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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.

Daniel Goldstein, MD
Latest Article

A Huge Value Question REGARDless of the RAINBOW

The cost of healthcare is spiraling out of control in the United States, and compared with other countries we don’t even have better health indices to show for it. We currently spend $2.8 trillion annually on healthcare, and this is predicted to increase greatly in the coming years.

Daniel Hayes, MD
Latest Article

The Explanation Behind the Observation?

The recommended primary treatment approach for women with metastatic breast cancer and an intact primary tumor is the use of systemic therapy. Local therapy of the primary tumor is recommended only for palliation of symptoms. However, a series of retrospective studies examining practice patterns for this problem show that about half the women presenting with de novo metastatic disease undergo resection of the primary tumor, and suggest that women so treated survive longer than those who do not undergo resection of the intact primary. In analyses that adjust for tumor burden (number of metastatic sites), types of metastases (visceral, nonvisceral), and the use of systemic therapy, the hazard ratio for death is reduced by 40% to 50% in women receiving surgical treatment of the primary tumor. The benefit of surgical treatment appears to be confined to women whose tumors were resected with free margins. However, these results may simply reflect a selection bias (ie, younger, healthier women with a smaller tumor burden are more likely to receive surgical treatment). In addition, the role of other locoregional therapy such as axillary dissection and radiotherapy is not addressed in these studies. In view of these data, the role of local therapy in women with stage IV breast cancer needs to be reevaluated, and local therapy plus systemic therapy should be compared to systemic therapy alone in a randomized trial.

Daniel J. Becker, MD
Latest Article

Attacking a Moving Target: Understanding Resistance and Managing Progression in EGFR-Positive Lung Cancer Patients Treated With Tyrosine Kinase Inhibitors

In this article, we review the available literature addressing the competing treatment strategies in EGFR-Positive Lung Cancer and attempt to clarify best treatment practices, including the emerging role of T790M-directed therapies.

Daniel J. Buchholz, MD
Latest Article

The Current Clinical Value of the DCIS Score

The DCIS Score provides clinically relevant information about personal risk that can guide patient discussions and facilitate shared decision making.

Daniel J. Culkin, MD, FACS, MBA
Latest Article

A Contemporary Review of HPV and Penile Cancer

This article provides a comprehensive and up-to-date review of the role of HPV infections in men and in the development of penile cancer.

Daniel J. George, MD
Daniel J. George, MD
Latest Article

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.

Daniel J. Haraf, MD
Latest Article

Clinical Radiation Oncology

Clinical Radiation Oncology, edited by Drs. Gunderson and Tepper, is a first-edition textbook designed primarily for those

Daniel J. Lebovic, MD
Latest Article

Lung Cancer After 70: Is it a Different Disease?

Despite the fact that elderly patients comprise over 50% of the non-small cell lung cancer (NSCLC) population, our knowledge regarding the efficacy and safety of chemotherapy in this group is suboptimal. The “elderly” (defined as individuals ≥70 years of age) experience physiologically normal aging of their bone marrow and kidneys, which inherently increases toxicity to therapy. Standard practice has often been to discourage the use of combination chemotherapy in these patients; however, general consensus guidelines emphasize that performance status should primarily guide the choice of treatment. Elderly patients with advanced NSCLC treated with platinum doublet therapy demonstrate similar efficacy (but increased toxicity) to their younger counterparts. Patients with metastatic disease in which a targeted and/or biological agent(s) was added to chemotherapy experienced benefits similar to those treated with standard platinum doublets, but with increased morbidity and mortality. In the future, effective testing of molecular targeted therapies will have to include elderly patients among research cohorts or risk excluding a large population of eligible patients. Overall, elderly patients with advanced NSCLC, while experiencing greater toxicity, demonstrate the same response rates and survival benefits as their younger peers.

Daniel J. Oates, MD, MSc
Latest Article

Health Literacy: Improving Patient Understanding

The review of health literacy and its impact on older adults by Amalraj and colleagues in this issue of ONCOLOGY brings much-needed attention to this very critical issue. The impact of limited health literacy is made even more critical given the increasing number of older adults in the United States, estimated to be 20% of the US population by the year 2030, and the fact that limited health literacy disproportionately affects them.

Daniel J. Zinn, MD
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.

