Technology

FDA has approved expanded labeling for single-agent Campath (alemtuzumab) as a first-line treatment of B-cell chronic lymphocytic leukemia.SearchMedica.com, the specialty oriented professional medical search engine, has received the 2007 Health Care Standard of Excellence WebAward from the Web Marketing Association.

Kanti Rai, MD, still remembers the life and quick death of a 3-year-old girl from Port Washington, Long Island, diagnosed with acute lymphocytic leukemia. It was almost 50 years ago when he was chief resident in pediatrics at North Shore Hospital, Manhasset, New York. He was shaken to his core. His mentor, Arthur Sawitsky, MD, suggested that he might try research, which is easier on the heart.

FDG-PET performed after two cycles of standard chemotherapy can accurately predict which patients with Hodgkin's lymphoma will respond or relapse

Small field of view positron imaging, optimized for breast cancer, is jockeying for position among several adjuncts to x-ray mammography. A proponent of the technology, Kathy Schilling, MD, believes it has an edge over MRI.

This review covers progress to date in the identification of molecular targets on blood vessels in cancers, as well as agents that act on those targets, with emphasis on those currently in clinical trials. Current vascular-targeting therapies comprise two general types—antiangiogenic therapy and antivascular therapy. Advances in antiangiogenic therapies, particularly inhibitors of vascular endothelial growth factors and their receptors, have clarified the capacity of these inhibitors to change tumor-associated vessel structure to a more normal state, thereby improving the ability of chemotherapeutics to access the tumors. The responses of other antiangiogenesis target molecules in humans are more complicated; for example, αvβ3 integrins are known to stimulate as well as inhibit angiogenesis, and cleavage of various extracellular proteins/proteoglycans by matrix metalloproteinases produces potent regulators of the angiogenic process. Antivascular therapies disrupt established blood vessels in solid tumors and often involve the use of ligand-based or small-molecule agents. Ligand-based agents, irrespective of the antiangiogenic capacity of the ligand, target antivascular effectors to molecules expressed specifically on blood vessels, such as aminopeptidase N, fibronectin extra-domain B, and prostate-specific membrane antigen. Small-molecule antivascular agents, which are not targeted to molecules on blood vessels, rely on physical differences between the vasculatures in tumors and those in normal tissues.

Vaccines have been exceptionally effective against diseases such as smallpox, measles, chickenpox, and polio. They are among the safest and most cost-effective agents for disease prevention. In recent years, vaccination has been considered for other diseases, including AIDS and cancer. Cancer vaccines can be categorized as preventive or therapeutic. Preventive vaccines, which are commercially available for cervical cancer and liver cancer, block infection with the causative agents of human papillomavirus and hepatitis B virus, respectively. The benefit of cancer treatment vaccines lies in their ability to "boost" the immune system response to cancer cells, which is generally low. Using vaccines in the treatment of cancer is relatively new, however, and chiefly experimental. Therapeutic vaccines for breast, lung, colon, skin, renal, prostate, and other cancers are now being investigated in clinical trials. Oncology nurses may play a significant role in reducing barriers to uptake of preventive vaccines among the general public and in increasing patients' acceptance of therapeutic cancer vaccines.

According to a RAND Corporation study, America's healthcare system could save more than $81 billion annually and improve the quality of healthcare if it were to broadly adopt electronic medical record (EMR) systems.

In the June issue of ONCOLOGY, authors McGregor et al did an admirable job of reviewing childhood cancer advances and current issues in their article entitled "Pediatric Cancers in the New Millennium: Dramatic Progress, New Challenges"

The integrins are a family of transmembrane receptors important for the cell-cell and cell-matrix interactions that relate to processes of cell adhesion, migration, invasion, angiogenesis, and survival.

Integrins have direct effects in stimulating proliferation and preventing apoptosis in cancer cells and mediating proangiogenic interactions between endothelial cells and extracellular matrix. Alterations of expression of various integrins and their receptors have been observed in various cancers in which angiogenesis is known to play a role, including colorectal cancer. Inhibition of specific integrins might thus inhibit both direct effects of integrins on cancer cells and tumor angiogenesis. Inhibitory peptides and anti-integrin monoclonal antibodies are currently being investigated in clinical trials in patients with solid tumors, with early evidence suggesting clinical benefit in disease stabilization with use of an anti-αvβ3 antibody in the settings of colorectal cancer, renal cell carcinoma, and melanoma. Integrin inhibition alone and with other targeted therapeutic approaches should be further investigated in clinical trials in patients with colorectal cancer.

