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Deferasirox for the Treatment of Chronic Iron Overload in Transfusional HemosiderosisThis report describes the Food and Drug Administration's review of data and analyses leading to the approval of the oral iron chelator, deferasirox for the treatment of chronic iron overload due to transfusional hemosiderosis.
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Inoperable Pancreatic Cancer: Standard of CareInoperable pancreatic adenocarcinoma is a dilemma that oncologists frequently encounter. Only 15% to 20% of patients are diagnosed when cancer of the pancreas is still surgically resectable. However, pancreaticoduodenectomy is the only curative option for this disease and should be offered to all patients who meet resection criteria and do not have significant comorbidities. For inoperable pancreatic cancer, the goals of treatment are to palliate symptoms and prolong life. Improved survival in locally advanced disease has been demonstrated with chemoradiation plus fluorouracil or with gemcitabine (Gemzar) alone. In metastatic disease, single-agent gemcitabine has been associated with improvement in symptoms and survival. Trials combining various chemotherapeutic agents with gemcitabine have not had a significant impact on overall survival, although meta-analyses suggest a small benefit. The targeted agent erlotinib (Tarceva) has shown a modest improvement in overall survival in combination with gemcitabine. This combination is another option for first-line therapy in patients with locally advanced or metastatic disease. Despite these recent advances, survival for patients with inoperable pancreatic cancer continues to be poor. Future investigations need to focus on understanding the molecular nature of this malignancy, with the goal of developing interventions based on this knowledge.
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Cancer Metabolism as a Therapeutic Target: Metabolic Synthetic LethalityDrugs targeting different metabolic pathways induced in tumors may be used in combination with one another to induce synthetic lethality in cancer cells, while preserving the survival of normally proliferating cells.
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Autonomy Versus Paternalism in Latin AmericaIn this paper, Dr. Cherny beautifully reviews how to balance the patient's right to be adequately informed about his or her disease with the powerful cultural beliefs held in many parts of the world.
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Use of Bisphosphonates in the Treatment of Prostate CancerRecently, there has been much controversy over whether patients with prostate cancer should be treated with bisphosphonates not only to decrease pain, but to prevent metastasis.
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Breast Cancer During PregnancyThe care of a pregnant breast cancer patient is a challenging clinical situation that historically has placed the welfare of the mother in conflict with that of the fetus. For the woman in this situation, the emotions usually
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Chemotherapy-Induced Nausea and Vomiting: Great Achievements but Room for ImprovementA review of "Chemotherapy-Induced Nausea and Vomiting: Which Antiemetic for Which Therapy?"
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Metastatic Malignant Melanoma From an Unknown Primary Presenting as a Large Axillary MassThe patient is an otherwise healthy male transferred from an outside hospital with a newly diagnosed melanoma from an unknown primary presenting as a large, left axillary mass.
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Hematopoietic Cell Transplantation, Second EditionHematopoietic Cell Transplantation, edited by Drs. Thomas, Blume, and Forman, is an excellent updated second edition of their comprehensive textbook designed for both practitioners involved in transplantation and those interested in the science of stem-cell transplantation.
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Diagnostic Evaluation of Hepatocellular Carcinoma in a Cirrhotic LiverHepatocellular carcinoma (HCC) is one of the world’s most common cancers. It is closely associated with cirrhosis, especially that due to viral hepatitis. The incidences of viral hepatitis and HCC are rising steadily in the United
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The Absent-Minded Professor: An Unusual Complication of MelanomaThe University of Colorado Health Sciences Center holds weekly second opinion conferences focusing on cancer cases that represent most major cancer sites. Patients seen for second opinions are evaluated by an oncologist.
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Should We Recommend Screening Mammography for Women Aged 40 to 49?In clinical trials, screening mammography has been shown to reduce mortality from breast cancer by about 25% to 30% among women aged 50 years and older after only 5 to 6 years from the initiation of screening. Among women 40 to 49 years old, the evidence supporting the efficacy of screening mammography is less convincing.
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Integrated PET-CT: Evidence-Based Review of Oncology IndicationsCombined-modality positronemissiontomography (PET)–computed tomography (CT) isbecoming the imaging method ofchoice for an increasing number ofoncology indications. The goal of thispaper is to review the evidence-basedliterature justifying PET-CT fusion.The best evidence comes from prospectivestudies of integrated PETCTscans compared to other methodsof acquiring images, with histopathologicconfirmation of disease presenceor absence. Unfortunately, veryfew studies provide this kind of data.Retrospective studies with similarcomparisons can be used to provideevidence favoring the use of integratedPET-CT scans in specific clinicalsituations. Also, inferential conclusionscan be drawn from studies whereclinical rather than pathologic dataare used to establish disease presenceor absence.
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Commentary (Ghosh et al): Advising Women at High Risk of Breast CancerDr. Wood has provided an excellentreview of the issuesfacing women at high risk fordeveloping breast cancer. In additionto emphasizing the significance of accuraterisk assessment, he describessurveillance techniques that enableearly detection of the disease and hasprovided a comprehensive review ofrisk-reduction options for women athigh risk.
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Developing Systemic Therapy for Esophagogastric CancerCancer Network spoke with Dr. Karyn Goodman about the importance of developing a systematic therapy regimen for the treatment of esophagogastric cancer.
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Genetic Testing in Gastrointestinal Cancers: A Case-Based ApproachIn this article, we use a case-based approach to focus on the hereditary aspects of the most common GI cancers, including pancreatic, gastric, and colon cancer.
