Authors

Vaccine Therapy for Patients With Melanoma

Investigation into the therapeutic use of vaccines in patients with metastatic melanoma is critically important because of the lack of effective conventional modalities. The most extensively studied melanoma vaccines in clinical trials are whole-cell preparations or cell lysates that contain multiple antigens capable of stimulating an immune response. Unfortunately, in the majority of studies, immune responses to these vaccines have not translated into a survival advantage. Advances in tumor cell immunology have led to the identification of candidate tumor cell antigens that can stimulate an immune response; this, in turn, has allowed for refinements in vaccine design. However, the exact tumor antigens that should be targeted with a specific vaccine are unknown. The univalent antigen vaccines, which have greater purity, ease of manufacturing, and reproducibility compared with polyvalent vaccines, may suffer from poorer efficacy due to immunoselection and appearance of antigen-negative clones within the tumor. Novel approaches to vaccine design using gene transfection with cytokines and dendritic cells are all promising. However, the induction of immune responses does not necessarily confer a therapeutic benefit. Therefore, these elegant newer strategies need to be studied in carefully designed clinical trials so that outcomes can be compared objectively with standard therapy. If survival is improved with these vaccine approaches, their ease of administration and lack of toxicity will firmly entrench active specific vaccine immunotherapy as a standard modality in the treatment of the melanoma patient.[ONCOLOGY 13(11):1561-1574, 1999].

Recent Advances in Hormonal Therapy for Advanced Prostate Cancer

Oottamasathien and Crawfordadvance a hypothesis withwhich I heartily agree-androgendeprivation/antagonist (AD/A)strategies should be considered in manymore patients than urologists and oncologiststraditionally teach. However,I think the authors could substantiallysharpen their message. I would like tomake five specific points, and thenoffer a few nitpicking comments.

Curbing Potential Radiation-Induced Cancer Risks in Oncologic Imaging: Perspectives From the ‘Image Gently’ and ‘Image Wisely’ Campaigns

The purpose of this review is to provide the oncology community with knowledge about the doses used in medical imaging, radiation-induced cancer risks from imaging, and considerations to keep in mind when balancing imaging benefits and risks in pediatric and adult oncologic settings.

Your Patient With Melanoma: Staging, Prognosis, and Treatment

Melanoma affects persons of all ages, causing more years of lost life than any other cancer except leukemia.[1] The American Cancer Society estimates that about 68,720 new melanomas will be diagnosed in the US in 2009, with more than 8,650 deaths, and an estimated lifetime risk of 1 in 50 for whites, 1 in 200 for Hispanics, and 1 in 1,000 for blacks.[2]

Use of Saline-Filled Tissue Expanders to Protect the Small Bowel from Radiation

The article by Hoffman, Sigurdson, and Eisenberg updates their experience in the use of temporary saline-filled tissue expanders (TEs) for small bowel exclusion. In their initial prospective study of 34 patients with a median time of patient surveillance after TE placement of 18 months, the authors demonstrated that small bowel was displaced from more than 95% of the radiation therapy treatment volume in 70% of 27 evaluable patients and from more than 75% of the treatment volume in 89% of patients.[1]

End Results of Salvage Therapy After Failure of Breast-Conservation Surgery

About 10% to 15% of patients who undergo breast-conservation surgeryand radiation therapy will subsequently develop ipsilateral breasttumor recurrence (IBTR). This paper reviews the biology, clinical management,and outcome of this entity. Risk factors for IBTR includeyoung age, positive microscopic margins, gross multifocality, an extensiveintraductal component, and lymphatic vessel invasion. The standardtherapy following IBTR has been mastectomy, but interest in furtherbreast-conservation approaches has recently arisen. Although theoutcome following salvage therapy is quite good, the risk of distantmetastases for patients with IBTR is three to five times greater than forthose without recurrence. The reason for this association has been controversial,but it now appears that IBTR is both a marker of the underlyingbiologic aggressiveness of the tumor and a source for furthertumor metastasis. Monitoring of patients following lumpectomy andradiation therapy, and aggressive therapy for IBTR when diagnosed,are clearly warranted. Prognostic factors at the time of IBTR and implicationsfor local and systemic therapy are discussed.

Liposomal Anthracycline Chemotherapy in the Treatment of AIDS-Related Kaposi’s Sarcoma

The treatments employed for Kaposi’s sarcoma in patients with acquired immunodeficiency syndrome (AIDS-KS) have been limited in their usefulness by toxicities and underlying immunodeficiency in this patient population.

