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Radium-223: Optimizing Treatment and Research of Osteoblastic Bone MetastasisElucidation of the underlying mechanisms of action for Ra-223 will soon expand its clinical utility with respect to improved patient selection and integrated bone-targeted therapies.
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VEGF Manipulation in GlioblastomaAngiogenesis is a pathologic hallmark of glioblastoma and continues to be an appealing therapeutic target in cancer, including high-grade gliomas.
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Postoperative Adjuvant Chemotherapy for Non-Small-Cell Lung CancerGiven that no therapeutic methods of postoperative adjuvant chemotherapy for non-small-cell lung cancer have been established, we selected UFT (tegafur and uracil) for investigation because UFT is less injurious to the host
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Commentary (Slavin): Nonmyeloablative Preparative Regimens for Allogeneic Hematopoietic TransplantationChamplin and colleagues haveelegantly summarized the conceptof nonmyeloablativestem cell transplantation (NST),stressing the importance of this newlyemerging procedure for the treatmentof patients with life-threateningmalignant hematologic and nonhematologicdiseases. This review doesnot include a description of the safetyand efficacy of NST for the treatmentof many life-threateningnonmalignant diseases for which noalternative therapy exists. This categoryencompasses a long list of geneticdisorders, diseases caused by adeficiency of stem cell products, andsyndromes associated with immunedeficiency. However, discussion ofthese illnesses is beyond the scopeof this review, which focuses oncancer.
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Endoscopic Ultrasound Fine-Needle Aspiration in the Staging of Non‑Small‑Cell Lung CancerPrecise mediastinal staging of non-small-cell lung cancer is extremely important, as mediastinal lymph node metastases generally indicate unresectable disease. Reliance on computed tomography (CT) and positron-emission tomography (PET) alone to stage and determine resectability is limited by false-positive results. Whenever possible, pathologic confirmation of metastases is desirable. Mediastinoscopy and transbronchial fine-needle aspiration are widely established but imperfect modalities. Endoscopic ultrasound fine-needle aspiration (EUS-FNA) has emerged as a diagnostic and staging tool because of its safety, accuracy, and patient convenience. We reviewed 13 prospective studies evaluating the comparative performance of EUS for staging lung cancer. We conclude that EUS is a valuable staging modality. Further studies of the role of EUS compared to other modalities such as integrated PET/CT and endobronchial ultrasound (EBUS) are forthcoming.
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Potential Role of Tumor Vaccines in GI MalignanciesLaheru and Jaffee review the potential role of tumor vaccines in the management of gastrointestinal (GI) malignancies, which represent the leading cause of cancer death and are believed to be poorly immunogenic. The authors carefully review the questions and controversies surrounding currently available immunotherapeutic strategies and describe ongoing clinical protocols using tumor vaccine therapy, a few of which deserve special comment.
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Irinotecan in Small-Cell Lung Cancer-Japanese TrialsIrinotecan has appeared to have significant activity against previously treated and untreated small-cell lung cancer (SCLC). The major toxicities of irinotecan are neutropenia and diarrhea, although there is interpatient
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Diagnosis and Management of Mycosis FungoidesMycosis fungoides (MF), the most common cutaneous T-cell lymphoma, is a low-grade cutaneous lymphoma characterized by skin-homing CD4+ T cells. It is notable for highly symptomatic progressive skin lesions, including patches, plaques, tumors, and erytheroderma, and has a poorer prognosis at later stages. Diagnosis remains difficult owing to MF’s nonspecific skin presentation and identification of the optimal treatment strategy is challenging given the paucity of controlled trials and numerous and emerging treatment options. Management includes topical therapy with the addition of systemic therapy for patients with later-stage disease including tumors; erythroderma; and nodal, visceral, or blood involvement. Topical therapies include mechlorethamine (nitrogen mustard), carmustine (BCNU), steroids, bexarotene gel (Targretin Gel), psoralen plus ultraviolet A (PUVA), ultraviolet B (UVB), and either localized or total skin electron radiotherapy. Systemic therapies include interferon, retinoids, oral bexarotene (Targretin), denileukin diftitox (Ontak), vorinostat (Zolinza), extracorporeal photochemotherapy (photopheresis), and cytotoxic chemotherapy. Herein, we outline clinically relevant aspects of MF, including clinical presentation, pathology, diagnosis, and staging. We describe in detail existing and emerging therapeutics and offer specific recommendations for management of each stage of MF.
