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Caleb T. Chu, MD
Latest Article

Future Directions of Monoclonal Antibody Use in Personalized Lung Cancer Therapy

With the new direction in research and clinical trials, treating patients who most benefit from treatment with minimal toxicity will continue to be the mainstay of personalized cancer therapy.

Cameron Muir, MD, MPH
Latest Article

Palliative Care and Oncology Partnerships in Real Practice

This article addresses the practical application of palliative care (PC) in the outpatient oncology setting.

Camilla Zimmermann, MD, PhD
Latest Article

Early Palliative Care: Moving From ‘Why’ to ‘How’

Integrating palliative care from the time of diagnosis can support both patients and families through difficult periods and prepare them for the journey ahead. It can improve quality of life while curtailing healthcare spending and increasing satisfaction with oncology care.

Camille Berriochoa, MD
Latest Article

POINT: Should Radiation Therapy After Surgery for Ductal Carcinoma In Situ Be Standard Practice?

At this time RT following BCS remains the standard of care for most patients. Current tools, including prognostic scores and tumor genetics, have failed to identify a cohort for whom RT confers no benefit with respect to invasive recurrences.

Cancer Center Director D. Ross Camidge, MD, PhD
Latest Article

From Radiotherapy to Targeted Therapy: 20 Years in the Management of Non-Small-Cell Lung Cancer

Non-small-cell lung cancer (NSCLC) is the leading cause of cancer death worldwide. Before 1980, radiotherapy was considered the only real recourse in advanced disease. In 1995, a landmark meta-analysis of trials conducted in the 1980s and early 1990s demonstrated a survival benefit with platinum-based chemotherapy. Newer chemotherapy agents and improved supportive care measures have allowed more patients to benefit from chemotherapy with reduced toxicity. Concurrent platinum-based chemotherapy and radiotherapy has improved the survival in stage III disease, and recently chemotherapy has also demonstrated improved survival in resected early-stage disease. The majority of patients still present with advanced unresec disease for whom the prognosis remains poor, but for key subpopulations the outlook has improved markedly since the emergence of targeted therapies directed against the epidermal growth factor receptor and vascular endothelial growth factor receptor pathways. Patient selection and the incorporation of targeted therapies with cytotoxic chemotherapy are the focus of many ongoing studies, and there is an abundance of new agents undergoing clinical trials. Together, these developments have moved us away from the nihilism of 20 years ago into an era of unprecedented optimism in taking on the many remaining challenges of managing NSCLC in the 21st century.

Candace Coggins, CARN, NP
Latest Article

Current Perspectives on Pain in AIDS

The article by Dr. William Breitbart and Lucia DiBiase offers an excellent in-depth review of our current knowledge of the epidemiology, pharmacologic, and nonpharmacologic interventions in the field of pain management in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS).

Candace J. Coolidge, PhD
Latest Article

Gene Therapy for Ovarian Cancer

Advances in molecular virology and biotechnology have led to the engineering of vectors that can efficiently transfer genes to target cells. Gene therapy strategies were developed along two lines: Cytotoxic approaches

Cara H. Glynn
Latest Article

About This Treatment Guide

The Oncology Group, a division of CMPMedica, publisher of the journal ONCOLOGY and the news magazine Oncology News International, as well as the comprehensive cancer website, cancernetwork.com, is pleased to bring you the 10th annual edition of Cancer Management: A Multidisciplinary Approach.

Carey A. Cullinane, MD
Latest Article

Cancer Management Chapter 41: Fluid complications

Malignant pleural effusion complicates the care of approximately 150,000 people in the United States each year. The pleural effusion is usually caused by a disturbance of the normal Starling forces regulating reabsorption of fluid in the pleural space, secondary to obstruction of mediastinal lymph nodes draining the parietal pleura.

Carisa Bohnak, BS
Latest Article

POINT: Should Radiation Therapy After Surgery for Ductal Carcinoma In Situ Be Standard Practice?

At this time RT following BCS remains the standard of care for most patients. Current tools, including prognostic scores and tumor genetics, have failed to identify a cohort for whom RT confers no benefit with respect to invasive recurrences.

Carl A. Olsson, MD
Latest Article

Metastatic Adrenocortical Carcinoma With a Prolonged Response to Mitotane

Adrenocortical carcinoma is a rare disease, with an annual incidence rate ranging from 0.5 to 2.0 cases per million individuals.

Carl E. Allen, MD, PhD
Latest Article

Langerhans Cell Histiocytosis: Emerging Insights and Clinical Implications

Langerhans 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.

Carl F. Blackman, PhD
Latest Article

Nonionizing Electromagnetic Fields and Cancer: A Review

We strongly agree with the authors that, although there is no compelling evidence to suggest that nonionizing electromagnetic fields represent a public health hazard, there is sufficient evidence of magnetic- and electric field-induced biologic effects to continue scientific investigation of this issue.