Targeting the Epidermal Growth Factor Receptor

The epidermal growth factor receptor (EGFR) promotes the growth of different cell types and has been implicated in tumorigenesis. The EGFR comprises a family of four structurally similar tyrosine kinases with a complex link to downstream signaling molecules that ultimately regulate key cell processes. Anti-EGFR agents have been developed as promising therapeutic anticancer targets, and some have been recently approved for the treatment of non-small-cell lung cancer and colon cancer. The two anti-EGFR therapies with the greatest clinical application are monoclonal antibodies that block the binding of ligands to EGFR and small-molecule tyrosine kinase inhibitors that inhibit the binding of adenosine triphosphate to the internal tyrosine kinase receptor of EGFR. We attempt to give an overview of the EGFR function and biology, focusing on the most important clinical findings and applications of EGFR inhibitors in lung and head and neck cancer.

Quick Reference for Oncology Clinicians

As a midcareer academic medical oncologist, I have found that some books are especially useful as a pocket reference. Some books are small enough for a briefcase, but not ideal for a coat pocket. Others are best sequestered on a bookshelf. Where a book is placed often influences how one will (or won't) use it or read it.

Allogeneic Marrow Transplantation

Allogeneic marrow transplantation is used to reconstitute hematopoiesis in patients who have received myeloablative therapy for a hematologic malignancy or in patients with irreversible marrow failure, to reconstitute the immune system in patients with severe immunodeficiency, and to normalize metabolism in patients with select inherited metabolic deficiency disorders.

Radiosensitization by Gemcitabine

Gemcitabine is a potent radiosensitizer in both laboratory studies and in the clinic. Initial laboratory studies showed that gemcitabine radiosensitizes a wide variety of rodent and human tumor cells in culture. Maximum

Commentary (Fuhrmann/Suter): Radiotherapy for Cutaneous Malignant Melanoma: Rationale and Indications

In their article on radiotherapy forcutaneous malignant melanoma,Drs. Ballo and Ang discuss fourkey points, which we will addressbelow.

Management of Pressure Ulcers

Pressure ulcers are a common problem, with about 1.5 to 3 million individuals in the United Stated affected. Treatment may be costly, requiring lengthy periods of hospitalization. Central to the development of pressure

Prophylactic Surgery in Hereditary Breast/Ovarian Cancer Syndrome

The hereditary breast/ovarian cancer syndrome is responsible forapproximately 5% of all breast cancers and 10% of all ovarian cancers.Although this accounts for a small portion of these diseases, muchattention has been focused on this syndrome because of the abundanceof research in this area. The majority of the hereditary breast/ovariansyndrome can be attributed to germ-line mutations in the BRCA1 andBRCA2 genes. Reliable screening techniques for these mutations havebeen developed and are readily available in clinical practice. Forpatients who are thought to have the hereditary breast/ovarian cancersyndrome based on family history or genetic testing, options exist foreither intensive screening or prophylactic surgery. This review willdiscuss the mechanisms by which mutations in the BRCA genes lead tothe development of cancer, the limitations of currently available screeningtechniques, and the efficacy of prophylactic surgery. In general,prophylactic oophorectomy can be performed laparoscopically as anoutpatient procedure, carrying as its main drawback the associatedconsequence of surgical menopause. Prophylactic mastectomy is quiteeffective in reducing the risk of breast cancer but is a more extensivesurgical procedure and results in disfigurement. For any given patient,the best estimates of individual risk of breast or ovarian cancer shouldbe weighed against the benefits of prophylactic surgery and the patient’spersonal wishes.

Combined-Modality Treatment for Operable Pancreatic Adenocarcinoma

Although in centers where pancreatectomy is performed frequently,associated morbidity and mortality rates have improved, long-term outcomesin pancreatic adenocarcinoma patients remain poor when surgeryis the sole therapeutic modality. The impact of adjuvant chemotherapyon survival in patients with localized pancreatic cancer remainsincompletely defined. The European Study Group for Pancreatic Cancer(ESPAC)-1 trial has suggested that overall survival rates are superiorwhen chemotherapy is added to surgery, even when regimens believedto be relatively ineffective in the treatment of advanced diseaseare used. The role of radiotherapy given with chemotherapy is alsounresolved, but chemoradiation continues to receive consideration inthe multimodality approach to localized pancreatic cancer. Enhancedcollaboration and increased involvement by pancreatic surgeons havehelped in the recruitment of pancreatic cancer patients for large-scalerandomized clinical trials in Europe and the United States. Many newerchemotherapeutic agents with efficacy in gastrointestinal cancers haveyet to be investigated in the adjuvant and neoadjuvant settings.

