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Authors

Dan A. Avradopoulos, MD
Latest Article

Diagnostic and Management Issues in Gallbladder Carcinoma

This paper by Abi-Rached and Neugut provides an overview of the diagnosis and treatment of gallbladder carcinoma, a rare, yet frustratingly difficult disease to manage [1]. Overall, we agree with the risk factors described in this review. We would add that, in addition to chronic cholecystitis, porcelain gallbladder, and retained gallbladder (secondary to cholecystostomy), cholecysto-enteric fistulas have also been associated with a higher incidence of gallbladder carcinoma [2,3] Patients with ulcerative colitis are known to be at higher risk for cholangiocarcinoma, and there is also some evidence that these patients have an increased risk of gallbladder cancer.

Dan A. Laheru, MD
Latest Article

Commentary (Laheru/Jaffee): Novel Vaccines for the Treatment of Gastrointestinal Cancers

The identification of key signaltransduction pathways and, inparticular, specific proteins thatare involved in the regulation of cancercell growth has provided unprecedentedopportunities for researchersinterested in targeted cancer treatment.The identification of molecular target-specific therapy offers the potentialof maximal therapeutic benefitwhile minimizing toxicity to normalcells. The accomplishment that led tothe sequencing and analysis of theentire human genome in 2001 has providedresearchers with the basic criticaltools to begin to identify anddifferentiate cancer from normal tissueat the genetic level.[1,2] Whilethe implications of this landmarkachievement are still being realized,it has become evident that the identificationof critical genes and proteinsinvolved in cell division and growthare just the beginning. The complexrelationships between multiple signaltransduction pathways, the surroundingtumor microenvironment, andpathways involved in immune-systemregulation have gained new appreciation.The ability to manipulate thesemultiple interactive systems with targetedtherapies represents a new treatmentparadigm in oncology.

Dan G. Duda, Dmd, PhD
Latest Article

Targeted Therapy in Rectal Cancer

Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) are often overexpressed in colorectal cancer and are associated with inferior outcomes. Based on successful randomized phase III trials, anti-EGFR and anti-VEGF therapeutics have entered clinical practice. Cetuximab (Erbitux), an EGFR-specific antibody, is currently approved in the United States in combination with irinotecan (Camptosar) for patients with metastatic colorectal cancer refractory to irinotecan or as a single agent for patients unable to tolerate irinotecan-based therapy. In retrospective analyses, patients with EGFR-expressing rectal cancer undergoing neoadjuvant radiation therapy had a significantly inferior disease-free survival and lower rates of achieving pathologic complete response. Based on the positive data in metastatic colorectal cancer and synergy with radiation therapy seen in preclinical models, there is a strong rationale to combine cetuximab with neoadjuvant radiation therapy and chemotherapy in rectal cancer. Bevacizumab (Avastin), a VEGF-specific antibody, was the first antiangiogenic agent to be approved in the United States for use in combination with standard chemotherapy in the first- and second-line of treatment in metastatic colorectal cancer. VEGF-targeted therapy may lead to indirect killing of cancer cells by damaging tumor blood vessels, and may increase the radiosensitivity of tumor-associated endothelial cells. VEGF blockade can also "normalize" tumor vasculature, thereby leading to greater tumor oxygenation and drug penetration. This review will address completed and ongoing trials that have established and continue to clarify the effects of these agents in rectal cancer.

Dan L. Longo, MD
Latest Article

Commentary (Longo)-Follicular Lymphoma: Expanding Therapeutic Options

Dr. Ganti and colleagues from the University of Nebraska provide a thorough review of the management of patients with follicular lymphoma, including many recent additions to the therapeutic armamentarium. The field is rapidly changing, and this article will be an enduring resource both for clinicians currently managing these patients and for anyone in the future who wants to understand what the state of the art was in 2004. Follicular lymphoma accounts for about one-third of non- Hodgkin’s lymphomas in the United States, making it likely that an individual oncologist will see one to three patients with follicular lymphoma each year. As the authors point out, numerous active agents have been developed for use in patients with follicular lymphoma over the past 5 years and additional promising new therapeutic agents and novel approaches (eg, vaccination) are in the development pipeline.

Dan Ollendorf, MPH
Latest Article

Impact of Uracil/Tegafur Plus Oral Calcium Folinate on Resource Utilization

Data from a multinational phase III trial were analyzed to evaluate the use of in- and outpatient services for 373 patients with metastatic colorectal cancer being administered uracil/tegafur (in a molar ratio of 4:1 [UFT]) plus

Dan Theodorescu, MD, PhD
Latest Article

Clinical Decision Making in Surveillance of Non–Muscle-Invasive Bladder Cancer: The Evolving Roles of Urinary Cytology and Molecular Markers

In this article, we discuss the requirements for development and validation of urine markers and the factors that hamper their clinical implementation. We also review current surveillance guidelines for NMIBC and provide an overview of approved urine markers for the detection and surveillance of NMIBC.

