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Andreas Rimner, MD, on Immunotherapy Combined with Radiation in Lung CancerThe radiation oncologist from Memorial Sloan Kettering Cancer Center, discusses several ongoing trials combining immunotherapy and radiation at the 14th Annual New York Lung Cancers Symposium®.
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DNA Microarrays in Lymphoid MalignanciesGene expression profiling using cDNA microarrays has the potentialto improve current lymphoma classification schemes by establishinga molecular diagnosis of these malignancies. The use of this technologyled to the discovery of biologically and clinically distinct subtypesof diffuse large B-cell lymphoma (DLBCL). Gene expression datacan also be used to formulate powerful mathematical algorithms thatpredict the clinical outcome in patients with DLBCL and mantle celllymphoma. In B-cell chronic lymphocytic leukemia, gene expressionprofiling identified ZAP70, an important prognostic marker whose expressioncorrelates with the mutational status of the immunoglobulinheavy chain gene and, therefore, with survival in these patients. Theseexamples illustrate that gene expression profiling may pave the way fordetailed molecular characterization of lymphoid malignancies that willultimately lead to tailored, disease-specific therapies.
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Neoadjuvant Therapy With Gemcitabine in Breast CancerPrimary systemic therapy (ie, preoperative or neoadjuvant) increasesthe possibility for breast-conserving surgery in patients with primarybreast cancer. Patients with pathologic complete response to primarysystemic therapy have improved survival compared with those with persistenttumors. Several phase II trials have evaluated gemcitabine-containingdoublet or triplet regimens as primary systemic therapy for breastcancer, results of which have shown promising clinical and pathologicresponse rates with manageable toxicity. Results of a phase I/II studyof gemcitabine (Gemzar)/epirubicin (Ellence)/docetaxel (Taxotere), orGEDoc, with prophylactic filgrastim (Neupogen), as primary systemictherapy in 77 evaluable patients with primary breast cancer are reportedherein. Dose-limiting toxicities were grade 3 febrile neutropenia(n = 1) and grade 3 diarrhea (n = 2) at the fourth dose level ofGEDoc tested (gemcitabine at 800 mg/m2 days 1 and 8, epirubicin at90 mg/ m2 day 1, and docetaxel at 75 mg/m2 day 1). As assessed byultrasound, 92% of patients responded overall (22% complete response),and 79% of patients could undergo breast-conserving surgery. Thepathologic complete response rate in resected breast tissue was 26%.
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UFT Plus or Minus Calcium Folinate for Metastatic Colorectal Cancer in Older PatientsTwo studies were carried out to determine the activity and evaluate the toxicity of oral chemotherapy with uracil and tegafur in a 4:1 molar ratio (UFT) plus or minus calcium folinate in elderly patients with advanced colorectal
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Supraclavicular Extraskeletal Myxoid Chondrosarcoma Presenting With a Sensorimotor Polyneuropathy Associated With Anti-Hu AntibodiesThis case shows the importance of searching for antineural antibodies in oncologic patients with new neurologic deficits, and of having a judicious workup for occult malignancies in patients with known antineural antibodies.
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Oligodendrogliomas: Questions Answered, Answers QuestionedIn light of the high bar that must be met for results to be truly practice-changing, and of the long period of time before survival results are mature in an indolent disease, the primary endpoint for clinical trials in anaplastic oligodendroglial tumors needs rethinking.
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The State of Prostate MRI in 2013Our aims in this article are to describe the various imaging sequences that comprise the multiparametric MRI exam, as well as to review current literature on the strengths/weaknesses of these sequences; to delineate strategies for standardizing interpretation and reporting of MRI results; and to expound on the role of prostate MRI in clinical practice.
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Stereotactic Radiation Therapy Combined With Immunotherapy: Augmenting the Role of Radiation in Local and Systemic TreatmentIn this review we detail the rationale supporting a combination of immunotherapy and stereotactic radiation. Additionally, we discuss the evidence for the immune stimulatory effects of focused radiation and the role that radiation may play in enhancing the systemic treatment effects of immunotherapy.
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Prostate Cancer Risk Assessment ProgramProstate cancer is the most common form of cancer (except skin cancer) in men. Several factors have been associated with an increased risk for prostate cancer, including age, ethnicity, family history, lifestyle, and
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Molecular Genetics of Hereditary Ovarian CancerApproximately 10% of all epithelial ovarian carcinoma cases are associated with inheritance of an autosomal-dominant genetic mutation conferring a predisposition to cancer with variable penetrance. Two such manifestations
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Clinical and Pathological Features Are Still the Best Determinants of Prognosis in MesotheliomaSignificant advances have been made in our understanding of the factors affecting the prognosis of malignant mesothelioma, and a number of biomarkers appear promising. However, at present it may be more fruitful to better define and characterize clinical factors that are well recognized as significantly impacting patient survival.
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How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management.
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Progress With a Purpose: Eliminating Suffering and Death Due to Cancercancer is the second leading cause of death in the United States, with more than 500,000 men, women, and children succumbing to the disease each year. The idea, then, that we can eliminate the suffering and death due to cancer in the United States by the year 2015 may appear impractical, if not irrational and impossible. It seems inconceivable that in the first part of the 21st century every patient could survive cancer. Doubt can be attributed to awareness of the biologic complexity of cancer and seeing the pace of clinical progress through the prism of the 20th century.
