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Advances in the Treatment of Gynecologic MalignanciesThe article by Kim et al is a comprehensive summary of several decades of research in the management of cervical and vulvar cancer. It describes the current status of treatment and possible future trials.
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Adjuvant Hormonal Therapy in Premenopausal Women With Operable Breast Cancer: Not-So-Peripheral PerspectivesWhile optimal adjuvant hormonal therapies for premenopausal women with operable breast cancer have yet to be defined, discussions and reviews of the state of the art and “areas of confusion” often fail to consider developments that are germane to keeping evidence-based clinical practice truly up-to-date.
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Who's Coding Whom?My practice has been concerned that we physicians were not maximizing our “coding potential”; that is, we were not receiving as much remuneration for each cancer patient visit as Medicare permits under its guidelines. Therefore, the practice hired a company that specializes in teaching physicians how to get more. This company is part of a newly minted industry that does nothing else.
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Second-Line Regorafenib Extends Survival in Sorafenib-Tolerant HCC PatientsThis video examines an exploratory analysis of the RESORCE trial, which tested regorafenib vs placebo in hepatocellular carcinoma patients following radiographic progression on sorafenib.
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An Approach to the Management of Rare TumorsThis case report presents the management of a very rare tumor. Confronting a rare tumor can be frustrating to both physician and patient.
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Persistence of Lymphedema Reduction After Noninvasive Complex Lymphedema TherapySecondary lymphedema is quite prevalent in cancer patients who require lymph node dissection for staging and/or treatment of their disease. Chronic lymphedema may arise shortly after surgical intervention or months to years afterward. The tendency of chronic lymphedema is to worsen over time.
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Treatment of Estrogen Deficiency Symptoms in Women Surviving Breast Cancer, Part 6Problem: Several million women worldwide have survived breast cancer but are currently advised against the use of estrogen for the management of menopausal symptoms and for the prevention of early cardiovascular death and osteoporosis.
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Silicone Breast Implants: An Oncologic PerspectiveIn 1992, the FDA decided that silicone gel-filled breast implants would be available only through controlled clinical studies, despite the fact that they had been used for mammoplasty in millions of women around the world
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Role of Interferon-Alfa in NHL: Still Controversial?Recombinant interferon-alfa (Intron A, Roferon-A) has been under investigation as a therapeutic agent for non-Hodgkin’s lymphoma (NHL) for 25 years. It has antitumor efficacy in a number of histologic subtypes but has not
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Midostaurin in FLT3-Mutated AML: Results of the RATIFY TrialIn this interview we discuss results of the CALGB 10603 RATIFY trial of midostaurin for acute myeloid leukemia presented earlier this month at ASH.
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Bladder Cancer: Time for a Rethink?In this issue of ONCOLOGY, Kamat and Mathew provide an excellent overview of the current status and future imperatives of bladder cancer treatment and research.
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Bulky Mediastinal Classical Hodgkin Lymphoma in Young WomenAlthough the cure rate remains high in women who present with bulky mediastinal stage I–II HL, the challenge remains to balance efficacy and minimize long-term toxicities.
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Chronic Myeloid LeukemiaChronic myeloid leukemia (CML) is a clonal myeloproliferative disorder resulting from the neoplastic transformation of the primitive hematopoietic stem cell.
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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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Non-Hodgkin LymphomaThis management guide covers the risk factors, screening, diagnosis, staging, and treatment of non-Hodgkin lymphoma.
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Concurrent RT With 5-FU/Epirubicin and Cisplatin or Irinotecan for Locally Advanced Upper GI AdenocarcinomaFrom the results of recent studies, it is likely that multimodality therapy with chemotherapy and radiation treatment may improve the overall outcome of locally advanced upper gastrointestinal (GI) malignancies, including esophageal, gastric, pancreatic, and biliary tract carcinomas. However, more effective, more optimal, and less toxic chemotherapy regimen(s) with concomitant radiotherapy are needed beyond the concurrent continuous-infusion fluorouracil (5-FU) with radiation that is commonly applied in general practice. Epirubicin (Ellence), cisplatin, and irinotecan (Camptosar) are all active cytotoxic chemotherapy agents in upper GI cancers. Two phase I studies were designed to test the tolerability of the combination of radiotherapy with infusional 5-FU, epirubicin, and cisplatin (ECF) or 5-FU, irinotecan, and epirubicin (EIF) in the treatment of locally advanced upper GI malignancies.
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Cancer Age: Can We Reliably Estimate and Apply This Knowledge?In their article, Patrone et al utilize a modified version of Collins’ law to estimate the age of breast, lung, and colorectal cancers. Collins’ law, which states that the period of risk for recurrence of a tumor is equal to the age of the patient at diagnosis plus 9 months, has been applied primarily to pediatric tumors, in particular embryonal tumors.[1,2] The results from the application of Collins’ law to these tumors have been reasonable, although exceptions have been reported and the law is not applicable to all cancers.[3,4] Its utilization in adults in the manner used in this paper is therefore unique.
