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Authors

Amar Shah, MD
Latest Article

Management of a Patient With Borderline Resectable Pancreatic Cancer

In this case report, we discuss the presentation, workup, and therapeutic management of a 40-year-old man who presented with borderline resectable, periampullary pancreatic cancer and underwent a margin-negative resection following neoadjuvant chemoradiotherapy.

Amato J. Giaccia, PhD
Latest Article

Imaging Tumoral Hypoxia: Oxygen Concentrations and Beyond

The role of hypoxia as a key determinant of outcome for human cancers has encouraged efforts to noninvasively detect and localize regions of poor oxygenation in tumors. In this review, we will summarize existing and developing techniques for imaging tumoral hypoxia. A brief review of the biology of tumor oxygenation and its effect on tumor cells will be provided initially. We will then describe existing methods for measurement of tissue oxygenation status. An overview of emerging molecular imaging techniques based on radiolabeled hypoxic markers such as misonidazole or hypoxia-related genes and proteins will then be given, and the usefulness of these approaches toward targeting hypoxia directly will be assessed. Finally, we will evaluate the clinical potential of oxygen- and molecular-specific techniques for imaging hypoxia, and discuss how these methods will individually and collectively advance oncology.

Ambuj Kumar, MD, MPH
Latest Article

The Moving Target of Cancer Care Costs

Patients aged 65 years and older represent 12% of the US population yet account for approximately 56% of cancer cases and 69% of all cancer mortalities. The overall cost of cancer in 2005 was $209.9 billion—$74 billion for direct medical costs and $118.4 billion for indirect mortality costs. This paper considers the direct, indirect, and out-of-pocket expenditures incurred by cancer patients ‚â • 50 years of age. Several major empirical studies on supportive care for older patients and cancer-related costs were reviewed. Insurance coverage, hematologic malignancies, squamous cell carcinoma of the head and neck, and cancers of the breast, prostate, colorectum, and lung were evaluated. Major sources of direct medical expenditures covered by third-party insurers for patients aged 65 years and older include extended length of hospital stay, home health assistance following hospital discharge, adjuvant prescription medications, lower-risk treatment (for prostate cancer), and advent of new pharmaceuticals (for colorectal cancer). The mean total direct medical cost for breast cancer is $35,164, and the cumulative cost for prostate cancer is $42,570. Emerging targeted cancer drug costs range from $20,000 to $50,000 annually per patient. Additional clinical trials and cost-effective treatments are needed for older patients to ameliorate the disproportionate economic burden among older individuals with cancer. Additional research about cancer costs may also lead to reforms in cancer care reimbursement, and therefore provide access to affordable health care for older patients.

Amelia B. Zelnak, MD, MSc
Latest Article

Genomic Subtypes in Choosing Adjuvant Therapy for Breast Cancer

Additional insight into the biology of ER-positive breast cancers, particularly the higher risk luminal B cancers, could aid in identifying potential targets and new, effective therapies. And though the majority of triple-negative breast cancers are the “basal-like” subtype, significant proportions are in other subtypes.

Amelia Tienghi, MD
Latest Article

Doxorubicin and Paclitaxel (Sequential Combination) in the Treatment

Based on preclinical data, we designed a phase I/II clinical trial to determine the efficacy and toxicity of doxorubicin followed by paclitaxel in the treatment of advanced breast cancer (either untreated or relapsed after

Amer A. Beg, PhD
Latest Article

Propelling Immunotherapy Combinations Into the Clinic

This review summarizes promising new targets and immunotherapy combination strategies currently under clinical development.

American Academy of Dermatology
Amin J. Mirhadi, MD
Latest Article

Radical Radiotherapy for Prostate Cancer Is the ‘Only Way To Go’

In 2008, approximately 186,000 American men were diagnosed with prostate cancer, resulting in about 28,600 deaths.[1] It is the most commonly diagnosed cancer, and second only to lung cancer as the leading cause of cancer death in men.