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Cancer and Healthcare Reform: Making the Pieces FitCancer service leaders must create the vision, embrace the change agenda, and drive the roadmap in order to make the strategic and clinical changeover to value.
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Recap Evolving HER2+ Metastatic Breast Cancer LandscapeExperts discussed the changing landscape in treatments for HER2-positive metastatic breast cancer.
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Highlighting Insights From the Marginal Zone Lymphoma WorkshopClinicians outline the significance of the MZL Workshop, where a gathering of international experts in the field discussed updates in the disease state.
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Longer Term Data Confirm Subcutaneous Rituximab Efficacy in Follicular LymphomaIn this video we discuss longer term results of the phase III SABRINA study, which tested the safety and efficacy of subcutaneous rituximab in patients with follicular lymphoma.
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Eltrombopag for the Treatment of Chronic Immune (Idiopathic) Thrombocytopenic PurpuraOn November 20, 2008, the US Food and Drug Administration (FDA) granted accelerated approval for eltrombopag (Promacta Tablets, GlaxoSmithKline) for the treatment of thrombocytopenia in patients with chronic immune thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulin therapy, or splenectomy.
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Reducing Racial Disparities in the Treatment of Lung CancerThis video discusses possible methods to help reduce racial disparities in the treatment and outcomes of early-stage lung cancer.
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Commentary (Glass): NCI's Cancer Information Systems-Bringing Medical Knowledge to CliniciansIn 1995, everyone is on the "Information Superhighway." The National Cancer Institute, not to be upstaged, has developed its Cancer Information Systems into a powerful and easy-to-use resource for all to use. The article by Hubbard, Martin, and
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Expanding Options for Pancreatic Cancer...So Where Do We Go From Here?In light of two recent positive clinical trials for advanced pancreatic cancer, we are currently facing an interesting situation that those of us who treat this disease have not had to deal with previously: what to do with this expanding array of choices?
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Current Management of Depression in Cancer PatientsIn their paper, Schwartz and colleagues review the risk factors for depression and suicide in patients with cancer and argue convincingly that screening for depression can be simply and quickly performed. They also delineate the efficacy and potential adverse effects of psychotherapeutic or psychopharmacologic treatments for these patients. Buttressing the identification and treatment of depression in the cancer patient are vital, ongoing scientific developments that flow from an increased understanding of interactions among the brain, endocrine system, and immune system. This rapidly evolving body of neurobiological knowledge has catalyzed fundamental changes in how we conceptualize depression in cancer patients and has important ramifications regarding the treatment and prevention of depressive syndromes in this setting.
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Approval of Olaparib Combo Impacts SOC in BRCA-Mutant Metastatic CRPCAndrew J. Armstrong, MD, MSc, spoke about the recent approval of olaparib plus abiraterone acetate and prednisone in patients with BRCA-mutant metastatic castration-resistant prostate cancer.
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In Hormone-Naive Metastatic Prostate Cancer, Should All Patients Now Receive Docetaxel? No, Not YetMeta-analyses of patients with low-volume metastatic hormone-sensitive prostate cancer will likely be required to attain sufficient power to address the role of docetaxel in this setting.
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gSevere, debilitating fatigue is common in cancer patients. For many,it is the symptom that interferes most with normal routines. Virtuallyevery modality used to treat cancer may cause fatigue, as can complicationsof the disease such as sleep disturbances, infections, malnutrition,hypothyroidism, and anemia. There is a significant overlap betweendepression and fatigue in many patients. Given the high prevalenceof cancer-related fatigue, frequent assessment of patients is essential.The evaluation should include an attempt to identify reversiblecauses of fatigue, and screening for depression. However, many cancerpatients suffer from fatigue even in the absence of any identifiable,reversible cause. For these patients, consideration can be given to suitableexercise programs, educational support and counseling, and energyconservation strategies. A trial of a stimulant medication is alsoreasonable. Given the heterogeneity of patients, individualized approachesare needed. For anemic patients undergoing chemotherapy,erythropoietic agents can increase hemoglobin levels. The impact ofthese drugs on fatigue and quality of life is uncertain. Recent reports ofincreased mortality and thrombotic events in cancer patients treatedwith epoetin require further investigation.
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Vitamin B3 Supplement Reduced Occurrences of Basal and Squamous Cell CarcinomasIn this video, Dr. Martin discusses the phase III ONTRAC study, which found that the use of nicotinamide, a form of vitamin B3, reduced the incidence of non-melanoma skin cancers by 23% among a group of high-risk patients.
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Healthcare Financing and the Cost of Cancer CareControlling healthcare spending has been, and appears destined to remain, at the center of the public policy debate at each level of government, given that much of the healthcare bill is paid by taxpayers.
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Psychiatric Assessment and Symptom Management in Elderly Cancer PatientsThe number of older adults in the general population continues togrow. As their numbers rise, the elderly and the management of theirmedical problems must be of increasing concern for health-care professionals.Within this older population, cancer is a leading cause ofmorbidity and mortality. Although many studies have looked at the psychiatricimplications of cancer in the general population, few studiestackle the issues that may face the older adult with cancer. This articlefocuses on the detection and treatment of depression, anxiety, fatigue,pain, delirium, and dementia in the elderly cancer patient.
