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The Benefits of Achieving Stable Disease in Advanced Lung CancerDr. Kelly has written an excellentarticle demonstrating theclinical significance of achievingstable disease in advanced non–small-cell lung cancer (NSCLC)patients. This hypothesis is supportedby clinical data from two phase IItrials (Iressa Dose Evaluation in AdvancedLung Cancer [IDEAL-1 andIDEAL-2]) of the epidermal growthfactorreceptor (EGFR) inhibitor gefitinib(ZD1839, Iressa) in previouslytreated patients. She appropriatelypoints out that although tumor shrinkageis a conventionally used end pointfor cytotoxic drugs, it may not be appropriatefor the “novel” cytostaticagents. For these agents, stabilizationof disease without obvious tumorshrinkage may result in a clinicalbenefit.
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Genetic Testing: The Bigger PictureSchrader and colleagues provide four compelling examples of the power of genetic testing to impact medical management for probands and their family members.
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Incorporating Collaboration and Personalization of Treatment in Breast Cancer CareThe field of breast oncology is constantly evolving to include trial diversity and multidisciplinary care.
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Head and Neck Cancer: Changing Epidemiology and Public Health ImplicationsCharacterizing the epidemiology of head and neck cancers is challenging and has received limited attention in the medical literature. Traditionally, 80%–90% of head and neck squamous cell carcinomas (HNSCCs) have been attributed to tobacco and alcohol use, but with growing public awareness and tobacco control efforts over the past few decades, there has been a downward trend in smoking prevalence in the US. There is also emerging evidence that human papillomavirus (HPV) is responsible for inconsistencies in HNSCC trends, with oncogenic HPV DNA found in approximately half of oropharyngeal cancers and in a high proportion of oropharyngeal cancers in nonsmokers and nondrinkers. The risk to HNSCC epidemiology is that whatever gains continue to be made in tobacco control may become lost in the increasing numbers of oropharyngeal cancers due to HPV. The purpose of this review is to explore the changing epidemiology of HNSCC, focusing on how it has been shaped by health policy and advocacy interventions and how it will continue to have public health implications in the future, particularly in considering preventive strategies against HPV. Given that the majority of HNSCCs are the result of exposure to preventable public health risks, more focus should be given to this area.
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Long-Term Effects of Chemo on the Cognitive Function of Cancer PatientsIn this podcast we discuss the long-term effects of chemotherapy on the cognitive function of cancer patients and the current status of research in this field.
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The Long Road-and the High Road-to Successful Implementation of OncoEMRWhat distinguishes those practices that are successful in their use of the EMR is their commitment to the product and their recognition that it is the central element in the treatment of their patients.
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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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UFT/Leucovorin Plus Irinotecan in Advanced or Metastatic Colorectal CancerUFT (with leucovorin) and irinotecan both have single-agent activity in colorectal cancer, with non–cross-resistant mechanisms of action. Combining these drugs would be anticipated to increase response rates while maintaining the advantages of a regimen based on an orally administered fluoropyrimidine.
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Unrelated Donor StemCell Transplantation: The Role of the National Marrow Donor ProgramApproximately 70% of patientswith life-threatening diseasestreatable with allogeneic bloodstem cell transplantation do not havematched related donors. The NationalMarrow Donor Program (NMDP) wasestablished in 1986 to provide humanleukocyte antigen (HLA)-matched,volunteer unrelated donors for thesepatients. The NMDP performs thistask by maintaining a registry of morethan 4.9 million volunteer donors ofmarrow and peripheral blood stemcells (PBSC) and 12 cord blood bankscontaining more than 25,000 units ofumbilical cord blood.
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Current Combined Treatment of High-Grade OsteosarcomasThe evaluation and treatment of osteosarcoma have evolved considerably over the past 2 decades, with corresponding dramatic improvements in prognosis. In large part, the improved outlook is attributable to
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Managing Colorectal Cancer Liver MetastasesThe combined-modality care of the patient with colon or rectal cancer metastatic to the liver demands a team approach. It is little wonder that there is much confusion about this topic, given the number of unique treatment options that are delivered in a sequential and reiterative process. The concept of multidisciplinary approaches to complex cancer challenges has been adopted for a variety of tumor types and situations.
