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Cisplatin/Etoposide vs Paclitaxel/Cisplatin/G-CSF vs Paclitaxel/Cisplatin in Non-Small-Cell Lung CancerA phase III trial conducted by Eastern Cooperative Oncology Group (ECOG) investigators assessed the possible impact of paclitaxel on survival, response, and toxicity in patients with
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Decision-Making in the Management of Early Prostate CancerAs part of our coverage of the ASCO GU Cancers Symposium, we discuss decision-making in the management of patients with early-stage prostate cancer.
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Brachytherapy for Carcinoma of the LungAn estimated 157,000 patients died of lung cancer in the United States in the year 2000.[1] Although surgery can be curative, only about 20% of patients are amenable to complete surgical resection. Most of the other patients are treated with radiation
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SWOG 80702: Impressions on the Efficacy DataPanelists discuss how the efficacy data from SWOG 80702 demonstrated that shortened duration of adjuvant chemotherapy (3 months vs 6 months) yielded comparable survival outcomes while significantly reducing treatment-related toxicities, challenging previous standard-of-care approaches for patients with stage III colon cancer.
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Commentary (Shuster): Delirium in Palliative CareMiriam Friedlander, YanaBrayman, and WilliamBreitbart have produced anexcellent review of delirium in thepalliative care setting. Their paper isthorough, readable, and thoughtful,and will be helpful to oncologists caringfor patients with advanced illness.I particularly like the fact that theauthors make it clear that delirium isnot only a very common complicationof advanced cancer, but that it isalso a major source of suffering anddistress for both patients and families.In view of the problems deliriumpresents and the frequency with whichdelirium arises as death approaches,this complication of advanced and terminalillness has received inadequateattention. My thanks and congratulationsgo to the authors for providingsuch a clear and helpful review of thischallenging clinical problem.
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GM-CSF and IL-2 Combination as Adjuvant Therapy in Cutaneous MelanomaCytokines have been used in the treatment of patients with cutaneousmelanoma. Granulocyte-macrophage colony-stimulating factor(GM-CSF, sargramostim [Leukine]) leads to dendritic cell/macrophagepriming and activation, and also increases interleukin-2 (IL-2)receptor expression on T lymphocytes. IL-2 creates lymphokineactivatedkiller cells and tumor-infiltrating lymphocyte cells. In thisopen-label, single-arm study of 16 high-risk patients, we combined thesetwo agents to take advantage of their different but complementary functions.All patients underwent potentially curative surgery. Postoperatively,each patient received GM-CSF at 125 μg/m2/d subcutaneously(SC) for 14 days; this was followed by IL-2 at 9 million IU/m2/d SC for4 days, and then 10 to 12 days of no treatment. In addition, patientswho had large tumors that could yield over 100 million live tumor cellsreceived autologous melanoma vaccines. The duration of follow-upranged from 21 to 42 months (median: 27 months). During follow-up,five patients developed metastases. This program was carried out on anoutpatient basis, and no hospitalization was required. It was well toleratedwith minimal side effects. The combination treatment regimen ofGM-CSF and IL-2 with or without autologous vaccine used adjuvantlyappears to benefit high-risk melanoma patients; further clinical testingof this regimen is warranted.
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Paclitaxel as First-Line Treatment for Metastatic Breast CancerWhen administered as a single agent in pretreated patients with advanced breast cancer, paclitaxel (Taxol) exhibits remarkable antitumor activity. This trial was undertaken to compare paclitaxel with standard
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Book Review:Wintrobe’s Clinical Hematology, 10th EditionThe 10th edition of Wintrobe’s Clinical Hematology is a two volume, multiauthored work that spans the ever-expanding discipline of hematology in over 2,600 pages. The book is appropriately introduced by an excellent short chapter written previously by Dr. Wintrobe on “The Diagnostic and Therapeutic Approach to Hematologic Problems.” There follows a valuable series of six chapters totaling 133 pages devoted to laboratory hematology, including blood and bone marrow examination, immunodiagnosis, clinical flow cytometry, cytogenetics, clusters of differentiation, and molecular genetics. These chapters contain ample illustrations, diagrams, tables, and references.
