausea, vomiting, and left upper extremity weakness. MRI of the brain showed numerous intracranial lesions.

Joshua L. Roffman, MD
Latest Article

Commentary (Roffman/Stern): Delirium in Palliative Care

Delirium in the setting of terminalillness is common; moreover,it can create extremehardships for patients and their families,who are already facing the mostdifficult of circumstances. However,delirium that develops in the contextof comorbid medical conditions maybe readily reversible with thoughtfulevaluation and effective management.Friedlander, Brayman, and Breitbartdescribe important factors to considerwhen assessing and treating deliriumin the context of end-stage illness.We will elaborate on their discussionand emphasize some common pitfallsassociated with the management ofdelirium.

Joshua M. Ruch, MD
Latest Article

Evolving Therapeutic Paradigms for Advanced Prostate Cancer

This review will discuss recently FDA-approved agents for advanced prostate cancer and those under investigation in phase III trials.

Joyce Liu, MD, MPH
Latest Article

New Advances in Ovarian Cancer

Epithelial ovarian cancer is the leading cause of death from gynecologic malignancy in the United States, with approximately 15,000 deaths per year. Platinum/taxane doublets have long been considered the standard treatment regimen for advanced-stage disease; however, recent studies have sought to improve on the outcome from this therapy. Intraperitoneal (IP) chemotherapy has been shown to yield superior progression-free survival (PFS) and overall survival (OS); however, logistical problems and toxicities have limited more widespread adoption. Recent studies have also suggested that a “dose-dense” schedule of paclitaxel in combination with carboplatin may result in improved outcomes, and the impact of biological therapies in the first-line setting is under active investigation. In the setting of recurrent disease, preliminary results suggest that novel doublet regimens such as carboplatin and pegylated liposomal doxorubicin may have similar activity to standard platinum/taxane doublets while carrying a reduced risk of allergic reactions. Additionally, targeted therapy remains an active area of investigation, with evidence of activity from agents such as PARP inhibitors, anti-angiogenics, and PI3 kinase inhibitors. Here, we review recent advances in our understanding of ovarian cancer and its treatment in both the newly diagnosed and recurrent settings.

Joyce Thompson, MD
Latest Article

Extending Principles Learned in Model Systems to Clinical Trials Design

Clinical results with irinotecan (CPT-11 [Camptosar]) and other camptothecin derivatives in various cancers, although encouraging, have fallen short of the expectations predicted by preclinical models. One proposed

Joycelyn L. Speight, MD, PhD
Latest Article

Commentary (Speight): Update on Malignant Mesothelioma

Malignant pleural mesothelioma(MPM) is an invasivelocally aggressive tumorthat is nearly always fatal. Historically,treatments resulting in durable controlhave seemed unobtainable andfostered a somewhat fatalistic managementapproach. Until recently, nonovel therapies had emerged that offeredreal hope for improvement inthe poor median overall and progression-free survival. In this issue ofONCOLOGY, Dr Antman and colleaguesprovide an overview of theepidemiology, natural history, andmanagement strategies for malignantmesothelioma, with an emphasis onMPM.[1]

Juan D. Garisto, MD
Latest Article

Active Surveillance for Prostate Cancer: How to Do It Right

In this review of active surveillance for favorable-risk prostate cancer, we will discuss the rationality of this approach, the biological evidence for employing active surveillance in Gleason pattern 3 and 4 prostate cancer, patient selection for active surveillance, clinical trial data on active surveillance, and the role of prostate cancer biomarkers and imaging studies for clinical decision making in patients with low-risk disease.

Juan Herrada, MD
Latest Article

Early-Stage Breast Cancer and Adjuvant Therapy

Carcinoma of the breast is the most common cancer in women in the United States and is second only to lung cancer as a cause of cancer death in women. The incidence of breast cancer has risen steadily over the past decade, with the most dramatic increase seen in smaller primary breast tumors, partly because widespread use of screening mammography permits earlier detection [1].

Juan Hinojosa-Fano
Latest Article

Man With Locally Advanced, High-Risk Prostate Cancer Asks About Adding Chemotherapy to His Treatment

A 55-year-old Hispanic male presents with a family history of gastric cancer in one sibling and prostate cancer in an older brother. CT performed in March 2015 for IMT surveillance showed a heterogeneous prostate with local invasion involving the bladder, seminal vesicles, and perirectal fat.

Judith A. Aberg, MD
Latest Article

Prophylaxis Against Fungal Infections and Cytomegalovirus Disease After Bone Marrow Transplantation

Among the serious complications associated with bone marrow transplantation are invasive fungal infections caused by organisms such as Candida and Aspergillus species and end-organ disease caused by

Judith A. Shell, PhD, LMFT, RN
Latest Article

Sexuality and Body Image Concerns After Treatment for Breast Cancer

The patient, KC, is a 41-year-old Caucasian female. She has been married to SC for 16 years and has three children, aged 14, 11, and 9 years old. She has always been a homemaker with plenty of energy and says that she has been “the rock” during any crisis. KC was diagnosed with T2N1M0 poorly differentiated invasive ductal carcinoma of the breast with lobular features in 2007. She decided to have a mastectomy without immediate reconstruction because she did not know if reconstruction was what she wanted. She has also undergone four courses of chemotherapy (doxorubicin [Adriamycin] and paclitaxel [Taxol]) followed by radiation therapy.

Judith E. Karp, MD
Latest Article

Management of Infections in Patients With Acute Leukemia

Several recent studies have addressed the management of infectious problems in patients with acute leukemia. Although those studies have served to emphasize the fundamental management principles formulated and proven

Judith F. Margolin, MD
Latest Article

What Is the Optimal Therapy for Childhood AML?