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Do Oncogenic Drivers Exist in Squamous Cell Carcinoma of the Lung?The Cancer Genome Atlas provides us with our first thorough insight into the genetic heterogeneity of squamous cell carcinoma of the lung; whether these findings will translate into personalized squamous cell lung cancer therapy is yet to be determined.
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Thalidomide in Solid Tumors: The London ExperienceInvestigators at the Royal Marsden Hospital and University College in London have studied thalidomide (Thalomid) as both low-dose (100 mg orally, every night) and high-dose (600 mg, given as 300 mg twice per day)
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Pathologic Evaluation of Prostatic Carcinoma: Critical Information for the OncologistDr. Epstein provides a comprehensive review of the pathology of prostatic carcinoma and its importance in guiding the clinical management of treatment for our patients with abnormal prostates and prostate cancer. Prostate cancer, its evaluation, screening, and treatment, remain in many aspects the most controversial for the urologic oncologist. Clearly, our decisions on how we treat patients with elevated PSA's, abnormal prostate exams, and a diagnosis of prostate cancer is influenced greatly by the interpretation of the pathologist of biopsies and radical prostatectomy specimens. In short, the oncologist and urologist are unable to make intelligent and accurate recommendations without accurate pathologic review.
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Small Steps Forward in the Land of Small TumorsMetastatic well or moderately differentiated neuroendocrine tumors of the gastrointestinal tract and lung (NETs) are a fascinating and markedly heterogeneous group of generally indolent, but relentless cancers.
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Commentary (Kinsella): Current Status of Radiation Sensitization by FluoropyrimidinesDrs. Pu, Robertson, and Lawrence provide a concise update of recent laboratory and clinical studies of fluoropyrimidine radiosensitization. From a clinical perspective, one can conclude that this drug-radiation interaction appears to be greater than additive and clearly has resulted in significant therapeutic gains, particularly for gastrointestinal cancers, as summarized in Tables 2 and 3 of their article. From a laboratory perspective, the focus has now shifted to trying to better understand the mechanisms of the interaction as related to molecular events at the G1/S interphase and in early S phase.
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Timothy Moynihan, MD, on ‘Death Cafés’ and the Importance of Discussing End-of-Life Issues With Your PatientsThis interview discusses the importance of discussing end-of-life issues with patients.
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Update on Adjuvant Chemotherapy for Early Breast CancerAdjuvant chemotherapy represents a significant advance in the management of early-stage breast cancer and, as such, has saved many lives. Worldwide, adjuvant chemotherapy has benefitted all groups tested, including
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PSA Testing in Prostate Cancer: Early Treatment vs ObservationIn this interview we discuss the role of early treatment, active surveillance, and watchful waiting in patients with PSA-detected early-stage prostate cancer.
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Cancer Chemotherapy in the Elderly PatientThe management of older patients with cancer is historically challenging because of a lack of prospective data regarding the appropriate management of this population. In this review, we address some of the issues and challenges surrounding the treatment of older cancer patients, including the withholding of medically appropriate treatment based on chronologic age, the historical omission of elderly from clinical trials, and the impact of geriatric assessment, and age-related changes in pharmacokinetics and pharmacodynamics. Finally, we conclude by discussing the existing evidence related to cancer treatment in the elderly, focusing primarily on the malignancies most commonly seen in older patients, and making general treatment recommendations where applicable.
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Primary Cutaneous CD30+ Lymphoproliferative Disorders: New Insights Into Biology and TherapyThe spectrum of CD30+ lymphoproliferative diseases of the skin includes CD30+ cutaneous anaplastic large cell lymphoma, lymphomatoid papulosis, as well as borderline cases. These entities constitute the second most common group of cutaneous lymphomas according to the newly revised World Health Organization and European Organisation for Research and Treatment of Cancer consensus classification. Recent progress in immune and molecular biology, and identification of therapeutic targets have increased our understanding of these diseases and have led to novel treatment approaches. This review will provide an update on recent findings of immunologic, molecular, cytogenetic features and treatment strategies for patients with CD30+ lympho-proliferative diseases.
