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Michael Baum, MD
Latest Article

Historical and Cultural Determinants in the Evolution of Adjuvant Endocrine Therapy

The direction of research into adjuvant systemic therapy for breast cancer has been determined in large part by historical and cultural differences between Europe and the United States

Michael Blute, MD
Latest Article

Management of Lymph Node–Positive Prostate Cancer: The Role of Surgery and Radiation Therapy

Current evidence for the management of lymph node–positive prostate cancer suggests both a disease-control and survival benefit to systemic ADT plus surgery and radiation.

Michael Boeckh, 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

Michael Boyiadzis, MD
Latest Article

New Therapeutic Options for Chronic Lymphocytic Leukemia

For decades, initial therapy for chronic lymphocytic leukemia (CLL) consisted of alkylators such as chlorambucil (Leukeran). The introduction of nucleoside analogs such as fludarabine and monoclonal antibodies such as rituximab (Rituxan) markedly changed the initial therapy of CLL, particularly in the United States. Fludarabine and combination regimens such as fludarabine/cyclophosphamide (FC) have achieved higher complete response (CR) rates and progression-free survival (PFS) than chlorambucil in previously untreated CLL, but long-term overall survival has not improved, due to concurrent improvement in salvage therapy of relapsed CLL patients. Upfront chemoimmunotherapy regimens such as fludarabine/rituximab (FR) and fludarabine/cyclophosphamide/rituximab (FCR) have similarly improved CR rates and PFS in previously untreated CLL patients, but it is unclear whether overall survival is improved. Advances in cytogenetic analysis and other biologic prognostic factors have greatly enhanced clinicians' ability to risk-stratify newly diagnosed CLL patients, and knowledge of such prognostic factors is necessary to properly interpret results of clinical treatment studies. The choice of initial therapy for an individual patient should depend upon the patient's age and medical condition, cytogenetic and other prognostic factors, and whether the goal of therapy is maximization of CR and PFS or palliation of symptoms with minimal toxicity.

Michael Brave, MD
Latest Article

Topotecan in Combination With Cisplatin for the Treatment of Stage IVB, Recurrent, or Persistent Cervical Cancer

Topotecan, a camptothecin analog previously approved for the treatment of ovarian cancer and small-cell lung cancer, was granted regular approval by the US Food and Drug Administration (FDA) on June 14, 2006, for use in combination with cisplatin to treat women with stage IVB, recurrent, or persistent carcinoma of the cervix not amenable to curative treatment with surgery and/or radiation therapy. The purpose of this summary is to review the database supporting this approval.

Michael Brines, MD, PhD
Latest Article

What Evidence Supports Use of Erythropoietin as a Novel Neurotherapeutic?

In its hormonal role, erythropoietin is produced by the kidney in response to hypoxic stress and signals the bone marrow to increase the number of circulating erythrocytes. It has become clear in recent years, however, that erythropoietin and its receptor are members of a cytokine superfamily that mediates diverse functions in nonhematopoietic tissues. Nonhormonal erythropoietin actions include a critical role in the development, maintenance, protection, and repair of the central nervous system (CNS).

Michael C. Garofalo, MD
Latest Article

Adjuvant Therapy for Pancreatic Cancer: No 'Definite' Standard

Despite attempted curative resection of localized adenocarcinoma of the pancreas, most patients experience a recurrence and die of their disease. The Gastrointestinal Tumor Study Group, European Organisation for Research and Treatment of Cancer, and European Study Group for Pancreatic Cancer trials have suggested the benefit of adjuvant therapy. However, the relatively few randomized trials available have not established a definite standard of care due to study limitations. Although these trials, and the recently published Charité Onkologie (CONKO)-001 trial, have shown a definite advantage of adjuvant chemotherapy, the most effective chemotherapy and the role of radiation therapy remain unclear. This review will discuss the data available from reported trials of adjuvant and neoadjuvant therapy in pancreatic cancer, address the issues leading to the ongoing controversies, and consider future directions for clinical trials.

Michael C. Large, MD
Latest Article

Active Surveillance for Low-Risk Localized Prostate Cancer

In this review, we summarize contemporary data pertaining to active surveillance, a safe and appropriate strategy for select patients with low-risk cancer characteristics who undergo monitoring at regular intervals.