Carl M. Mansfield, MD, ScD
Latest Article

Brachytherapy in the Treatment of Breast Cancer

Dr. Subir Nag et al are to be congratulated for their excellent, thorough analysis and presentation of the use and role of

Carl Pinsky, MD
Latest Article

Status of Radiolabeled Monoclonal Antibodies for Diagnosis and Therapy of Cancer

Almost exactly one decade ago, in an editorial published in the New England Journal of Medicine [1], I noted that "progress is slow but sure" in the development of monoclonal antibodies for clinical use. At that time, only muromonab-CD3 (Orthoclone OKT3) was approved for human use to prevent rejection of kidney transplants. In the ensuing 10 years, only one oncologic monoclonal antibody product, satumomoab pendetide (OncoScint CR/OV, Cytogen, Princeton, New Jersey) [2] has been approved by the FDA. Progress surely has been slow.

Carl Tahn, MD, MPH
Latest Article

Commentary (Tahn/Khuri): Second-Line Treatment of Small-Cell Lung Cancer

Small-cell lung cancer (SCLC)poses one of the greatest managementchallenges in clinicaloncology, as the mortality rate approaches95% within 2 years afterpresentation for patients with extensivedisease, despite widespread useof combination chemotherapy.[1]Given a disease that is largely managedby the community physician andfor which recent definitive clinicaltrials are relatively scarce,[2] it isincumbent upon the clinician to becognizant of the critical factors innostudies suggesting that three-drugcombinations are indicated.

Carla Chalouhy, MD
Latest Article

Radium-223 in Bone-Metastatic Prostate Cancer: Current Data and Future Prospects

This article will describe the historic background of Ra-223; outline the clinical studies which led to phase III trials of this agent; highlight key results of these phase III studies; and explore possible future directions for use of Ra-223 and other alpha particles-both in prostate cancer and for management of other diseases.

Carla Eide, MD
Latest Article

Considerations for Treating Pain in the Older Cancer Patient

Pain in older cancer patients is a common event, and many times it is undertreated. Barriers to cancer pain management in the elderly include concerns about the use of medications, the atypical manifestations of pain in the elderly, and side effects related to opioid and other analgesic drugs. The care of older cancer patients experiencing pain involves a comprehensive assessment, which includes evaluation for conditions that may exacerbate or be exacerbated by pain, affecting its expression, such as emotional and spiritual distress, disability, and comorbid conditions. It is important to use appropriate tools to evaluate pain and other symptoms that can be related to it. Pain in older cancer patients should be managed in an interdisciplinary environment using pharmacologic and nonpharmacologic interventions whose main goals are decreasing suffering and improving quality of life. In this two-part article, the authors present a review of the management of pain in older cancer patients, emphasizing the roles of adequate assessment and a multidisciplinary team approach.

Carla P. Roberts, MD, PhD
Latest Article

Fertility Preservation in the Gynecologic Cancer Patient

Clinicians, researchers, and survivorship communities are beginning to recognize the late effects of cancer treatment, such as infertility, and the negative impact this can have on cancer survivorship. Reproductive concerns that emerge within cancer experiences have been shown to be negatively associated with quality of life. Gynecologic cancer can present before childbearing has been started or completed, during pregnancy, or can even arise out of pregnancy, as is the case with gestational trophoblastic disease. Parenthood has been cited as an important aspect of cancer survivorship. As a result, interest concerning fertility preservation, reproductive concerns, and family-building options in cancer survivorship has increased, in addition to awareness of the emotional ramifications of cancer-related infertility. Education and support are clearly an essential component of cancer survivorship. Furthermore, more attention and investigation is still needed about the reproductive issues of gynecologic cancer survivors in the future.

Carla Ripamonti, MD
Latest Article

Current Status of Patient-Controlled Analgesia in Cancer Patients

Patient-controlled analgesia (PCA) is a relatively new technique in which patients are able to self-administer small doses of opioid analgesics when needed. Many different devices are available for opioid infusion, including

Carla Van Bennekom, MPH
Latest Article

The REMS Publication Paradox

The introduction of mandatory risk evaluation and mitigation strategy (REMS) programs, in which patients must participate in order to receive a new therapy, provides an opportunity to examine an issue affecting ethical oversight and publication of scientific study results.

Carline Robert, MD
Latest Article

Cutaneous Side Effects of Multikinase Inhibitors Used in Renal Cell Cancer

Paralleling the increasing use of multikinase inhibitors in the field of cancer therapy, patients and clinicians are confronted with frequently occurring cutaneous side effects associated with the use of these new drugs. Two such targeted agents, sunitinib (Sutent) and sorafenib (Nexavar), were recently approved by the US Food and Drug Administration to treat patients with metastatic renal cell cancer (RCC).