Daniel Keizman, MD
Latest Article

LHRH Antagonists vs LHRH Agonists: Which Is More Beneficial in Prostate Cancer Therapy?

Crawford and Hou[1] review the data on luteinizing hormone-releasing hormone (LHRH) antagonists in prostate cancer. They describe the results of a phase III trial comparing monthly degarelix to monthly leuprolide in men with advanced prostate cancer. Degarelix treatment was associated with a more rapid decline of serum testosterone, and was not associated with an initial surge of serum testosterone seen during the first few days of treatment with leuprolide. They discuss the role of this new form of medical gonadal suppression for the treatment of prostate cancer.

Daniel Knowles, MD
Latest Article

Epidemiology and Pathogenesis of AIDS-Related Lymphomas

Dr. Aboulafia provides an accurate overview of the relationship between immunodeficiency and malignant lymphoma, the lymphoproliferative disorders that occur following solid organ transplantation, and the epidemiology and pathogenetic mechanisms possibly involved in acquired immunodeficiency syndrome (AIDS)-related lymphomagenesis.

Daniel L. Miller, MD
Latest Article

Commentary (Miller): Adjuvant Chemotherapy for Resected Non–Small-Cell Lung Cancer

Lung cancer continues to be themost common cause of cancerdeaths in the United States forboth men and women. Unfortunately,the majority of patients presentwith local or distant disease at thetime of diagnosis. Surgical resectioncontinues to offer the best chance forlong-term survival; however, less than25% of patients have surgically resectabledisease. Even after surgicalresection for early-stage disease a significantnumber of patients will developrecurrent disease, with themajority being distant in nature. Developmentof distant disease usuallyproves to be the terminal event inmost patients. Multiple treatmentmodalities have been investigated asadjuvant therapy to decrease the incidenceof distant disease after completesurgical resection. Untilrecently, no modality has shown asurvival advantage in patients afterresection for non–small-cell lung cancer(NSCLC).

Daniel L. Suzman, MD
Latest Article

In Hormone-Naive Metastatic Prostate Cancer, Should All Patients Now Receive Docetaxel? Yes; We Must Beware of Drawing Conclusions From a Subset Analysis

Ultimately, while further follow-up will be enlightening, we believe that there is sufficient evidence now from the primary analysis of CHAARTED to justify the combination of docetaxel and androgen deprivation therapy in all men with metastatic hormone-sensitive prostate cancer.

Daniel Liberthson, PhD
Latest Article

KS Clearly Not a Conventional Neoplasm

SAN FRANCISCO-“Kaposi’s sarcoma (KS) conforms very poorly to conventional notions about cancer,” Donald Ganem, MD, of the University of California, San Francisco, said at a conference on globally emerging viral infections. “It’s properly classified as in the gray zone between proliferative hyperplasia and frank neoplasm.”

Daniel M. Green, MD
Latest Article

Current Issues in the Diagnosis and Management of Wilms' Tumor

Paulino has thoughtfully reviewed the etiology, diagnosis, and management of Wilms' tumor. Investigators from the National Wilms' Tumor Study Group (NWTSG) first divided Wilms' tumors into two groups: those with a favorable histology and those with an unfavorable histology.[1]

Daniel M. Labow, MD
Latest Article

The Surgical Management of Peritoneal Carcinomatosis of Colorectal Origin

In the United States, approximately 20% of patients with colorectal cancer present with distant metastasis at diagnosis. In 25% of cases, the peritoneal cavity is the only site of metastatic disease, which is not indicative of a generalized systemic disease, as is the case with lung or liver metastases.

Daniel M. Moore, Jr, JD
Latest Article

Cancer Survivors’ Employment and Insurance Rights: A Primer for Oncologists

From the survivor’s viewpoint, Ms.Hoffman’s paper addresses a critical need, expressed in both its title and its conclusions: Medical professionals who treat cancer patients need to be aware of the anxieties faced by those diagnosed with cancer “so

Daniel Nizri, MD
Latest Article

The Role of Irinotecan and Oxaliplatin in the Treatment of Advanced Colorectal Cancer