Michael C. Perry, MD, FACP
Latest Article

Phase II Study of Docetaxel and Irinotecan in Metastatic or Recurrent Esophageal Cancer: A Preliminary Report

The outcomes for patients with metastatic or recurrent esophagealcancer are dismal, with 1-year survival rates of approximately 20%. Inthis phase II study, we studied the combination of docetaxel (Taxotere)and irinotecan (CPT-11, Camptosar) in patients with metastatic orrecurrent esophageal cancer. Eligible patients included those withhistologic or cytologic diagnosis of adenocarcinoma or squamouscancer of the esophagus or gastroesophageal junction who had receivedno previous chemotherapy for metastatic esophageal cancer. Previouschemotherapy in the neoadjuvant or adjuvant setting was allowed.Patients received irinotecan at 160 mg/m2 over 90 minutes followed bydocetaxel at 60 mg/m2 intravenously over 1 hour, with chemotherapycycles repeated every 21 days. Patients were reevaluated every twocycles. Of a planned 40 patients, 15 were enrolled, with 14 patientsevaluable for toxicity and 10 evaluable for response and survival. Thecombination of docetaxel and irinotecan resulted in a response rate of30%. An additional 40% achieved stable disease. The median survivalwas 130 days, with three patients still alive at the time of this analysis.The toxicities included 71% incidence of grade 4 hematologic toxicities,with 43% febrile neutropenia. One patient died of cecal perforationafter one cycle. There was no evidence of pharmacokinetic interaction,as systemic clearance of both drugs was similar to that seen after singleagentadministration. In conclusion, the regimen of docetaxel andirinotecan is active in metastatic or recurrent esophageal cancer.However, this combination chemotherapy regimen has an unacceptablerate of febrile neutropenia. This regimen needs to be modified toreduce the incidence of febrile neutropenia.

Michael Carducci, MD
Latest Article

Follow-up Care for Cancer: Making the Benefits Equal the Cost

The premise that early diagnosis of certain types of malignancies improves outcome and survival is a cornerstone of modern medicine. Routine use of the Pap smear has been associated with reduced mortality from cervical cancer. Randomized trials

Michael D. Hogarty, MD
Latest Article

Pediatric cancers enter the whole-genome sequencing pipeline with the initiation of the St. Baldrick’s project

A collaborative project to sequence the neuroblastoma cancer genome could revolutionize diagnosis and treatment.

Michael D. Lagios, MD
Latest Article

An Argument Against Routine Use of Radiotherapy for Ductal Carcinoma In Situ

The major conclusion to bedrawn from the extensivelypublished University of SouthernCalifornia (USC)/Van Nuys databaseon ductal carcinoma in situ(DCIS) is that, to the extent that DCIScan be totally excised, the ipsilaterallocal control rate will approach 100%with surgery alone, regardless of tumorgrade or size or patient age. Thisconclusion, noted by Dr. Silverstein,was achieved only through prospectivemammographic/pathologic correlationand a meticulous pathology protocolthat required orientation, selectiveinking of margins, sequential sectioningand processing of the entirespecimen, and prospective calculationof size and margin status.

Michael Dattoli, MD
Latest Article

Reviving the Acid Phosphatase Test for Prostate Cancer

Prostatic acid phosphatase (PAP) emerged as the world's first clinically useful tumor marker in the 1940s and 1950s. With the introduction of the prostate-specific antigen (PSA) test in the 1980s, which performed significantly better than PAP in terms of screening and monitoring response to treatment, PAP fell into disfavor. An increasing number of recent studies have identified PAP as a significant prognostic factor for patients with intermediate- and high-risk prostate cancer. PAP appears to be particularly valuable in predicting distant failure in higher-risk patients for whom high levels of local control are achieved with aggressive initial local treatment. As prostate cancer care becomes increasingly focused on identifying the minority of patients who would benefit from aggressive systemic therapy, a reevaluation of the potential contribution of the prostatic acid phosphatase test seems timely.

Michael Diaz, MD
Latest Article

How the Sequester Cuts Are Harming Oncology

Now is a critical moment for all involved in caring for cancer patients to engage in this national policy debate; numerous cancer advocacy organizations have already joined the effort to oppose the sequester cuts to oncology drugs.