Aminah Jatoi, MD
Latest Article

Anorexia and Cachexia

Many patients with advanced cancer undergo a wasting syndrome associated with cancer anorexia/cachexia and asthenia. In defining these terms a bit further, anorexia is associated with a marked loss of appetite and/or an aversion to food.

Aminu Birhan, MD
Latest Article

Management of Locally Advanced or Unresectable Head and Neck Cancer

In the following sections, we will first review the radiotherapy techniques that have been investigated. We will then review the progressive advances achieved with the addition of chemotherapeutic strategies to RT in an attempt to achieve better outcomes.

Amir Y. Shaikh, MD
Latest Article

Cardiovascular Toxicity of Newer Chemotherapeutic Agents: The Heart of the Matter

Standard heart failure regimens remain the mainstay of therapy for chemotherapy-related cardiac dysfunction until newer randomized trials suggest otherwise, and earlier detection of toxicity through judicious surveillance with biomarkers and noninvasive imaging remains the cornerstone of management for the foreseeable future.

Amit A. Patel, MD
Latest Article

Systemic Approaches for Multifocal Bronchioloalveolar Carcinoma: Is There an Appropriate Target?

Bronchioloalveolar carcinoma (BAC) is a subset of pulmonary adenocarcinoma characterized by distinct and unique pathological, molecular, radiographic, and clinical features. While the incidence of pure BAC is rare, comprising only 1% to 4% of non–small-cell lung cancer (NSCLC), mixed subtypes (including BAC with focal invasion and adenocarcinoma with BAC features) represent as much as 20% of adenocarcinomas-and that figure may be increasing. Despite the longstanding recognition of this entity, there is no established treatment paradigm for patients with multifocal BAC, resulting in competing approaches and treatment controversies. Current options for multifocal BAC include both surgery and systemic therapies. Unfortunately, prospective data on systemic approaches are limited by study design and small patient numbers; there are only seven phase II studies involving four therapies. This article evaluates key characteristics of BAC, including the current understanding of histopathology and tumor biology. In addition, it comprehensively reviews the systemic phase II studies in an attempt to clarify the therapeutic challenges in this disease. It also includes the first proposed treatment paradigm that integrates both EGFR mutational status and the sub-histologies, mucinous and nonmucinous BAC.

Amit Arora, MD
Latest Article

Commentary (Arora/Freifeld): Infectious Complications of Lung Cancer

The article by Dr. Seo providesa comprehensive review of theepidemiology, presentation, andtreatment of infection in lung cancerpatients. Infection is a significant causeof morbidity and mortality in cancerpatients, as a consequence of immunologicabnormalities that result from thecancer itself as well as from cytotoxiccancer therapies. Granulocytopenia andlymphocyte dysfunction commonlyoccur following intensive therapy formany solid tumors such as lung cancer,and these cellular deficiencies particularlypredispose patients to certain infections.Respiratory infections arecommon during the course of lung cancer,often as a result of direct effects onthe lung including radiation therapy andtumor burden causing obstruction, especiallywith bronchogenic carcinomasor carcinoid tumors. Postsurgical infections,following biopsy or thoracotomyfor resection, are also common.Infectious complications are problematicfor both patient and oncologistsbecause they may delay treatment andimpair quality of life.

Amita Patnaik, MD
Latest Article

Commentary (Patnaik/Rowinsky)-Epidermal Growth Factor Receptor Inhibitors for the Treatment of Colorectal Cancer: A Promise Fulfilled?

The past decade has given rise toan explosion of rationally designed,molecularly targetedtherapeutic agents. The epidermalgrowth factor receptor (EGFR) hasserved as the principal platform forthe development of such novel targetedtherapies, resulting in a paradigmshift in the treatment of a vast array ofsolid malignancies. Damjanov andMeropol have provided a comprehensiveand insightful overview of the roleof EGFR-directed therapeutics in colorectalcancer. They have chosen tofocus their discussion on the compoundsthat are furthest along in clinicaldevelopment and, hence, havereviewed the monoclonal antibodiescetuximab (Erbitux), ABX-EGF, andEMD 72000, as well as the small-moleculetyrosine kinase inhibitors gefitinib(Iressa) and erlotinib (Tarceva).