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Use of High-Resolution CT Imaging Data in Lung Cancer Drug Development: Measuring ProgressLung cancer is the leading cause of cancer death throughout the United States.[1] Despite massive efforts, tobacco consumption continues to grow, with a large and predictable impact on premature mortality across the globe.[2]
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Addressing the Disparities in Prostate Cancer Care and OutcomesDr. Kittles discusses the race-based health disparities in prostate cancer, and one genetic-environmental crossover that is clinically significant.
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Active Surveillance in Small Renal MassesIn this interview we discuss a new study that looked at the outcomes of patients with small renal masses who were followed with active surveillance.
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Update on the Management of Primary CNS LymphomaPrimary central nervous system (CNS) lymphoma is a non-Hodgkin’s lymphoma restricted to the nervous system. The incidence of this lymphoma is rising in the immunocompetent population but may be decreasing in patients
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UFT Plus Cisplatin With Concurrent Radiotherapy for Locally Advanced Non–Small-Cell Lung CancerA phase II study of combined-modality treatment consisting of uracil and tegafur (in a molar ratio of 4:1 [UFT]) plus cisplatin (Platinol) and concurrent radiotherapy was conducted to evaluate the activity of this regimen in
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Langerhans Cell Histiocytosis: Emerging Insights and Clinical ImplicationsLangerhans cell histiocytosis is a disorder characterized by lesions that include CD207+ dendritic cells along with an inflammatory infiltrate. Langerhans cell histiocytosis has a highly variable clinical presentation, ranging from a single lesion to potentially fatal disseminated disease.
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Central Nervous System Germ Cell Tumors: Controversies in Diagnosis and TreatmentThe variability and complexity of central nervous system germ cell tumors have led to controversy in both diagnosis and management. If a germ cell tumor is suspected, the measurement of cerebrospinal fluid and serum alpha-fetoprotein and beta–human chorionic gonadotropin is essential. A histologic specimen is not necessary if the patient has elevated levels; however, if the tumor markers are negative, a biopsy is needed to confirm the diagnosis of a germinoma. Germinomas are extremelyradiosensitive, enabling 5-year survival rates that exceed 90%. Treatment has traditionally included focal and craniospinal axis irradiation; however, multiple ongoing studies are being conducted to examinethe efficacy of reduction or elimination of radiation therapy with the addition of chemotherapy. Nongerminomatous germ cell tumors, on the other hand, are relatively radioresistant with a poorer outcome. The combination of chemotherapy and irradiation is associated with overall survival rates of up to 60%. This article provides a review of the controversies in diagnosis and treatment of central nervous system germ cell tumors.
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Dr. Rimas Lukas on Controlled Interleukin-12 Combined With a PD-1 Inhibitor in Recurrent GlioblastomaCancer Network spoke with Rimas V. Lukas, MD, of Northwestern University Feinberg School of Medicine, about the combination of controlled interleukin-12 with a PD-1 inhibitor in recurrent glioblastoma.
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Consider Thrombotic Microangiopathy in Pediatric and Hematopoietic Stem Cell Transplant PatientsThe article by Dr. George is of great use to the practicing clinician, not only in the hematology-oncology setting but also in general practice or emergency medicine.
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Infection in a Leukemia PatientMs. C is a 41-year-old Hispanic woman that came to our facility regarding her leukemia. She presented in January 2005 with migratory myalgias, headaches, and gingival bleeding. Complete blood count (CBC) revealed a white blood cell count (WBC) of 18.0/µL with 53% blasts, hemoglobin at 8.1 g/dL, and a platelet count of 12/µL. Bone marrow biopsy confirmed a diagnosis of acute lymphocytic leukemia.
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Survival Advantage Seen for HNPCC Colorectal CancerHereditary nonpolyposis colorectal cancer (HNPCC) is a dominantly inherited syndrome that is estimated to be responsible for between 0.5% to 5% of all colorectal cancers.[1] The syndrome is caused by germline mutations in any of at least four mismatch repair genes.
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The New Generation of Targeted Therapies for Breast CancerThe article by Drs. Syed andRowinsky is well written andcomprehensive. They introduceseveral biologic pathways that are importantin breast cancer and focus onnew pharmaceutical agents designedto disrupt these pathways. Patients andphysicians hope that agents that targetthe tyrosine kinase signal transductionpathways, block tumor angiogenesis,modulate apoptosis, and inhibithistone deacetylation will be effective,nontoxic therapies for breastcancer. These molecularly targeted approacheshold promise, but deliveringon this promise requires that we movebeyond histologic characterization ofthe disease and rethink the design ofclinical trials.