Looking Ahead: What’s on the Horizon in Advanced Melanoma

Panelists discuss how emerging advances in melanoma treatment include next-generation tumor-infiltrating lymphocyte therapy, oncolytic immunotherapy, bispecific antibodies, cancer vaccines, and neoadjuvant approaches that may allow de-escalation of both surgery and systemic therapy while improving treatment-free survival.

Woman With Rare Cause of Rectal Bleeding

A 56-year-old Caucasian woman presented to her primary care physician with a 3-month history of intermittent bright red rectal blood with defecation. At her initial visit, a digital rectal examination, anoscopy, and a pelvic examination with DNA testing for high-risk HPV were performed; all results were negative. She was referred for a colonoscopy, which revealed an abnormal area with a 3 × 4–cm mass in the rectum at a distance of 10 cm from the anal verge.

Nutritional Implications of Dental and Swallowing Issues in Head and Neck Cancer

Management of patients who have head and neck cancer necessitates a multidisciplinary approach.[1,2] Comprehensive care must be initiated prior to therapy, maintained throughout course of treatment, and systematically coordinated for the rest of the patient’s life. As Dwyer and Minasian note, a multidisciplinary team that includes dental professionals, a speech/language pathologist, and a registered dietician is best suited for this complex management challenge. These individuals, working in conjunction with physicians, nurses, and other professionals, can provide patients with key preventive and therapeutic supportive care interventions.

Minimally Invasive Resection of Early Lung Cancers

This review looks at the current data and guidelines for thoracoscopic resection of stage I NSCLC and discusses the potential for limited lung resection in patients with the disease.

Adrenal Lesion Discovered in 50-Year-Old Patient

Current Combined Treatment of High-Grade Osteosarcomas

The evaluation and treatment of osteosarcoma have evolved considerably over the past 2 decades, with corresponding dramatic improvements in prognosis. In large part, the improved outlook is attributable to

Commentary (Frank): Gene Therapy for Head and Neck Cancers

Lamont et al have presented a very clear and concise review of current gene therapy strategies in the management of squamous cell carcinoma of the head and neck. While the presentation highlighted the most important work to date in this expanding field, it also made reference to some controversies and challenges that we are now facing. With this in mind, I would like to expand on and clarify several points raised by the authors.

Current Approaches to the Treatment of Well-Differentiated Thyroid Cancer

Well-differentiated thyroid cancer is something of an anomaly in the field of oncology for two primary reasons. First, the team of physicians who manage the patient consists primarily of endocrinologists, endocrine surgeons, and nuclear medicine physicians instead of medical oncologists, surgical oncologists, and radiation oncologists. Second, there is an extremely high rate of cure with remarkable 10- and 20-year survival rates due to the indolent nature of the tumor, even in the setting of lymph node metastases.

BOOK REVIEW: Changing the Odds: Cancer Prevention Through Personal Choice and Public Policy

The premise of Steen's book is that nearly everyone is confused about cancer prevention. The public, for whom the book is written, is the most confused, but cannot be faulted. According to Steen, the responsibility for their confusion lies with scientists and the press. Scientists make mistakes by reporting preliminary data from inadequate and mostly "workmanlike, undistinguished" (page 3) studies. The press, in turn, repeats these mistakes, adds some of its own, and so oversimplifies a complex topic that the public, in the end, receives "unconnected facts, partial truths, and outright lies" (page 3).

Commentary (Olsen): Role of Laparoscopic Techniques in Colorectal Cancer Surgery

Drs. Milsom and Hammerhofer review some of the controversies surrounding the use of laparoscopic procedures in the management of colorectal cancers. They detail the approach followed in the development of their technique, and outline the phase 3 clinical trials that they are currently conducting, which are aimed at demonstrating the usefulness and appropriateness of laparoscopic colon resection for the treatment of colorectal cancers.

1 Million Americans a Day Risk Injury in Tanning Salons

BUENOS AIRES--The tanning salon industry has grown enormously in recent years, with as many as 2 million regular patrons in the United States, and 1 million people visiting daily, W. L. Morrison, MD, of Johns Hopkins University, said at the Sixth World Congress on Cancers of the Skin.

Lymphatic Mapping in the Treatment of Breast Cancer

Developed initially for the treatment of malignant melanoma, lymphatic mapping and sentinel lymph node biopsy have recently been introduced into the treatment of early breast cancer. In breast cancer patients, harvested

Treatment of In-Transit Melanoma: An Opportunity to Discover Critical Knowledge

While patients with in-transit disease represent a wide spectrum of disease that requires individualized therapy, great opportunity exists to learn from our treatment interventions in these individuals.

Testicular Cancer

This testicular cancer management guide covers the diagnosis, staging, and treatment of germ-cell tumors and seminoma.