Dana B. Cardin, MD
Latest Article

Treatment of Early-Stage Pancreatic Cancer

Early trials of adjuvant therapy in pancreatic cancer had multiple limitations including small sample size, population heterogeneity, and inability to distinguish between components of combined modality treatment.

Dana Barnea, MD
Latest Article

Obesity and Metabolic Disease After Childhood Cancer

In this review, childhood cancer survivor populations at risk for metabolic late effects, as well as mechanisms and ongoing intervention studies, will be detailed.

Dana Goldman, PhD
Latest Article

Commentary (Goldman): Evaluating the Total Costs of Cancer

Longitudinal cohort studies ofspecific populations providesome of the most compellingevidence for research spanning epidemiology,medicine, and social science.The Framingham Heart Study(FHS) is a good example. Initiated in1948, the FHS tracks a cohort of whitemen and women who reside in thetown of Framingham, Massachusetts.The study population receives biennialmedical exams and personal interviews,and an additional study hasfollowed their offspring. The FHShas contributed much of our knowledgeabout cardiovascular disease incidenceand prevalence, and its riskfactors.

Dana Rathkopf, 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.

Dana Zakalik, MD
Latest Article

How We Treat Tumor Lysis Syndrome

When tumor cells are rapidly broken down and their contents released into the extracellular space, the released ions and compounds can cause metabolic disturbances too great to be neutralized by the body's normal mechanisms.

Danai Daliani, MD
Latest Article

Soft-Tissue and Bone Sarcomas

Sarcomas are a heterogenous group of tumors originating from mesenchymal tissues. According to American Cancer Society estimates, approxiately 8,070 new cases will be diagnosed in 1995, including 6,000 cases of soft-tissue sarcomas and 2,070 cases of bone tumors [1].

Daniel A. Hamstra, MD, PhD
Latest Article

Salvage External Beam Radiotherapy for Prostate Cancer After Radical Prostatectomy

This article defines the biochemical recurrence of prostate cancer, distinguish SRT from ART, outline the evidence for SRT, and makes recommendations with regard to radiotherapy volume and dose.

Daniel A. Rushing, MD
Latest Article

Phase I/II Study of Weekly Irinotecan and Paclitaxel in Patients With SCLC

This phase I/II nonrandomized, open-label study was designed to assess the safety and benefit of sequencing irinotecan (Camptosar, CPT-11) plus paclitaxel (Taxol) immediately after cisplatin (Platinol)/etoposide (VePesid,

Daniel A. Wollin, MD
Latest Article

Extended Pelvic Lymph Node Dissection for Prostate Cancer: Do More Nodes Mean Better Survival?

At the present time, without clear data to suggest improved survival for patients undergoing extended pelvic lymph node dissection, the procedure cannot be universally recommended.

Daniel B. Carr, MD
Latest Article

Commentary (Carr/Goudas): An Alternative Algorithm for Dosing Transdermal Fentanyl for Cancer-Related Pain

To assist in converting patients from one opioid agent to another in their daily practice, many oncologists carry pocket dosage conversion guides based on package inserts approved by the US Food and Drug Administration (FDA). One such guide issued by the manufacturer of transdermal fentanyl (Duragesic), reproduced in Table 3 of the expert consensus article written by Breitbart et al, presents the equivalent of 25 µg/h of transdermal fentanyl as 45 to 134 mg/d of oral morphine. In another guide, distributed by one of the manufacturers of controlled-release morphine, the 25 µg/h strength of transdermal fentanyl is said to be equianalgesic to 15 mg of controlled-release morphine administered every 12 hours (and both are deemed equivalent to 10 mg of controlled-release oxycodone every 12 hours). Faced with such a wide range of conversion factors, it is of little surprise-as Breitbart et al point out-that clinicians often fail to achieve equianalgesia when converting patients from one opioid to another.

Daniel C. Ihde, MD
Latest Article

Small-Cell Lung Cancer: Treatment Progress and Prospects

Although small-cell lung cancer (SCLC) represents only 20% of all lung cancer cases in the United States, it is the most lethal subtype. Combination chemotherapy unequivocally offers the best chance for improved survival in

Daniel Catovsky, MD
Latest Article

Pentostatin Treatment of Cutaneous T-Cell Lymphoma

Mycosis fungoides is an indolent primary cutaneous T-cell lymphoma (CTCL) that usually progresses from localized skin lesions to systemic disease. Sézary syndrome is a distinct variant characterized by generalized

Daniel Chua, MB
Latest Article

Chemotherapy in Advanced Nasopharyngeal Cancer

Chemotherapy is an integral part of treatment for patients with nasopharyngeal carcinoma. Chemotherapy can achieve long-term survival rates of up to 15% to 20%, even in patients with recurrent or metastatic disease. In

Daniel Coit, MD
Latest Article

Melanoma Surgical Practice Guidelines

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in

Daniel Cornfeld, MD
Latest Article

Multiparametric MRI: Standardizations Needed

Multiparametric MRI is a promising tool for identifying cancer within the prostate. It has the potential to drastically change the way prostate cancer is staged and treated. However, work remains to make this technique reproducible and accessible to the community-based radiologist and urologist.