Amitabha Mazumder, MD
Latest Article

New Questions About Transplantation in Multiple Myeloma: Review 1

Multiple myeloma is now the most common indication for autologous stem cell transplantation (ASCT) in North America, with over 5,000 transplants performed yearly (Center for International Blood and Marrow Transplant Research [CIBMTR] data). While the role of ASCT as initial therapy in multiple myeloma has been established by randomized studies, newer therapies are challenging the traditional paradigm. The availability of novel induction agents and newer risk stratification tools, and the increasing recognition of durability of remissions are changing the treatment paradigm. However, even with arduous therapy designed to produce more complete remissions—for example, tandem autologous transplants—we have seen no plateau in survival curves. A tandem autologous procedure followed by maintenance therapy may be performed in an attempt to sustain remission. Sequential autologous transplants followed by nonmyeloablative allotransplants are pursued with the hope of "curing" multiple myeloma. We examine how the key challenges of increasing the response rates and maintaining responses are being addressed using more effective induction and/or consolidation treatments and the need for maintenance therapies after ASCT. We argue that given the biologic heterogeneity of multiple myeloma, risk-adapted transplant approaches are warranted. While the role of curative-intent, dose-intense toxic therapy is still controversial, conventional myeloablative allogeneic transplants need to be reexamined as an option in high-risk aggressive myeloma, given improvements in supportive care and transplant-related mortality.

Amod A. Sarnaik, MD
Latest Article

POINT: Surgical Management of Lymph Node Basin in Sentinel Lymph Node–Positive Melanoma

CLND as standard of care for patients with SLN-positive metastatic melanoma is supported by a wealth of compelling prospective data.

Amy Coghill, MSN, RN, OCN
Latest Article

Implementing Survivorship Care Plans Within an Electronic Health Record

Survivorship care is “a distinct phase of care for cancer survivors that includes four components: (1) prevention and detection of new cancer or recurrent cancer; (2) surveillance for cancer spread, recurrence, or second cancers; (3) intervention for consequences of cancer and its treatment; and (4) coordination between specialists and primary care providers to ensure that all of the survivor’s health needs are met.”

Amy E. Cyr, MD
Latest Article

Molecular Profiling Assays in Breast Cancer: Beyond Prime Time and Into Syndication

Future randomized studies should focus on determining which patients benefit most from the inclusion of molecular diagnostics in treatment decision making and on the development of treatment algorithms that incorporate patient factors, histologic and biologic findings, and molecular markers.

Amy E. Gates, MD
Latest Article

AIDS Malignancies in the Era of Highly Active Antiretroviral Therapy

The introduction of highly active antiretroviral therapy (HAART) has had a dramatic impact on the morbidity and mortality of individuals living with human immunodeficiency virus (HIV). In addition to contributing to dramatic

Amy E. Gravell, MS
Latest Article

Current Clinical Trials of Flavopiridol

Flavopiridol [2-(2-chlorophenyl 5 ,7-dihydroxy-8-[cis-(3-hydroxy-1-methyl-4-piperidinyl)-4H-1-benzopyran-4-one, hydrochloride] is a semisynthetic flavone with a novel structure compared with that of polyhydroxylated flavones, such as quercetin and genistein.[1] It is derived from rohitukine, an alkaloid isolated from the stem bark of Dysoxylum binectariferum, a plant indigenous to India.[2] Originally synthesized and supplied by Hoechst India Limited, flavopiridol is provided to the Division of Cancer Treatment and Diagnosis of the National Cancer Institute (NCI) by Aventis Pharmaceuticals, Inc.