Improvement in pediatric acute myelogenous leukemia (AML) over the past 30 years has been only modest. Although rates of complete remission induction have climbed steadily to 85% or 90%, cure rates remain in the 50% to 60% range. These figures may inspire envy from medical oncologists treating adults with AML, but they lag far behind the successes in treating pediatric acute lymphocytic leukemia (ALL).

Judith Feinberg, MD
Latest Article

Prophylaxis Against Fungal Infections and Cytomegalovirus Disease After Bone Marrow Transplantation

Among the serious complications associated with bone marrow transplantation are invasive fungal infections caused by organisms such as Candida and Aspergillus species and end-organ disease caused by

Judith L. O’donnell, RN
Latest Article

Gemcitabine and Irinotecan in Locally Advanced or Metastatic Biliary Cancer: Preliminary Report

Chemotherapy has had limited success in biliary tract cancer. Of thenewer agents, gemcitabine (Gemzar) and irinotecan (CPT-11, Camptosar)both have single-agent activity in patients with advanced disease.We conducted a phase II trial to study the efficacy and toxicity of thecombination of gemcitabine plus irinotecan in patients with locallyadvanced or metastatic biliary tract cancer. The study has enrolled 14patients with histologically or cytologically documented cancer of thebiliary tract or gallbladder with bidimensionally measurable disease,Eastern Cooperative Oncology Group performance status 0 or 1,decompressed biliary tree, and no prior exposure to chemotherapy.Gemcitabine at 1,000 mg/m2 and irinotecan at 100 mg/m2 were bothadministered on days 1 and 8, every 21 days. In patients who had lessthan grade 3 hematologic and less than grade 2 nonhematologic toxicityfollowing cycle 1, the dose of irinotecan was increased to 115 mg/m2 forsubsequent cycles. A total of 65 cycles of chemotherapy have beenadministered, with an average of 4.5 cycles per patient (range: 1 to 11cycles). The median treatment duration was 3 months (range: 0.75 to 8months). An objective partial response was determined radiographicallyin two patients (14%) while stable disease for periods ranging from 4to 11.5 months was noted in six patients (43%). Toxicity consisted ofgrade 3/4 neutropenia in seven patients (50%) with no episodes offebrile neutropenia, grade 3/4 thrombocytopenia in four (28%), grade3 diarrhea in two (14%), and grade 3 nausea in one patient. Thecombination of gemcitabine plus irinotecan appears to possess modestclinical activity, and it is well tolerated in patients with advanced biliarycancer. Patient accrual is ongoing to this study.

Judith M. Fouladbakhsh, PhD
Latest Article

Yoga

Yoga, an ancient tradition that originated approximately 5,000 years ago in Central Asia, is a complete system of mental and physical practices for health and well-being. Predominantly practiced within the philosophical context of Ayurvedic medicine in India, yoga as a mind-body therapy is now also increasingly popular in the West, practiced by approximately 15 million individuals.

Judith A. Paice, RN, PhD
Latest Article

Navigating Cancer Pain Management in the Midst of the Opioid Epidemic

Two public health crises, the epidemics of chronic pain and of opioid misuse, are creating challenges for cancer pain management.

Judy E. Garber, MD, MPH
Latest Article

Commentary (Masciari/Garber): Evaluation and Management of Women With BRCA1/2 Mutations

The review by Beth Peshkin andClaudine Isaacs in this issue ofONCOLOGY is an excellentoverview of the recognition, evaluation,and clinical management ofwomen with BRCA1 and BRCA2mutations. It is comprehensive andpractical, and emphasizes the approachthat a risk assessment and clinicalgenetics program might take tothe evaluation of an individual concernedabout the possibility thathereditary breast/ovarian cancer predispositionmight be present in herkindred. The authors clearly and conciselypresent the risks of breast, ovarian,and other cancers associated withBRCA1 and BRCA2 mutation carrierstatus, as well as some of the issues thathave arisen in the estimation of thoserisks. They provide a review of factorsthat may modify gene penetrance(cancer risks), and devote the finalsegment of their article to a clear andrational discussion of the surveillanceand preventive options available forthe management of the associatedbreast and ovarian cancer risks.

Judy Jones, MS
Latest Article

Future Directions in the Adjuvant Treatment of Colon Cancer

Adjuvant chemotherapy has been shown to alter the natural history of patients with resected colon cancer. Two regimens (fluorouracil [5-FU] plus levamisole (Ergamisol) and 5-FU plus leucovorin) have been found most

Judy Sisk, RN
Latest Article

Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast Cancer

A phase II trial evaluated the effectiveness and toxicity of combination paclitaxel (Taxol), gemcitabine (Gemzar), and trastuzumab (Herceptin) as first-line therapy for patients with newly diagnosed HER2-overexpressing

Juergen Dethling, MD
Latest Article

UFT Plus Calcium Folinate Plus Radiotherapy for Recurrent Rectal Cancer

Uracil and tegafur (in a molar ratio of 4:1 [UFT]) plus calcium folinate comprise the components of the oral agent, Orzel, which appears to have activity comparable to intravenously administered 5-fluorouracil. This article

Juhi Husain, MD
Latest Article

Granulocytic Sarcoma in a Patient With Myelodysplastic Syndrome

Our case illustrates the fact that MDS-associated GS can be treated palliatively with radiation and hypomethylating agents in an appropriate setting. With the growing geriatric patient population, effective treatment options are needed in this disease.