Daniel D. Lydiatt, DDS, MD
Latest Article

Surgical Approach to Organ Preservation in the Treatment of Cancer of the Larynx

The management of cancer of the larynx has arguably become the most complicated task in the field of head and neck oncology. Both physicians and patients struggle to decide how initial treatment should be delivered. Treatment decisions

Daniel D. Von Hoff, MD
Latest Article

Special Targets for the Treatment and Prevention of Cancer: Angiogenesis, VEGF, COX-2

Identification of targets in tumor cells vs normal cells (or at least a differential in their expression) is certainly a promising method for approaching the treatment and, indeed, the prevention of cancer. Presently, targeting of patient tumor cells has taken on even greater importance and interest with the discovery of the new agent imatinib mesylate (STI571, Gleevec), which is targeted to a kinase present in chronic myeloid leukemia (CML) cells (p210 BCR-ABL abnormal cells), which is required for CML cells to survive, but is not present in normal leucocytes.[1] The results with this agent targeted to the p210 BCR-ABL tyrosine kinase are indeed spectacular. The agent is of even greater interest in that it also works against some gastrointestinal stromal sarcomas with gain of function mutations in c-kit (CD117).[2] This activity of a targeted agent against a solid tumor increases the interest in targeted therapy to an even greater degree.

Daniel E. Bergsagel, MD
Latest Article

Use of Bisphosphonates in Patients With Metastatic Bone Disease

The urge to control the manifestations of incurable chronic diseases, such as the anemia, renal failure, and bony disease of myeloma and the bone disease of breast cancer, is understandable. Successful control of these disease manifestations greatly improves a patient’s quality of life. This is especially important since patients with either of these malignancies may live with the disease for 20 years or more. Considerable success has been achieved in the correction of anemia with erythopoietin (Epogen, Procrit), and simple hydration has reversed renal failure and improved the survival of patients with myeloma.[1] Anyone who has witnessed the frightening spasms of back pain in myeloma patients, precipitated by a sneeze or an attempt to turn over in bed, understands the dreadful fear that patients have of uncontrolled bone pain.

Daniel E. Haggstrom, MD
Latest Article

New Targets and New Mechanisms in Lung Cancer

This review will describe the well-known use of VEGF antibodies; the current uses of EGFR and ALK tyrosine kinase inhibitors; newer agents being used against MET, FGFR, and other intracellular targets; insights regarding the field of immunotherapy in lung cancer; and finally, newer developments in chemotherapy.

Daniel F. Hayes, MD
Latest Article

CYP2D6 Testing for Breast Cancer Patients: Is There More to the Story?

The promise of pharmacogenetics is personalization of therapy for individuals through refinement of the risk/benefit profile of pharmaceuticals based on inherited gene mutations. Classic examples of the impact of pharmacogenetics in clinical practice include variants in dihydropyrimidine dehydrogenase and treatment with fluorouracil.

Daniel F. Roses, MD
Latest Article

Breast Cancer

This is a comprehensive 701-page volume filled with excellent illustrations, photographs, tables, and schematics. The overall structure of the book takes the reader from molecular oncology issues through pathology, diagnosis, staging, treatment, and a

Daniel Flores Morales, 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.

Daniel G. Coit, MD, FACS
Latest Article

Commentary (Coit): Management of Small Bowel Adenocarcinoma

Malignant small bowel tumors are extremely rare, accounting for 0.1% to 0.3% of all malignancies. Fewer than 2,400 new cases of small bowel malignancy are reported in the United States each year.[1] Malignant tumors, which account for about two-thirds of all primary small bowel tumors, consist of four primary subtypes: adenocarcinoma, carcinoid tumor, lymphoma, and sarcoma (or gastrointestinal [GI] stromal tumor). Each malignancy is characterized by unique predisposing factors, anatomy, and biology. The prevalence, pattern, and relevance of both regional lymph node and distant metastases differ. As a result, the study of malignant small bowel tumors, taken as an aggregate, is fraught with difficulty.

Daniel G. Haller, MD
Latest Article

Commentary (Hewitt/Haller): Adjuvant Therapy for Colorectal Cancer

During the 1980s, the only drug routinely used to treat colorectal carcinoma was single-agent fluorouracil (5-FU), a drug that had shown no proven benefit in the adjuvant setting. Since then, significant improvements in the overall management of colorectal cancer have been made. This review will compare today's standard of care for adjuvant colorectal carcinoma to that practiced 20 years ago. The authors examine key questions asked about adjuvant therapy and the answers that ultimately changed clinical practice standards and improved overall survival for patients diagnosed with this disease. In addition, this review explores whether 5-FU should be given as part of a multidrug regimen and which route of administration is best when this drug is given. Further, the authors delve into both the use of locally directed therapies to the liver or peritoneum to improve outcomes and the selection of patients to receive adjuvant chemotherapy. Finally, a look to the future shows monoclonal antibodies to be an avenue of great promise in fighting colorectal cancer.
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