Adhesion molecules have traditionally been thought of simply as receptors that permit anchorage to other cells or to the underlying extracellular matrix (ECM). However, within the past decade it has become apparent that adhesion molecules such as integrins mediate critical cytosolic signaling events that have a dramatic impact upon cell proliferation, survival, and motility. Integrins act to regulate both physiologic and pathologic events, including complex processes such as angiogenesis, tumor growth, and metastasis. For these reasons, integrins have become attractive targets for drug development, and several effective integrin antagonists are now under clinical evaluation. In turn, the use of integrin-targeted reagents has provided additional mechanistic insights into the workings of the receptor. In particular, it has become apparent that integrins are "mechanosensory" receptors that operate in a context-dependent manner. While integrins that ligate substrate-immobilized ligands typically transduce positive signals into the cell, antagonized or unligated integrins promote negative signaling into the cell, leading to cell cycle arrest or apoptosis. Thus, integrins appear to fulfill a biosensor function, wherein they constantly interrogate the local ECM, and modulate cell behavior accordingly. These new roles that integrins play reinforce the choice of integrins as a therapeutic target, even as they lead us to reassess and optimize current clinical strategies.

Integrins play an important physiologic role in cell adhesion, and accumulating evidence suggests that they also regulate cell growth, proliferation, migration, and apoptosis. A number of congenital and acquired disease states have been associated with integrins, and small- molecule integrin inhibitors have been approved for treatment of benign hematologic diseases. In cancer, aberrant expression with normal functioning rather than dominant genetic variations of genes coding for integrins has generally been observed. This aberrant expression is mediated through "bidirectional" receptor signaling and interaction with corresponding signals from growth factor signaling pathways, leading to inhibition of apoptosis, induction of cell proliferation, extracellular matrix remodeling, migration, and angiogenesis. From a clinical perspective, a growing number of molecules targeting integrins have been developed for treatment and imaging purposes; clinical studies in melanoma, prostate cancer, and other malignancies are underway. This review summarizes the biology of integrins, the signal transduction pathways they regulate, and their role in different stages of carcinogenesis. Furthermore, it provides a synopsis on the clinical advancements in integrin targeting for therapeutic and imaging purposes in cancer.

The laptops were humming at The Oncology Group's Exhibit Hall booth at ASCO, as SearchMedica introduced its new professional medical search engine for cancer specialists

Novel modulators of the polo-like kinase 1 (Plk1) pathway targeting the cell cycle may be effective as anticancer agents.

Early metabolic imaging with positron emission tomography (PET) identifies responders to neoadjuvant chemotherapy for advanced adenocarcinoma of the esophagogastric junction

Rising costs, evolving markets, and tighter regulatory conditions are challenging the way community oncologists purchase drugs. OneOncology, Inc., an innovative new healthcare technology company, simplifies the time-consuming process of procuring oncology products. Cancer Care & Economics (CC&E) recently spoke with the company's founder and chief executive officer, M. Steven Kirchof, a nationally known expert in community cancer care.

Early metabolic imaging with positron emission tomography (PET) identifies responders to neoadjuvant chemotherapy for advanced adenocarcinoma of the esophagogastric junction

Add to the growing list of novel anticancer agents the nuclear export inhibitors (NEIs), which are showing robust efficacy in vivo and are soon to be entering late-stage preclinical testing.

Researchers at Stanford and the University of California, San Diego (UCSD) have decoded the gene expression profiles of hepatocellular carcinomas (HCCs) noninvasively using the radiographic features of the tumors as seen on three-phase contrast-enhanced CT scans

Xoft, Inc.'s Axxent Electronic Brachytherapy System for accelerated partial breast irradiation (APBI) recently had its first clinical use in two lumpectomy patients treated at WellStar Kennestone Hospital.

Dynamic positron emission tomography (PET) imaging with a novel [18F]-labeled cyclic peptide tracer appears able to detect primary breast tumors and metastatic lesions to a variety of organs.

To combat the development of resistance to cytotoxic agents and increase the potency of DNA-damaging agents, compounds are needed that will abrogate the DNA repair pathways.

Vanderbilt University researchers have developed a noninvasive technique for monitoring the response to treatment with tyrosine kinase inhibitors (TKIs) and radiation therapy (RT)

Dendreon Corporation recently announced that it received a Complete Response Letter, commonly referred to as an "approvable" letter, on May 8, 2007 from the US Food and Drug Administration (FDA) regarding its Biologics License Application (BLA) for sipuleucel-T (Provenge) for the treatment of asymptomatic, metastatic, androgen-independent prostate cancer.

Computer software used to help decipher screening mammograms reduces interpretation accuracy, increases the rate of unnecessary biopsies, and offers no clear improvement in the detection of invasive breast cancer, the largest and most comprehensive community-based study of the technology has found.

Piecemeal and unorganized efforts have hindered research and development of cancer biomarkers

Martin D. Abeloff, MD, Editor-in-Chief of Oncology News International, was a recent featured guest on "The Charlie Rose Science Series" on PBS television. The episode, entitled "The Latest in Cancer Research," was the fourth in a 12-part special series focusing on the importance of scientific research in human health.

In a Quality Indicator (QI) project, oncology nurses at M.D. Anderson Cancer Center showed that changing intravenous (IV) bags of hazardous drugs (such as chemotherapy agents) is an unsafe procedure with nearly universal contamination of the nurses' gloves, gowns, and drapes.

AVEO and Schering-Plough to Develop Anti-HGF Antibody

Diagnostic imaging consumes about 3.6% of the total health care dollars nationally ($80 billion), and is growing steadily at about 18% per year.