Amy H. Hou, MD
Latest Article

The Role of LHRH Antagonists in the Treatment of Prostate Cancer

Physicians have known since 1941 that testosterone suppression benefits patients with symptomatic metastatic prostate cancer.[1] The pioneering study in this regard showed that estrogen therapy achieved comparable efficacy to castration by improving acid and alkaline phosphatase levels associated with relief of cancer-related symptoms. More than 6 decades later, however, many of the therapies subsequently developed for achieving androgen deprivation still suffer from serious limitations.

Amy K. Stevens, MD
Latest Article

Management of Asymptomatic Rising PSA After Prostatectomy or Radiation Therapy

Controversy exists over the optimal management of patients with an asymptomatic rising prostate-specific antigen (PSA) following definitive therapy for clinically localized prostate adenocarcinoma.

Amy P. Abernethy, MD, PhD
Latest Article

It's Time to Have ‘The Talk’: Cost Communication and Patient-Centered Care

Barriers to cost discussions fall into three categories: inaccessible cost data, ethical concerns, and insufficient training.

Amy S. Clark, MD, MSCE
Latest Article

Using Nuclear Medicine Imaging in Clinical Practice: Update on PET to Guide Treatment of Patients With Metastatic Breast Cancer

We review how radiolabeled glucose and estrogen analogs can be used in breast cancer patients. We focus this review on the application of positron emission tomography imaging to ER-positive metastatic breast cancer as an example of how imaging can guide breast cancer treatment.

Amy Storfa, MD
Latest Article

Polypoid Lesions of the Lower Female Genital Tract

A 46-year-old multiparous (gravida 3, para 3) woman presented to her primary care provider with a palpable vulvar polypoidal mass, measuring 7 cm in greatest dimension. The mass was painless and had been growing in size over the past 2 years. Her medical history was remarkable for obesity, hypothyroidism, and an appendectomy at age 17. Her family history was significant for a sister with breast cancer, diagnosed at age 34. A core biopsy was performed.

Amy V. Young, MD
Latest Article

Management of Locally Advanced or Unresectable Head and Neck Cancer

In the following sections, we will first review the radiotherapy techniques that have been investigated. We will then review the progressive advances achieved with the addition of chemotherapeutic strategies to RT in an attempt to achieve better outcomes.

Amy Walton, RN
Latest Article

Chronic Diarrhea in Post-treatment Colorectal Cancer Survivors

Early detection of cancer and novel chemotherapy agents have resulted in longer survival following a colorectal cancer diagnosis.

Amy Y. Chen, MD, MPH, FACS
Latest Article

A Shifting Paradigm for Patients with Head and Neck Cancer: Transoral Robotic Surgery (TORS)

This paper by Drs. Bhayani, Holsinger, and Lai describes a new approach to an old problem. Advances in the management of head and neck cancer over the past few decades have been made predominantly in the area of non-surgical therapy. Starting with the Veterans Affairs Cooperative Trial for laryngeal cancer in the early 1990’s,[1] advances in the administration of chemotherapy and radiation therapy have enabled patients to forego traditional extensive resections that compromised speech and swallowing function.[2] The advances in combined chemoradiation for advanced head and neck cancer have come with a detriment to some patients in survival and quality of life.[3] Effective treatment, but with decreased morbidity was needed.

Ana C. Ceja-Bojorge, MD
Latest Article

Man With Recurring Chordoma and Progressive Disease Despite Radiotherapy and Radical Resection

A 60-year-old man presented with lower limb claudication and a painful mass on his left buttock. Physical examination revealed a firm round mass, fixed to deep planes. A biopsy was performed and revealed a chordoma.

Ana G. Ruiz Allison, MD
Latest Article

Endocrine Malignancies

Endocrine neoplasms are relatively uncommon, but those that do occur are often difficult to detect and treat effectively. According to 1991 estimates, there were 13,900 cases of endocrine cancers in the United States, 12% of which will ultimately prove fatal.
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