Michael Diefenbach, PhD
Latest Article

Prostate Cancer Risk Assessment Program

Prostate cancer is the most common form of cancer (except skin cancer) in men. Several factors have been associated with an increased risk for prostate cancer, including age, ethnicity, family history, lifestyle, and

Michael E. De Vera, MD
Latest Article

Getting a Handle on Posttransplant Recurrence of HCC

In this issue of ONCOLOGY, Kim et al discuss adjuvant therapy after liver transplantation to decrease recurrence of hepatocellular carcinoma (HCC). Liver transplantation offers the best overall and recurrence-free survival for the treatment of stage I and II HCC. The landmark study in 1996 by Mazzaferro demonstrated that liver transplantation of patients with one lesion less than 5 cm or with up to three lesions but all less than 3 cm (the Milan criteria) resulted in low recurrence rates and similar survival to patients without HCC.[1]

Michael E. Egger, MD
Latest Article

Extending the Role of Hepatic Metastasectomy in Stage IV Melanoma and Breast Cancer: Patient Selection is Critical

Resection of liver metastases represents a major advance of the last few decades in the treatment of colorectal cancer.

Michael E. Ray, MD, PhD
Latest Article

Combined-Modality Staging for Localized Adenocarcinoma of the Prostate

The goal of identifying a set of pretreatment risk-stratifying factors for patients with localized prostate cancer is to be able to individualize treatment and optimize patient selection for clinical trials. Low-risk patients are most likely

Michael E. Stefanek, PhD
Latest Article

Emotional and Behavioral Responses to Genetic Testing for Susceptibility to Cancer

Drs. Lerman and Croyle provide a quite thorough review of an area in need of continuing research-ie, patients' behavioral and emotional responses to genetic testing for cancer susceptibility. The authors present current information on what we do and don't know about the psychological characteristics of individuals likely to undergo testing, possible adverse reactions, issues specific to the genetic counseling process, family coping and adaptation, and possible ways of managing psychological sequelae of genetic testing. Admirably, the authors note that much of their discussion should be considered speculative until more empirical data specific to genetic testing is available. Given this "state of the science," I will raise some additional questions based on some of the statements made by Drs. Lerman and Croyle.

Michael F. Sarosdy, MD
Latest Article

Commentary (Sarosdy): Age-Specific Reference Ranges for PSA in the Detection of Prostate Cancer

Dr. DeAntoni provides a timely, critical review of the concept of age-specific prostate-specific antigen (PSA) ranges, as well as other frequently used attempts to improve the accuracy of serum PSA testing in the diagnosis of unsuspected prostate cancer. His review is complete, and his assessments of each of the modalities reflect not only the majority view but also realistic appraisals of the limitations of this less-than-perfect test.

Michael Fanucchi, MD
Latest Article

Treatment of Advanced Non–Small-Cell Lung Cancer in Special Populations

Only a minority of elderly patientswith advanced non–small-cell lung cancer(NSCLC) have been offered palliativechemotherapy, as indicated by clinicalsurveys beginning in the 1980s.Lilenbaum’s thorough review of thetreatment of locally advanced and metastaticNSCLC studies in two specialpopulations (elderly and Eastern CooperativeOncology Group [ECOG]performance status [PS] 2 patients)highlights a new trend seen with theadvent of better-tolerated chemotherapyregimens.

Michael Frumovitz, MD, MPH
Latest Article

Small- and Large-Cell Neuroendocrine Cervical Cancer

Small- and large-cell neuroendocrine tumors of the cervix are exceedingly rare and exceedingly aggressive.

Michael G. Herman, PhD
Latest Article

Commentary (Herman/Wharam): Current Techniques in Three-Dimensional CT Simulation and Radiation Treatment Planning

Stephenson and Wiley demonstrate that three-dimensional (3D) CT-based simulation is an improvement in the simulation process. The growing importance of CT in radiation oncology treatment planning has been discussed previously [1] and is further emphasized in this article. The advantages of geometric optimization in three dimensions for radiation therapy treatment planning also are described. These results are applicable to both 3D and two-dimensional (2D) dose planning, because the treatment team can visualize and delineate structures on axial or reconstructed CT planes in greater detail than is possible with conventional simulation projected radiographs.