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Romiplostim for the Treatment of Chronic Immune (Idiopathic) Thrombocytopenic PurpuraOn August 22, 2008, the US Food and Drug Administration (FDA) granted marketing approval (licensure) to romiplostim (Nplate, Amgen Inc) for the treatment of thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.
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Management of Infections in Patients With Acute LeukemiaImprovements in outcome following treatment for acute leukemia have derived from various sources: the introduction of new chemotherapeutic agents; the development of effective drug combinations; the use of multistage approaches to induction consolidation, and maintenance therapy to optimize durable control; and advances in supportive care to reduce treatment-related mortality. Certainly, infectious morbidity and mortality have plagued effective antileukemic therapy for many years. As a result, control of infectious complications has been an important area of clinical study. Through the concerted efforts of many clinical investigators, progress has occurred, and, today, infectious mortality is an infrequent complication of antileukemic therapy.
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Venous Thromboembolism in a Gynecologic Cancer PatientMrs. S. is a 37-year-old Caucasian female who sought care at her home institution overseas during a period of several months for complaints of esophageal reflux, constipation, early satiety, increasing abdominal girth, and fatigue.
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Role of Laparoscopic Techniques in Colorectal Cancer SurgeryLaparoscopic intestinal resection is a relatively new application of endoscopic technology that has evolved as a direct result of the successes and benefits seen with laparoscopic gallbladder surgery. Currently acceptable and
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Diagnostic Use of Radiolabeled Antibodies for CancerAntibodies against a variety of tumor-associated antigens have been studied, as well as a number of modifications to the antibodies themselves, including Fab' fragments and chimeric, humanized, and human
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Role of the Genetic Counselor in Familial CancerThe authors offer a comprehensive overview of familial cancer risk counseling, providing both a general definition of this new genetic counseling specialty and specific components of the counseling process. Genetic counseling is, by and large, a referral service, and this is also true of cancer risk counseling. This places great importance on the health-care provider's ability to recognize families who may be at increased risk for an inherited form of cancer and should be referred for cancer risk counseling. It seems reasonable, therefore, to consider the issues relevant to making such a referral, including information on collecting an initial cancer history, strategies for handling a positive history, and the realities of DNA-based testing.
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A Phase I Study of Paclitaxel, UFT, and LeucovorinThis phase I study examines the dose escalation of UFT given in combination with fixed doses of oral leucovorin and weekly doses of paclitaxel in patients with metastatic solid tumor malignancies (excluding colorectal cancer). There are two main objectives for this study.
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Neuroblastoma: Biology and TherapyNeuroblastoma is the most common extracranial solid tumor of childhood, accounting for 15% of cancer-related deaths. These tumors have a predilection for young children; 60% of cases occur before age 2 years and 97%
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Commentary (Pisters): Adjuvant Chemotherapy for Resected Non–Small-Cell Lung CancerIn this issue of ONCOLOGY, Solomon,Mitchell, and Bunn providean excellent review on adjuvanttherapy for resected non–smallcelllung cancer (NSCLC). Theauthors have thoroughly reviewed therecent literature and highlight severalimportant areas for discussion. Theauthors appropriately frame the importanceof the clinical issue at hand.
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Roles of Advanced Practice Nurses in OncologyManaged care is a process of health-care management that integrates financing, cost-containment strategies, and business principles with the delivery of health care. Managed care’s rapid transformation of specialty practices,
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You Never Forget Your First RadiologistThe radiologist could not have known exactly what was in store for me, but it obviously wasn’t good. Couldn’t he have dredged up even a nanoparticle of empathy
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Biomarkers in Colon Cancer: The Chasm Between Expectations and RealityAt this juncture, various commercially available assays for colon cancer may be of little added value, and accelerated biomarker development with clinical validation is desperately needed.
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Aromatase Inhibitors and Bone LossThe aromatase inhibitors (AIs) anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin) are significantly more effective than the selective estrogen-receptor modulator (SERM) tamoxifen in preventing recurrence in estrogen receptor-positive early breast cancer. Aromatase inhibitors are likely to replace SERMs as first-line adjuvant therapy for many patients. However, AIs are associated with significantly more osteoporotic fractures and greater bone mineral loss. As antiresorptive agents, oral and intravenous bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), pamidronate (Aredia), and zoledronic acid (Zometa) have efficacy in preventing postmenopausal osteoporosis, cancer treatment-related bone loss, or skeletal complications of metastatic disease. Clinical practice guidelines recommend baseline and annual follow-up bone density monitoring for all patients initiating AI therapy. Bisphosphonate therapy should be prescribed for patients with osteoporosis (T score < -2.5) and considered on an individual basis for those with osteopenia (T score < -1). Modifiable lifestyle behaviors including adequate calcium and vitamin D intake, weight-bearing exercise, and smoking cessation should be addressed. Adverse events associated with bisphosphonates include gastrointestinal toxicity, renal toxicity, and osteonecrosis of the jaw. These safety concerns should be balanced with the potential of bisphosphonates to minimize or prevent the debilitating effects of AI-associated bone loss in patients with early, hormone receptor-positive breast cancer.
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Commentary (Look): The Effect of Tamoxifen on the EndometriumIn his excellent review, Dr. Barakat has made many useful observations about the effects of tamoxifen (Nolvadex) on the endometrium. As the potential number of women on tamoxifen increases, several points merit emphasis and dissemination to all gynecologists who may be asked by medical oncologists to render opinions on such patients.