Colorectal carcinoma is one of the most common malignancies in the western world, and although fluorouracil (5-FU) has been used in its treatment for almost 40 years, new agents with significant activity have been introduced recently. Irinotecan (CPT-11, Camptosar), a topoisomerase I inhibitor, administered at 300 to 350 mg/m2 every 3 weeks is significantly more active than continuous-infusion 5-FU in patients who have experienced disease progression after conventional therapy with 5-FU. In comparison to best supportive care, irinotecan improves survival and preserves quality of life despite treatment-related toxicity. Moreover, the combination of irinotecan and 5-FU has been explored in a number of different schedules. In previously untreated patients, overall response rates are high. Irinotecan can also be combined with mitomycin (mitomycin-C [Mutamycin]), oxaliplatin, or raltitrexed (Tomudex). Oxaliplatin is a new-generation platinum compound that has demonstrated activity against colorectal carcinoma in preclinical trials. It has been evaluated as a single agent against advanced colorectal carcinoma in the salvage setting and also in combination with 5-FU as initial therapy for metastatic disease (where it shows significant activity). The toxicity profile of oxaliplatin (chiefly characterized by neurotoxicity) differs from that of irinotecan (primarily producing diarrhea) and the potential, therefore, exists for combining these agents or for exploiting their possible synergy with 5-FU. The introduction of these two new active agents of different pharmacologic classes promises to enable significant improvements in the treatment of patients with colorectal carcinoma. [ONCOLOGY 15(4):415-434, 2001]

Daniel Noel, MD
Latest Article

Docetaxel/Doxorubicin/Cyclophosphamide in the Treatment of Metastatic Breast Cancer

Preliminary results from phase I trials suggest that the use of docetaxel (Taxotere) and doxorubicin (Adriamycin) is a well tolerated and highly active combination regimen for

Daniel P. Cahill, MD, PhD
Latest Article

Primary and Metastatic Brain Tumors

Intracranial neoplasms can arise from any of the structures or cell types present in the cranial vault, including the brain, meninges, pituitary gland, skull, and even residual embryonic tissue.

Daniel R. Budman, MD, FACP
Latest Article

New Directions With Capecitabine Combinations in Advanced Breast Cancer

Capecitabine (Xeloda) offers a unique mode of action. The drug is currently being combined with other active agents in the treatment of advanced breast cancer. The recent demonstration of improved disease-free and overall

Daniel R. Carrizosa, MD, MS
Latest Article

Outlining Next Steps for Tarlatamab in Early-Line ES-SCLC and Beyond

Data from the phase 3 DeLLphi-304 trial at ASCO 2025 revealed a survival advantage with tarlatamab vs chemotherapy in second-line ES-SCLC.

Daniel R. Tobin, MD
Latest Article

Peaceful Dying

Peaceful Dying is a work of considerable effort and organization. Dr. Tobin has painstakingly analyzed his experience as a physician caring for patients with terminal illness and compiled a step-by-step guide to help both patients and their families

Daniel Rosenblum, MD
Latest Article

Alternatives to Fee for Service Involve Risks

To do better than merely survive under managed care, oncologists who are accustomed to fee-for-service practice must plan new strategies, particularly if they expect to stay in practice more than a few more years.

Daniel Sargent, PhD
Latest Article

General and Statistical Hierarchy of Appropriate Biologic Endpoints

The introduction of newer classes of chemotherapeutic agents, with varying mechanisms of action by which they affect tumor growth and viability, has challenged the traditional norms of clinical trial design and drug approval in oncology. Most notably, the emergence of cytostatic biologic agents with antitumor efficacy has necessitated reassessment of appropriate primary endpoints for phase II and III trials in advanced disease from both a clinical and regulatory standpoint. Recent data in the field establishes an endpoint hierarchy, which places progression-free survival (PFS) between overall survival (OS) and response rate (RR) as appropriate primary endpoints for assessing the clinical efficacy of cytostatic and cytotoxic agents.

Daniel Sauder, MD
Latest Article

Sentinel Lymph Node Biopsy in a Young Child With Thick Cutaneous Melanoma

The article by Bisseck and colleagueshighlights an importantissue encountered increasinglyby physicians-melanoma in childrenand adolescents. The incidence andmortality of melanoma continues torise.[1] It is now the fifth most commoncancer in men and the seventhmost common cancer in women. Inour practice at the Johns HopkinsMelanoma Center, we have treated agrowing number of children and adolescentswith melanoma, includingmany with stage III disease identifiedby sentinel node technology, similarto that described by Bisseck andcolleagues.
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