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Phase II Study of Rituximab in Combination With Fludarabine in Patients With Chronic Lymphocytic LeukemiaThis 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).
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Efficacy and Safety of Tositumomab/Iodine-131 Tositumomab in the Expanded Access Study: Interim Report From Two InstitutionsRelapsed or refractory low-grade non-Hodgkin’s lymphoma (NHL) and transformed low-grade NHL are incurable diseases. Tositumomab/iodine-131 tositumomab (Bexxar) is a novel
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Phase II Study of Rituximab in Combination With Fludarabine in Patients With Chronic Lymphocytic LeukemiaThis 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).
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The Health Economics of Palliative CareOnly a few studies have assessed the economic outcomes of palliative therapy. The major areas of interest include hospice care, the process and structure of care, symptom management, and palliative chemotherapy
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Iodine I 131 Tositumomab for Patients With Follicular Non-Hodgkin’s Lymphoma (NHL): Overall Clinical Trial Experience by HistologyIodine-131 tositumomab (Bexxar) is a new radioimmunotherapy in development for the treatment of patients with low-grade or transformed low-grade non-Hodgkin’s lymphoma. The data from five phase I-III studies, which enrolled patients with low-
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Iodine-131 Tositumomab for Patients With Low-Grade or Transformed Low-Grade Non-Hodgkin’s Lymphoma: Complete Response DataTositumomab/iodine-131 tositumomab (Bexxar) is a radioimmunotherapeutic agent in development for patients with low-grade or transformed non-Hodgkin’s lymphoma (NHL). This analysis focuses
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Palliative Care and Oncology: Integration Leads to Better CarePatients with advanced progressive cancer require care plans that address their physical, emotional, and psychosocial needs, as well as their goals of care.
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Encouraging Improvement in Cytopenias of Patients With Myelodysplastic Syndromes With ThalidomideMyelodysplastic syndrome patients present with variable cytopenias even though their bone marrows are generally hypercellular. Excessive cytokine-induced apoptosis of hematopoietic cells in the marrows has been proposed as a possible
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Challenges and Opportunities for Immunotherapies in Gynecologic CancersThe advent of immunotherapy presents us with new treatment approaches in gynecologic cancers, with preliminarily promising outcomes. Multiple clinical trials are currently being conducted to better define the role of immunotherapy. Further investigation is warranted to develop and identify predictive biomarkers.
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Treatment of Metastatic Colorectal Cancer: From Cytotoxic Agents to Molecular Agents and Multitargeted StrategiesColorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related death in United States. For nearly 50 years, fluorouracil has been the only anticancer drug proven to benefit patients with metastatic CRC (mCRC), and it continues to be the backbone on which most treatment regimens are built. In the past 10 years, development of the topoisomerase I inhibitor irinotecan (Camptosar), the third-generation platinum analog oxaliplatin (Eloxatin), and the oral fluoropyrimidine capecitabine (Xeloda) advanced mCRC treatment and opened up an era of combination chemotherapy. More recently, monoclonal antibodies such as bevacizumab (Avastin), cetuximab (Erbitux), and panitumumab (Vectibix) have become available for use in mCRC treatment in combination with cytotoxic agents and as monotherapies. The addition of these targeted agents to the mCRC treatment armamentarium has resulted in more therapeutic options and improved treatment outcomes for the patients. The prospect of mCRC treatment is ever promising as more targeted agents such as vatalanib are being introduced and as intelligent combination regimens are being designed based upon a better understanding of pharmacokinetics. In this article we review various treatment options, including cytotoxic and targeted agents, currently available for patients with mCRC.
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Soft-Tissue and Bone SarcomasSarcomas are a heterogenous group of tumors originating from mesenchymal tissues. According to American Cancer Society estimates, approxiately 8,070 new cases will be diagnosed in 1995, including 6,000 cases of soft-tissue sarcomas and 2,070 cases of bone tumors [1].