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Dr. Gadgeel on Docetaxel Plus Trametinib in KRAS-Mutated Recurrent NSCLCIn this video, Shirish M. Gadgeel, MD, of Rogel Cancer Center, University of Michigan, discusses combo docetaxel/trametinib in G12C or non-G12C KRAS mutation-positive, recurrent NSCLC.
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Language, the Literature, and the PatientThe articles and accompanyingcommentaries in ONCOLOGYprovide important clinical informationbut also an opportunity tocall attention to language projectingattitudes and judgments that are unintended,probably unconscious, andgenerally unchallenged. We note thatrecent articles and reviews refer tothe “patient having failed” treatment;patients are identified with their canceras if they are one, and the descriptionof therapy as “salvage” indirectlycompares the human experience oftreating patients to saving, rescuing,or restoring goods.
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PRRT And The Neuroendocrine Tumor Treatment AlgorithmCancer Network spoke with Dr. Shishir Maithel about grading and diagnosing neuroendocrine tumors and how PRRT best fits into the treatment algorithm of these tumors.
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Proteomics to Diagnose Human Tumors and Provide Prognostic InformationBiomedical research is in themidst of unprecedented transformationstemming from theoverall impact of molecular biologyon medical research, including theemerging high-throughput genomicsbasedtechnologies. These new paradigmsare leading to better definitionof the disease state as well as moreprecise and less toxic therapeutic strategies.But even as we begin to understandthe implications of gene-basedinformation on the genesis, pathophysiology,and progression of disease andon the development of novel therapeuticapproaches, the dawn of theera of proteomics is heralding evenmore radical changes.
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Management of Small Bowel AdenocarcinomaSmall bowel adenocarcinoma is a relatively rare malignancy. Only limited information is available on the incidence, prognosis, and role of chemotherapy in the treatment of this disease. We present a review of currently
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Diagnostic Dilemma: GI DiseaseThis photograph is from an upper gastrointestinal endoscopy on a 15-year-old male. He has a history of a total colectomy and is being evaluated for iron deficiency anemia. He denies abdominal pain, weight loss, and melena. He notes occasional bright red blood on the toilet paper but denies hematochezia.
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The Role of Genomic Techniques in Predicting Response to Radiation TherapyThe understanding of the relationship between genetic variation and an individual patient’s response to radiation therapy has gained significant ground over the past several years. Genetic markers have been identified that could ultimately serve as the foundation for predictive models in clinical practice, and that hold the potential to revolutionize the delivery of precision medicine in oncology.
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Unusual Myelomas: A Review of IgD and IgE VariantsAlthough survival of patients with IgD or IgE multiple myeloma is shorter in comparison to those with IgG or IgA multiple myeloma, the outcome for patients with IgD and IgE subtypes is improving with the use of novel agents and autologous transplantation.
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UFT Plus Cisplatin in Advanced Non-Small-Cell Lung Cancer: Interim Analysis of 67 PatientsA single-institution phase II study indicated that combination chemotherapy using UFT (tegafur and uracil) plus cisplatin (Platinol) in patients with non-small-cell lung cancer was active with less host toxicity than other cisplatin-
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POINT: HER2-Targeted Combinations in Advanced HER2-Positive Breast CancerWe acknowledge that the “more is better” approach may not always hold true. For example, preclinical data provided a rationale for combining pertuzumab with T-DM1, but recent reports suggest that this strategy may not prove more effective than single-agent T-DM1 therapy in the clinic.