Carlo C. Diclemente, PhD
Latest Article

Smoking Cessation: Recent Developments in Behavioral and Pharmacologic Interventions

Smoking kills more than 430,000 people each year in the United States and is currently estimated to be responsible for 30.5% of all cancer-related deaths in our society. The majority of these deaths could be prevented,

Carlo Garufi, MD
Latest Article

Hypersensitivity Reactions to Oxaliplatin: Incidence and Management

The paper by Gowda et al is anotherwell-done work on allergicreactions in patients treatedwith oxaliplatin (L-OHP, Eloxatin)for advanced colorectal cancer.Oxaliplatin was found to be an activeagent in the treatment of this disease10 years ago,[1] and its role in combinationwith leucovorin and fluorouracil(5-FU) is a cornerstone in thetreatment of advanced colorectalcancer,[2-7] as it will probably alsobecome in the adjuvant setting.[8] Althoughthe drug’s dose-limiting toxicityis a cumulative sensory neuropathy,allergic and idiosyncratic reactions mustalways be considered due to their severityand because they can representan important, irreversible reasonfor treatment discontinuation.

Carlo Milandri, 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

Carlos A. Garay, MD
Latest Article

Chemoprevention of Colorectal Cancer: Dietary and Pharmacologic Approaches

Colorectal cancer is a major cause of death in the United States, where it accounts for approximately 57,000 deaths per year. Thus, the prevention of this disease would have a significant impact on public health. Chemoprevention is defined as the use of natural or pharmacologic agents to disrupt the process of carcinogenesis. Substances explored as chemopreventive agents in colorectal cancer include: (1) the nonsteroidal anti-inflamma-tory drugs (NSAIDS), which may inhibit the evolution and formation of adenomas by their inhibition of cyclooxygenase and decrease of prostaglandin synthesis; (2) antioxidants, such as vitamin E or C, which may modulate carcinogenic substances; and (3) folate and calcium, which may interfere with tumor cell growth and replication. Dietary intervention can be accomplished by decreasing fat intake and increasing fiber consumption, both of which have been linked to a lower incidence of colon cancer in multiple epidemiologic studies. This field is continuing to evolve. Hopefully, ongoing research efforts will offer a better understanding of the role of these and other substances in chemoprevention. This article summarizes the available data regarding dietary and pharmacologic approaches to colorectal cancer chemoprevention. [ONCOLOGY 1(13):89-98, 1999]

Carlos A. Perez, MD
Latest Article

Cervical Cancer

This management guide covers the screening, diagnosis, staging, and treatment of cervical cancers.

Carlos Augusto De Andrade, MD
Latest Article

A Pharmacoeconomic Comparison of UFT and 5-FU Chemotherapy for Colorectal Cancer in South America

The escalating role played by managed care organizations in the health-care system is reflected in the increased demand for cost-effectiveness analyses (CEAs) to assess the balance between economic impact

Carlos Delfino, MD
Latest Article

Gemcitabine/Paclitaxel as First-Line Treatment of Advanced Breast Cancer

Gemcitabine (Gemzar) and paclitaxel exhibit good activity and goodsafety profiles when used alone and together in the treatment of advancedbreast cancer. In a phase II trial, 45 patients with metastaticbreast cancer received gemcitabine at 1,200 mg/m2 on days 1 and 8 andpaclitaxel at 175 mg/m2 on day 1 every 21 days. Twenty-seven patients(60.0%) had prior adjuvant therapy. Objective response was observedin 30 patients (objective response rate 66.7%, 95% confidence interval[CI] = 52%–71%), including complete response in 10 (22.2%) and partialresponse in 20 (44.4%). Median duration of response was 18 months(95% CI = 11–26.7 months), median time to tumor progression for theentire population was 11 months (95% CI = 7.1–18.7 months), medianoverall survival was 19 months (95% CI = 17.3–21.7 months), and the1-year survival rate was 69%. Treatment was well tolerated, with grade3/4 toxicities being infrequent. Grade 3/4 leukopenia, neutropenia, andthrombocytopenia were each observed in six patients (13.3%). No patientwas discontinued from the study due to hematologic ornonhematologic toxicity. Thus, the gemcitabine/paclitaxel combinationshows promising activity and tolerability when used as first-line treatmentin advanced disease. The combination recently has been shownto be superior to paclitaxel alone as first-line treatment in anthracyclinepretreatedadvanced disease according to interim results of a phase IIItrial and it should be further evaluated in comparative trials in breastcancer.

Carlos Dzik, MD
Latest Article

Expanding Androgen- and Androgen Receptor Signaling–Directed Therapies for Castration-Resistant Prostate Cancer

This article reviews the most recent advances in androgen receptor-directed therapies for castration-resistant prostate cancer, and new agents under development.