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ACR Appropriateness Criteria® Borderline and Unresectable Pancreas CancerThese guidelines review the use of radiation, chemotherapy, and surgery in borderline and unresectable pancreas cancer. Radiation technique, dose, and targets were evaluated, as was the recommended chemotherapy, administered either alone or concurrently with radiation. This report will aid clinicians in determining guidelines for the optimal treatment of borderline and unresectable pancreatic cancer.
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Multidisciplinary Management of Breast Cancer Brain MetastasesThis review summarizes the most up-to-date approach to the multidisciplinary management of patients with breast cancer brain metastases.
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Yoga and cancer care: Guide your patients down the right pathDr. McCall is a board-certified internist and the medical editor of Yoga Journal. He is the author of Yoga as Medicine: The Yogic Prescription for Health and Healing (Bantam, 2007). He can be found on the Web at www.DrMcCall.com.
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The Prostate Cancer Intervention Versus Observation Trial (PIVOT)The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is a randomized trial designed to determine whether radical prostatectomy or expectant management provides superior length and quality of life for men with clinically localized prostate cancer. Conducted at Department of Veterans Affairs and National Cancer Institute medical centers, PIVOT will enroll over 1,000 individuals less than 75 years of age. The primary study end point is all-cause mortality. Secondary outcomes include prostate cancer- and treatment-specific morbidity and mortality, health status, predictors of disease-specific outcomes, and cost-effectiveness. Within the first 3 years of enrollment, over 400 men have been randomized. Early analysis of participants' baseline characteristics indicate that enrollees are representative of men diagnosed with clinically localized prostate cancer throughout the United States. Therefore, results of PIVOT will be generalizable. These results are necessary in order to determine the preferred therapy for clinically localized prostate cancer. [ONCOLOGY 11(8):1133-1143, 1997]
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ACR Appropriateness Criteria® Postradical Prostatectomy Irradiation in Prostate CancerThe purpose of this article is to present an updated set of American College of Radiology consensus guidelines formed from an expert panel on the appropriate use of radiation therapy in postprostatectomy prostate cancer.
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Brachytherapy Boost Techniques for Locally Advanced Prostate CancerDr. Vicini and colleagues provide an excellent review of the experience to date utilizing interstitial brachytherapy in the treatment of locally advanced prostate cancer. As the authors mention, ample evidence suggests the existence of a dose-
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Stereotactic Radiosurgery for Brain MetastasesWorldwide, approximately 100,000 patients have undergone stereotactic radiosurgery for a variety of intracranial lesions, of which brain metastases represent the most common treatment indication. This article summarizes the major issues surrounding the management of brain metastases, and also analyzes 21 independent reports of Gamma Knife– or linear accelerator–based radiosurgery, representing over 1,700 patients and more than 2,700 lesions. Variable reporting in the studies precludes a definitive, rigorous analysis, but the composite data reveal an average local control rate of 83% and median survival of 9.6 months, both of which are comparable to results in recent surgical reports. The most important prognostic factors for survival appear to be fewer than three lesions, controlled extracranial disease, and Karnofsky performance score (KPS). The exact impact of dose has not been clarified, but a dose-response relationship, especially for ³ 18 Gy, is emerging. The role of whole-brain radiotherapy remains unresolved. It may enhance local control but does not convincingly improve survival and, in some series, is associated with an increased risk of late complications. Chronic steroid dependence and increased intracranial edema do not appear to be common problems. This is an opportune time for the completion of ongoing randomized trials to validate these observations. [ONCOLOGY 13(10):1397-1409,1999]
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Commentary (Collins/Hurwitz)-Epidermal Growth Factor Receptor Inhibitors for the Treatment of Colorectal Cancer: A Promise Fulfilled?Damjanov and Meropol havedone an excellent job of reviewingboth the complex biologyof epidermal growth factor signalingand the current status ofepidermal growth factor receptor(EGFR, ErbB-1) inhibition for thetreatment of colorectal cancer. As theypoint out, several factors have madeEGFR a potentially high-value targetin cancer therapy. In addition, theyreview several phase II studies thathave demonstrated clinical activity foranti-EGFR antibodies in patients withadvanced colorectal cancer.
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Is Personalized Medicine Here?This review describes the achievements in therapeutic and molecular diagnostics, details evolving molecular platforms, and highlights the challenges for the translation of these developments to daily clinical practice.