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Monoclonal Antibodies That Mimic the Action of Intravenous Immunoglobulin Can Inhibit Immune ThrombocytopeniaIntravenous immunoglobulin (IVIG) is prepared from large pools of plasma from healthy donors and is widely used to treat autoimmune diseases, especially immune thrombocytopenic purpura (ITP). Human polyclonal antierythrocyte antibodies, such as anti-D, can also be effective at treating ITP in individuals expressing the appropriate antigen. The demand for IVIG and anti-D exceeds the supply, and the development of a recombinant product to replace these human-derived blood products would be highly desirable. We have hypothesized that monoclonal antibodies directed against red cells may be effective in inhibiting immune forms of thrombocytopenia.
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Ibritumomab Tiuxetan Radioimmunotherapy Is Safe and Well Tolerated in Patients With Relapsed or Refractory B-Cell Non-Hodgkin’s LymphomaIbritumomab tiuxetan (Zevalin) consists of an anti-CD20 murine IgG1 kappa monoclonal antibody covalently bound to tiuxetan (MX-DTPA), which stably chelates yttrium-90 for therapy. Ibritumomab tiuxetan therapy involves pretreatment with
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Current Management of Acute Lymphoblastic Leukemia in AdultsIntensive remission chemotherapy followed by post-remission consolidation and maintenance therapies has achieved complete remission rates of 75% to 90% and 3-year survival rates of 25% to 50% in adults with acute lymphoblastic leukemia (ALL). These results, although promising, are still less favorable than those achieved in childhood ALL. However, various novel experimental and clinical approaches show promise for improving cure rates. Also, specific therapies directed at high-risk subgroups with ALL are beginning to emerge. Detection of specific chromosomal abnormalities at diagnosis identifies patients who are at risk of failing to achieve remission, as well as those who are likely to have short, intermediate, or prolonged disease-free intervals after successful remission induction. Such prognostic information may, ultimately, be used to assign risk categories and to individualize post-remission therapy. [ONCOLOGY 9(5):433-450, 1995]
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A Phase II Randomized Study of Doxorubicin Alternated With Docetaxel vs Sequential Administration of Four Cycles of Docetaxel Followed by Four Cycles of Doxorubicin as First-Line Chemotherapy in Metastatic Breast Cancer PatientsFrom March 1996 to March 1998, 106 patients with untreated metastatic breast cancer (MBC) were treated with docetaxel (Taxotere) (100 mg/m²) and doxorubicin (75 mg/m²) on an alternating cycle-by-cycle (doxorubicin, docetaxel, doxorubicin, etc) or sequential (four cycles of docetaxel, then four cycles of doxorubicin) basis, every 3 weeks, for a maximum of eight cycles.
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Management of Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM)Observation is the standard of care. However, clinical trials are ongoing to determine whether early therapy with newer agents can prolong the time to progression-and most importantly, prolong survival.
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Cancer Treatment Can Result in ‘Financial Toxicity’ for Patients and FamiliesAs part of our coverage of the 2017 ASCO Annual Meeting, we discuss the impact of financial toxicity on cancer patients and their families.
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UFT/Leucovorin Plus Bolus Epirubicin and Cyclophosphamide in Advanced/Metastatic Breast CancerThis article describes the design and early results of an open-label, nonrandomized phase I/II trial of oral UFT plus leucovorin therapy in combination with bolus injections of epirubicin and cyclophosphamide in patients with advanced or metastatic breast cancer. This study was designed as a cohort dose-escalation study with the principal aims being to determine dose-limiting toxicity, overall toxicity, maximum tolerated dose, tumor response, and time to disease progression.
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Current Strategies for the Immunotherapy of Multiple MyelomaHere we outline the most promising novel cellular immune strategies for patients with multiple myeloma. In addition, we highlight combinatorial approaches that, it is hoped, will further optimize cellular immunotherapies for myeloma and lead to deep and durable responses and, possibly, even cures.
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Understanding the Kinetics of Cancer: Implications from Prevention to PrognosticationThe choices that patients and clinicians make when dealing with cancer are dictated by time, whether they are arranging for screening mammography and colonoscopy, compiling treatment plans, or determining follow-up intervals and the age of freedom from follow-up.
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A Role for Hepatic Metastasectomy in Stage IV Melanoma and Breast Cancer: Reestablishing the Surgical ModalityThis review summarizes the existing literature that addresses the topic of metastasectomy in patients with melanoma and breast cancer.