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Endometrial Carcinoma and Precursors: Diagnosis and TreatmentThis clinically oriented text focuses on the diagnosis and management of endometrial adenocarcinoma and endometrial hyperplasia. Due to its clinical orientation, the book does not include information on the molecular basis of endometrial cancer.
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Is Radical Prostatectomy Appropriate for Very-High-Risk Prostate Cancer Patients? No.It is our opinion that surgery is inappropriate for very-high-risk prostate cancer and that a combination of EBRT and ADT should be the preferred treatment modality.
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Pituitary Adenomas: Current Methods of Diagnosis and TreatmentPituitary adenomas are benign neoplasms that can be effectively managed by a variety of therapeutic options. The clinician's goal in managing patients with these tumors should be to minimize the morbidity of each intervention used in diagnosis and treatment. Standard diagnostic interventions include MRI, hormonal assessment, and tissue diagnosis. Therapies include transsphenoidal surgery, external-beam radiotherapy, newer stereotactic irradiation techniques, and medical management. Appropriate treatment selection requires detailed knowledge of the expected outcomes and side effects of each option. Newer and perhaps less toxic treatment techniques are evolving and require further evaluation. [ONCOLOGY 11(6):791-796, 1997]
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Proton-beam therapy calls for unique skillsThe first proton-beam therapy center in Loma Linda, Calif., opened almost 20 years ago, and today six are operating in the U.S. Another center will open by the end of 2009 with several more planned in the next two years, including centers in continental Europe and the UK. A growing body of research affirms the efficacy of proton-beam therapy (see Table).
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Can HNPCC Be Diagnosed in Presymptomatic Patients?This special series on cancer and genetics is compiled and edited by Henry T. Lynch, MD, director of the Hereditary Cancer Institute and professor of medicine and chairman of the Department of Preventive Medicine and Public
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Lymphatic Mapping in the Treatment of Breast CancerDeveloped initially for the treatment of malignant melanoma, lymphatic mapping and sentinel lymph node biopsy have recently been introduced into the treatment of early breast cancer. In breast cancer patients, harvested
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Commentary (Barden/Daly): Surgery in the Older PatientThe elderly population in the United States increased by a factor of 11 in the past century, while the under age 65 population tripled in that same period.[1] Given that the majority of cancers occur in patients over 65 years old, there is an increasing need for surgical interventions in the elderly.
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Historical and Methodological Perspectives on Cancer Outcomes ResearchOutcomes research is the study of the net effects of the health care process on the health and well-being of individuals and populations. It encompasses a wide breadth of issues, including measurement of patient preferences and health status, broadly referred to as quality of life. Evaluation of health-related quality of life in research studies has been facilitated by the development of a number of measurement tools. In addition to general health tools, cancer-related tools are available, some of which include cancer site-specific or symptom-specific measures. Preference assessment, from the perspective of the patient or general population, is necessary to incorporate quality of life into economic analyses. Various techniques are available to assign preference values to outcomes; metrics such as quality-adjusted life-years (QALYs) are then used to combine quality and quantity of life into a usable value for economic analyses. In the future, quality of life and economic measurements should be incorporated into phase III trials, effectiveness trials, and observational studies. [ONCOLOGY 9(Suppl):23-32, 1995]
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Is Imatinib Still an Acceptable First-Line Treatment for CML in Chronic Phase?Is it reasonable to start all new CML patients on treatment with imatinib alone and continue the drug indefinitely in those who fare well, or should one start treatment with one of the newer agents or possibly with imatinib in combination with another anti-CML agent in order to secure the best possible outcome for an individual patient?
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Commentary (Palesty et al)-Imatinib Mesylate: A Molecularly Targeted Therapy for Gastrointestinal Stromal TumorsDr. Eisenberg has produced anexcellent, concise, yet comprehensivereview of the evolutionof the KIT inhibitor imatinibmesylate (Gleevec) and the preoperativeand postoperative treatmentdilemmas surrounding mesenchymalgastrointestinal stromal tumors(GISTs), particularly in the face ofadvanced disease and recurrences. Thefocus of the article is on the naturalhistory of GISTs, from a molecularand pathobiologic perspective, toclarify the rationale for the use ofimatinib.