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Chemotherapy for Breast Cancer During Pregnancy, With Neonatal Lupus in the NewbornA 34-year-old, gravida 2, para 1, previously healthy African-American woman presented with a right breast mass on self-examination in the second trimester of pregnancy.
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Rational Design of Irinotecan Administration Based on Preclinical ModelsMost clinical drug regimens for irinotecan (CPT-11 [Camptosar]) have been empirically based on classic in vivo pharmacokinetic and pharmacodynamic considerations. We propose an alternative approach that attempts to
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Chemotherapy for Soft-Tissue SarcomasIn patients with high-risk localized disease, the use of systemic chemotherapy should be strongly considered to delay recurrence and/or reduce the patient’s risk of developing metastatic disease. In patients with metastatic disease, systemic chemotherapy remains the mainstay of treatment.
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ACR Appropriateness Criteria® Adjuvant Management of Early-Stage Endometrial CancerAfter a review of the published literature, the panel voted on three variants to establish best practices for the utilization of imaging, radiotherapy, and chemotherapy after primary surgery for early-stage endometrial cancer.
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Irinotecan in Small-Cell Lung Cancer-Japanese TrialsIrinotecan has appeared to have significant activity against previously treated and untreated small-cell lung cancer (SCLC). The major toxicities of irinotecan are neutropenia and diarrhea, although there is interpatient
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Recent Advances in Hormonal Therapy for Advanced Prostate CancerHormonal treatment of advanced prostate cancer should be consideredfor patients who have stages C and D1 disease, a high risk of recurrenceafter local therapy, or prostate-specific antigen–measured recurrenceafter local treatment. This approach is dependent on most prostatecancer cells being androgen-dependent, but androgen-independentcells may arise after several years of hormonal therapy. Options forandrogen blockade primarily include orchiectomy, luteinizing hormone–releasing agonists and antagonists, and nonsteroidal antiandrogens.There is some controversy regarding combined androgen blockade,intermittent androgen blockade, and the question of whether earlyandrogen blockade is superior to delayed therapy. Convincing data doexist for the use of adjuvant/neoadjuvant hormonal therapy with external-beam radiation therapy. Although hormonal therapy is an importanttreatment modality for advanced prostate cancer, long-termtreatment carries significant side effects that need to be considered.
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Recap: Bladder Cancer Treatment AlgorithmThe Oncology Brothers recap the discussion on treatment practices for patients with bladder cancer.
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What Is the Current Standard of Care for Anti-HER2 Neoadjuvant Therapy in Breast Cancer?This article provides a comprehensive summary of the knowledge gained from recent neoadjuvant trials conducted with agents targeting HER2, and will put them into perspective with current treatment recommendations from American and European guidelines.
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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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Clinical Applications of The Cancer Genome Atlas Project (TCGA) for Squamous Cell Lung CarcinomaWe summarize here key findings from the comprehensive analysis of squamous cell lung cancer by The Cancer Genome Atlas group and discuss the clinical implications of these findings.
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Commentary (Raijman/Wallace): Management of Malignant Biliary Obstruction: Nonoperative and Palliative TechniquesThe first description of percutaneous biliary drainage in the United States appeared in 1965 [1]. The percutaneously placed catheters were left in the obstructed biliary tract for drainage for up to 5 days. Since then, biliary drainage techniques have advanced substantially, and options have proliferated. Now, the nonsurgical palliation of malignant biliary obstruction, accomplished either endoscopically or percutaneously, is a well-established therapeutic modality.
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Paclitaxel and UFT Plus Oral Calcium Folinate in Pretreated Metastatic Breast CancerThis phase I study was designed to determine the maximum tolerated dose (MTD) and dose-limiting side effects of combination treatment with paclitaxel (Taxol) and UFT (uracil and tegafur in a 4:1 molar ratio) plus oral