Michael G. Sarr, MD
Latest Article

Commentary (Sarr/Farnell): Combined-Modality Treatment for Operable Pancreatic Adenocarcinoma

Pisters and colleagues from theM. D. Anderson Cancer Centeroffer a state-of-the-art discussionof the staging and treatment ofpancreatic cancer. Their treatise addressesmost of the current issues ofcontroversy surrounding this diseasefrom a largely nonparochial standpoint,and should serve as a primerfor the multidisciplinary approach tothe treatment of pancreatic ductal cancer.Their call for and justification ofregionalization of treatment in patientswith potentially resectable diseaserings true with virtually all nationaland international studies that have examinedthis topic from the aspect ofmorbidity, mortality (and thus survival),duration of hospitalization, andof course in our current economic climate,cost.[1-7] This topic should nolonger be considered controversial.

Michael Girardi, MD
Latest Article

Cutaneous T-Cell Lymphoma: Pathogenesis and Treatment

Cutaneous T-cell lymphoma (CTCL) is a malignancy of a distinctive subset of T-helper cells designated “cutaneous T cells” because of their central role in the normal functioning of the skin immune system. Guided by

Michael Goggins, MD
Latest Article

Pancreatic Cancer: Recognizing an Hereditary Predisposition

Although candidate genes for hereditary pancreatic cancer have been identified (Figure 1), namely p16 and BRCA2, pancreatic cancer patients having an inherited predisposition will not be easy to recognize on clinical grounds.

Michael H. Levy, MD, PhD
Latest Article

Integration of Palliative Care Into Comprehensive Cancer Care: Accountable Collaboration

n their article, Dennis et al call for timely integration of palliative care into standard oncology care and sustained collaboration between these two specialties, to provide comprehensive, individualized care for patients with advanced, incurable cancer and their families.[

Michael Hallek, MD
Latest Article

New Menus for CLL Treatment

Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with an extremely variable course. Survival after diagnosis can range from months to decades. As the pathogenesis of the disease is increasingly understood, we begin to unfold the molecular patterns that define the different prognostic subgroups and to develop strategies to predict the clinical course.

Michael Hallek, MDDirector
Latest Article

Phase II Study of Rituximab in Combination With Fludarabine in Patients With Chronic Lymphocytic Leukemia

This phase II trial investigated the safety and efficacy of a combined-modality treatment with rituximab (Rituxan) and fludarabine (Fludara) in patients with fludarabine- and anthracycline-naive chronic lymphocytic lymphoma (CLL).

Michael Henke, MD
Latest Article

Reassessments of ESAs for Cancer Treatment in the US and Europe

Anemia is a widely prevalent complication among cancer patients. At the time of diagnosis, 30% to 40% of patients with non-Hodgkin lymphoma or Hodgkin lymphoma and up to 70% of patients with multiple myeloma are anemic; rates are higher among persons with myelodysplastic syndromes. Among patients with solid cancers or lymphomas, up to half develop anemia following chemotherapy. For almost 2 decades, erythropoiesis-stimulating agents (ESAs) were the primary treatment for cancer-related anemia. However, reassessments of benefits and risks of ESAs for cancer-associated anemia have occurred internationally. We reviewed guidelines and notifications from regulatory agencies and manufacturers, reimbursement policies, and utilization for ESAs in the cancer and chronic kidney disease settings within the United States, Europe, and Canada. In 2008 the US Food and Drug Administration (FDA) restricted ESAs from cancer patients seeking cure. Reimbursement is limited to hemoglobin levels < 10 g/dL. In the United States, ESA usage increased 340% between 2001 and 2006, and decreased 60% since 2007. The European Medicines Agency (EMEA) recommended that ESA benefits do not outweigh risks. In Europe between 2001 and 2006, ESA use increased 51%; since 2006, use decreased by 10%. In 2009, Canadian manufacturers recommended usage based on patient preferences. In Canada in 2007, approximately 20% of anemic cancer patients received ESAs, a 20% increase since 2004. In contrast to Europe, where ESA use has increased over time, reassessments of ESA-associated safety concerns in the United States have resulted in marked decrements in ESA use among cancer patients.