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OncView™ Podcast: Immunotherapy Response Monitoring in MelanomaJohn Kirkwood, MD, PhD, discussed considerations for treating patients with melanoma using immunotherapy and how to properly monitor responses.
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Liver, Gallbladder, and Biliary Tract CancersThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of liver, gallbladder, and biliary tract cancers using radiation, surgery, and medical treatment.
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New Insights Into the Immunomodulatory Effects of Exercise and Potential Impact on TumorigenesisExercise at the right dosage could provide a potent stimulus for acute changes and long-term adaptations in numerous biological pathways that influence tumorigenesis.
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Squamous Cell Carcinoma of the Anal MarginThis paper consists of a review of the literature on carcinoma of the anal margin, as well as the authors' institutional experience with this uncommon malignancy. The authors offer recommendations for treatment based on the size of the tumor, which correlates with the T-stage from the TNM or Union Internationale Contre le Cancer (UICC) staging systems. They recommend radiation alone or local excision for T1 lesions, radiation and elective nodal irradiation for T2 lesions, and chemoradiation, including irradiation of the primary tumor and inguinal and pelvic nodes, for T3 and T4 lesions.
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Nonmyeloablative Preparative Regimens for Allogeneic Hematopoietic TransplantationHigh-dose myeloablative therapy with allogeneic hematopoietictransplantation is an effective treatment for hematologic malignancies,but this approach is associated with a high risk of complications.The use of relatively nontoxic, nonmyeloablative, or reduced-intensitypreparative regimens still allows engraftment and the generation ofgraft-vs-malignancy effects, is potentially curative for susceptiblemalignancies, and reduces the risk of treatment-related morbidity.Two general strategies along these lines have emerged, based on theuse of (1) immunosuppressive chemotherapeutic drugs, usually apurine analog in combination with an alkylating agent, and (2) lowdosetotal body irradiation, alone or in combination with fludarabine(Fludara).
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ASCO: Recent Advances in Using a “Systems Approach” in OncologyJohn Mendelsohn, president of the MD Anderson Cancer Center, discusses with ONCOLOGY the recent advances in using a “systems approach” in oncology and how he believes this will affect outcomes in the future.
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The Molecular Basis of Cancer, 2nd EditionEdited by John Mendolsohn, MD, Peter M. Howley, MD, Mark A. Israel, MD, and Lance A. Liotta, MD, PhD, The Molecular Basis of Cancer is designed for students, researchers, and physicians in a variety of disciplines. It does not provide a detailed description of the clinical manifestations of human neoplasia. There is, instead, an extensive presentation of the scientific basis of cancer development and therapy. The book includes the contributions of 61 authors, virtually all of whom are recognized experts in their respective fields, from throughout the United States and Europe. The references are comprehensive and relatively current, given the lag time in going to press. The book will certainly benefit both basic scientists and clinicians alike.
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Current Issues in the Treatment of Resistant Bloodstream InfectionsBloodstream infections cause significant morbidity and mortality for patients with hematologic malignancy. Antimicrobial drugs are the most reliable currently available treatment for infection, but several issues must be
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Prostate Cancer in the Older ManMost 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
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Live Viruses in Cancer TreatmentAlthough antitumor activity and a low toxicity profile have been demonstrated for several oncolytic viruses, the development of viral therapy in cancer treatment has been limited by a lack of definitive phase III trials. The use
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Does Radiotherapy in Unresectable Pancreatic Cancer Add Value?This video reviews the conflicting data and perspectives regarding the use of radiotherapy in unresectable pancreatic cancer.
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Key Takeaways: Optimal Use of JAK Inhibitors in MF and Future Directions in CarePanelists share key takeaways on management strategies in myelofibrosis and hope for future evolutions in the treatment paradigm.