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Managing Early-Stage Breast Cancer in Your Older PatientsAs the aging population in the United States continues to grow, the incidence of diseases of the elderly, such as breast cancer, are increasing. Many more elderly women are expected to be diagnosed with new breast cancers, most of them in an early stage. Appropriate treatment of these women is important, as they have poorer outcomes when undertreated. In this review, we will discuss the biology and treatment of early breast cancer in elderly women. We will focus on the role of comorbidity and its effect on life expectancy, treatment decisions, current recommendations for primary treatment with surgery, radiation and neoadjuvant strategies, and adjuvant treatment including local radiation therapy and systemic treatment with endocrine therapy, chemotherapy, and newer agents. Finally we will discuss the importance of clinical trials in the elderly.
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Triplet Combination Strategies to Manage Metastatic HSPCLooking toward the future management of metastatic HSPC, experts consider the results of triplet combination trials like ARASENS and PEACE-1.
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Optimizing the Delivery of Antineoplastic Therapies to the Central Nervous SystemThis review describes the anatomy of the blood-brain barrier and currently available methods to quantify the entry of therapeutic compounds into the brain. It also summarizes data from a variety of approaches designed to improve drug delivery to the central nervous system.
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Should Every Patient With Newly Diagnosed MM Receive a Transplant?In light of recent clinical trial data, key opinion leaders reflect on the appropriate selection of transplant for patients with newly diagnosed multiple myeloma.
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Mantle Cell Lymphoma: Clinicopathologic Features and TreatmentsMantle cell lymphoma (MCL) accounts for approximately 6% of non-Hodgkin’s lymphomas. Patients usually present with advanced disease, with a tendency for extranodal involvement. MCL is an aggressive lymphoma with moderate chemosensitivity, but it remains one of the most difficult therapeutic challenges. Complete response rates to chemotherapy range from 20% to 40%, with median survivals of 2½ to 3 years. Anthracycline-containing regimens do not prolong survival compared with nonanthracycline regimens. Single-agent rituximab (Rituxan) has produced response rates of about 30%, and when combined with an anthracycline-containing regimen, response rates increase to above 90%; however, an impact on survival has not yet been demonstrated. More intensive regimens such as hyperCVAD (hyperfractionated cyclophosphamide [Cytoxan, Neosar], vincristine, doxorubicin [Adriamycin], dexamethasone, methotrexate, cytarabine) with either stem cell transplant or rituximab have been associated with promising results.
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Biological Basis of Radiation SensitivityRecent studies have elucidated some of the molecular and cellular mechanisms that determine the sensitivity or resistance to ionizing radiation. These findings ultimately may be useful in devising new strategies to improve the
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Are AIs for Breast Cancer Linked With Increased Myocardial Infarction Risk?This video examines a study that looked at whether aromatase inhibitors are associated with higher myocardial infarction risk in breast cancer patients.
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Influenza Vaccination in Patients With Cancer: an OverviewInfluenza infection is a potential cause of additional morbidity and mortality in patients who are immunocompromised because of cancer or its treatment. Of particular note, influenza infection may delay or interrupt chemotherapy and necessitate hospitalization. Successful immunization depends on an intact immune system that can produce antibodies in response to antigen exposure. Patients with cancer often have a suppressed immune system, resulting from their disease and/or immunosuppressive therapies, and as a consequence they may have a suboptimal serologic response to influenza vaccination. Since vaccination is the only proven method for preventing influenza infection, the Advisory Committee on Immunization Practices recommends seasonal influenza vaccination for adults without contraindications who have disease- or medication-related immunosuppression. Patients with cancer should be given the trivalent inactivated vaccine. Preliminary data suggest that administering the vaccine between cycles of chemotherapy may yield the best results.
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Adjuvant Hormonal Therapy for Premenopausal Breast Cancer: Incorporating Clinical ExperienceThe article “Adjuvant Hormonal Therapy in Premenopausal Women With Operable Breast Cancer: Not-So-Peripheral Perspectives” by Richard Love, published in this issue of ONCOLOGY,
